Wednesday, 2 December 2015

Exercise Physiology, Body Building and Lessons Learnt



Exercise Physiology, Body Building and Lessons Learnt

 Before I began my studies in Clinical Exercise Physiology I was twenty four years old and had been training with weights for around seven years. Despite having no formal education in the matter, I felt as though I had a reasonable understanding of my body and how to train it. I was making progress with both the weights I was lifting and my physique, but I couldn’t escape the fact that I seemed to be perpetually getting injured. 

Following a full labral repair on my left shoulder it was recommended to me that I see an exercise physiologist for rehabilitation. After a few short sessions with my shoulder improving in leaps and bounds, I decided that this was a field that I wanted to be a part of. Before that point I didn’t even know exercise physiology existed as a profession, and probably would have asked the same question I hear every day now, “Is that like a physiotherapist”? If you’re wondering what the general differences are, physiotherapists are trained as diagnosticians and in the acute treatment of injuries and their symptoms. Exercise physiologists are trained in the treatment of acute or chronic disease and pathology through exercise. They are also able to educate patients on home exercise and lifestyle changes that will improve their health outcomes.

 In 2012, after my second year of hard (injury-free) training, I started to seriously consider competing in a natural bodybuilding show. I definitely enjoyed training, but dieting, not so much. In the first two years of post-surgery training, I dropped from 118kg to 107kg, while observing increases in strength and muscle mass. I initially experimented with a six day training split separating legs, chest, shoulders, back, arms, core/calves, with very little cardiovascular training. 

At the time I was studying full time and working a physical job for 30 hours a week, so I didn’t prioritize cardio in my training regimen to begin with. During this initial period I adjusted my diet to more of a whole foods approach, with very little portion control. I found this was effective enough with my increased level of exercise and satiation from the foods I was consuming. After making the decision to compete, I reassessed my training and consulted a dietitian about a competition plan. 

Through some experimentation and consideration of the available data, I elected to halve the sessional volume for each muscle group, and combine two sessions into each workout. To accommodate for the halving in volume per muscle group, the frequency of specific training sessions was doubled, meaning each workout was completed twice a week. The reason being that an increased frequency in hypertrophic stimulus should convert to more muscle growth, even if the strength of stimulus is slightly lower in intensity. 

In the month leading up to the competition, training sessions remained similar in focus, while high intensity cardio consisting of wingate sprints was introduced three times a week to aid in the final stages of fat loss. When competition time came around I was feeling excessively drained. The intense training, low calorie diet and water cutting really took it out of me. I jumped on stage that day and won my two divisions. The mens tall class novice, and mens tall class open divisions. 

Competing for me was a positive experience on the whole, but I certainly have ideas of how I will do things differently next time. Coming in leaner to competition season, concentrating more on posing work, and having a healthier mental preparation without large cuts in dietary water, would leave me happier and in a better overall state to compete in the future. 

Throughout the process of training and prepping, I was always thinking of ways I could integrate my physiology knowledge and learning resources to my training, and ways in which my training could grant me a practical perspective to the content I was studying. Now two years later, at the end of my studies, I see that what I gained from this degree was not every piece of knowledge I would need to be a flawless practitioner or competitive bodybuilder, but skills. It equipped me with the knowledge of anatomy and biomechanics, but more importantly it taught me how to apply this knowledge to situations that were not covered in the degree. The field is too broad to cover every injury, pathology or presentation in detail, so instead the aim is to provide the required baseline knowledge and give you the skills to research, extrapolate and learn for yourself.

 Before starting the degree I believed myself to have a reasonable working knowledge of exercise selection, muscles activated, load and volume management and generally good form. Now at the end of my degree I see that I was mostly correct, but I only knew the how, I didn’t know the why. Knowing how to do something is well and good if everything is working perfectly, but if you don’t understand the why, you’ll never be able to work around problems that you encounter along the way. 

Whether it is an office worker with shoulder impingement, a young child with muscular dystrophy, or a fast bowler who needs to put 5km/h on his bowling pace, you need to understand why a system works the way it does in order to change it for the better. 

