What Causes Frozen Shoulder?

Adhesive capsulitis or frozen shoulder has different causes, but before we get into that, let’s look at the two different types of frozen shoulder.

The Two Types of Frozen Shoulder

Frozen shoulder can be classified into two types: primary frozen shoulder and secondary frozen shoulder.

• Primary frozen shoulder does not have an initiating event or cause. It has been suggested that frozen shoulder may be attributed to specific genetic abnormalities (Roy, 2012). Cultures of the tissue obtained from the glenohumeral joint capsules of patients with frozen shoulder revealed aberrations involving chromosome 7 or 8 in the fibroblasts.
• Secondary frozen shoulder is often linked to a significant event, such as trauma, surgery, illness, or infection. Overall, secondary frozen shoulder is caused by any condition affecting the shoulder that results in inflammation of the joint capsule. This causes the formation of scar tissue, thickening, and the eventual shrinkage of the capsule that envelopes the glenohumeral joint. These changes leave less room for the humerus to move, thus, limiting the movement of the joint.

To be more concise, frozen shoulder may be caused by any injury involving the shoulder joint. The outcome of these changes in the shoulder causes pain, and tightens and restricts the joint’s movement.

Shoulder Injuries that Could Lead to Frozen Shoulder

The following injuries have been associated with frozen shoulder:

• Shoulder tendinitis. This frequently involves inflammation of the biceps tendon or rotator cuff tendon. Tendons are tough fibrous tissues that connect a muscle to a bone. In this condition, the tendon involved is usually red, sore, and swollen. Shoulder tendinitis is commonly caused by an injury, overuse of or repetitive shoulder motion, infection of the tendon, or chronic inflammation of the tendon which could occur with rheumatoid arthritis.
• Shoulder bursitis. As previously discussed, bursa is a sac-like structure that functions as a cushion between bones and tendons. This fluid-filled sac also serves as a shock absorber between bones and muscles around the joint. The bursa is filled with synovial fluid that is used to lubricate the articulating joints. Shoulder bursitis involves inflammation of the bursa in the shoulder joint. Bursitis may be caused by an injury, an underlying rheumatic condition, or infection.
• Rotator cuff injury. This mainly involves irritation or damage to one of the four muscles making up the rotator cuff. An injured or damaged rotator cuff tendon may lead to frozen shoulder symptoms. These muscles work as a unit to further stabilize the shoulder joint, assisting the shoulder as it moves in different positions. Inflammation of the rotator cuff tendon, impingement of any of the four muscles of the rotator cuff, or tearing of the rotator cuff tendon causes rotator cuff syndrome.

Shoulder injury typically involves pain. Pain limits movement of the affected shoulder and may impede an individual from performing his or her usual routine. Prolonged immobilization has been connected to frozen shoulder. The incidence of frozen shoulder is higher in patients with diabetes, especially those dependent on insulin. Diabetes mellitus is a metabolic disease characterized by increased blood glucose levels, and is caused by absence of or insufficient secretion of insulin. It has been suggested that excess glucose molecules stick to the collagen fibers in the joint capsule, contributing to joint stiffness (Sports Injury Clinic, 2012).

Diagnosis and Prognosis of Frozen Shoulder

Diagnosing Frozen Shoulder

Frozen shoulder syndrome is diagnosed by a physician who performs a complete medical history and conducts a thorough physical examination. Patients with signs and symptoms of frozen shoulder are often referred for an x-ray of the shoulder. The physician usually orders a magnetic resonance imaging or ultrasound in order to examine the soft tissues of the shoulder, such as the rotator cuff, or to get a deeper understand of the injury.

Common Outcome for Frozen Shoulder

The prognosis (probable outcome) for patients with frozen shoulder syndrome who receive the right treatment is generally favorable. Often times the first treatment options given are physical therapy, frozen shoulder exercises, and conservative modalities described in the next section, which all have a positive effect on frozen shoulder. Without a consistent and aggressive treatment, the effects of frozen shoulder can be permanent (Shiel, 2011).

Rick Kaselj, MS .

Hey, here is the Frozen Shoulder Client Guide

You can download it by CLICKING HERE or click the image bel0w.

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Today I have some great information on nutrition and injury recovery.

I have to say, I think this is one of the best interviews that I have done.

The interview is with Dr. John Berardi who is the nutrition guy.

Enjoy the interview!

CLICK HERE to listen to the interview with Dr. John Berardi on nutrition and injury recovery.

CLICK HERE to listen to the interview with Dr. John Berardi on nutrition and injury recovery.

What Dr. John Berardi Goes Through in the Interview on Nutrition and Injury Recovery:

• How nutrition is important for injury for athletes but also the general public
• The 4 stages of injury recovery
• Athletes that are always in a state of injury and what they do to keep performing
• Which fats to eat in order to promote healing and which ones to avoid
• How long it could take the tissue to recover from an injury
• After you get injured, the 4 foods you need to start eating
• The 3 supplements or foods that have the active ingredient to help reduce inflammation of an injury
• How water ends up affecting your injury recovery
• The specific vitamins and minerals that help with post-injury recovery
• John talks about his amazing business and how he helps people and fitness professionals

A few things you need to know about listening to the interview:

• To listen to the interview, scroll down to the bottom of this page and click the play button symbol. If you do not have time to listen to it right now, just click the “download” button and download it to your computer. Then you can listen to it on your computer when you like. Plus you can subscribe to the itunes podcast and get all the interviews when they are ready. Enjoy!
• If you use Chrome as your web browser, at times it can act up when playing the interview. I would suggest listening to the interview in another web browser (Firefox, Safari, Internet Explorer, etc.)
• Here is a video explaining how to download the interview recording

A Few Words About John

Dr. John Berardi’s bio is very impressive.  I have known of him for a number of years.  It was great to finally chat with him on the call and also chat with him for a few minutes after the call.  John comes from a research background and brings that to nutrition in the areas of performance, weight loss, muscle building and fitness education.  I have read a lot of his stuff and I like the fact it is very unique and grounded in research.  I am sure you can search around the internet and find some huge bio of John, but that is a quick summary from my point of view.

If you have a neat specialization that would be of benefit for fitness professionals to know about, please do contact me. I would love to share it with the EFI world.

If you know of a fitness professional that may benefit from this, please forward it onto them.

As you can see from the tittle of this article, this is part 1 with John.  I do have a part 2 where he goes into more detail when it comes to nutrition and injury recovery.  Watch for it, I will have it up soon.

Take care.

Rick Kaselj, MS

P.S. – If you liked this nutrition interview, here are some other articles that may interest you:

• Nutrition Interrogation with Brian St. Pierre
• Why Fitness Professionals Should Be Giving Nutritional Advice with Yuri Elkaim
• Training and Nutritional Advice with John Romaniello

Rick Kaselj, MS

Nutrition and Injury Recovery with John Berardi [ 21:51 ] Play Now | Play in Popup | Download

Have you ever left your business to be run by your employees only and then come back to chaos? Or just as bad, had phone call after phone call about simple things that have been carried out before by your employees, or at least don’t take YOU too much brain power to work out?

Well if that’s happened to you, your business is very much how my business USED to be. I was in exactly the same boat…one time I went away from my business for a day to help prepare for my sister’s wedding…and I forgot my phone. I came back to find 15 emails and 6 voicemails…All from my employees!

As you can imagine I was pretty worried by this and was well prepared to return to a business burnt to the ground or at least on its way to bankruptcy…As it turned out the desperate and “hugely important problems” that I had phone calls for were as follows:

• “You left your phone.” (they thought I would check my voicemails remotely apparently)

• Someone called interested in what we had to offer……It turned out that NO phone number, email,  or even name were taken (as “I didn’t think to”) so I couldn’t call back.

• “Where is the paper for the printer?”

• “The toilet towels need changing.”

• “I’m finished for the day.”

• “Oh, forgot to say someone came in, interested in what we have to offer.” By now you know they didn’t get any details from them. “But it’s O.K., they said they would probably come back in to see us.”

And don’t even get me started about the emails!!

As you can imagine this didn’t put me in the best of moods. In fact I vowed never to leave my phone anywhere again!

This wasn’t by any means an isolated incident……I went a whole year and a  half without taking more than 3 consecutive days away from my “business”, for two main reasons:

1 – I didn’t trust my employee (I only had one at the time) to be able to handle everything without me. So I figured I would be better off not leaving him too long than have the stress of worrying and/or getting phone calls from him the whole time.

2 – I wouldn’t be making any money! This was the most persuasive factor for me not to leave my business for long. If I wasn’t there, I wouldn’t be earning any money, was my opinion. “No one else can do the technical aspect of my business…I’m the best at it.”

Being tied to my business and not being able to go anywhere further than a few hours’ drive was obviously not ideal for my relationship with my girlfriend of the time. I say “of the time” as it turned out that it was too much for our burgeoning relationship to handle…Apparently she understood I loved my business and was desperate for it to be successful, but not being able to spend any quality time – even when we were together as I tended to be stuck frantically answering emails or phone calls – was too much.

