Category Archives: Training Basics

Maximalist is the new minimalist: The absurdity of fitness trends

I saw my first pair of maximalist running shoes in a store last summer and I had to do a quick self-check: is it April fool’s Day? Nope, it’s August. This was the shoe I saw on the shelf in a reputable running and triathlon shop:

I was there waiting to pick up my bike but I had to ask about the shoe. And that’s when I learned about the new maximalist running shoe trend. Apparently extra cushioning is what we need to prevent running injuries in 2016. That’s one mighty big pendulum swing when you consider that in 2010 we learned that we need minimalist running shoes to prevent injuries.

Aside from putting an amused look on my face, the Hoka (the clown-like shoe above) brought me back to two conclusions that I have often hold:

  1. Scientists and/or companies claiming that “this is the one true answer” is your first sign that you should be sceptical of everything else that person or organization says. Science is rarely that certain, and it is never that certain before the science has had a chance to be vetted by other scientists. This typically takes years, which means by the time there is evidence that it is “the one true answer”, it’s probably not that exciting any more so nobody is talking about. So pretty much if you’re talking about an amazing new scientific discovery, understand that it may or may not be true at this point. This is not a dismissal of the scientific process. That is sound. It’s an accusation that most of the science that makes it to the mainstream has cut corners out of the scientific process.
  2. There probably isn’t a “one true answer”, but rather there are different best answers for different people and different scenarios. Minimalist running shoes may be the best option for you; so may maximalist. Heck, maybe the running shoes that got run out of town in 2010 are the best option for you. Or maybe running isn’t great for you. How can you tell? Great question. I’m not an expert in running shoes, but I’m going to go out on a limb and suggest that trial and error is probably your best bet.

Unfortunately the “this not that” mangling of the scientific process is also prominent in the nutrition world. I just read an interesting article about how “leptin resistance is the main reason people gain weight and have such a hard time losing it.” Some of you will remember that not long ago “The real reason that you may have struggled to lose weight is insulin resistance.” It would seem that leptin is the maximalist shoe of the nutrition world.

Elsbeth Vaino, B.Sc., CSCS, is an engineer turned personal trainer who is both amused and annoyed at the inadequacy of what often passes as science.

Like what you’re reading? Sign up for my (non-spammy) newsletter

* indicates required


Email Format


3 Minute Gym Warm-up

If you’re in a hurry, or just don’t want to spend a lot of time on your warm-up at the gym, and you know how to do a Turkish Getup (TGU), then I’ve got a great option for you. It takes 3 minutes. I call it either the deconstructed TGU or the 3 stop TGU. It’s kind of cool that one rep of one exercise does such a great job of warming up your joints and your cardio respiratory system.

If you’re not familiar with the TGU, then instead of using this as a warmup, use it as practice for your getup.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa who is a big fan of efficiency.

Like what you’re reading? Sign up for my (non-spammy) newsletter

* indicates required


Email Format


A variation on a new glute bridge variation

Last month I saw a great video posted by Bret Contreras showing a variation on a bodyweight glute bridge that very effectively targets the glutes. The reason it’s effective is that he basically fires up the whole body in a manner that prevents some of the typical “cheats” that people often do when trying to do glute bridges.

While glute bridges seem like an easy exercise (lie on your back, lift your butt up. how hard can it be?), the reality for many is that they feel glute bridges everywhere but their butt. When I ask clients where they feel a glute bridge, I often get some combination of hamstrings, back, quads, and abs. This is not everyone – some people do glute bridges and feel their glutes – but it is more than the minority.

This glute bridge with frog pumps that Bret posted struck me as a great option, so I gave it a try. And it was indeed a great option. Check it out here.

Essentially it’s a glute bridge but with feet flat against each other, flatten the lumbar spine, push the elbows into the floor, and bring the chin to the chest.

I did like it, but I opted for two minor changes:
- instead of chin to chest, I went for a neutral neck alignment, which looks like a packed neck, or what I call “ugly neck”. Take a look at my chins in the video and you’ll see why I call it ugly neck. I opted for this because I know some of my clients would have a hard time with holding the chin to chest position.
- Instead of feet flat, I went for feet angled to each other. Many people will be fine with the feet together position, but I personally found it irritating for my hips as I don’t have great hip mobility. I also have a few clients whose knees didn’t like the feet together position. So the angled feet position was a nice alternative for those with either hip or knee stuff.

