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Embracing the Suck: Understanding Inflammation Part 2

by Geoff Rand

In Part 1 of this article we learned about the body's response to tissue damage and how inflammation is a natural response that is the start of the repair and healing process.  In Part 2 we'll look at NSAIDs and their effects and some alternative treatments.

NSAIDs

NSAIDs are Non-Steroidal Anti-Inflammatory Drugs.   They include the common-named medicines like Ibruprofen, Motrin, Advil, Aleve, Tylenol, and Nuprin.  NSAIDs work by inhibiting the activity of cyclooxygenase (COX), an enzyme that is part of the cell repair process.  While COX works to repair cell damage, a byproduct of this action is increased sensitivity to pain.  NSAIDs block the production of the COX enzymes, and thus the pain from the inflammation isn’t felt.  Good, right?  Not really.  Here’s why.

While some enzymes of the COX family do cause an increase in pain sensitivity, others in that family control production of platelets that protect the stomach lining.  This can cause bleeding and ulcers when they aren’t allowed to function normally.  Other functions of COX enzymes are protein metabolism and stimulation of satellite cell proliferation, which when suppressed, result in greatly reduced muscle growth.  Long term use of NSAIDs can cause liver and kidney damage.  When you limit COX production, you can also set yourself up for increased chance of heart attack or stroke.

It would be great if the pill you ingested knew where it was needed and only affected that area, but it doesn’t.  Once the medicine is released, it affects the whole body, whether it is needed or not.

So when you take that pill, you are causing many vital body functions to be acted upon, not just your pain receptors.  While an occasional NSAID use is not likely to completely derail your training regimen or muscle growth, continued use, like we practiced in the Army, can lead to greatly reduced benefits from exercise and, more serious health problems associated with suppression of important body functions.

Alternatives

So, if taking a pill is bad for me, then I’m back at being in pain and not wanting to workout or feeling unable to move, right?  What are my alternatives?

Dr. Kelly Starett of Mobility WOD advocates MCE, Movement, Compression, and Elevation.  In this treatment, you move safely what you can, when you can.  Compress lymphatic and soft tissue, which helps carry waste material away from the injured area.  Elevate to further help drain the affected area.  Note that MCE has replaced RICE (Rest, Ice, Compression, Elevation) as the recommended treatment for soft tissue and joint injuries.  Icing is especially detrimental to the healing process.

Along the lines of the MCE prescription are techniques to mobilize the inflamed areas like regular mobility sessions or yoga.  While the benefits of mobility classes are pretty easy to see, yoga has been shown to reduce the production of stress hormones that promote inflammation, and reduces the number of pro-inflammatory molecules in the body.  Plus the gentle movements help to increase blood flow and encourage movement of lymphatic fluid, aiding reduction in inflammation.

Curcumin capsules and the Tumeric root they are derived from

Curcumin capsules and the Tumeric root they are derived from

Curcumin, which is found in the spice Tumeric, is sometimes referred to as a natural NSAID.  It doesn’t suppress all of the COX enzymes, and is considered a safer alternative to the synthetic NSAIDs.  It also has other beneficial characteristics such as reduction of muscle atrophy, normalizing the effects of insulin, and reduction in estrogen levels (which could lead to increased testosterone levels).  Note that unaltered Curcumin has low bioavailability.  This means that in 1-2 hours, the level of Curcumin retained by the body is much less than when it was originally ingested.  To assist with the duration of the Curcumin’s effects, choose a brand that pairs it with ingredients that increase its bioavailability.

Fish Oil Capsules

Fish Oil Capsules

You can also take a high quality Omega-3 fatty acid, like fish oil.  Omega-3s help to increase blood flow, which aids in muscle recovery and growth and reduces inflammation.  It has also been shown to have benefits to heart and immune system health.

Coach Dave enjoys helping to resolve inflammation issues.

Coach Dave enjoys helping to resolve inflammation issues.

There is always the option of foam rolling or light to moderate exercise.  Both treatments will assist with keeping the affected areas mobile and help drain the lymphatic fluid from them.  Electronic Muscle Stimulation therapy may also be helpful to optimize your recovery and get you back to normal faster.