Back then I thought she was being unreasonable and all entrepreneurs and small business owners would have to be in the same position.

It was a few months after that break up that I spoke to a business owner at a networking event, who was happily married and had started his relationship with his wife and his business at pretty much the same time as me!!

There were a few glaring differences between his life and mine at the time, despite us having started our relationship and business at the same time…

1 – His relationship lasted, obviously.

2 – His business was twice my size in the same amount of time despite starting with exactly the same…just ourselves.

3 – He had taken two 3 week breaks in the last year and a half.

4 – I was the one that had to be rude and leave the conversation in mid-flow to answer an “important” phone call from my employee. It turned out to be about a task that he had done a hundred times.

5 – He had a lot more hair!!

As I discussed our respective differences I kept hearing the word “systems” pop out of his mouth…Not wanting to appear ignorant and a lesser business man (despite the fact that I now realize I was), I didn’t ask him what he meant by the word “systems”.

At any rate they seemed important to him as he must have mentioned them a hundred times. So when I got home I was intrigued enough (more by the guy’s apparent calmness about his business, his ability to holiday whenever he wanted and the fact that his business was double the size!) to try and look up the word, “systems”.

The best I could come up with was the Wikipedia definition which is as follows:

“Most systems share common characteristics, including:

▪   Systems have structure, defined by components/elements and their composition;

▪   Systems have behavior, which involves inputs, processing and outputs of material, energy, information, or data;

▪   Systems have interconnectivity: the various parts of a system have functional as well as structural relationships to each other.

Systems may have some functions or groups of functions.”

If this makes no “real world” sense to you then you are exactly like I was… In fact it made so little sense that I left it at that and made a whole load of “reasons” why my business was different to the guy’s at the networking event and how “systems” weren’t actually right for my business.

I didn’t let the fact that I didn’t know what these so called systems actually were bother me.

One thing that I did remember was a book title that the guy had mentioned a couple of times… “The E-myth”…Well, at the time I was always keen to buy a book from Amazon and have it sit next to my bed looking brand new. (Books rarely ever got opened as by the time I did get to bed I was too tired from running my business to be able to read anything… There was definitely no point in trying to find time to read during the day!)

So I carried on with my every day business tasks (which by then I could do with my eyes closed as I’d had to do them everyday for the last year and a half, which made it harder for me to understand how my one employee had to ask so many questions for most tasks despite the general having been done every day for the last 90 days).

The business seemed to stay the same which was fine as “we are in a recession, don’t you know, so its good to actually be staying the same and not shrinking.” I wouldn’t say I was happy with my business but I had come to terms with it and had managed to forget about the guy from the networking meeting.

That was until we met again…this time at a charity auction (where he bid on and won a holiday to Las Vegas, I may add). We got talking again about our businesses and this time I didn’t try and hide behind any bravado and I actually asked him this exact question:

“I know you seem to think systems are important and have allowed you freedom and for your business to grow very fast…and I started to read that book you told me about. But I still don’t actually know what a system is and where to start…and actually I don’t have the time!”

This turned out to be the most important question I’d ever asked as it encouraged James to take pity on me and take me under his wing. He allowed me to see totally inside his business and learn exactly what he meant by systems and what they can do for your business life and as clearly your personal life as well.

Following this “education” from James I was able to completely change my business around. I went from having just one employee and doing all the technical work that I thought only I could do to having 5 employees and not having to do any of the technical work. Oh and I’ve also taken two 3 week holidays, and I now live with my girlfriend (the same one who dumped me for “not having any time for her at all”… All this after just over a year.

************************************************************

Why it works

James, my original mentor and teacher, was very impressed with my progress with completely systemizing my business. I’d managed to actually achieve it quicker than he had, and now my business is actually more successful than his.

I put the speed with which I was able to achieve it (once I knew what I was doing) down to the system that I was actually able to work out and apply to my business.

I believed that the approach with which I systemized my business and allowed myself to step away from the day to day running of things and concentrate on the stuff that was going to grow my business exponentially was unique to me and my business.

HOW WRONG WAS I?! In fact that couldn’t have been further from the truth… It turns out my approach to the systemization and automation of my business allowed it to work with any business!

It isn’t specific to certain types of industries or businesses with one person or 4…It’s suitable for all shapes and sizes of small businesses!

I first worked this out when my good friend, Sarah, asked me to help free up her time. Sarah owns a small beauty salon which she originally started out as a lifestyle type of business, i.e to provide her with a decent income and lots of free time doing something that she loves.

Well due to a few marketing systems that I encouraged her to implement, her salon went from 50% empt, to her becoming more and more stressed at the number of phone calls and voicemails from people asking for appointments!

So one of the first things I got Sarah to do was to change her answer phone message saying that she would only respond to text messages!

You’re probably thinking the same thing she did……I CAN’T DO THAT, YOU’RE CRAZY! AND ANYWAY, THEN I’LL JUST HAVE LOADS OF TEXT MESSAGES INSTEAD!

The long and short of it is I taught her how to write a system in 10 minutes that allowed her to handle her texts every day in 10 minute blocks twice a day. And in fact now she has one of the junior beauticians handle it for her. So her diary is handled for her!

About Stephen and Mark Gray,

Owners of The Systems Solution

The Gray twins are committed to a healthy lifestyle having played professional rugby for Bedford and most recently fitness modeling for national magazines.

They carry this strong belief into their two training studios where their knowledge of systems has enabled them to have these businesses work for them.

You can check out their Systems Solution for done for you Systems that run your business at www.thesystemssolution.com

I was not really filtering out my spam box. These are a few things that were in my inbox and on Facebook. Let’s get to it.

Cure My Elbow Pain

This was a question that came up for the Muscle Imbalances Revealed – Upper Body (MIRU) coaching call.  I thought the answer would be of interest to you.

Can you tell me how to cure elbow pain? Basically it hurts if I do chin ups, lying dumbell skull crushers (I think that’s where I hurt it and a little on bench press). Also, can you tell me the other types of elbow pain there is (if any other) and if the treatment for curing would be different for each one?

Of the MIRU crew, Dr. Jeff Cubos took on the question.  Just a reminder that the MIRU crew will be holding a seminar this June on Spinal Health & Core Training.  We hope to see you there.

“Unfortunately, it is quite difficult to answer clinical conditions online.

There are many components to the elbow proper and far more components to pain itself.

I will say this, unless there was an acute trauma or structural deformity, the tissues surrounding the elbow may likely be overloaded. Aside from training that progresses too quickly or with too much load, I’d look to the thoracic and shoulder girdle regions.

Often the scapulothiracic joint complex lacks requisite dynamic or static control causing the muscles that cross the elbow to do more work. I’ll often start by addressing mobility issues, then go after control.

I really like quadruped both on elbows and hands for scapulothoracic control ensuring that the scapula is properly positioned or centrated throughout the movement. The hand should also have good contact with the floor in a slightly external rotated position with load being put at the 1st and 5th mcp and base of the palm. The fingers should be spread out.

It may also be worthwhile to seek the help of a clinician who does soft tissue therapy to address the quality of the local tissues and mobility of the distal tissues.

I hope that helps. Sorry I couldn’t be specific but you are more than welcome to email me.”

- Dr. Jeff Cubos

It is back to Rick.  I would say, get it looked at and get an accurate diagnosis and approval to start an exercise program.  If what you have is lateral epicondylitis or tennis elbow, I will suggest this program:

What to do about Osteochondritis?

Tom, I would check out the interview with I did with Zach Moore on Exercise and Osteochondritis. I know this will help you out.

Funny Stuff

Since I do this injury stuff, I have been getting all kinds of nicknames, here is another one to add to the list:

I am Very Weak in the Push-up?

A question from Quebec:

Harold, I know you have both the Upper Body and Lower Body of Muscle Imbalances Revealed.

I would take the time to work on the scapular stabilizers.  You can do this in a plank position – Dr. Jeff Cubos talks about above or you can do this in an open chain fashion with exercises targeting the middle fibers of trapezius, lower fibers of trapezius and serratus anterior as I go through in the Scapular Stabilization Exercise Program.

I would also check out Tony Gentilcore’s Component #1 – Corrective Exercise Strategies for Athletes (and Meatheads, too) with Tony Gentilcore that is in MIRU.  He goes through some great exercises that you can do to help with upper body strength exercises.

My Shoulder Cracked?

A question from Brazil:

Sergio, I want to help you out but there is not enough to go on. My advice would be to get it looked at.  Get an accurate diagnosis, clearance to start an exercise program and written guidelines on what you can and can’t do.  Then we can go from there. My big advice: take the time to rehab your shoulder or you will get injured again.

Nice Stuff on Facebook

I am so glad to help fitness professionals and people with injuries.  Very motivating to get comments like this:

Kind Words

More amazing words for the Scapular Stabilization Exercise Program:

“I would describe the Scapular Stabilization Exercise program as very comprehensive, foundational and exceptionally accessible for clients, with a wonderful explanation for the “why” behind all exercises / approaches.

Exceptionally well laid out, with a great background review of the scapular, shoulder movement, and involved muscles to provide a holistic approach.