Here’s a video of this modification:

If you find you have a hard time feeling your glutes when you do do glute bridges, try out Bret’s variation instead, and if your neck, knees, or hips don’t love that variation then try my variation to the variation.

Elsbeth Vaino, B.Sc., CSCS, owns a personal training studio in Ottawa that specializes in getting people stronger and moving better.

Like what you’re reading? Sign up for my (non-spammy) newsletter

* indicates required


Email Format


Wear and tear from repetitive movements

I noticed something cool at my gym (Custom Strength) this morning. Take a look at this photo:

Shawshank redemption rope?
Shawshank redemption rope?

What you’re looking at is the anchor point for the battling ropes that we use for conditioning. If you’re not sure what that means, take a look at this video:

I love it as a conditioning exercise. That’s not quite accurate. I love it as a conditioning exercise for my clients. ;)

So back to that picture above. Take a look at the concrete around the attachment point. You can see a deep groove in the concrete at the bottom, and a shallower groove to the right. This is damage to the concrete from the ropes hitting it. The deeper groove at the bottom was made between March 2014 and Dec 2015, and the shallower groove on the right is from the position the ropes get used in since we changed the gym layout over Christmas – so not quite 4 months of use. A piece of rope being moved up and down by humans can make a hole in concrete, given enough repetitions. That’s pretty cool!

Here’s a photo of our other rope.

Rock dust for the yard
Rock dust for the yard

Note the concrete dust? The white ropes (previous image) haven’t been used since the cleaners were in on Sunday, but the black ones (this image) have been used by about 10 people. That strikes me as an impressive pile of concrete dust from 10 people, each using the ropes for about a minute. 10 minutes of human-powered rope movement left a pile of concrete dust and thus presumably a bit deeper of a hole than was there last week.

In addition to how cool and remarkable this is, it makes me think about repetitive movements we do with our body. How many steps in a marathon? How many swings in a tennis tournament? How many strokes in a swim meet? All the more reason to spend a little time getting stronger and moving better, to give your body some support for all those repetitions.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer who loves introducing athletes to smart training as a means for improved sports performance and enjoyment with a side benefit of reduced injury risk.

Like what you’re reading? Sign up for my (non-spammy) newsletter

* indicates required


Email Format


Your bones can change

A friend sent me this article that talks about an exercise effect that is rarely discussed: changes to our bones.

The short version of the article is that sprinters tend to develop thicker shins and tennis players can develop a thicker racquet arm, while swimmer’s and cyclists tend to have no such effect. The article also notes that children who walk sooner have thicker shins than those who walk later. The other side is true as well, which is why astronauts lose bone mass while in space.

This is Wolff’s Law in action. In a nutshell, Wolff’s Law states that if the body feels it is not set up to continue to support the pressure it is put under, it will create new bone to help. We can see this in the feet of ballet dancers, and in the pelvic shape of teenage girls who play sports. Sometimes these changes are not the result of exercise, but of daily living. People with obesity develop thicker femoral heads (the top of the thigh). Yet another example of how amazing the human body is!

The article notes that this effect is smaller in older populations, suggesting that studies have not shown large changes in bone mineral density in the elderly. The author suggests this may be because we can’t produce as much force as we age. This is an interestingly timed comment for me, as I just had a client report back to me this week that her rheumatologist reported that her bone mineral density has increased again – the second time she has had an increase since starting strength training with me.

I found myself questioning the conclusion that the effect is smaller in seniors. I followed the link in the article for “elderly people”, which led to this study abstract which makes no mention of smaller effects in seniors. It does mention that “the effects of age and starting age on the osteogenic effects of exercise are not well known. It also appears that exercise interventions are most effective in physically inactive people or counteracting conditions of disuse such as bed rest”.[1] I would argue that suggests that they don’t really know the effect on seniors, but if we’re talking about inactive seniors, the study suggests a big potential impact on bone strength.