By Ben Stavar, QUT Exercise Physiology prac student with Exercise Physiology Brisbane


Tuesday, 24 November 2015

Mental Health and Diet

I recently watched a webinar by Associate Professor Felice Jacka - a principal research fellow at Deakin University. Her research focuses on lifestyle behaviours, particularly diet, as risk factors for the common mental disorders, depression and anxiety. I've summarised the key points from her webinar below........

Gut Microbiome
99.5% of genetic material is microbial - meaning we're only 0.5% 'human'. Needless to say, our gut microbiome is extremely important. Our gut microbiome drives the following:

  • metabolism and body weight
  • immune system
  • mood and behaviour
Gut microbiota is heavily influenced by the  environment - geography, medication use, stress and most importantly, diet, influences the gut microbiome. Diet has a greater impact than the human genome! For example, the gut can change its microbiota within 24 hours of eating a high fat/high sugar diet; and it takes one year for the gut to repair itself after one course of antibiotics.
Pregnancy, the gut, diet and epigenetic changes
There is clear evidence that expecting mothers who experience a viral or bacterial infection have an increased risk of their offspring developing autism or schizophrenia.  Probiotic use during pregnancy can minimise this risk by helping to keep the gut microbiota healthy.

Expecting mothers with an unhealthy diet are more likely to have offspring with increased externalising behaviours and poor cognitive function. Research suggests that unhealthy diets during pregnancy alters methylation and gene expression of dopaminergic and opioid genes, which leads to increased anxiety in females and aggression in males. A diet high in fat up-regulates inflammatory genes which increases oxidative stress and mitochondrial dysfunction.

The gut and brain interaction
The gut and brain interact with each other via the vagal nerve. In studies of germ-free mice (no gut microbiota), stress response and stress hormones were increased, and levels of neurotransmitters (such as serotonin and noradrenaline) were altered. Research has shown that probiotic use reverses these anxiety-like behaviours. Fermented milk products with a probioitc can modulate brain activity, with lactobacillus rhamnos shown to decrease anxiety and depression.


Studies indicate that within four months of a high fat/sugar diet, free radicals increase and neurological function within the hippocampus decreases. This causes cognitive defects and decreased performance with attention and speed of information retrieval. Adults with a healthy diet have a larger hippocampus and better memory. These declines are apparent after only one week of poor diet!

A poor diet can also lead to a 'leaky gut', whereby tight junctions within the gut do not work properly causing bacteria and toxins to enter the bloodstream. This leads to systemic inflammation and a myriad of health complications, including depression.

To decrease inflammation and thus improve the gut and brain interaction, and to prevent unwanted epigenetic changes (poor diet/lifestyle factors affecting offspring), researchers suggest to:
  • reduce fat and sugar intake
  • increase fibre intake
  • increase vitamin D intake
  • exercise regularly
  • reduce stress levels (meditate!)
  • avoid medications where possible
  • get adequate sleep 
  • avoid substance abuse
  • take a probiotic
Future research is looking at how psychiatrists can routinely incorporate diet as a treatment modality for depression treatment and prevention - nutritional medicine should be considered in mainstream practice to help treat depression and combat the rising prevalence of this disability world-wide.

Thursday, 1 October 2015

Neck Pain and Posture
by Todd Snowdon

We have probably all experienced a headache at some point in our lives whether it be due to stress, hormones or staring at a computer screen for too long. This blog focuses on the role posture has to play on headaches and how muscular imbalances of the neck in particular, can contribute to cervicogenic headaches (CGH).

The Journal of the American Osteopathic Association describes cervicogenic headache as a syndrome characterized by chronic hemicranial pain that is referred to the head from either bony structures or soft tissues of the neck.