The exercises are very well described, LOVE the “errors” section to assist with improving accuracy of each exercise. Love the handouts and the E-book. Overall, the best thing is the ease of lay out/presentation of material, so all is easy to understand and implement immediately.”

Catherine Holden

Baltimore, MD

Occupational Therapist, Registered, Licensed

Nice that People Like EFI

 Ahhh, thanks:

Shoulder Injury Guide

Little feedback on the free shoulder injury guide that I give away at EFI:

“I think the gifts are wonderful.

I’m looking to take my knowledge in this direction (corrective exercise).

Where I am in Atlanta, (Roswell GA) there are a lot of tennis moms with the issues, back issues, plantar fasciitis and shoulder pain.

I want to be the go-to guy in this region”.

Thank you in advance,

Andre Coman

Roswell, GA

Personal Trainer

Effective Rotator Cuff Exercises

Feedback on the program:

“I currently work with clients who have past or present shoulder injuries due to overuse or athletically related. Because of Effective Rotator Cuff Exercises, I have a more in depth knowledge of the functions of the rotator cuff and it’s vulnerability to injury.”

Brian Bobo

That is it.

Have a great weekend.

Rick Kaselj, MS

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Today I have some great information on grip strength and injuries.

The interview is with Jedd Johnson who is the grip strength guy.

Enjoy the interview!

CLICK HERE to listen to the interview with Jedd Johnson on Grip Strength and Injuries

CLICK HERE to listen to the interview with Jedd Johnson on Grip Strength and Injuries

What Jedd Johnson Goes Through in the Interview on Grip Strength and Injuries

• What is grip strength and why it is not just hand strengthening
• How grip strength relates to improved athletic performance
• Importance of balancing your flexors and extensors for maximizing grip strength
• Big link between the elbow and grip
• Why those grip things at the sporting good store are useless
• How you can use a pool noodle to improve grip strength
• Why does it take most people a long time to overcome a grip injury
• Great example of improving your grip strength by using a towel
• What are grip strength competitions, feats of grip strength, strong man and power lifting
• How does grip strength help you in the gym
• What injuries does poor grip strength lead to
• Examples of feats of strength – bending nails, tearing cards, bending bars
• What is grip strength and how you can get started
• How Jedd got into grip strengthening
• Who is Jedd Johnson

A few things you need to know about listening to the interview:

• To listen to the interview, scroll down to the bottom of this page and click the play button symbol. If you do not have time to listen to it right now, just click the “download” button and download it to your computer. Then you can listen to it on your computer when you like. Plus you can subscribe to the itunes podcast and get all the interviews when they are ready. Enjoy!
• If you use Chrome as your web browser, at times it can act up when playing the interview. I would suggest listening to the interview in another web browser (Firefox, Safari, Internet Explorer, etc.)
• Here is a video explaining how to download the interview recording

A Few Words About Jedd

Jedd Johnson is a CSCS through the NSCA, RKC through Dragondoor, and has been competing in strength sports since 2003.  Readily competing in Grip Sport competitions around the nation, Jedd is also a prolific writer and speaker about Grip and other strength and muscle building topics.  He owns and runs DieselCrew.com, a site dedicated to the pursuit of strength, especially Grip Strength and the promotion and growth of the sport and practice he loves with such passion, Grip.

How to Improve Your Grip Strength

If you want to improve your grip strength, CLICK HERE to learn about Jedd’s Home Made Strength 2.

If you want to try a feat of strength, you can CLICK HERE to check out Jedd’s Nail Bending Program:

If you have a neat specialization that would be of benefit for fitness professionals to know about, please do contact me and I would love to share it with the EFI world.

If you know of a fitness professional that may benefit from this, please forward it onto them.

Take care.

Rick Kaselj, MS

P.S. – If you liked this fitness training interview, here are some other articles that may interest you:

• Common Training Mistakes that Lead to Injuries
• Why Fitness Professionals Must Focus on Fascia
• Thinking Beyond the Physical

Grip Strength and Injuries with Jedd Johnson [ 26:00 ] Play Now | Play in Popup | Download

Going to Orange County and attending a very unconventional fitness business conference called “Fitness Business Summit” was very refreshing compared to most conferences that I go to.

Sad to say, most fitness conferences these days are organized by fitness association and run by fitness equipment companies.  This has taken away from the quality of information that fitness professionals get and just ends up being a fitness equipment expo/circus.

I attended Fitness Business Summit last year and I was back this year.  Last year I was an attendee and this year I was one of the presenters.

Even though I am a presenter, I make sure to attend as many of the sessions as I can.  Let me highlight some of the lessons that I learned at Fitness Business Summit 2012 (FBS12).

From Pizza Driver to Mr. Olympia

I am not much into body building and don’t quite get it but I know it is something that takes a lot of work, focus and dedication, especially if you become Mr. Olympia.

FBS12 started off with Ronnie Coleman who was Mr. Olympia 8 times.  WoW!

(Ronnie Coleman and Me – I know, his biceps are as big a my thigh)

Ronnie went up on stage and told his story.  He talked about how he was a pizza driver after college and fell into body building.  After a while of being a pizza driver, he got tired of it and became a police officer.  (I would not want to cross that police officer.) He continued being a police officer until he won his 3rd Mr. Olympian.

The most powerful thing he said was, “Be the best at what you do.”

He did this when he played college football, during his schooling, when he was a pizza driver, as a police officer and being a body builder.  An important lesson for us all.

Smart Dude but Dumb Business Owner

Up first was Dan Ritchie.  I should have started off with Dr. Dan, who has a PhD in balance training and the older adult. (I will interview him very soon on EFI). What I have seen with other very educated people is they think their intelligence in one area carries over to business.  Sad to say, this is often a huge mistake.

Dan Ritchie, fellow presenter Rebecca Tabbert and Me/I (Rick Kaselj)

Dan is one of the smart guys that did not make this mistake.  He spent a period of time getting his PhD in college and now he is in the real world getting his PhD in Real World Business.  He is applying what he has learned from other successful fitness owners to his business and is doing amazing.

From Dan, this was the big lesson that I learned: you might be smart in one area but you can’t be smart in all.  If you want to get better in another area you need to learn, apply, get experience and network with others that have done it or are where you want to be.

How to Go from Eating Two Year Old Microwave Dinners to Changing Your Industry

Michael Parrella, Just WoW-ing the Crowd

I would not want to meet Michael Parrella in a dark back alley but I am happy to know him and know he has my back.

Michael’s story is crazy.  He went from being so broke he ate two year old TV microwave dinners that his best friend’s mom had hoarded at her house to now helping thousands of people get introduced to karate and helping hundreds of karate studios grow their business and reach their dreams.

I have been lucky to know Michael since last September and he has always been so open and helpful with my business.

During our first conversation, I asked him what was his plan “B” if his business failed.  He replied:

“Success was my plan “A” and I was not going to stop until I got there.”

Awesome advice.

3 States, 2 Countries and a Province

This article has gone a few miles. It did not take me long to write but I have been working on it for a few thousand miles.

A Favorite Spot of Mine

I first started it in Blaine, Washington, USA which is about 30 minutes from my house and is in another country and province (Surrey, British Columbia, Canada).

If I have to travel to the USA, I do what I can to leave a little earlier and visit Blaine. It is only about 30 to 60 minutes from Vancouver, Canada but it feels like a world away. It is a sleepy sea-side town and has a few of my favorite places there.

My favorite place is this coffee shop which looks over the Pacific Ocean and is in an old train caboose.  It very much reminds me of when I was a kid and had birthday parties at the old McDonald’s caboose.  Where have those things gone?  I like sitting on the deck, beside the caboose, looking over the ocean and doing a little writing – like this article.

Sadly, on this trip, the caboose was closed. I hope it is a temporary thing, but I had a plan “B”.

I headed off to the other coffee shop in town which is in the old heritage house. I was hoping I would be lucky and I would be able to get the table beside the front window which looks over to city hall and is right beside the coffee shop fireplace.

The coffee shop was abuzz this morning, which always makes writing easier.

While in the coffee shop, I worked on my presentation that I was doing this weekend in Orange County, California. It is always fun molding a presentation. It is amazing to take an idea, shape it and carve it into a specific message. I know people will learn a little and have a good chuckle.

Learning at 10,000 Feet

Next it was off to the Blaine airport and a flight down to Orange County.

This is such a cool photo but don’t know how to have it face up. Ugh.

What I have been doing of late when flying is using the time to learn. I will load up my iPhone with video presentations that I have, plus I will bring a few research articles (going through a great one on frozen shoulder.)

Let me share with you a few of the nuggets of information that I got from the 3 presentations that I viewed (I have a tough time watching one thing so I bounce around between a few).

Shatterproof Spine by John Izzo

• John when through an example with an Oreo cookie that was priceless. Everyone talks about the discs of the spine being a jelly donut but John had a great example on how it was like an Oreo cookie.
• John never highlighted this but he has done a lot of training with golfers and in his presentation he has a lot of great information relating to golfers and back injuries.
• In one part of the presentation he talked about compression, rotational and shear/bending stress in golfers. He said the shear/bending stress in amateur golfers is 80% greater compared to the professional. In a traditional golf swing, there is 8 times the stress of body weight when it relates to compression stress. The greatest rotational stress in the golf swing is the transition from back swing to down swing. Very fascinating! All of these points are a great explanation of why golfers have so much lower back issues.