In fact this US Physical Activity Guidelines Advisory Committee Report from 2008 provides a review of studies on the topic. The results very clearly show improvement in bone mineral density (BMD) among seniors, including one to two percent increase in lumbar spine density per year from resistance training. From the report: “Although a benefit of 1 to 2 % per year may seem small, this is roughly equivalent to preventing the decrease in BMD that would typically occur over 1 to 4 years in postmenopausal women and elderly men”. [2]

As my friend who sent me the article said, “Like I needed another reason but really drives home the importance of an active lifestyle for kids- impacts the rest of their lives.”

In other words: walk away from the computer and go run, jump, play, or lift weights. Just tell your boss it’s a crucial medical intervention.

Elsbeth Vaino is an engineer turned personal trainer in Ottawa who loves discussing the geeky reasons for exercising. In fact if you’re a personal trainer on the west coast, consider coming to see me speak at the NSCA BC Provincial Clinic on May 28th. I’ll be talking about structural variations between individuals and their effect on exercise.

Like what you’re reading? Sign up for my (non-spammy) newsletter

* indicates required


Email Format


References:
[1] http://link.springer.com/article/10.1007%2Fs12018-013-9151-4#/page-1
[2] http://health.gov/PAGuidelines/Report/pdf/CommitteeReport.pdf

6 Week pre-season training program starts Monday

It is not too late to get yourself fit for summer sport season, although you’re definitely cutting it close.

This is a great option for you if:

  • You usually get yourself to the gym before the season starts, but you have a new couch and there’s stuff on TV.
  • Every year while coughing up a lung during your first game, you promise yourself that next year you’ll spend some time in the gym before the season starts.
  • You never did pre-season training before and you did fine. And in completely unrelated news, you aren’t 25 any more.
  • You do work out pre-season, but you’d prefer a more structured program that is geared toward athletic performance, a fantastic workout environment, and feedback from a coach on your form.

Still reading? Here’s what we’re offering:

  • Two 60 minute group training sessions each week (pick 2 of Mon 530pm, Wed 730pm (FULL), Saturday 10am (FULL). UPDATE: WE NOW ONLY HAVE SPOTS OPEN FOR THE MONDAY SESSION, SO IF YOU REGISTER, IT WILL BE ONE SESSION PER WEEK, NOT TWO.
  • Sessions will address strength, power, mobility, and conditioning.
  • Program lasts 6 weeks, starting the week of April 4th and finishing the week of May 12th (just in time for City of Ottawa field opening).
  • $180+HST. UPDATE: SINCE WE NOW ONLY HAVE AN OPTION FOR ONE SESSION PER WEE, THE PRICE IS REDUCED TO $100+HST
  • Availability is limited: there are only 10 spots total, and each class is limited to 7 people.
  • All sessions take place at Custom Strength, which is located at 939 Somerset St. W

NOTE: if you are dealing with an injury, please be sure to mention that when you contact us. Depending on the nature of the injury, this option may not be available for you. We do have training options for everyone, but group training is not typically a great option in the presence of an injury. Send in an email though with an indication of what the injury is, and any guidance your physical therapist/athletic therapist/chiropractor has provided in terms of readiness.

Send me an email with the form below to register or if you have questions.

* indicates required field

Powered by Fast Secure Contact Form

Is Tiger Woods’ back injury the result of his training?

An article on Yahoo Sports today quotes Tiger Woods’ caddy suggesting his injuries have been because of his dedication to gym work: “I guess when [Tiger] looks back, he might question some of the activities that he did, some of the gym work that he might have done that, you know, had all these injuries escalate“. I suppose that’s possible, but is it likely?

Maybe it is more likely that this level of injury is normal for someone who has golfed for hours each day for 38 years? The 40 year old Tiger was doing the talk show tour showing off his golf skills when he was 2. In golf age, he is much older than 40. Is this perhaps a sign that early specialization eventually takes its toll, even on the exceptions who make it big?

Maybe there is something about his swing that makes him both excellent but also vulnerable? There’s a theory in the golf rehab world that his current back problems stem from a 2008 post-knee surgery swing change. Elite performance can come at a price to the body.

Maybe it is because he is in his 40s. According to this Golf Channel article, “Less than 10 percent – just 20 of 216 – of all majors were won by players 40 and over. It does happen, especially at the British Open (the last three British Open champions were all 40-somethings). But since 2000, only one golfer – 41-year-old Vijay Singh – has won a Masters, U.S. Open or PGA Championship.