Finally, inflammation can be caused by diet.  This type of inflammation is undesirable and avoidable.  Some smart changes to your diet like cutting out dairy, breads, processed foods, and sugar will greatly reduce your inflammation, as I’ve found during the Lurong Challenge.  I don’t think it’s a coincidence that my shoulder issues have gone away since eating clean.  Don’t forget to hydrate as well.  Staying hydrated is a key element in ensuring the body is functioning properly and flushing out the toxins it needs to get rid of.

Inflammation can be a good thing, and you should be experiencing some degree of it if you are pushing yourself to be better, faster, and stronger.  Welcome the feeling as proof that you are working hard toward your goals.  Just don’t try to interrupt your body’s natural method of recovery by immediately reaching for a pill.   Embrace the suck.

Sources:

https://www.crossfitinvictus.com/blog/the-case-against-nsaids/

http://www.active.com/articles/is-inflammation-holding-you-back

http://www.evergreennutrition.com/free-radicals-and-inflammation

http://www.medicinenet.com/cox-2_inhibitors/page2.htm

https://www.t-nation.com/training/do-pain-pills-impair-muscle-growth

https://www.mobilitywod.com/propreview/people-weve-got-to-stop-icing-injuries-we-were-wrong-sooo-wrong-community-video/

http://crossfitimpulse.com/why-fish-oil/

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Embracing the Suck: Understanding Inflammation Part 1

by Geoff Rand

When I was in the Army, we pretty much ran on Motrin.  Before a long run, after a long run, after a long ruck march, after a vigorous Physical Fitness Test, before bed, after waking up, we took it all day long.  We called it Ranger Candy or Vitamin M.  The medics handed it out like M&Ms.  I’ve since found out that this was a horrible practice and suppressing the body’s natural pain response is extremely counter productive to the healing process.

 

Inflammation is a response from the immune system after experiencing tissue damage.  Tissue damage can be in the form of micro tears that are normal occurrences when building muscle by lifting weights or stressing our joints when running or jumping.  It can also be more serious damage like a strain, sprain, or tear.

Whatever the cause or degree of injury, the body’s response is the same.  The inflammatory process happens in three phases.  In the first phase, blood saturates the site of the injury, which causes heat, swelling and associated pain, and stiffness.  Think of this phase as the fire department being called to put water on a fire.  Then, specialized white blood cells come in and soak up the damaged cell debris.  They are like the trash trucks hauling away the garbage.  In the third phase, cells called macrophages move in and start to rebuild the damage.  They are the construction crew.

Inflammation is a necessary process for the body to heal and become stronger.  The swelling and pain produced is a signal to discontinue the activity that caused the injury while the body recovers and rebuilds.  Studies have shown that the more you stress your body, the more resistant it is to experiencing the pain from inflammation.  In other words, the harder you work your muscles and joints, the more stress they are able to take before they start to signal you to slow down.  Think of how you feel on your first day back at CrossFit after returning from vacation.  You need to rebuild your tolerance to the stresses your body was able to withstand before you left.

If you train too hard for too long without adequate recovery time, the body will become overwhelmed trying to put out all the fires, and things will start to break down.  Muscles and joints become chronically inflamed or degenerate to the point of a serious injury occurring.  

Recovery time is essential, but your regimen should not include popping a pill for pain.  Studies have shown that taking certain pain medications after a workout can nearly totally negate any gains you may have made during that session.

In the medical community and society as a whole, there has been a trend to treat pain as an illness by taking medication to suppress pain.  In certain cases taking pain meds is appropriate, like with a broken bone or after surgery, but for every bump and bruise and general soreness after a workout, it is not.  Suppressing the natural healing process might make the pain go away, but it will also delay and increase the recovery time.  And, taking some common pain reducing medications can cause other undesirable effects throughout the body.

In Part 2 of this article, we’ll look at what NSAIDs are and how they affect the body when taken as well as some alternatives to taking them.

Sources:

https://www.crossfitinvictus.com/blog/the-case-against-nsaids/

http://www.active.com/articles/is-inflammation-holding-you-back

http://www.evergreennutrition.com/free-radicals-and-inflammation

http://www.medicinenet.com/cox-2_inhibitors/page2.htm

https://www.t-nation.com/training/do-pain-pills-impair-muscle-growth

https://www.mobilitywod.com/propreview/people-weve-got-to-stop-icing-injuries-we-were-wrong-sooo-wrong-community-video/

http://crossfitimpulse.com/why-fish-oil/

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Tase Me Bro

by Geoff Rand

I consider myself somewhat of an expert in the use of electro-muscular incapacitation devices.  In 2006, I was one of only six officers in the country to accidentally set someone on fire with a Taser.  Over the years, I’ve conducted an informal survey of nearly two-dozen unwilling participants and the overwhelming consensus was that this device provides quite an intense workout.  100% of the study participants indicated either verbally or non-verbally, that given the choice, they would never want to do that 5-second workout ever again.