Post Rehab Essentials by Dean Somerset

• Dean had a great slide on the thoracic and lumbar spine mobility which highlighted how much movement is in each of the areas of the spine.
• He highlighted the importance of an individual’s hydration level, which can have an effect on disc space height in the spine. (Another great reason to stay hydrated).

Complete Core Training by Mike Robertson

• Let me start off with this. I wonder how Mike sounds when he is angry? Every time I have a talk with him or watch one of his presentations, he is as calm as can be. During his presentations, he is the same way but is if full of great information.
• He made a side comment during his presentation but I thought it was interesting. He talked about how to improve hip mobility. He suggested you work on 4 things in order to improve your hip mobility: foam roll your hip flexors, perform dynamic stretching warm ups, take your hips through full range of motion (based on your ability) when it comes to lifting (squats, dead-lifts, lunges, etc), and perform static stretching at night.
• Mike also talked about the movement in the spine, especially rotation. He highlighted the rotation that the lumbar spine has is 10 to 15 degrees while the thoracic spine has about 70 degrees. If your client needs to improve spinal rotation, it is best to work on the thoracic spine and not the lumbar spine for rotational improvement.

There was a lot more in each of the presentations but those are a few things that stood out.

After about three hours, I was in Cali.

I was sad to have the learning end but happy to be able to squeeze out between two of the worst airplane passengers (Ms. Grumpy and Mr. Bumper).

I learned a lot on that flight and can’t wait for the flight back.

I think that is it.

It looks like my presentation time has changed and I will be talking Friday afternoon so I have to get working on it.

Have a great Friday and we will talk to you next week.

Rick Kaselj, MS

I am back with another exercise and injury interview for you and today it focuses on the business side of fitness.

A big thing that has changed over the last few years with myself is how much I focus on business.

When I started off in fitness, way back in 1994, I focused on the techniques related to fitness.  I did this for about 10 years.  Then in 2004, I started to spend more and more time studying, meeting business people and implementing what I have learned when it comes to business.  This has been one of the keys that has helped me reach more people, help more people and help my business grow.  One person that has helped me is Bedros Keuilian.

I interviewed Bedros for you and we specifically talk about marketing tactics for personal trainers and bootcamp owners.

If you don’t know who Bedros Keuilian is, he is a business coach for fitness professionals.  In the interview he gives a lot of great info bombs to help fitness professionals.

Enjoy!

CLICK HERE to listen to the interview with Bedros Keuilian on Strange Personal Training and Bootcamp Business Marketing Tactics.

CLICK HERE to listen to the interview with Bedros Keuilian on Fitness Marketing.

What Bedros Keuilian Goes through in the Interview on Personal Training and Bootcamp Marketing

• Why is it so important for a fitness professional to invest in understanding business and learn about marketing
• Selling is a skill and not a gift
• Common mistakes that personal trainers and bootcamp instructors make when marketing
• What makes Jillian Michaels so much better than other trainers (it isn’t her certifications)
• What are keys to your marketing material (3 things you must have)
• Importance of getting before and after pictures of your clients
• The importance of not being a generalist
• Why the future of fitness is in being a specialist
• How you can specialize in a number of niches
• The number one thing you need to do in order to get your clients to take action
• Why cutting your prices is a big mistake
• The two future trends when it comes to personal training and bootcamp marketing (very good stuff)
• Who is Bedros Keulian

A few things you need to know about listening to the interview:

•  To listen to the interview, scroll down to the bottom of this page and click the play button symbol.  If you do not have time to listen to it right now, just click the “download” button and download it to your computer.  Then you can listen to it on your computer when you like.  Plus you can subscribe to the itunes podcast and get all the interviews when they are ready.  Enjoy!
• If you use Chrome as your web browser, at times it can act up when playing the interview.  I would suggest listening to the interview in another web browser (Firefox, Safari, Internet Explorer, etc.)
• Here is a video explaining how to download the interview recording

If you are looking for some marketing tools, here are some:

Click here for a video presentation that I put together when it comes to using social media to get medical referrals:

Or you can click here for a video presentation that I put together when it comes to using social media to get more personal training clients:

If you have any business tips for fitness and health professionals, please do share them below in the comment area.

If you know of a fitness professional that may benefit from this, please forward it onto them.

Take care.

Rick Kaselj, MS

P.S. – If you liked this fitness business interview, here are some other posts that may interest you:

• Online Fitness Business Lessons from Vegas
• Social Media for Your Fitness Business
• 3 Ways to Get More Injury Rehabilitation Referrals

Bedros Keuilian on Strange Personal Training and Bootcamp Business Marketing Tactics [ 25:55 ] Play Now | Play in Popup | Download

Imagine this scenario…

You are a performance trainer specializing in injury prevention and athletic development for youth and teen athletes.  One of your existing clients refers you to work with one of his teammates.

You present your program to him and his parents and being the great closer that you are, of course, you close the contract.

You work with the kid for 3 months in the off-season.  He is the classic overachiever.  Pretty skilled in his sport, but not the most explosive or very fluid in his movement.

The kid works his butt off and you see a huge improvement in his athletic ability.  And even better, when he goes back to work with his team as the season approaches, his coach notices the changes and asks, “What did you do this off-season, kid?”

The kid raves about your off-season training program, so the coach grabs your contact info and reaches out to set up a meeting

This is a huge opportunity because if you play it right, you will go from making $75-$150 per hour doing personal or small group training, to $300-$400 per hour in a team setting.

But now you run into three issues:

1. Your training program is designed for a one-on-one or small group setting.  You don’t have enough equipment for 30-50 kids.
2. Not only do you have no equipment to work with, you also have no facility, except the field or court to work with.
3. And on top of all that, you only have 30-60 minutes per week to work with the team.

I ran into the same issues as I learned to leverage my time and took my training progressions from individual to team settings.  I also wanted to stay true to my injury prevention progressions and not cheat any of the athletes, parents, or coaches.

But before I present you my solution to this problem, allow me to introduce myself…

My name is C.J. Easter and if you follow college football, I was best known as Stanford Football #12 before Andrew Luck.  I am currently the CEO of the Performance Science Training Institute and am now known as the Stanford Speed, Agility, and Injury Prevention Expert.

My company contracts with youth sport organizations and high school athletic programs to implement speed, agility, and injury prevention programs on a mass scale.

You can find out more about the system that I use at Performance Science Training Institute.

Ok, enough of me and back to your dilemma… How do you stay true to your progressions and not “sell out” for the financial opportunity of working with a large group?

I’m going to take you from a micro-variable level all the way to the macro level of the concepts behind our team-training program.

Feel free to swipe these concepts and use them to truly leverage your time and win your first big team training program.

So here’s a quick glimpse of how we break down our progressions as well as a completely done-for-you training session:

We break down athletic movements into 8 categories, based on the dominant joint.  We call these the “stem cells” of athletic movements because all other athletic movements are derived from these patterns.

Here are our “Easy Eight”:

• Ankle Flexion
• Ankle Extension
• Bilateral Knee Dominant
• Unilateral Knee Dominant (F/B)
• Unilateral Knee Dominant (L/R)
• Bilateral Hip Dominant
• Unilateral Hip Dominant
• Core Stability

Now that we have a base set of movements, let’s look at how we progress our athletes through these movements:

• Isometric: To develop muscle memory of proper movement mechanics and to build strength at the point at which the body is at the greatest mechanical disadvantage

• Repetition: To develop the strength through the full range of motion to repeatedly recreate proper movement patterns

• Dynamic: To develop the ability to create proper movement patterns on the move and prepare the body to create force on the move

• Explosive: To develop the ability create and absorb maximal force with proper movement mechanics

These progressions must complement and supplement the team’s skill development and game schedule, so we break our progressions up into four types of sessions:

• Development Session:  This is a session in which we are looking to make some athletic gains with our athletes.  We can push your athletes in these sessions because you don’t have to worry about a little soreness the next day affecting their game performance.  For example, let’s say they play a game on a Saturday and they don’t play again until the next Thursday, a Development Session fits well on a Monday or Tuesday of that week.

• Pre-Game Session:  This type of training session is to be scheduled the day before a game.  The goal is to work out any tightness or soreness to prepare the legs to be fresh and explosive the next day.  This movement progression remains constant throughout the program to allow the athlete to develop a focused routine going into game day.

• Game Day:  This is go-time!  We want to increase the internal temperature (“warm-up”), wake up the proper neuromuscular movement patterns that we’ve been training, and prepare the body to be explosive and compete.  This movement progression remains constant throughout the program.

• Post-Game Session:  This is a recovery day.  The muscles break down after the intensity of competition, so we want to increase blood flow to the muscles to aid in recovery and maintain strength.