An interesting point I would like to make here is that although a headache is characterised by pain in the head; it is commonly due to referred pain from the cervical spine and surrounding musculature.
This is where posture plays an important role in the development of CGH. For example, if you place undue stress through your neck and shoulders by poking your chin out whilst looking at the computer screen; there is an increased workload placed on your neck extensors to hold your head in place. Patients we see in the clinic who present with CGH commonly (but not always) have tight neck musculature including sternocleidomastoid, upper trapezius, levator scapulae, scalenes, suboccipitals, pectoralis minor and pectoralis major due to posture.

It has been well reported in the literature the involvement of tight musculature of the neck contributing to CGH. Basically, if muscles are providing greater tension in one particular area of the neck, this can cause compression through the joints of the cervical spine. As you are probably well aware, there are numerous nerves exiting between these cervical joints that extend into the skull. As a result this compression on the nerves can lead to headaches.

If protraction of the head (poking chin out) becomes a habitual posture, poor deep neck flexor activation and control is common. Fernandez De-Las-Penas et al conducted a study looking at the impact of poor deep neck flexor musculature. Basically, they concluded that patients with CGH had a reduced holding capacity of their deep neck flexors and a forward head posture.  

So how can you relieve headaches?

Before you go popping the miracle pain killers or other pharmaceutical drugs for temporary relief; let’s have a look at fixing the problem long term. So we have established the role posture plays in headaches. In terms of treatment, correcting the abnormalities of joints and muscles that are related to postural abnormalities is the initial focus. Here at the clinic, we see a majority of patients who have been slumped over a desk punching the keyboard for copious hours. What we focus on with these individuals is correcting the muscular imbalances by stretching (commonly the cervical extensors) and strengthening (commonly the cervical flexors). This is beneficial initially, but not from a long term perspective.

Re-training the cervical muscles is very important in providing strength to support the neck and head in the correct position. We have had success with our patients and it has been reported in the literature that this re-training of cervical muscles is beneficial in reducing the incidence of CGH. This is because by supporting the cervical spine in an “ideal” position it de-loads the cervical spine and ligamentous structures thus reducing the likelihood of compression on neural structures.  
One area that is commonly overlooked with respect to headaches is the role of the scapular stabilisers. If scapulohumeral rhythm is poor or thoracic musculature is weak, there is a reliance on scapular elevators to hold the shoulder in place. This can increase the amount of tension required by these muscles which changes the alignment of the cervical spine.

In the clinic we aim to educate the patient on how to decrease the amount of cervical load by re-training appropriate musculature and by correcting posture. This is certainly an alternative to treating headaches with medication and I urge you to seek an EP or health professional to assist in overcoming chronic headaches and find a positive treatment option once and for all J

The Journal of the American Osteopathic Association, April 2005, Vol.105, 16s-22s

Fernandez-De-Las-Penas C, Perez-De-La-Heredia, Molera-Sanchez A, and Miangolarra-Page JC. Performance of the Craniocervical Flexion Test, Forward Head Posture, and Headache Clinical Parameters in Patients with Chronic Tension-Type Headache: A Pilot Study. Journal of Orthopedic and Sports Physical Therapy. February 2007.37(2):33-39

Wednesday, 16 September 2015

Surgery Visit

Ty and I were recently given the fantastic opportunity to observe Kelly Macgroarty in theatre. Kelly is an Orthopaedic surgeon and owner of the Brisbane Knee and Shoulder Clinic. On the day, Kelly performed a total knee replacement, ACL replacement, rotator cuff repair, AC repair and an AC reconstruction. Ty and I found the experience very interesting from a rehabilitation perspective in which it enabled us to see the entry point of the surgery and what structures were disrupted; minor subtleties that can affect the outcome of rehab.

This provided us with a great insight into the complexities of arthroscopic surgeries in contrast to total joint replacements. Interestingly, the arthroscopy procedures took longer to perform than the total joint replacement due to the intrinsic nature of the surgery.
A highlight of the day (besides my little rest in the tea room after seeing the calliper break after attempting to lift the clavicle into position), was the discussion with Kelly after the ACL replacement surgery.

Kelly is a leader in the new ACL repair technique; The Short Graft. This new technique requires taking a graft from the hamstring tendon (semitendinosus) and folding it back on itself four times (in the past, two hamstring tendons were used as a graft). This is then placed on a tensioner and sutured so it forms a single tendon.