The Taser works by hacking and disrupting the signals from the nervous system to the muscles.  If you’ve never been tased, imagine two barbed darts penetrating ¾” into your skin, spread up to 38” apart and energizing you with 50,000 volts of electricity, causing every muscle between the probes to rapidly contract hundreds of times a second.  After 5 seconds of that, it’s easy to see how one can become totally fatigued.

I began wondering if this life-saving technology could be toned down a bit and turned into a device to help stimulate and exercise muscles or even aid in recovery.  It turns out it can, and it has already been done.  I really need to start patenting my ideas as soon as I think of them…

I first experienced Electronic Muscle Stimulation (EMS) while at Rehab 2 Perform following my dry needling sessions for my shoulder injury.  They use the Compex Sport Elite EMS machines.  In the EMS therapy, a series of adhesive pads are placed around the area to be stimulated and electrodes are attached to the pads.  The machine then fires short electric pulses to the pads for sessions of about 25 minutes at an intensity you control.  The electric pulses cause activation in the targeted muscles.  It feels a little weird at first having your trap writhe independent of your control, but you leave feeling refreshed.

Our muscles are made up of slow and fast twitch fibers that work in relays to help us do work such as lifting loads.  When the brain signals the muscle to contract or release, chemical reactions within the muscle cause it to move.  The body always keeps a reserve to help prevent overexertion and damage, so it is physically impossible to voluntarily fully contract a muscle to 100% capacity. 

Similar to Tasers, EMS machines directly stimulate the muscles by bypassing the body’s normal methods of signaling.  As a result, EMS machines can produce complete contraction in muscles.  Don’t worry though.  They fire at a much slower rate and voltage than a Taser.

EMS therapy is beneficial in that it can directly target specific muscles and work them independently of others.  The electrical stimulation fires in waves through the muscle, helping to work it in ways you just can’t achieve through normal exercise or manipulation.  If you’ve read my other articles, you know that working a muscle helps pump it full of rejuvenating blood and nutrients while ridding it of toxins, all speeding up recovery.  EMS therapy is a highly efficient method of achieving this goal.

One of the most famous users of EMS machines was martial artist Bruce Lee.  Lee began using EMS therapy after a back injury in 1970.  He used EMS not only to speed his recovery, but also to work his muscles in ways he believed were more efficient than traditional exercise.

I haven’t used EMS to develop strength, however some studies have shown that when incorporated into specific workout programs, EMS can produce gains in excess of what traditional exercises can achieve alone.  However, these studies were conducted on elite athletes training under intensely supervised programs.  EMS probably isn’t going to get you those 6-pack abs while you sit on the couch stuffing your face.  Sorry.

I use EMS to help speed my recovery from certain workouts, most often high rep bouts of pull ups or push ups, which seem to aggravate my shoulder issues.  Recently, I used my EMS machine to help reduce my pain right after I got home from the gym.  I mixed a recovery drink, slapped on the pads and electrodes, and lied on the sofa.  After completing the 25 minutes of the EMS program in active recovery mode, my shoulder was nice and loosened up and the pain was nearly gone.

If you are interested in EMS therapy, I would suggest first experiencing it at a rehabilitation center like Rehab 2 Perform.  Go through a couple sessions, and see how the therapist sets the pads up.  If you think you might need frequent sessions and are interested in picking up your own EMS machine, be aware they are not cheap.  You can find inexpensive battery powered devices that seem similar to the professional ones, but the cheap ones lack the multiple settings, programs, and intensity controls of ones like the Compex and other brands.  Expect to pay $300-600 for a good EMS device.  Check eBay as used ones sometimes pop up there.

There’s no one therapy that works for everyone.  For me, I find that dry needling helps relieve pain that won’t go away with less intensive methods.  EMS therapy helps keep me going and so far, has allowed me to recover at home without having to schedule a doctor’s visit, since I can apply the EMS machine’s pads myself.  I haven’t figured out a way to dry needle myself yet.

