Secrets and Staples: Calve Stretching Secret

The slant board calve stretch is the most effective way that I have found to have clients add some length to this often shortened structure. I like to use multiple techniques, but will review the static stretch for the calves in today’s post. This can be an effective corrective exercise technique for those who demonstrate reduced dorsiflexion. I may use an over-head squat, active range of motion test or goniometry to assess motion at the ankle. If there is muscular tightness,  then more often than not I will recommend this technique early on in their programming.

Goniometry Ankle Dorsiflexion

Staples to keep in mind for the corrective exercise specialist or personal trainer:
make sure the slant board is set at the proper angle. If a client has only six degrees of dorsiflexion, don’t set the slant board at a 15 degree angle or you will only further exacerbate the impairment.
make sure the slant board is the proper distance away from a wall or supporting structure for client comfort, control and consistency.
check for good alignment throughout the rest of the kinetic chain. Even the head and neck. 
walk around your client to see the big picture and get in close to check the little details, especially around the lower extremity.
 (get it?)
have the client only stretch one side at a time to maximize the load going into the calve complex and account for asymmetries.
Here are the key cues for clients:
heel down
toes straight
quads engaged
squeeze glutes
align ear-shoulder hip-knee-ankle
Once they have the basics, check to make sure that the arch of the foot is neutral. You can manipulate the arch of the foot with supportive footwear, a rolled up face cloth etc., and by supinating the foot using the gluteal complex. I will have a video out on this soon.
Pronation is a total body movement and if the arch of the foot is collapsing, we need to make sure the related joints are mobile and the associated muscles are providing dynamic stability. Don’t get lost in the intrinsic musculature of the foot. That’s why it is so important to see the big picture and monitor the entire kinetic chain.
Thanks for reading,
Eric
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Secrets and Staples: Calve Stretching Secret

When setting a client up on a slant board to stretch their calves, you might want to pay attention to what they have on their feet. In a backlash against overbuilt, pronation control, elevated heel running shoes I have seen many trainers and corrective exercise specialists remove clients footwear prior to beginning the stretch.
At a glance this might seem like a good idea. Remove the elevated heel that is placing the client in plantar flexion to allow for greater dorsiflexion, right? Maybe so. If an individual has a pure sagital plane restriction at the ankle joint (as evidenced by an excessive forward lean in an overhead squat assessment for example) then this could work if the individual can maintain the alignment of the longitudinal and transverse arch of the foot while weight bearing.
Barefoot training in the fitness arena has slowly gained momentum over the last 12 years or so, unless you have been practicing yoga or martial arts for the past few thousand years and you have been doing that barefoot for a very long time.   However, many people do not have the extensibility of the calve complex or stability of the muscles and joints in the plantar surface of the foot to maintain a neutral alignment of their arches during a weight bearing stretch for the calve complex.
If a client pronates excessively during transitional (squatting) or dynamic (walking) movements or static posture (standing calve stretch) when they are barefoot then you might want to let them wear their sneakers. Especially if they wear a custom fit orthotic.
They might need the artificial support to hold the arch in place with all that load coming down into the lower extremity during the stretch. This will allow proper joint alignment and lengthening of the appropriate aspects of the calve complex. If compensations are allowed, then dysfunction will perpetuate itself. clients will spend day after day lengthening the WRONG tissues, making them more prone to injury.
If you don’t have adequate arch support (ie. wearing a minimalist shoe or are barefoot) then you can fold up a small towel or wedge something else under the arch to help hold it into place.
I hope this little “secret” is helpful.
Thank you for reading.
Eric Beard
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Rest, Recovery and Regeneration Part IV

Before I go any further with this series of posts, I want to take the time to post a link to another blog.
 
Patrick Ward is also an LMT and ran a series of similar, okay almost identical blog posts, back in 2010. Now our content is slightly different but our tittles are the same. I know there are many of us who discuss these topics, I just felt weird stumbling across one of his post the other day when I was preparing this one. I don’t want to be Rob…or Fab here…I bet most of my reader’s don’t even remember Mili Vanilli???
They were lip syncing long before Jessica Simpson or Beyonce were singing into their hair brushes.
 