And each of these sessions are a part of a larger phase.  Here’s how we approach Phase 1:

Phase 1- Pre-Season ≈ 2 Weeks

Goal:

• To prevent injury by progressively preparing the body for competition
• To establish a foundation of strength, flexibility, and speed and agility mechanics to build upon for the rest of the season

Volume:

• Assuming a lighter schedule for this phase and more general prep than game-planning
• 2 Development Days, Pre-Game, Post Game, Game Day
• (Assuming 1 game per week in this phase) 50 mins/week of strength and flexibility development, 40 mins/week of speed and agility development, 30 mins/week of cardiovascular base conditioning*
• Assuming 4 practices/week at about 2 hours per practice, Phase 1 takes up approximately 25% of the week

Below is a completely done-for-you Development Session that you can use right away to train a team.

Phase 1, Week 1, Development Day 1

Beginning of Practice

Athletic Movement Fundamentals- 10 mins
(Stationary, team all together)
(Assuming this is your athletes’ first time performing these movements, we allow 30 seconds in between each movement to explain the next one)

Set 1
Calf Raise Reps- 15 seconds
Rest- 30 seconds

Set 2
Same movements as above with only 15 seconds rest in between

Speed Mechanics- 7.5 mins
(Again assuming this is your athletes’ first time performing these movements, we allow 30 seconds in between each movement to explain the next one)

Hey, I hope this article opened up your eyes a bit.

I will be back again with another article for you.

Later.

CJ

===============================

Thanks a bunch CJ, that was great.

Rick Kaselj, MS

I am back with another exercise and injury interview for you and today it focuses on a knee injury.

The specific knee injury we are going to talk about is osteochondritis.

I am going to talk with Zach Moore who is a strength coach and he is going to talk about how he overcame numerous knee surgeries and osteochondritis.  In the interview he talks about how it was a bit of a journey to find a place that got him doing the right exercises for osteochondritis.

Enjoy!

CLICK HERE to listen to the interview with Zach Moore on Exercise and Osteochondritis.

CLICK HERE to listen to the interview with Zach Moore on Exercise and Osteochondritis.

What Zach Moore Goes through in the Interview on Exercise and Osteochondritis

• Zach talks about his injury, osteochondritis
• What osteochondritis is and how Zach got it
• The variety of surgeries he had to have for osteochondritis
• He did all kinds of rehab after his surgery and for his osteocondritis, but was not happy with the results
• How getting an assessment from Bill Hartman was the key to helping him to finally get on the right rehab track
• The importance of focusing on the hip when it comes to knee injuries
• Exercises to focus in on for osteochondritis
• Key exercises to avoid if you have osteochondritis
• Important exercise techniques for lower body exercises
• The mindset you need to have in order to overcome your injury
• The right kind of research to do for your injuries
• How being a client at IFAST and meeting Mike Robertson and Bill Hartman was the start of his strength coach career
• Tips for those recovering from knee injury and pain
• Who is Zach Moore

A few things you need to know about listening to the interview:

•  To listen to the interview, scroll down to the bottom of this page and click the play button symbol.  If you do not have time to listen to it right now, just click the “download” button and download it to your computer.  Then you can listen to it on your computer when you like.  Plus you can subscribe to the itunes podcast and get all the interviews when they are ready.  Enjoy!
• If you use Chrome as your web browser, at times it can act up when playing the interview.  I would suggest listening to the interview in another web browser (Firefox, Safari, Internet Explorer, etc.)
• Here is a video explaining how to download the interview recording

If you are looking for the knee injury exercises that I use with clients, you can check out Knee Injury Solution by clicking here:

If you liked this interview and are looking for other exercise and injury advice, check out these other articles, videos and interviews:

• Exercise after C-Section with Carmen Bott
• Rapid Recovery from Neck Fusion Surgery with Josh Henkin
• Hip Flexor Injury Exercise Considerations with Dr. Casey Kerrigan

If you have an injury recovery story, I would like to hear it.  Please do contact me – I would love to interview you.

Rick Kaselj, MS

Exercise and Osteochondritis with Zach Moore [ 21:34 ] Play Now | Play in Popup | Download

Another post for you on corrective exercise for performance.

It is post that I lost but I am glad that Nick reminded me about it.

Now, Nick has been on EFI before.

You can take a look at his other posts:

• Corrective Exercise to Improve Your Deadlift – Part 1
• Using Corrective Exercise to Overcome an Injury – Part 2

Here we go with part 3 of Nick’s articles.

8 Things I Learned About Corrective Exercise for Performance

I could probably write a book talking about everything I’ve done with this experience but I think this gives you a pretty good idea of what went down. Here are some main points that you should take home from my experience that can hopefully help you whether you are a lifter or any kind of athlete.

#1 – Don’t be Afraid to Take it Easy Once in Awhile

I knew the importance of this and did deload from time to time, just not as much as I probably should have. Plan deload weeks and take it easy if you are feeling off. It’s OK.

However, you do need to be training hard enough to earn this. Many people don’t train anywhere near hard enough to warrant this.

#2 Find Someone Who Can Analyze You and Find Your Muscle Imbalances that Need to be Taken Care of

Everybody has something and anybody who trains hard is going to have bumps in the road and aches and pains here and there.

If you don’t, then you aren’t training hard, plain and simple.

But find out what could use some work and do something about it. You will thank yourself later and will avoid injury setbacks and probably hit some surprising PR’s.

#3 – Don’t Underestimate the Importance of Soft Tissue Work

Massage therapy, ART, chiropractic, self massage tools and the list can go on. Tissue work can speed healing, address muscle imbalances (when combined with the appropriate exercises and movement) and help keep your body healthier and functioning better like you wouldn’t believe.

It is so important that I actually went to massage therapy school so that I can better help clients.

A couple of things on this, though: make sure you know why you are working something and make sure you know how it affects you muscularly and neurologically.

“Rolling” blindly can do more harm than good. (I should have some work coming out about this in more detail soon)

Also, if you get work done by a professional, make sure that they know their stuff and at least have a decent understanding of what it is that you do.

With an injury to a muscle, other muscles around the area are going to need treatment as well since they will develop trigger points and adhesions as a compensation effect. If it doesn’t seem that you are getting back to 100%, perhaps synergists or antagonists need some release, whether it’s adhesions, trigger points or neurological related stiffness. In my case, my deep rotators, TFL, psoas transversospinalis, erectors, lats and teres major all needed work to truly get things better.

On top of this, the fascia in the area will most likely need to be released in order to restore normal movement. It needs to glide nicely in all directions. If it doesn’t, movement and muscles will not be optimal and healing will not be fully sufficient.

Keep in mind that once you break up scar tissue, it needs to be realigned through proper movement or you’ll be right back to square one. I also want to add that if you don’t have an S tool such as a thera cane or the kind I have, the body back buddy, you should get one. With my S tool, I can hook right into any specific spot along my back that I need to. I was able to get deep into QL and the surrounding musculature to break up lodged adhesions and trigger points. It’s amazing. Lacrosse balls also work wonders when it comes to getting deep into the hip. Without self massage tools, I can’t imagine how hard it would have been to fully heal the injured tissue.

#4 – Address Your Weak Points and Find Someone Who Can Help You Figure Them Out if You Aren’t Sure

I have been a huge fan of Louie Simmons’ work for quite some time and one main point that he always makes is that bringing up weak points is probably the most important thing one can do to raise their big lifts.

You can squat all day but if you have a weak muscle holding you back and you don’t take care of it, you will not progress like you want. I think that for a decent amount of time, I did not focus on what were truly my weak points. External obliques, glute max, glute med and lower traps all were holding me back. Since I was forced to deviate from my usual style of training, I’ve been able to make these all strong points through different methods and exercises. The results: my squat and pull have never felt better and I feel more stable than ever with my presses because of the lower trap and scap work.

#5 – Don’t Try to do Everything on Your Own

There was a period of time after finishing my time at Ifast and leaving La Crosse that I didn’t have anybody knowledgeable around me to keep an eye on my movement.

Once I found some knowledgeable people in Milwaukee (where I’m at now), things suddenly got a lot better. Surprise!

Even the very best lifters on the planet need training partners and coaches to help them get better. Don’t try to be a hero all on your own. It’s impossible to fully analyze yourself. Get some help from somebody knowledgeable and you will go much farther. If you do have an injury, find a new way to train hard and get better.

For me, I set goals on the major single leg lifts with the sled, with my special exercises, with conditioning and even with technique. With most injuries, there will usually be a way to still train hard without aggravating the problem at hand. Set some new and exciting goals and work on your weak areas so that when you are ready to go again, you will be even better.

#6 Do Everything You Can to Educate Yourself on Movement and Anatomy

McGill, Sahrmann, Kendall, Myers, Chaitow, Robertson, Hartman, Cressey, Kaselj and the list goes on; I’m always constantly trying to learn more. I always do so that I can better help clients; with my situation, I wanted to learn everything I could to make myself better and prevent future occurrences. There are a lot of very smart professionals out there putting out priceless information and you can always find something that can help you with your issues. I think a lot of people with injuries and pain tend to rely too much on doctors, specialists, etc. and passive treatments/temporary pain reducers.