If you have a problem area that hasn’t been resolved with other methods, give EMS therapy a try.  You might find that tasing yourself does the trick.  Just keep that electric current away from the pepper spray to be safe.  Trust me on this.

Sources:

https://www.t-nation.com/training/truth-about-ems

http://breakingmuscle.com/mobility-recovery/does-electrical-stimulation-work-for-recovery

http://www.livestrong.com/article/359490-how-are-the-muscular-nervous-systems-connected/

http://www.ptdirect.com/training-design/anatomy-and-physiology/skeletal-muscle-the-physiology-of-contraction

http://breakingmuscle.com/mobility-recovery/science-says-electrical-myostimulation-can-speed-recovery

 

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Recover Hard

by Geoff Rand

 

We’ve all had a tough workout or even a tough week of workouts.  Sometimes you might feel like just taking a week off.  I know I have.  Rest is important, but inactivity is not a prescription for recovery.

Until Dave and Amanda told me about Stan Efferding and his Rhino’s Rhants videos, I had no idea who he was.  Stan is a professional body builder and power lifter who holds several world records.  He has also trained other professional athletes.  Stan has a unique perspective on recovering from injury, having been slated for a hip replacement surgery.  However, instead of getting sliced open, Stan sought out alternative treatments (specifically Active Release Therapy--ART--which I’ll cover in a future article) and was not only able to avoid hip replacement, he went from being barely able to walk to squatting over 900 pounds just a few months later.  While Stan's work with ART and other active strategies helped him recover from injury, they are just as effective in recovering from general fatigue and soreness.

Stan Efferding

Stan Efferding

I think we can all agree that working out with free weights is more effective than working out with machines.  That is why you won’t find machines in CrossFit Boxes.  We are the machines.  The use of free weights engages stabilizing muscles that make those movements far more effective than what you can get from a machine.

Along the same lines, it would make sense that working out harder, more specifically doing a more difficult version of an exercise (GHD sit-up vs. Abmat sit-up, for example) is more effective than doing the easy exercises.  Stan says do the “hard sh!t.”  The same holds true for recovery, the harder sh!t is more effective than the easier sh!t.

For recovery, there are passive treatments like anti-inflamatories, glucosamine, and other pills.  Passive therapies, which Stan describes as “things that are done to you not by you”, are things like cryotherapy, contrast showers, Epson salts, and ice baths. 

When you take anti-inflamatories or apply ice, you are actually inhibiting the body’s natural process of healing by restricting blood flow.  While this may temporarily lessen the sensation of pain, you are actually delaying the recovery of the injury or stressed muscle.

Stan also groups massages, acupuncture, foam rolling, and cupping into the Passive category.  He describes these as “easy” and while maybe more effective than all the baths and pills listed above, they are more superficial and temporary, at least how he sees them.

Our bodies will heal better and faster if we incorporate movement into our recovery methods.  This is stuff you do, versus stuff that is done to you.  Ever have a coach yell at you to “walk it off”?  There might actually be some merit to that.

Our muscles need blood and the nutrients it carries to heal and grow.  Being sedentary limits this blood flow.  You’d be better off getting up and moving around as much as you can depending on your injury or area of soreness.  There’s always a way to scale a CrossFit workout, and you can always do a mobility or yoga class, so there’s no excuse for not coming in.

Hand in hand with our circulatory system is our lymphatic system.  This system rids the body of toxins and waste, however it lacks the pump that our circulatory system has.  The way lymph is moved through the body is through muscle contraction.  So, that sore muscle you have is best healed by, you guessed it, moving that same sore muscle.  If you choose to do nothing, or sleep, or even worse, take a bunch of days off, you’ll only feel worse.

Stan described his recovery after a heavy leg day as several sets of sprints on a recumbent bike.  While this may seem to be overworking and causing further fatigue to an already tired muscle group, the opposite is true.  Pumping large amounts of blood into the legs stimulates healing and speeds recovery.  He says that your active recovery should make you sweat and get your heart rate up.  The goal is to maximize blood flow but avoid placing further load on that muscle group.  High Intensity Interval Training (HIIT), air squats, rows, and hill sprints would also work.

So the next time a WOD crushes you, avoid the temptation to stay in bed or on the couch.  Get up and get your butt in the Box and do some active recovery.  Your muscles will thank you.  

Yippee-ki-yay.

Source: 

https://www.youtube.com/watch?v=-LCagbUS0nQ

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