Enough with the disclosure stuff!
 
We were talking about the three R’s, rest, recovery and regeneration. I stopped last time with the promise to cover contrast therapy next. Contrast therapy is another recovery tool used in rehabilitation, performance and wellness programs. 
 

“The Turks, Russians, Finns, Romans and Chinese have all used the idea of contrast therapy, transferring the body from very warm temperatures to very cold temperatures, as part of a regular health and wellness routine. The theory behind contrast therapy is simple—the heat from a hot sauna brings blood (and its nutrients) to the surface, which can soothe pain and ease sore muscles, then shocking the body in a cold plunge, which in most modern bathhouses remains at about 50 degrees Fahrenheit, increases circulation and pushes that nutrient-rich blood back into the body’s core.”-Erika Allen.

Contrast therapy works off of the principle of convection, the transfer of heat from one place to another via the movement of fluids. 

There is literature available on this subject due to it’s inclusion in physical therapy and athletic training protocols. Here are links to a few abstracts:
 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320244/ It may not impact deep muscle temperature as much as we thought.
http://www.ncbi.nlm.nih.gov/pubmed/3133668 Following an ankle sprain, ice reduces swelling better than heat and contrast therapy.
http://www.jsams.org/article/S1440-2440(07)00007-2/abstract Decreases blood lactate level and heart rate after sprinting better than active recovery.
The best time to apply contrast therapy may be within 20-30 minutes of a workout to maximize recovery even though it can be used on off days as part of a regeneration or injury rehabilitation program. There are many approaches to applying these treatments. 

Dr. Wnornowski suggests applying hydrotherapy as the use of a hot tub or whirlpool which ideally includes turbulent flow with water at 38-45 degrees C for 20-30 minutes. Whole body immersion should be avoided at temperatures greater than 40 C (normal body temperature being <38 C), due to the potential for hypotension. This can lead to light “headedness” pretty quickly. Contrast baths induce alternating periods of vasoconstriction and vasodilation and are useful for relatively subacute afflictions of joints and extremities, e.g.- ankle sprains. The affected body part is alternated between hot (38-45 C) and cold (10-18 C) baths, usually spending about 10 minutes in hot water, and then 1 minute in cold water then progressing to a cycle of 4 minutes hot, and 1 minute cold. This can be continued for up to 30 minutes total.

Don’t have a $1500 a year membership to a swanky health club? There are other ways to experiment with this type of therapy. A hot pack, hydrocollator pack, hot shower or hot water bottle can be substituted for a hot tub and ice cups, cold shower, frozen vegetables and cold packs can be substituted for a cold bath or cold plunge in a pinch.

Ice alone can be used after a pulled muscle, joint sprain, or traumatic tendonitis. When swelling is noted, a good rule of thumb is to use cold therapy for the first 48-72 hours (acute period), or until after swelling and pain have peaked. Thereafter, heat or contrast therapy may be more advisable, as one enters the subacute phase (3-7 days), or for prolonged symptoms lasting beyond a week.

Cryotherapy (ice therapy) dates back to Hippocrates and the ancient Greeks but it took until the 1940’s for cold/ice therapy to be used extensively for the treatment of acute and subacute injuries, and rehabilitation. It works off of constriction. Temperatures of 10-25 degrees Celsius  are common when applying ice packs or submerging tissues in water. 
 