Anything is possible, and thus it is possible that Tiger Woods’ back woes are the result of his training. But the limited body of evidence related to training and golf suggests otherwise. A Sports Health review of the scientific literature on golf injuries notes that “the majority of injuries sustained by professional golfers relate to overuse“, and that “simple modifications reduce the incidence of injuries, such as using a bag cart and performing a 10-minute warm-up before game play. Other studies have identified that increased hip flexibility can be helpful as well. Additional factors that increase the risk of sustaining a sports-related injury include decreased static trunk strength, delay in trunk muscle recruitment, and limited trunk endurance.

Given the body of evidence on training and golf, and the statistics on golf performance and aging, the more likely scenario is that the caddy is wrong.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa who is not a huge fan of people making unsubstantiated (and likely untrue) statements in the media.

Like what you’re reading? Sign up for my (non-spammy) newsletter

* indicates required


Email Format


Bear Crawl as an exercise?

I just read this great post from Tony Gentilcore about bear crawls. It piqued my interest because it’s an exercise I love to use with my clients (so busted for seeking out articles that support my bias). He lists some great reasons for people to do them, but I wanted to elaborate on one: motor learning (the first reason #2 that he lists).

I have used bear crawls for a long time, but became especially interested in them a few years ago after reading this article written by physical therapist John D’Amico. John works with a lot of golfers in Florida, and has developed an interest in “accessing the nervous system through manual therapy and exercise as a means to attaining better mobility in my middle-aged to senior golf fitness clients.” So he did a little test:

  • Did initial range of motion tests on 10 male golfers (average age 68)
  • Taught them how to do a standing cross-crawl pattern
  • Had them perform 20 repetitions of the standing cross-crawl pattern five times per day
  • Re-tested range of motion on the same joints three days later

Here is a video of what his clients did:

He saw impressive improvements in great toe dorsiflexion, ankle dorsiflexion, hip extension, hip internal rotation, and hip flexion. From standing in place lifting up the opposite arm and leg. Huh. Give John’s article a read for the full results as well as his discussion.

I had previously used bear crawls as part of our warm-up when I coached the Ottawa Junior ultimate team, and I remember being surprised at how difficult the crawl movement pattern was for many of the kids. These were skilled teenage athletes, but many of them initially had a very hard time moving opposite arm and leg at the same time. It was as though their body didn’t know how to do it. Before seeing John’s post, I had read about benefits from acquiring a lost cross crawl pattern, although nothing with much scientific merit. In other words cool theories but not backed up by much. John’s post isn’t hard science either, but in my opinion, it is compelling. And given how little time it takes and how many other benefits there are (as Tony notes), bear crawling as an exercise is kind of a no-brainer.

If you’re interested in trying them, take a look at this great demonstration video by Joe Bonyai. He includes forward/reverse bear crawls as well as a stationary bear crawl with hold, which he refers to as “bear paws”.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa Canada whose gym has a Bear Crossing sign posted.

Like what you’re reading? Sign up for my (non-spammy) newsletter

* indicates required


Email Format


Congratulations to Me

Today is the five year anniversary of my first Custom Strength client. I’ll be honest that I am very proud of myself for the business I have built since the first client I trained under my own business name.

Like most entrepreneurs, I tend to deflect accomplishments to others when they are brought up. Instead of accepting the compliment, I mention all the great people around me; that I couldn’t have done it without the support of my friends and family; or that my amazing clients make it so easy. All true. But the other truth is that I had a great vision and then worked my ass off to build that vision. And now I’ve got this thing I call Custom Strength; this place I go to every day; this thriving community of amazing people working hard to be better; and it’s awesome.  And the reason this awesome thing exists is because one day I decided to quit my lucrative consulting career to pursue my passion.