The advantages of this technique is that the graft is thicker (9mm as opposed to 7.5-8mm), it is also shorter and stiffer than the grafts used previously. A major benefit from only using one hamstring tendon is the recovery time. With this new technique the patient is walking 4 hours post operation resulting in significantly less quadricep atrophy and an increase in functionality. 
Another interesting point Kelly made was the importance of ice and compression post op. He raised a very good question: essentially, the nature of surgery causes acute trauma just like that encountered on a sporting field; therefore why not apply the same RICE protocol?

Dr Macgroarty discussed with Ty and I the differences between the short graft and the LARS tendon graft commonly used in the past for football players. The LARS technique uses an artificial tendon to replace the damaged ACL. The reason this was commonly used in elite sportsmen was because it enabled players to be playing after 3 months post surgery. Sounds amazing right?
The problem however; was that the re-rupture rate was significantly increased. This is due to the fact the LARS tendon is the strongest at the time of insertion and only becomes weaker as it is not a biological tissue. Therefore it does not re-model and adapt to the loads required for sport. Although the short graft technique requires 7-8 months of rehabilitation before athletes return to competitive sport, studies have shown a decrease in re-rupture rates and longevity of the knee mechanics.

The forever improved methods and recent advances in medicine and science is certainly an exciting field. It makes you wonder; what’s next? 

Todd 

Wednesday, 1 July 2015

Lower Back Pain

by Todd Snowdon

I have been asked numerous times over the past few years; what conditions have I dealt with the most? Not surprisingly, my reply is “lower back pain”.

It is important to note that lower back pain is a rather complex issue - some of which are briefly outlined below.

A common re-occurring theme we see in the clinic is lower back pain due to poor posture, biomechanics and lifestyle factors. Ultimately, the three are interrelated.

Thoracic kyphosis (rounding of shoulders, chin protracted forward) is an example of poor posture resulting from copius amouts of sitting at a desk. This can lead to an increase in lumbar lordosis (lower back curvature) that changes the orientation of the pelvis. This in turn places increased load through the lumbar vertebrae in a less than ideal position and thus abdominal and lower back musculature is required to create tension from a position of reduced mechanical advantage.


So, how can exercise help?

The main benefit from an exercise perspective is the ability to re-train the muscles crucial in maintaining “correct” posture. These are both the gross musculature and the stabilisers. Exercise aims to restore full range of motion whilst providing additional mechanical support to the lower back. Common exercises aim to improve flexibility, range of motion, strength, stability and neuromuscular control. One area we focus on is the contributing factors as to what may be causing the lower back pain such as weak or tight musculature. Once this has been identified, appropriate exercises to correct this imbalance or weakness can be prescribed.

There has been particular focus in the past on core and gluteal strengthening to improve LBP.  Core stability or transverse abdominus control, is very important as a delayed onset of transverse abdominus activation has been shown in the literature to be associated with lower back pain. This is because the transverse abdominus muscle and multifidus are spinal stabilizers and support the lumbar spine during lifting, bending, forward flexion; at the time where there is an increased amount of load placed through the lumbar vertebrae.  It is also an essential contributor to pelvic position and control.

With respect to LBP, emphasis should also be placed on gluteal and hamstring strengthening. Why? Think of the attachments sites and the effect this has on pelvic position. Muscle tightness or shortening of the muscle, effects the biomechanics of the lumbar spine and pelvis.  For example, a common observation we see are strong/shortened hip flexors and weak/lengthened hamstrings, this can lead to an anterior pelvic tilt which changes the position of the lumbar spine. So you can see how tight or overused muscles can pull on their anchor points for example; the pelvis, and cause lower back pain due to the change in biomechanics and forces placed through the spine.

In summary, improving gluteal control and strength in relation to pelvic position, is very important in lower back rehabilitation/prevention.