Using ice alone has advantages, especially immediately following an injury. Tissue damage sustained during an injury can cause uncontrolled swelling. This swelling can increase the damage of the initial injury and slow the healing process. Applying ice immediately following a musculoskeletal injury will reduce the amount of swelling. Ice decreases: swelling, tissue damage, blood clot formation, inflammation, muscle spasms, and pain. At the same time, the ice enhances the flow of nutrients into the area, aids in the removal of metabolites (waste products), increases strength, and promotes healing.
According to Laurel Freeman ice initially constricts local blood vessels and decreases tissue temperature. This constriction decreases blood flow and cell metabolism, which can limit hemorrhage and cell death in an acute traumatic injury. After approximately 20 minutes of ice, blood vessels in the injured area then dilate (open) slowly, increasing the tissue temperature, an effect which is termed “reactive vasodilation.” A study reported in the Journal of Orthopedic Sports Physical Therapy in 1994, found that, despite the reactive vasodilation, there was a significant sustained reduction in local blood volume after ice was applied. On the other hand, some people may argue that this can slow the healing process…more on that debate another day.
 
Submersing a body part, or entire body, during hydrotherapy may increase the effectiveness of the treatment. Areas with large blood vessels, particularly around the head, neck, chest and groin, are more susceptible to heat loss because those blood vessels don’t constrict as effectively as the smaller ones near the skin. Reaching these areas with ice or heat packs may take longer to achieve the desired effect. I would avoid submersing the head in hot or cold water however, for obvious reasons. 
 
Yes the ice can hurt, but hey if this guy will give you a shoulder rub while you sit in a trash barrel full of ice and cold water, what the heck?
Using heat first then ice second is thought to enhance the flushing effect, shuttling metabolites and toxins out of an area and fresh blood and nutrients back into an area with even greater speed. The thought process is to end with the ice to minimize inflammation.  You may find the traditional approach of heat pre-workout and ice post workout to prove effective. I know for a fact that heat helps me get ready for a workout and a study has indicated that ice prior to exercise may decrease a joint’s proprioceptors ability to work optimally, I stay clear of ice before unless I am in significant pain or I am utilizing contrast therapy.
No time for the ratings I alluded to in my last post, guess I’ll get to that next post!
Thanks for reading!
Eric Beard
A-Teamer
Corrective Exercise Specialist
Integrated Manual Therapist
Have you seen my SMR DVD? Click below for a short excerpt.
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Rest, Recovery and Regeneration Part III

So what about the dry sauna?
There are two basic styles of saunas: conventional saunas that warm the air and infared that warm objects. Infrared saunas may use various materials in their heating area such as charcoal, active carbon fibers or other materials. The temeprature in saunas genraly run betweeen 158 degrees and 212 degrees Fahrenheit. You can see the container of water with the ladle in it to pour water on the hot stones to increase the temperature. Don’s stand too close to the rocks as you are pouring the water on them, the rising steam can buring the inside of your nose! I have done that before…ouch! 
 
Spending time in the suana is sometimes called “sauna bathing.” Long-term sauna bathing may help lower blood pressure in patients with hypertension and improve the left ventricular ejection fraction in patients with chronic congestive heart failure. There are temporary improvements in pulmonary function that occur in the sauna may provide some relief to patients with asthma and chronic bronchitis. Sauna bathing may also alleviate pain and improve joint mobility in patients with rheumatic disease, decrease pain, enhance relaxation and increased cicculation. 
 
Contraindications to sauna bathing include unstable angina pectoris, recent myocardial infarction, severe aortic stenosis, pregnancy, high or low blood presssure or being under the age of 16. Sauna bathing is safe, however, for most people with coronary heart disease with stable angina pectoris or old myocardial infarction. Very few acute myocardial infarctions and sudden deaths occur in saunas, but alcohol consumption during sauna bathing increases the risk of hypotension, arrhythmia, and sudden death, and should be avoided. Stay off the sauce in the hydrotherapy areas in general!
I am pretty sure Homer would have a can of Duff in there if he could!
So there is more scientific research avaiable on dry saunas that steam rooms, but it woud make sense to me that some of the benefits weould cross over from the two modalities. External heat causes the body to try and regulate internal temperature. Pores open, sweat comes out, breathing changes.
 
Make sure to cool down at the end. A shower is s nice touch and helps to return the body to homeostasis as well. 

