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”. 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”. 
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.
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.
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 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.
I had a craving for cake this morning, so of course I made muffins. I previously wrote about how muffins were dead to me. Usually we eat them because we think they are the healthy choice, even though we really want the doughnut, when the reality is they are not a healthy choice. As I note in that article, muffins often have more calories, more fat and more carbohydrates than doughnuts. Yes, there is sometimes a bit more fibre, but not much, and not enough to make them anywhere near healthy.
The truth of the matter is that muffins are cake. Breakfast cake, if you will. So let’s start calling it what it is so that we can make a proper decision about them. This morning, for instance, I really wanted some breakfast cake. So I made some. Eyes wide open to the fact that this is not a healthy breakfast choice. Which is okay sometimes. I’m a firm believer in the idea of eating healthily most of the time, but that it’s okay to be imperfect. As Dr. Yoni Freedhoff put it (maybe slightly paraphrased), “eat as healthily as you can reasonably enjoy”. This might mean something different for you than for me, and it means something different for me than for a person who is training for an elite level athletic pursuit. For me these days, it involves getting enough protein, vegetables, and water. But it also includes (home made) pizza, red wine, and on rare occasions, breakfast cake.
I resurrected breakfast cake for myself because sometimes it is exactly the treat I want. Especially chocolate chip ones. A good chocolate chip muffin is white cake with a liberal sprinkling of chocolate chips. What’s not to like? But let’s be clear: there is nothing healthy about it. It’s time we liberate the muffin from the shackles of its false brand and acknowledge breakfast cake!
Even though I recognize breakfast cake’s true self, I still found myself not fully getting it. The photo above is the tray of breakfast cakes just before putting them in the oven. The recipe includes a crumble on top made with cinnamon, flour, sugar, and butter. As I sprinkled it on top of the muffins, I thought to myself, “wow, I can’t believe I’m putting this much sugar and butter on top.“. And then I chuckled to myself. Yes, crazy to sprinkle flour, sugar and butter on top of a dough made up primarily of flour, sugar, and butter.
Now that we’ve addressed the true self of breakfast cake, give some thought to zucchini bread, banana bread, and apple loaf. While they each contain some fruit or vegetable, guess what? Cake.
Now if you’ll excuse me, I’ve got some blueberry crumble breakfast cake to enjoy.
Elsbeth Vaino is a personal trainer who recognizes that people can be healthy without being perfectly healthy.
Like to eat healthy? Always on the lookout for great recipes with a healthy twist? If so, you are probably a coconut oil keener. Am I right? Coconut oil is great. For some things. But did you know coconut oil is actually an unhealthy choice for some recipes? Let me explain.
Most non-chefs select oils for cooking based solely on the type of fat. Not long ago, that meant vegetable oils for everything. This was during the saturated fats are evil period. Fast forward a few years to the Mediterranean era where olive oil was all things to all recipes. We now live in the time of the coconut oil, which makes that the perfect oil for all uses. Or so suggest the healthy recipes that make their way around the interweb.
It’s amazing how quickly truth changes in the era of the internet.
I’m just going to put this out here: When it comes to oil for cooking, unless you were taught by a cook, everything you know is wrong. Let me explain that.
There are three important criterion for selecting an appropriate cooking oil for a recipe, but most people make their selection based on only one. The three criterion are:
Most healthy recipes shared on the internet take only #1 into account. If you’re a chef, you undoubtedly take numbers 2 and 3 into account.
I just finished making a healthy recipe for (pretty tasty) banana oatmeal squares that said to use butter or olive oil to grease the baking dish. Olive oil for banana oatmeal squares? Really? Think of it this way: would you put olives in a banana oatmeal square? I love olives, but not with bananas and oatmeal. Many oils have a taste, so if you’re going to use it in a recipe, make sure you’re picking an oil for which the taste works. Before using an oil for a recipe – even just for greasing a pan – ask yourself the question above: “how would this recipe taste with olives in it?” In this case, the butter would have been a good choice, but I opted for coconut oil which I think also complements the flavour of the ingredients nicely. Coconut is not a slam dunk though. Have you ever had eggs cooked in coconut oil? That’s not a good combination. There’s a reason nobody adds coconut oil to their eggs – it doesn’t go. If it doesn’t go as an ingredient, it doesn’t go as a cooking oil.
This is one of the reasons vegetable oils remain popular among cooks as a cooking oil. Unlike many oils, vegetable oil is essentially flavourless. That means from a taste perspective, it goes with everything. Which means it is versatile.
The other reason vegetable oil remains a popular choice is that it has a fairly high smoke point. Every oil has a smoke point, which is the temperature at which the oil starts to burn. When cooking, it is important to use an oil whose smoke point is higher than the cooking temperature you’ll use. For many recipes, this is another knock against coconut oil as it has a relatively low smoke points, or at least unrefined coconut oil does. The coconut oil in my cupboard (unrefined) has a smoke point of 350 degrees Fahrenheit. That’s quite low. Thankfully this brand notes on the label that it is for medium heat cooking. Unfortunately not all brands list smoke point on the label, leaving people to inadvertently use inappropriate oils for their cooking needs. If you’re someone who loves to use coconut oil for all your cooking please reconsider, or make sure you use a refined coconut oil for the high heat cooking to avoid adding vile-tasting free radicals to your meal.
Interested in reading more about smoking point of cooking oils, including a table of oils and their smoke points? There’s a great article about it on seriouseats.com. Note SeriousEats.com is also a great source for delicious recipes.