Ultimately, you need to take initiative for yourself in order to truly fix issues and get better. If you are a professional in a related field, books and DVDs, etc. from people like those listed above can be great. If you are not, find a professional who can turn you in the right direction.

#7 – Have patience

This is probably one of the biggest issues for me. Injuries take time to heal, imbalances take time to fix and strength takes time to build. Let things heal and take an ample amount of time to make problem areas better and you will ultimately come back stronger than ever. At first, I wanted to go hard again overnight. I had to learn to step back and realize that it was going to be a longer process to get the healing and the training that I needed to come back healthy and stronger with. Be patient, work at things that will help you get stronger and promote healing and you will come back better. You have to invest both mentally and physically in the process.

#8 – Injuries Don’t Always Need to be a Total Setback

They really can be a blessing in disguise and just might help you get over a hump. Hopefully, my experience can give you some kind of information or some kind of push to help you with your own experience and get you on the path to new PR’s and better performances!!

Remember, train hard but also train smart!!

About the Author

Nick Rosencutter is a Certified Strength and Conditioning Specialist and Certified Personal Trainer through the National Strength and Conditioning Association and is also a Nationally Certified and Licensed Massage Therapist. He received his Bachelor’s degree in Exercise and Sports Science with a Fitness emphasis and Strength and Conditioning Concentration from the University of Wisconsin La Crosse, and received his diploma in Massage Therapy from Lakeside School of Massage Therapy in Milwaukee. He has worked with all varieties of clients ranging from fat loss to various levels of athletes and is also a competitive powerlifter. He currently trains clients at Southridge Athletic Club in Milwaukee and offers corrective exercise and movement training at Miller Sports and Wellness Chiropractic in West Allis. You can learn more at his website www.rosencutterultrafitness.com

Rick Kaselj, MS

.

As you know, I just finished up the Injury of the Month focusing on shin splint exercises.

Creating the program was a lot of fun and it is always great to look at what I do, what I have learned working with people with shin splints and compare this with the research.

I wanted to highlight a few very cool things that I learned when it related to exercises for shin splints.

Before I get into the details, let’s start with a definition of shin splints.

What are Shin Splints?

“Medial tibial stress syndrome (MTSS) is an overuse injury or repetitive-stress injury of the shin area. Various stress reactions of the tibia and surrounding musculature occur when the body is unable to heal properly in response to repetitive muscle contractions and tibial strain.” - Galbraith 2009

There was a lot of reference to Medial Tibial Stress Styndome (MTSS) in the research.  Along with MTSS, there were 13 other names that referred to shin splints.  Now that is a little confusing.  It would nice if everyone stuck to one.

Now that we have the definition out of the way, here are a few things that I learned about shin splints when digging in the research.

Orthotics Increases Your Risk of Getting Shin Splints

This was a bit of a shock.

This statement took a little figuring out.

We all know that with medications, they all have side effects. Medication will solve one problem but often times creates another.

It looks like orthotics are the same. The use of orthotics may solve one problem but increase your risk of getting shin splints.

Very interesting.

Let me dig into things a little further.

Athletes that use orthotics have a greater risk of getting shin splints (Hubbard 2009).

Something to keep in mind if you are an athlete or work with athletes.

In military recruits, about 4% of them will get shin splints (Herring 2006).  This is a lot of people that are injured.  The military has spent a lot of money on research, trying to find out what to do for new military recruits that enter basic training.  The recommendation that the research came up with was to use a shock absorbing insole in order to decrease the risk of shin splints.

Remember, if you are a runner, when your running shoes hit about a 250 to 500 miles, the

absorption of the shoes has decreased by 40%.

All of this makes sense looking at the definition, above.

Summary of Shin Splints and Footwear:

• A rigid orthotic increases the stress on the shin area which increases the risk of shin splints.
• The boots that military recruits are given and the  surface they mainly walk on is very firm which leads to increased stress on the shin area, which leads to greater risk of shin splints.
• Lastly, looking at runners, as the mileage increases on their shoes, there is less shock absorption which leads to greater stress on the shin and an increase in shin splints.

No Evidence for Shin Splint Stretching

I was kind of surprised about this, but there was no evidence supporting shin splint stretching or tibialis anterior stretching.

Very interesting.

Plus there was no evidence on the benefit of foam rolling the shins for shin splints.

That being said, I did include them in the Shin Splints Solved program.

I put them in stage 1 of the program as I feel they are good for countering the tension that builds up in tibialis anterior and helps with pain management.

The Best Exercises for Shin Splints are….

This was another surprise for me.

The most common recommendations that people are given for shin splints is to stretch the shin, roll the shin and decrease training but that is not a long term solution.

It makes sense.

If running hurts, doing some stretching is not going to lead to having your shin splints go away and get you back to running again.

The stretching and rolling will help with initial recovery and pain management but will not be the key thing to get you back to running.

If you search the internet for exercises for shin splints, you will see stretching and toe wiggling exercises are the preferred exercise.  (Note – Just because it is the most popular recommendation does not mean it is the right recommendation.)

In a 2008 study by Dr. Debbie Craig, she recommended to “increase the strength and endurance of the soleus muscle.”

This is hard to do with stretching, foam rolling and toe wiggling exercise.

But you can do it with plyometrics.

Recommended Exercises for Shin Splints

• Doing stage 1 exercises that focus on recovery, pain management and introducing plyometric movements.
• Moving onto stage 2 exercises which focus on strengthening the ankle, challenging the hip and performing exercises that prepare the body for plyometrics.
• The last stage (#3) is introducing plyometrics exercises.

There you go.  A new exercise program for shin splints.

References for Exercises for Shin Splints

Here are the references for what I talk about above.  In Shin Splints Solved, I have a full list of the 18 research papers that I referenced in the program plus there are links to the abstracts and a few of the full articles, for those that like to dig in the research (like me).

Craig DI. (2008). Medial tibial stress syndrome: evidence-based prevention. J Athl Train. 2008 May-Jun;43(3):316-8.

Galbraith RM, Lavallee ME. (2009). Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Oct 7;2(3):127-33.

Herring KM. (2006). A plyometric training model used to augment rehabilitation from tibial fasciitis. Curr Sports Med Rep. 2006 May;5(3):147-54. 

Hubbard TJ, Carpenter EM, Cordova ML. (2009). Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc. 2009 Mar;41(3):490-6.

I hope this was a benefit to you as much as it was a benefit to me.

If you are interested in the Shin Splints Solved program you can check it out here.

Just a reminder of what you get with the Shin Splints Solved program

In the Shin Splints Solved Program you will get:

1. A comprehensive video presentation that gives you all you need to know when it comes to shin splints and tells you what you need to do to overcome shin splints.
2. A researched back exercise program with over 29 shin splint exercises with descriptions and photos.
3. Then you will get videos of all of the exercises which will show you how to do the exercise right so you can get maximal benefit from the program.

That is it, have a great day.

Rick Kaselj, MS

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I remember back to my first few years as a trainer….

I had no clue about nutrition.

And this from a guy who ended up playing pro soccer in spite of eating a typical North American diet.

I was “taught” from some very high-up professors and college textbooks that eating lots of grains and tons of protein was essential for an athlete…and anyone who works out regularly, for that matter.

Unfortunately, my total neglect for proper nutrition led to me down the path of developing an auto-immune condition at 17 years old, having less energy than a dead battery, and constantly struggling with eczema breakouts and asthmatic attacks.

Thank god those days are long gone!

But still, MILLIONS of health conscious people, perhaps even your clients, have been led to believe the same nutrition nonsense that had infested my mind.

So why is it so important that you and your clients have a solid handle on the complex relationship between food and human health?

It’s simple…

Diet is 80% of the equation when it comes to losing weight, having more energy, and living a longer healthier life.

Even in rehab settings, better nutrition leads to better quality tissues, which means less soreness and stiffness. Imagine, a foam roller session that actually didn’t make you (or your clients) cry!

Yes, working out and following properly prescribed exercises is critical for strength, rehab, and creating a lean body, but we ALL know that “you cannot out train a bad diet.”

Teaching People How to Fish

I commend individuals like you because you’re committed to not only treating people of what ails them but you’re also in the game of educating them on how to take greater responsibility for their health and body.

And that, my friend, is the true meaning of the word doctor – to be a TEACHER.

Your clients don’t win when you simply tell them to do something. They win in the long run when they are informed and truly understand how to prevent problems from happening in the first place, right?

“Why is my knee hurting?” says the patient.

“I’m not sure yet but take these pills or just do these exercises and you’ll feel better” responds the practitioner.

That’s an all too familiar scenario in the medical and health field that needs to end.

Thankfully, you don’t do that.

And the same thing happens in the world of food and nutrition.

Here are some familiar conversations…

“You want to lose weight? Ok then, you got to try this diet that helped my aunt lose 30 lbs diet. All she ate was brown rice and bananas!”

It’s ridiculousness like this that is keeping our population sicker and fatter than ever before.

You and your clients don’t need another diet. In fact, we need another diet like the US needs another debt crisis!