Can this help with your rest, recovery or regeneration? Recovery and regeneration for sure. Heck it may even help to improve athletic enhancement!

 

One study found that “that 3 weeks of post-exercise sauna bathing produced a worthwhile enhancement of endurance running performance, probably by increasing blood volume.”
 
Here are a few of the studies that I found on PubMed.
http://www.ncbi.nlm.nih.gov/pubmed/2248758  incidence of common cold decreased
 
I had to click on the one about mother roasting. I envisioned some sort of canibalistic sauna ceremnoy and I had to know more. Fortunately it is therepeutic for the mom. Mother roasting is often done to ‘dry out’, cease expulsion of lochia, restore the uterus to its pre-pregnancy condition and to alleviate postpartum abdominal pain. It is supposed to help the mother heal after giving birth. Enough about that…
Another creepy thing about steam rooms and suanas is that scene in Estern Promises with Viggo Mortenson.
If you have seen the movie you know what I am talking about, if not…starts out with some promise but ends poorly in my opinion, but I digress…yet again…
 
So suana bathing may offer improved recovery from workouts. Studies suggest that 15 minutes in a sauna provides physiological effects that would take 2 hours of rest to achieve. If an athlete can recover from a bout of training more rapidly, that is an advantage in my book.

Saunas may stimulate the release of growth hormone too. Direct heat for 8-10 minutes relaxes muscles and improves local and general blood flow. Saunas reduce the likelihood of neurotic reactions, improve sleep, and normalize metabolic processes. This promotes the excretion of toxins (cadmium, lead, zinc, nickel, sodium, sulfuric acid, and cholesterol) through perspiration via the vasodilatation of sweat glands. If the toxins are not eliminated, fatigue lingers and affects CNS stimulation.

More good news for sauna bathing. Just remember…plenty of H2O before, during (if you can) and after.
 
I’ve got more to say in my next post or two which will include contrast therapy and an overview of the effectiveness of several recovery and regeneration techniques. So I’m going to log off and get some sleep.
 
Thanks for reading my post! 
 
Eric Beard
A-Teamer
Corrective Exercise Specialist
Integrated Manual Therapist
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Rest, Recovery and Regeneration: Part II

Welcome back!
Let’s start with the steam room. Some people prefer the dry heat of the sauna, I prefer the moisutre and humidity of the steam room. Some tips to keep in mind when using a steam room;
1) Drink water before, during and after.
Pre-hydration will help you to get the most out of this experience. Although you are in a humid environment your body does not take the water from the atmosphere in. Imbibing water while usage of saunas and steam rooms has been a tradition in many cultures. It is thought to help witht he flushing/detoxification and to prevent or minimize the effects of dehydration.
2) Dress appropriately. Swimsuit or au-natural? This depends on two things; the first is if the steam room is co-ed and the second your comfort level around other people when naked.
Dr. Phil may need to help you work through your feelings if you find yourself naked in a co-ed steam room when everyone else has their suits on!
3) Ease into it. If you are not accustomed to the moist heat, then start with less than five minutes and work up from there. Just think of what happened to Rick in Hall Pass when he over did it in the hot tub!
4) Check the temp. Be careful if the steam room is cranking over 212 degrees. You could get scalded like a steamed weenie!
 
So what do steam rooms technically do for you? “As heat from the steam penetrates deep into the skin, the body reacts in an effort to cool itself by activating the hormonal and nervous systems to dilate (widen) the blood vessels. This dilation increases blood flow and directs more blood closer to the surface of the skin. Increased blood flow to the muscles brings an increase of oxygen and nutrients needed for the muscles to heal and work properly.”-Chris Sherwood. 
 