This is the point in the story where people often say they never looked back. I’m here to tell you that those people are liars. We all look back. Every time things get shitty – and I don’t think there’s an entrepreneur in the world who hasn’t been through a shitty period – we look back. I have often thought about how my life would be if I had stayed in the engineering consulting world. The money was sure good, as were the hours, and those combined for some fantastic vacations. Those thoughts still lead me to the same conclusion though: opening Custom Strength was one of the best decisions I ever made.   I say this 5 years in, at a point where I still take home less money than I did before making this change. Although 2016 is looking like it will be the year where my hard work and vision reap financial rewards that surpass those levels. *knocks on wood while typing this*

Deflection of accomplishments isn’t the only thing that prevents entrepreneurs from tooting their own horns and acknowledging success. Relativism is the other. I almost succumbed to it. Not only is Custom Strength five years old, it is also healthy and growing.  Despite that, I almost stopped myself from celebrating this accomplishment because there are so many businesses that are bigger and more profitable than mine. Some have been around longer, some started with money (I started with a huge debt from a previous business), while some are newer and also started without money. In other words if you look for it, you will find an example of someone who has done better than you.  I’m excited that I have finally reached the level of entrepreneur where I can celebrate my success in relation to my hopes and goals instead of in relation to what others have done. I’m quite certain I’m not the only entrepreneur who struggled with this.

Five years! It has been both a fun and challenging ride.

The fun mostly involves what I actually do, which is training clients. People often talk about thankless jobs. I have a thankful job. It’s amazing. At least a couple of times a week someone tells me about the things in their life that are better because of their training with me.

It’s a good thing the highs have been so great, because the lows really, well, sucked. Like that time I came back from a Christmas trip to find out that the gym space I was renting had flooded from a leaky roof and the landlord decided he wouldn’t fix it until April. I’m not talking about a slow leak here; I’m talking fills-a-bucket-in-an-hour leak. Good times.

Then there was the time – just 9 months ago in fact – that I almost bankrupted my business. Imagine how you would feel when you did the books and realized that the numbers don’t actually add up and that if you don’t fix your spending, and increase your revenue right away, you won’t survive another month. That was my introduction to tracking churn rate. I had always prided myself on tracking business metrics, but it turns out the metrics I was tracking were insufficient for growth periods. I moved into a bigger and more expensive space in 2014, which required financing for moving costs, some new equipment, and a 2.5 time increase in rent. When I looked at my numbers, some were hidden by extra money I had borrowed to cover those expenses, while net revenue shortcomings were easy to explain by the temporary new expenses I had incurred. The big lesson I learned there: Never look for a way to explain revenue shortfalls; look for ways to uncover what they really mean. It’s a very minor but crucially important difference in perspective.

Thankfully my friend Pete and I were talking about our businesses and he mentioned that one of the reasons investors were so interested in his company was that their customer churn rate was so favourable. He then asked what my churn rate was. I didn’t know, but I was confident it was good because our clients mostly stick around for a long time. The next day I pulled the relevant data together and calculated it. I also looked at client acquisition rates, and used the two together as a predictor of growth or decline. That was eye-opening! It turns out there had been a two month period just before we moved where we lost quite a few clients. They were all for normal life reasons, like moving out of town, as opposed to dissatisfaction with training, so I hadn’t really given it much thought. But that followed a period where I did no marketing because I was so focused on moving and getting the new space running the way I wanted, and then because everything appeared to be running so well in the gym, I focused my attention on two side projects:  my hip training ebook and preparing presentations for a few seminars where I would be speaking. In other words, we lost clients and then spent the next six months not replacing them. 

While doing churn rate calculations, I also dug deeper into all of my business financials, which lead me to realize that I had to make changes to some of my expenses or I wouldn’t survive. Even if I increased revenue, my monthly expenses were just too high for this to ever be a strong business. That meant making some difficult decisions, which was no fun. Had I been tracking churn and acquisition rate, I would have realized that I had lost those clients and hadn’t replaced them, and I could have addressed it before it became a problem. Knowing my churn rate allows me to predict if a revenue drop is coming, which allows me to address it before impact. Had I also done a better job of splitting out investment money from revenue, I would also have come to the same conclusion earlier than I did.

I’m still slightly embarrassed that my inability to properly assess my financials almost cost me my business. I mean, I’m a numbers person! I use the expression playing with Excel instead of working with Excel. How on earth did I not see this coming? I was so embarrassed that I contemplated not including this in this post. After all this post is really about a celebration. But then I remembered reading stories like this from other entrepreneurs and how helpful it was to me when I was feeling overwhelmed.  So there you have it – the lows in my entrepreneurial process included a big dumb mistake that almost prevented me ever getting to this five year mark.