Your clients need to be informed about how food and their body interact and not just take a leap of faith on the latest fad diet without much understanding of what’s it doing to them.

The TRUTH About Nutrition

There are certain facts that most health care professionals and nutritionists agree on. These must be understood before someone even decides to go on a diet.

You see, once you are aware of these facts (and fundamental concepts), you can make intelligent decisions about any particular diet and the theory upon which it is based.

Although we live in a world of speed and convenience, someone who loses weight quickly will regain it just as fast, if they continue jumping from one diet to the next rather than applying the basic fundamentals to their daily diet.

No diet will ever fix you (or your clients) UNLESS you (they) fix their habits and have a much better understanding of what food is doing to them.

When that happens, you (they) are in control. And that is how life-long health is created.

After all, how many fitness professionals are sick, fat, and out of shape? Maybe a few, but the vast majority of us walk the talk – at least most of the time, right?

And that’s because we KNOW the power of being fit, healthy, and strong. We’ve experienced it firsthand. We understand how the body works. We can literally see beneath the flesh and comprehend the consequences of certain exercises and treatments.

Now, what if you (and your clients) had that same understanding of nutrition? What if most of your frustrating and confusing nutrition questions could be answered? What if you didn’t have to spend hours scouring the web or reading books or magazines or enrolling in expenses CEC courses to master this knowledge?

Wouldn’t that be incredible?

Now, YOU become a trusted resource for your clients with regards to helping them eat healthier. Just another tool in your toolbox to helping them reach their ultimate health goals.

Plus, they can have the knowledge (and thus power) to overlook stupid diet gimmicks and truly understand how to eat for maximum health and vitality.

That’s the dream.

But that can’t happen if we continue down the same path that has led 66% of the North American population to be overweight and sick. The US spends the most money on healthcare but has the 74^th ranked healthcare system in the world.

Obviously, it’s time for a change and that change is coming.

In order to really take your health to the next level, you need to rely on yourself – not someone else. Just like watching someone working out won’t make you strong, nor will following yet another diet get you any healthier.

Instead, what needs to be happen is for you (and your clients) to learn the fundamentals of nutrition. Once you understand how your body and food interact, then you will be able to make healthier and wiser choices.

Unfortunately, most of the information coming at us nowadays is superficial and conflicting at best. It leaves us confused, frustrated, and lost about what to do. Just look at how many people are still asking how much protein they should eat or whether fat is bad for us.

Millions of people are confused and it’s because they DON’T understand the basics.

Super Nutrition Academy is the only online nutrition course that solves this problem. In as little as 1 hour of learning per week, students can finally get the answers to their health and nutrition question in a “no B.S.”, science-backed, and easy to understand format.

No longer will you/they have to surf the web only to end up more confused than before. At last, the most pressing health and nutrition topics can be easily understood and mastered even for those who don’t have any formal education in health.

There is nothing like Super Nutrition Academy and that’s exactly why it was created – to empower the individual to become their own “health master” so they can finally be in control of their health!

Yuri Elkaim is a Registered Holistic Nutritionist, a Certified Kinesiologist, and the Strength & Conditioning Coach for men and women soccer program at the University of Toronto. He’s the best-selling author of Eating for Energy and the creator of the Total Wellness Cleanse.

As a former pro soccer player turned health and fitness leader, Yuri and his cutting-edge nutrition and fitness programs have helped more than 50,000 people around the world live healthier and fitter lives.

The “buzz word” of the day in the fitness industry is “finishers”.  But unfortunately, most people, including fitness professionals, go about them all wrong and they end up doing more harm than good.

What are Workout Finishers or Metabolic Finishers?

First, if you haven’t heard the phrase “workout finisher” or “metabolic finisher”, let me explain.  I like to call them “intervals on caffeine without cardio equipment”, but that’s just me.  By the way, why do I keep putting “quotations” on random “words”?  I have “no” idea.

How to Incorporate “Finishers” into your Clients’ Workouts?

Anyway, Rick asked me to give you some information on how to incorporate finishers with your clients or yourself with your current workout program.  That’s actually part of the beauty of a finisher – you can use them with just about any workout program.

The idea behind a finisher is to complement your efforts of your main program.  It’s like taking your workout and pouring awesome sauce on it.  The awesome sauce will help you burn more calories during your workout, but more importantly, after the workout (what the cool kids call, the “afterburn effect”).  Ha-ha, quotes.

A workout finisher typically takes 10 minutes or less, but the effects of them lasts for hours.  I’ve used metabolic finishers that last literally just one minute.  The variety of them can prevent boredom, plateaus, and most importantly avoid injuries.  I think Rick talks about avoiding and getting through injuries on this blog, but I’m not sure.  << Ha!  Good one, Whitfield.

That’s the key to using finishers with your program – avoiding injuries.  It’s especially important when you are using exercises with the abs.

That “Abs” Buzz Word

Abs – that’s another one of those buzz words.  99% of the time, that is what clients are looking for: to lose belly fat.  My coaching clients know that the simpler approach you can use to gain a goal, the more successful you will be in obtaining it.  But most people try to lose their gut by doing things that have very little return on investment (if any).  Some people even sabotage their efforts by doing these two common things:

• Long, steady state cardio as their main workout
• Crunches, sit-ups and other exercises that can actually strain your lower back and neck

The One-Two Punch for Losing Belly Fat SAFELY

Studies have shown that you can actually increase your appetite when doing long, steady-state cardio.  So, let’s say you burned 250 calories using cardio, but your appetite caused you to eat 350 more calories than usual due to your appetite.  That’s a surplus of 100 calories each day.

In my professional opinion – that’s NOT awesome sauce.

But there’s good news.  Studies have shown that intervals and/or finishers burn even more calories than steady-state cardio, without increasing your appetite.  So, by replacing your steady state cardio with a short ab-focused finisher like the following, you’ve established punch number one against belly fat (in case you didn’t get that – punch number one is using a finisher).

After your main workout, do the following circuit twice, resting for 20 seconds between circuits:

1. Lunge Jumps (6 ea)
2. Decline Push-ups (10)
3. Inverted Rows (8)
4. KB/DB Swings (20)
5. Cross-Body Mountain Climbers (8 ea)

As you can see, there are no crunches or sit-ups.  This is also better because you are spreading the effort between different muscle groups, unlike steady-state cardio or intervals.  If you are performing intervals on a bike, that’s much better than cardio, but your legs are doing all the work, with no effort from the upper body.  With a finisher like above, you’re using different muscle groups and you’re doing it in less time.  This allows you to burn fat with less risk for injury.  By using a strategic combination of conditioning moves and core exercises, along with incomplete recovery, you have set up your body to burn more fat, along with safely strengthening your core.  That brings me to punch number two.

Safe, but Effective Ab Exercises

With my clients (as well as myself), I use a variety of movements that challenge your core safely but effectively.  This includes a variety of planks, jackknifes, renegade rows, etc., etc.  Your abs were meant to work in unison.  By using crunches,  you’re just working the top layer of your abs, as well as possibly putting strain on your back and/or neck.  The risk for reward simply isn’t worth it.

But here is where it can be tricky.  You only have so much time.  If you want to work on your waistline, using the above moves simply won’t be enough.  Sure, your abs will get rock solid, but you will need to burn the layer of fat on top.  It would be like buying a really awesome t-shirt and telling your friends about it, but you wear it inside out.  Hhmmm, not really.  That actually doesn’t make any sense.  And now I’m making this even more awkward by pointing out the oddness of it.  I think I’m just going to start a new paragraph… kinda’ like a clean slate.

Wow, that was rough.  Anyway, you can actually combine the powerful effects of effective core work and a metabolic finisher at the same time.  The key is to use incomplete recovery, effective ab exercises and conditioning moves in a strategic combination to keep the heart rate up and to be able to manage fatigue.  In other words, doing a bunch of box jumps over and over can lead to injury as well as not being the most effective means to burn fat.

I would say the perfect ab finisher is when you feel your core being worked, you love/hate it at the same time, and you feel victorious at the end of your workout, but just before the defeated borderline   The idea is to finish strong, but not zap you so hard, that you find yourself not being able to recover between workouts.

Along with a solid nutrition program and a professionally designed resistance training program, finishers will help you to start seeing a difference in your abs and clothes in no time.  I use finishers all the time to help my clients jump-start their fat loss program or bust them through a weight loss plateau.  They are challenging, but they do work.

But if it was easy, wouldn’t everyone be doing them?  I have 105 reasons I use them with my training programs.

I Have Lost 105 lbs Myself

Finish strong and thanks for having me Rick!
Mike Whitfield, (AKA “Mikey”), CFNC, CTT

Mike has designed 33 Ab Finishers you can use yourself or with your clients right here:

CLICK HERE for Mike’s 33 Ab Finishers

Mike Whitfield, CFNC, CTT (known as “Mikey”) is a certified Turbulence Trainer who resides in Georgia.  After losing 105 lbs, his passion propelled him into the fitness industry.  His unique approach of using metabolic resistance training and metabolic workout finishers has helped thousands of people lose fat through his online and offline programs.  He is known across the fitness industry for his “finishers” and he is the author of the Workout Finishers and Ab Finishers programs. He has been seen on the Turbulence Training blog, Men’s Health Blog, and he has been featured in the AJC.  You can read his humor and fat loss advice at CrankTraining.com .
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Over the last few months, a common question has been appearing in my email box:

What if Exercise is Not Enough for Your Knee Injury?