What about health in oils? As noted above, once vegetable oils were considered the pinnacle of health while saturated fat was the work of the devil. The current trend is the opposite. So what’s the truth? This will unfortunately be different depending on what you read. That’s sad state of modern nutrition information: many “experts” have taken to cherry-picking scientific findings that support one concept while ignoring evidence that brings it into question. It is true that the evidence that once vilified saturated fat has been brought into question, but this does not mean that saturated fat is perfectly healthy. Similarly, the modern vilification of vegetable oils is that they are bad because we ate so much of it that our diets became overly high in omega-6 fatty acid, which put our bodies out of balance with the omega-3s. I think that argument has a lot of merit – or at least the part about the omega-3 to omega-6 fatty acid balance. What doesn’t make sense is that we should stop using it entirely. If the problem was that we ate too much of it relative to other fats, then the solution is not to get rid of it entirely: it’s to eat less of it relative to other fats.
If you aim to make all of your cooking oil choices based on smoke point and taste, you will end up using a balance of oils. I would argue that the present body of knowledge suggests that a balance of different oils is the healthiest option.
Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa who gets frustrated by the myriad of bad recipes mislabelled by fitness and nutrition professionals as “healthy and delicious”.
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”.
I just received the following question this morning from one of the participants of my 8 Week Get Lean Challenge. The challenge is one where participants adopt one new habit change per week. One of the habits is to fill half your plate with vegetables a set number of meals per week (depending on what level of the challenge you are doing). The following question refers to this vegetables habit:
Q: ” I wanted to know what your thoughts/opinion was on “GREENS” the popeyes substitute? Would that be considered as half the plate, should I take these? If I can take these how much to they count towards my portion?”
A: “I think greens are great, however, they won’t count toward your half plate as vegetables. The reason for this habit is two-fold: it ensures you get lots of veggies, and it helps to prevent you from over-eating non-veggies. The latter is as important as it reduces the likelihood that you’ll overeat. So you can see that the greens helps toward the first goal but not toward the second. ”
I do feel a bit sheepish for taking the slightly-misleading-contrarian-blog-post-title approach, but I’m feeling a bit contrarian today, so it seemed appropriate. In fact I have nothing against Greens supplements. I even think they’re a good idea for those who otherwise won’t get much in the way of vegetables. I’d much rather someone take these with a low-vegetable diet than follow a low-vegetable diet and not take them. It’s a way to get the many, many micronutrients vegetables have to offer, and that’s a good thing. But if I had a say, I’d much rather have someone add actual vegetables to their diet so that they get both the micronutrient and macronutrient benefits. What is this macrunutrient benefit? Primarily it’s that vegetables tend to be high in fibre and protein, and they are low in calories. Here are a few examples of what 100 calories of vegetables look like.
And for comparison, a couple of examples of 100 calories of not vegetables.
Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa, Canada who thinks vegetables are the bomb. That is if people still say that things are the bomb. Otherwise, she thinks they are…(please help a once-was-cool-ish-now-is-old-and-less-cool trainer and blogger with her diction by commenting with a better expression below.)
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!
Dinner parties, cookie exchanges, and chocolate gifts oh my!
‘Tis indeed a season full of tempting treats. This means three things for anyone who finds healthy eating to be a challenge at the best of times:
It’s about to get a whole lot harder to stay on your healthy eating plan.
Many of you are going to feel guilt about this, thus initiating a nasty spiral of negativity.
That will be compounded by the “How to Earn your Holiday Treats” exercise memes that will start floating around facebook any day now, which can further accelerate that negative spiral.
How about this year, we choose a better option to enjoy the holidays? With that in mind, here are my 3 tips for enjoying a healthy-ish holiday:
It’s the holiday season. Hopefully you’re going to go to parties and take part in feasts with family and friends. Accept it and plan to enjoy the holiday eating. Celebrations and connection are important. And throughout history, food has been a central part in celebrations. For those of you trying to follow healthy eating plans, adjust your expectation for the month. Instead of aiming for healthy, aim for healthy-ish. Is there cake for dessert? Have some. Are there cookies at your staff meeting? Have one. The world won’t stop orbiting around the sun if you do so, and your pants will probably fit almost as well at the end of it. Switch back to healthy in January, and by the end of January, you will be back where you are today.
Seek out and say yes to vegetables every chance you get. This is my best tool for healthy-ish eating, and the best option I can suggest to stay healhty-ish and avoid jumping into the deep end of holiday indulgence. Going to a Christmas party? Seek out soup or salad for lunch that day. Is the dinner party family style (serving dishes on the table and you fill your plate), or buffet style? If so, go a bit heavier on the veggies and a bit lighter on the non-veggie options. Vegetables provide a fantastic one-two punch for healthy eating. They are low in calorie and chock-full of micro-nutrients, and they take up space on your plate that would otherwise be filled with lesser foods.
Judge your indulgences before you enjoy them. My criterion is 8 out of 10 for indulgences. Sometimes it’s 7, if I’m in a “meh, calories-schmalories” mood. If my perceived Deliciousness Factor (DF) for a cookie, cake, pie, beer, or second serving of stuffing isn’t at least a 7 or 8 out of 10, then I pass. Don’t worry if you find yourself scanning and thinking “these are all 6s, but I want a treat!” Trust me when I say that this will either never happen, or if it does, your goal for next year should be to become friends with better cooks.
That’s it. Three simple tips to enjoying the holiday season without stressing about the food. It’s a celebration! Relax and enjoy!
Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa, Canada who apparently doens’t believe in spell check or re-reading blog posts to check for basic typos.
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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:
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.
Richard Gregory’s response:
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.
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!
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.
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. “
“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!
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!”
Exercise and nutrition for healthy living and sports performance