Five years! Since that financial debacle there have been far more ups than downs, and business is good. That scare forced me to do what I had to in regards to expenses and to put more time into marketing such that we are growing at a good but manageable pace, which means I’m not celebrating that my business has survived for five years; I’m celebrating that my business is successful five years in. In addition to allowing myself to feel pride in this accomplishment, I also decided I should buy myself a five year Custom Strength anniversary gift. A new pair of skis seems like a good gift. Here’s hoping Mother Nature will help me celebrate by providing some snow!

Post-Concussion Symptoms During Training

I have a client, whom I’ll call Jim, who suffered a concussion during an ultimate game this summer. He has had concussions before, and suffered post-concussion symptoms for many weeks. He took 5 or 6 weeks off from training with me during the post-concussion period while he was under the care of athletic therapist and osteopath Richard Gregory. Richard is the head therapist at Ottawa Osteopathy & Sports Therapy and is one of the best manual therapists in Ottawa. I learned a lot from him when he used to be my boss, and I continue have a great relationship with him.

Jim returned to training once his post-concussion symptoms were gone. He enjoyed several weeks of training that felt great, but then after one session, some of the symptoms returned: By the time he got home he felt nauseous and had to go to bed. This happened again the following session.

I wasn’t sure what to think so I reached out to Richard to see if he could suggest anything. The following emails share some context and Richard’s amazing explanation of what was likely going on and some guidance on addressing it:

Email from me to Richard Gregory:
“Hey Rich,
Jim was in Tuesday and again last night and both times ended up with post-concussion symptoms returning. He had had several training sessions prior to that without problems. Tuesday I think he was fine during training but then felt a bit off that night and very off the next morning.

Thursday we talked about it and the plan was to backtrack to the workout he had done the previous time, which had been fine, but by the end of his power section (kb swings and push presses) he was done.

Any thoughts? I was wondering if it might be one or more of:

  • Maybe the rapid vertical to almost horizontal head movement in swings is complicit? (he has been doing them without problems for a while – with no weight increase). He’s also been doing single leg RDLs which of course have that same vert to horiz motion. But those are also not new this week.
  • Tuesday we upped the intensity on a few of his exercises a bit. I put him on a protocol called 5-3-1, where basically set one is pretty easy, set two is moderate, and then set 3 is hard as you do as many reps as you can with good form at that weight. Then we use that to calculate future weights. It’s cool as it is very responsive to fluctuations in ones energy/strength/ability. And the calculations use 1RM percentages but applied to 90% 1RM weights, meaning they are not aggressive. His reps ended up in the 8 to 12 range on the last set. Maybe too much volume? Or maybe the intensity of ‘as much as possible’ was too much?
  • Maybe it’s combined volume of work over the week that is now putting him over the edge? He’s doing twice weekly and I think playing Frisbee once and maybe biking etc? Hopefully he’ll clarify. If this is likely, should we go with either less intense both days, or do 1 intense day, 1 easy day?
  • He mentioned that he stopped doing the vestibular exercises once he no longer had symptoms – so maybe 2 months ago? Is it worth bringing those back in and then planning to do them in some maintenance capacity even after he feels fine?

I welcome any thoughts that could help with Jim’s programming/training so he can train at the optimal level and with reduced likelihood of more symptoms.

Thanks!

Els”

Richard Gregory’s response:

“Hey guys,
Here’s my DIY sleuth guide for getting rid of post-concussion symptoms. The symptoms are sometimes very specific and sometimes very vague. Hopefully this info will help you figure out what the issue was.

Cerebral BP Changes:
Post-concussion brains lose their ability (temporarily) to regulate the blood flow (pressure) to the brain amidst rapidly fluctuating body blood pressures. The control of cerebral blood flow (cerebrovascular autonomic regulation) is run on both negative (factors that decrease brain BP) and positive (factors that increase brain BP) feedback loops. If HR spikes too rapidly, pressure sensors in the aorta and the brain’s middle cerebral artery adjusts and dials down blood flow to the brain. The reverse also happens. After a concussion, abnormal blood flow control gives the owner of this brain a very vague malaise feeling of just not feeling right. The recipe to make this go away is to train the vascular system to be more efficient. As you exercise at lower or moderate intensities for steady state (no intervals), you get new arterial growth in the brain (arterioles). This allows a larger number of vessels to provide the same brain tissue with blood flow thus decreasing irregular flow issues. Additionally, the regular steady state cardio (ideally 5/week for 20-35 minutes) “resets” the ability of the brain to regulate blood flow amidst changing body BP. Setbacks which occur months after the concussion usually happen for the following reason.