Thursday, 14 May 2015

The North Face 100 – Blue Mountains – 2015


      This weekend will my first Blue Mountains North Face 100 ("that's 100km of running for those unaware of the existence of ultra-marathons" - Ty). Over the past year I have gone through nearly four pairs of running shoes and I've spent countless hours in the Mt. Coot-tha forest training for what will be my toughest physical event to-date. The training has been a huge test for my psyche – 6-8 hour runs along arduous terrain combined with regular sightings of hungry goannas and big snakes have provided me with the mental toughness to hopefully finish!

     The race has constantly been in the back of my mind – there is so much to think of and so much that can wrong on the day. Most of my training has been in hot and humid Brisbane conditions. The Blue Mountains will be anything but hot and humid. All runners must carry a mandatory running kit that includes thermals, a beanie, gloves, headlamp, space blanket, snake bite kit, compass, map, whistle, phone, water proof jacket and adequate food and water. Failure to have these results in a time penalty, and in some cases, disqualification. Hopefully I won’t need most of this gear, but never-the-less it’s best to be prepared for the worst case scenario. The temperature this weekend is looking to be around 3-13 (so cold!). Some showers are expected but hopefully they stay away – running with wet shoes and socks on slippery surfaces is an added challenge that I don’t need!

     Nutrition on the day is imperative for a successful outing. During training I have munched on energy gels (GU in particular), energy chew blocks, Cliff bars, pikelets with syrup, mini Snickers bars, snakes (the lolly kind), bananas and I’ve complemented these food sources with electrolytes in my two front water bottles (400ml each) and my 1L hydration bladder at the back (my bag is actually quite comfortable). I aim to eat something every 60-80 minutes (varying the food source constantly to avoid taste fatigue) and I regularly take sips of my electrolyte fluid. This coming weekend I’ll keep my nutrition the same and top up water and add electrolytes (via a tablet) at each checkpoint (five in total every 15-20km). I’ll try not to be tempted by the various foods on offer at these checkpoints (such as fruit buns and hot noodles). Gastrointestinal issues are more likely to occur consuming food that one hasn’t trained with!

    I’m looking forward to accomplishing this challenge and getting back to some normality. It will be refreshing to not worry about scheduling the lengthy training around work and other commitments. My husband will hopefully have a normal wife again – one who is less obsessed about sleep and more fun to be around! I’m also looking forward to spending less on supplements and food. Whilst supplements never should replace food, they are a good top-up and my regular intake of sulforaphane, omega-3, an activated B-complex and a probiotic has helped to reduce inflammation and assist with my immunity and recovery (albeit expensive)! Much of my recovery can also be attributed to the strength training program I have completed regularly, along with muscle release work (thank you Ty). Touch wood my body holds up and immunity stays strong until at least Sunday!!


     Hopefully this time next week I will report back with some positive news. My aim is to finish the 100km strongly, ideally under 20 hours so I can receive a much-sought after ‘belt buckle’, preferably around 15 hours so my poor husband isn’t waiting too long for me. I shall enjoy my last few days of taper, keep ‘rolling’ out my muscles and prepare my mindset for a long day at the office this Saturday. Wish me luck!

Camilla. (Soon to be conquerer of the North Face 100! - Ty)

Thursday, 19 February 2015

When you have your main meal affects your overall weight loss…...