Over two thousand years ago the Greek physician Parmenides was credited with saying “Give me an opportunity to create fever and I will cure any illness.” A fever will stimulate the immune system and stunt the growth of bacteria and virus. For example at 104 degrees farenheit the polio virus is reduced up to 250 times and at 106 degrees pneumococcus dies. Now a good steam will not rid you of pneumonia or polio, but it can speed up the production of interferon , a powerful anti-viral protein. The flip side of this is that gunk like athletes foot can grow in moist wet enviornments and you may want to wear flip-flops and sit on a towel.*note that I have been using steam rooms for years and have yet to pick up anything from one*
 
Another benefit is if you are experiencing respiratory issues such as bronchitis, asthma, or allergies the warm moisture in a steam room may clear allergens and mucus from the respiratory system as well as calm down inflammed respiratory pathways.
There is a quote about exercise and physical exersion by Dr. George Sheehan “Sweat cleanses from the inside. It comes from a place a shower will never reach.” Now the steam room is not a replacement for exercise by any means, but it sure can feel like a workout. You come out a little sweaty, the moist environment probably makes you feel like you are sweating more than you are, your pores are open, you might be breathing a little heavy, you are rleaxed and clear headed when you get out. In some circles the steam room is a stop on the “executive workout” circuit.
Anecdotally I see most people using the steam room to finish off their workouts. One guy I know calls it the “pleasure after the pain.” A disadvantage of going for a steam after a workout is a potential disruption in your nutritional recovery strategy. For example if you slurp down a post workout recovery shake before a steam session then the heat could draw the blood away from the stomach and intestines in an effort to regulate body temperature and impair the digestion process. There is an easy solve for this, wait until you are out of the steam room before you have your BCAAs.
I use the steam room primarily pre-workout. I feel like this makes any flexibility technique more effective. The fascial system as a whole softens and “breathes” as well. The skin is also an organ and by helping it to “breathe” we may improve our mobility, movement and overall performance. As the body tries to cool itself it will export heat from the lungs with our breathe and through pores via sweat especially. Most people are stuffed inside of some sort of professional clothing (don’t even get me stated on shoes) all day and not moving much so their skin, as an organ but proprioceptors and mechanoreceptors too, are deadened. Waking up these aspects of the human movement system could help us be more responsive earlier on in the workout. I know that I feel more “warmed-up”/ready for any type of workout if I have steamed first, including cardio with the vasodilation that occurs. I can get into my HR zones quicker and easier.
So I’m supposed to be focussing on rest, recovery and regeneration…I know. I see the steam room fitting well into the recovery and regenration phases. Taking a steam immediately following a workout can help to flush the body of waste products and help to temporarily lower blood pressure. Here are my top three benefits of a steam bath in regards to regeneration:
1) It can promote a sense of relaxation
2) It can provide a reduction of muscular tension
3) It can boost the immune system
I would be remiss if I did not provide a few cautionary tidbits.
People who are pregnant, have heart disease, high or very low blood pressure (or who are taking any medication that affects blood pressure), epilepsy, are taking antibiotics, using any type of mind-altering drug (like stimulants, tranquilizers, alcohol) shouldn’t use steam rooms. People under the age of 16 do not regulate temperature as well as adults and therefore should probably avoid steam rooms unless precautions are taken. Feel free to check with an individual’s primary healtcare provider if there are any questions whether a steam room is right for them or not.
 
Some other tips; shower first to clean the pores, drink plenty of water before duriong and after as I have already mentioned, stay in for a maximum of 15 minutes (depending on the temperature and intensity of the steam), try some electrolye supplementation before or after, don’t eat a large meal just before or just after. One last word on fluid loss, sweat glands can secrete up to 30 grams of sweat per minute which is approximately one pint per every 15 minutes so the risk of dehydration is very real in a steam room. Fatigue and other indications of dehydration can occur with as little as 1 to 2% loss in body weight. This is what accounts for the deceptive and short lived weight loss assocaited with a g steam.
 
That’ll do ‘er for me. I’ll be back wit Part III soon, thanks for reading!
 
Eric Beard
A-Teamer
Corrective Exercise Specialist
Integrated Manual Therapist
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