Brain owner says “I feel good. Thank God that rehab is done. I did at least 4-5 weeks of cardio like 5/week. Now I’m gonna just live my life.” Frisbee happens, a couple of workouts but the steady pace cardio fades off. The effect of the auto-regulation can fade but over time, the more consistently that cardio is trained (over weeks and months), the fade of efficacy of the auto-regulation will stop happening.

How to test it:
Smart way – start doing cardio steady pace at least 20-30 minutes 5 days per week and wait 3-4 weeks before doing heavy weight days or cardio intervals. If you feel better, that was likely the issue. You’ll also know it was the issue if you relate to the brain owner that did considerably less cardio than during the rehab stage at the time you felt the set back. Remember to avoid the breath holding when you go back to the weights and the interval workouts.

Painful way – go to Els’ gym. Do no warm up, drink a Rockstar energy drink to prime your adrenaline. Do 5 sets of heavy squats with lots of breath holding. Then immediately lie down. Feel the wave of nausea wash over you. Feel crappy the rest of the day and possibly the next day. (I don’t recommend you do this). If you feel not so good, you have a temporarily altered cerebral auto-regulation.

I recommend completing the “Smart way” of 3-4 weeks of cardio.

Vestibular Dysfunction:
The improved vestibular dysfunction attained from completing a methodical and specific vestibular rehab program often needs to be reinforced. If the concussion happened several months ago and you did vestibular rehab for about 3-5 weeks, then you may need to “top up” your neuro-vestibular synapses. It is common to achieve a normal or sometimes even greater than normal level of vestibular function but then have this function fade imperceptibly over the course of 2-6 months. This can leave you feeling vaguely nauseated and very low energy. If this is the case, do the following test:

Vestibular test: (Jim knows this test)
Stand in place with eyes focused on a spot, rapidly turn 180degrees and stare at a spot straight ahead of you. Repeat the same test 2-3 times on each side with about a 10-20 second break between reps.

Video of the test:

If you feel woozy, your field of vision feels like it’s moving but you’re standing still or you see blurry, your vestibular function isn’t up to snuff. You can play the same game from lying to sitting rapidly or standing to looking at the floor. Jim only had a rotational dysfunction at the time we tested for it so it’s unlikely that a new vertical issue arose and also unlikely that the rotational dysfunction was stimulated by the gym exercises. Regardless, this is a harmless test and is worth doing. The rehab is to repeat the test for 3x2minutes at a pace that is sustainable and doesn’t provoke symptoms. Do this daily for 5-10 days. I got concussed in 2012 and I still break out a little spin-o-rama 3x2minutes every 8-12 months. I feel like it fades, then I do it for like 2-3 days and it pops back to normal. The need to top up my vestibular function has significantly decreased over time and I feel normal for 12 months at a time. This is not a finding that is available in the literature yet but leading researchers and concussed athlete practitioners (like me) have observed it in the clinic.

Additional vestibular training exercise video:

Global Neural Fatigue:
The concussed brain doesn’t distinguish well between too much exercise, too much work or too much emotional stress. It just knows when it’s been too much. Some researchers are using the term brain bucks. Every time you do work, exercise or experience an emotional stress, the brain pays using a finite amount of brain bucks. The better you sleep, the better you eat (fish oils, healthy fats, low simple sugars) the more brain bucks you get. If you’re sleep deprived, drinking lots of alcohol and eating poorly, then you might have a few less brain bucks. The workout may have been the same, the intensity may have changed only slightly but there may have been other factors such as travel for work, perceived emotional stress etc. Try to think back and see if you felt perhaps you worked a bit more, slept a little less or had other factors that might have made the same well thought out workout cost the last available brain buck. This would leave you feeling like you’re just done and you really don’t want to do the next set. If you think this was the issue, the solution is to monitor your overall brain expenditure by doing a little less (when possible) on the days you’re going to work out. You can also significantly increase your brain’s function and ability to tolerate stress, sleep better, get more out of relaxing etc by doing 10 minutes of mindfulness training. I particularly like Headspace. It’s easy, realistic and doesn’t require wearing silk pants and chanting. Not that there’s anything wrong with that. It’s also been shown that changing one’s perception of negative stress (distress) into a positive stress (eustress) which will embolden you for future stresses can significantly lower the correlated cortisol spike, BP spike etc and consequently, it would cost you less brain bucks to live through the same life stress. Cool Ted talk on this here. Kelly McGonigal: How to make stress your friend.