There have been numerous studies in relation to overall caloric consumption leading to weight loss, however, could there be another important factor to consider?
 Besides the obvious, total amount of energy consumed vs energy expelled, the timing of meals throughout the day has been proven to effect biochemical markers, fat mobilization and consequently weight loss. It has been proven by Garaulet et al 2013, that timing of meals has an effect on weight loss independent of the overall caloric consumption. “In 420 overweight/obese patients undergoing a 20-week weight-loss diet, those who ate their main meal late lost significantly less weight than early eaters. This difference in weight loss success was not explained by differences in caloric intake, macronutrient distribution, or energy expenditure”. 
So what is the justification in avoiding dinner three hours before bed?
A study by Bandin et al 2014, looked at how meal timing affected glucose tolerance, substrate oxidation and circadian (internal body clock) related variables. They concluded by eating a meal close to bedtime, it decreased resting-energy expenditure, decreased fasting carbohydrate oxidation, decreased glucose tolerance, blunted daily profile in free cortisol concentrations and decreased thermal effect of food. 
Another study by Watanabe et al 2014, considered the chrononutrition viewpoint. Chrononutrition explains nutrition in terms of chronobiology and considers the effects of diurnal rhythms, thereby providing new perspectives in nutrition research (Ramsay et al, 2007). Chrononutrition considers the following three components: timing of meals, speed of eating, and the order of food consumption during a meal. Watanabe et al, concluded that the evening is the period in which one can easily gain weight due to the BMAL1 gene (a gene responsible for glucose metabolism and muscle insulin sensitivity), being most active in the period from 10pm to 2am. So basically, the later a meal is eaten, the more strongly the BMAL1 gene is activated and the more likely it is to cause an accumulation of internal fat. 
Is skipping breakfast beneficial to weight loss?
Watanabe et al, 2014, also compared weight gain in individuals who ate dinner within three hours prior to sleeping to those who skipped breakfast altogether. Not surprisingly, both groups gained more weight than the control group and the group who skipped breakfast gained the greater amount of weight. 
“Esquirol et al reported that people who skip breakfast have a 3.4-fold greater risk of developing metabolic syndrome compared with those who eat dinner less than three hours before bedtime and that people who eat snacks at night have 2.6 times the risk of having metabolic syndrome compared to those who do not eat snacks at night”. 
But why? 
There are four lines of evidence which suggest why skipping breakfast is not beneficial:
  1. Skipping breakfast can cause not only a decrease in physical activities in the morning but also a decrease in total energy expenditure which can result in the development of obesity.
  2. A far-infrared radiation thermograph test that measures thermal release from the body, showed that participants who skip breakfast have a low body temperature and decreased energy metabolism. 
  3. While skipping meals reduces overall calorie consumption, it results in blood sugar level spikes. This means forgoing breakfast can cause a decrease in serum blood sugar concentrations, resulting in the breakdown of muscle tissue via the gluconeogenic pathway as a means to provide glucose for the brain; the decrease in muscle volume leads to a subsequent decrease in physical strength. Which consequently results in a decrease of basic metabolism due to the decrease in muscle volume. 
  4. When individuals are hungry, they can conserve energy by limiting physical activities, which can result in a condition whereby the body does not lose weight but instead gains weight easily.

Take home message
Basically, to avoid excessive weight gain, eat breakfast, avoid eating fatty foods particularly at night and avoid eating three hours prior to going to bed. 

References:

Bandin, C., Scheer, F.A., Luque, A.J., Avila-Gandia, V., S, Zamora., Madrid, J.A., Gomez-
            Abellan, P., Garaulet, M., 2014, Meal timing affetcs glucose tolerance, substrate 
           oxidation and circadian-related variables: A randomized, crossover trial, International 
           Journal of Obesity, 10.1038
Esquirol, Y., Bongard, V., Mabile, L., 2009, Shift work and metabolic syndrome: respective  
                impacts of job strain, physical activity, and dietary rhythms, Chronobiology Int,  26: 
                544–559. 

Garaulet, M., Gomez-Abellan, P., Alburquerque-Bejer, Juan., Lee, Y., Ordovas,   
          J.M., Scheer, F.A., 2013, Timing of food intake predicts weight loss 
          effectiveness, International Journal of Obesity, 37(4):604-611

Ramsey, K.M., Marcheva, B., Kohsaka, A., Bass, J., 2007, The clockwork of metabolism, 
                  Annual Review of Nutrition, 27:219-40

Watanabe, Y., Saito, I., Henmi, I., Yoshimura, K., Maruyama, K., Yamauchi, K., 
                Matsuo, T., Kato, T., Tanigawa, T., Kishida, T., Asada, Y., 2014, Skipping 
                Breakfast is Correlated with Obesity, Journal of Rural Medicine, 9(2):51-58