These are the three most common issues I see that cause setbacks in my post-concussion athletes. Hopefully, you’ll find a solution to the issue. If you hit a barrier you can’t get past, give me a ring. Sorry for the essay.

Hope you guys had a good weekend!

Rich”

My email back:
“Wow, that was amazing. Thanks for the essay! So really this is:
1. back to cardio for 3 to 4 weeks and no gym (what about Frisbee?)
2. Figure out a good frequency to continue some vestibular test/training – likely will need less often over time.
3. Sort out if there is a stress/perceived stress aspect.
4. Start back at the gym again in 3 to 4 weeks with a similar approach, although perhaps this time we hold off on intervals a bit longer and probably if it will be twice weekly, we make one a light day for a while.
Sound right? Thanks again Rich. Obviously this is helpful for Jim, but this is also super helpful for me to get this great explanation and insight.
Els”

Richard’s email back:
“Hey Els,
I suggest 2-3 weeks of no heavy lifts, no strength tests, no max reps, no valsalva etc. I suggest cardio 5xweek for about 20-35 minutes steady pace. If the ultimate has been feeling fine, then continue. I’d suggest the ultimate be played as a poachy D and handler and possibly skip the odd point while taking one of the weaker players to cover on D. Gym can probably continue at lower intensities in 1-2 weeks depending on how Jim feels. Also worth doing the vestibular tests as they’re easy and safe.

My guess is that it’s a BP issue that just needs a bit of priming. Let’s let Jim chime in on how he feels and go from there.

Have a good day guys. “

Jim’s reply:

“A Huge Thank You to both of you for taking the time to discuss this with me and with each other. I honestly can’t put into words how much I appreciate it. It feels really good to know that you both care enough about how I’m doing to take the time to exchange all these ideas by email. I know it takes a lot of time to write all this down and it would be easier if I just made appointments and came into the office, so I appreciate the time spent on these emails a lot!
I suspect the reason for the relapse is just what Richard said: “I feel good. Thank god that rehab is done. I did at least 4-5 weeks of cardio like 5/week. Now I’m gonna just live my life.”

From early March until late April I had a really good routine of doing my vestibular pen-following and rotation exercises. From mid-April until late May I had a really good routine of 4-5x per week cardio for 20-30 minutes – a lot of bike rides along the canal in the morning or evening. I wasn’t a huge fan of the pen-following/rotation exercises and was happy to let them go, but I really enjoyed biking along the canal. The only reason I stopped biking was a customer event that required me to be at work much earlier and later than usual each day for the last month, which made it hard to find time for biking during reasonable daylight hours. That customer event is over now, and I’m happy to get back to biking in my free time.

Until last week, I was feeling really good. I was playing ultimate once per week, having two really solid workouts with Els, and doing some interval training 1-2x per week on my own. Last week for the first time I felt symptoms again – super barfy and dizzy after workouts with Els. On Friday night I “tested” myself with one set of 60 seconds of pen-following, and I could only make it through 30 seconds before I got barfy and dizzy and I had to lie down. The good news is that last night I was able to do two sets of 60 seconds with no ill effects.

I will get back to my cardio bike rides (which I really enjoyed anyway), and more of the vestibular exercises to top that up.

Thank you both, again, so much!

Cheers,
Jim

PS “poachy D and handler and possibly skip the odd point while taking one of the weaker players to cover on D” – that sounds like a lot of fun, I should try that!”

Richard’s reply:
“Good luck with the barfy exercise. You’ll bounce back way quicker the second time around. Keep your eyes peeled for a tiny relapse in another few months and do the cardio and the barfy thing again.

Have a great day!”