I have been sitting on my hands, thinking of a reply and it finally hit me:

You Break the Knee Injury Rules

All of this came in a subtle way:

• clients asking what else they can do for their knee injury
• customers that ordered Knee Injury Solution
• registrants from past Exercise Rehabilitation of the Knee courses
• a family member asking for some help

I have purchased your knee injury solution product and many more.

They are great.

I have several clients though (I’m a Personal Trainer) that have knee injuries that are not going to go away.

For instance, the lady who has no meniscus left and damaged cartlidge and tendons throughout her knee but is told she’s too young for a knee replacement.

She wants to continue training, and she does, but she has no or very little stability in both knees and cannot perform any degree of squat or lunge without pain.

We therefore avoid these exercises, but there’s only so many hip bridges and rom deadlifts we can do.

We also do a bit of band work, but must be very careful about which plane we move in. She must sit for most things, even upper body work as some days just a bit of upper body movement is too much for her unstable knees.

Any ideas how I can further approach this?

On good days we can do boxing, battling ropes etc for cardio, cycling is no good-too much pain and definitely no running or even walking is out some days.

I have 3 clients in this same situation all due to being obese for years-all have reduced to healthy weight now and have endured knee operations that haven’t helped.

JB

This is the Knee Injury Solution program that JB was talking about:

Let me go through a few things that she can do.

I can easily just ramble off stuff that I know would help but I wanted to dig in the research and see what it had to say on what she and you can do about knee injuries.

#1 – Losing Some Weight can Eliminate the Need for a Knee Replacement

Let’s start here.

This is a huge statement.

We oftentimes do not want to start here with our clients but it is probably the biggest factor and if this is not dealt with, everything else won’t matter much.

A lot of the research refers to osteoarthritis (OA) of the knee and hip and what can be done to help each with management and recovery of knee injuries.

Let’s look at some research that came out last month from Anandacoomarasamy (WoW, that is a last name.).

It is well documented in the research that weight loss can reduce symptoms in the knee due to OA.

This should be enough to motivate people to lose some weight.

In the pager, researchers wanted to see the effect weight loss had on knee cartilage structure.  They had 111 obese adults in the study,  at a mean age of 51.7 and 32% had clinical knee OA.  They found that a 7% weight loss had a positive effect on the medial femoral compartment, not the lateral compartment.

In the paper, they made this powerful statement :

“Weight loss is associated with improvements in the quality (increased proteoglycan content) and quantity (reduced cartilage thickness losses) of medial articular cartilage.”

They ended with the statement that weight loss could be enough to “reduce need for total joint replacements.”  A very very very powerful statement.

To sum it up, your client might have to search out the best way for them to lose some  weight.  This might mean changing their exercise routine, having you clean out their kitchen, making a lifestyle change or medical weight loss.

This probably should be the first and most important step for one’s knee injury.

Where to get more information - Anandacoomarasamy A, Leibman S, Smith G, Caterson I, Giuffre B, Fransen M, Sambrook PN, March L. (2012). Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012 Jan;71(1):26-32.

#2 – Stop Doing Upright Lunges

I have a feeling this statement is going to make the fitness technique police go crazy and a good chance a number of fitness educators will complain to the association that I am telling people to break the rules when it comes to the lunge.

The biomechanics of it is simple and the research backs it up.

Move from an upright lunge position to a trunk forward lunge position.  

This will decrease the stress on the knee and activate gluteus maximus which will make the exercise easier to do but help work gluteus maximus which most people with knee injuries need to work on.

Not sure what else to say other than try it.

Do a lunge that has been approved by the fitness gods.

Then do a lunge with your trunk forward.

• How does it feel on your knee?
• How do the muscles in your knee feel?
• How does your seat feel when you do it?

Okay, moving on.

Where to get more information - Farrokhi S, Pollard CD, Souza RB, Chen YJ, Reischl S, Powers CM. (2008). Trunk position influences the kinematics, kinetics, and muscle activity of the lead lower extremity during the forward lunge exercise. J Orthop Sports Phys Ther. 2008 Jul;38(7):403-9. Epub 2008 Apr 15.

#3 – Take Some Good Pills

I am not a big pill popping fan.

After being sick this week and feeling how quickly I started feeling better after taking the right pills, my view has started to change.

The evidence is good when it comes to glucosamine sulfate and chondroitin sulfate in order to interfere with the progression of OA in the knee and the hip.

Dose, frequency, brand, form, etc are things to consider.  I might dig in the research another time to see what it says about this.

If you’ve got a knee injury, look into GS and CS.

Before, I move on, pain may not be a good thing to look at when it relates to this stuff working.

Let me explain:

“This trial showed that glucosamine hydrochloride and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with OA of the knee. However, exploratory analyses suggest that the combination of glucosamine hydrochloride and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain.”

Glucosamine sulfate and chondroitin sulfate have small to moderate effect on symptoms (pain being one of them) but may interfere with the progression of osteoarthrits (OA).

Where to get more information - Bruyere O, Reginster JY. (2007). Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging. 2007;24(7):573-80.

#4 – What You Are Eating is Making Your Knee Injury Worse

If we look at weight loss being important for a knee injury and most often times the cause of weight gain is diet.  Plus, if there are specific things we can eat that can help our knee injury, then there has to be specific things that we are eating now that can be making our knee injury worse.

The first person to highlight this to me was Dr. Peter Osbourne.

Above was an interview I did with him at a conference that we were at.  When he told me that, it got me thinking a lot about how what we eat can be slowing down our knee injury recovery.

I will be seeing him again next month so I will work on getting another interview for  you.

Plus Dr. Peter Osbourne has a great article on “Foods that Contain Gluten” which is eye opening.

The Last Word

I hope you enjoyed this article and got as much out of it as I did putting it together.

I think I have focused so much on exercise helping injuries and have not spent enough time looking at other things that will help with injury recovery.  I am always challenging what I am doing, learning new things, testing things out and sharing what has worked.

If you do have any feedback or insight, please do let me know.

Rick Kaselj, MS

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It has been a rough week.

I don’t remember the last time I was as sick as I was this week. It definitely throws you for a loop and gets you thinking. I will write more about it later.

Let me highlight a few of the things that have happened since getting sick on Sunday.

By the way, I am feeling a lot better. Thank you for everyone’s emails.

Still Helping People Overcome Injuries

“The Effective Plantar Fasciitis Exercise program looks AWESOME… exactly what I was looking for.

What exercises to do, how often, how to progress… I like having an action plan and this is going to help me for sure!!

Thanks so much Rick, you’ve given me hope that I might be running (at least part of it!) my Ironman in August instead of walking like I was starting to resign myself to!

BH

Very cool!

It is awesome to help people overcome their injury and get them back to doing what they want even when you are in bed sick.

That is More Than Other Companies

Hi Rick,

Thanks for the reply. That is more than I usually get from most forums, companies. Thank you.

I train for “life” since I currently sit behind a desk all day at work. It beats getting crippled by not moving. haha.

I train my oldest 17 y.o. son and one or two of his team mates for their high school varsity soccer team in the off season. They put on some muscle and got a LOT stronger in the seven months we trained last year. They made it to state, and had a good season. We will be starting to train again in a couple of weeks as I felt it would be good for them to just relax and be kids and do anything besides soccer or training for a month.

Thank you for the gift. I believe I will select the rotator cuff exercises program since I recently injured mine falling through the attic hole and catching myself in a bent elbow iron cross. Beat hitting the concrete floor. My PT has been working on it and it is doing OK. I still can’t do hand stand push ups, but I will get my party trick back with time. Patience.

Which program is it that you think will help my knee pain?

Your programs are good simple basic advice that will help the majority of people with their injuries.

I look forward to your response.

Best,

SR

SR,

I just sent you the rotator cuff program.

Great attitude on the “Training for Life”.

Very cool that you train your son. I hope I get that chance when my kids grow up.

When it comes to the knee program, I like what Bill Parravano talks about. I have an interview with him that I will put up soon.

Plus the article from Anthony Mychal on Cure Chronic Knee Pain has got a lot of good feedback.

Is this Good for Golfer’s Elbow?

Hi Rick,

The release of your new tennis elbow course is just in time for
me. However, my issue, which has come and gone and come again
over nearly four decades of lifting weights, is medial instead
of lateral epicondylitis. Will your new course help with that,
too? I’m hoping so! Otherwise, you need a golfer’s elbow course
now.

Best regards,
MT

I would have to say the Tennis Elbow Pain Solution would not help you with your medial epicondylitis or golfer’s elbow.

In the next few months, I will work on putting together an exercise program for golfer’s elbow.

As you know, this month’s Injury of the Month is shin splints.  The program will be coming out next week.  Then the next injury that I will focus in on will be frozen shoulder.

To Push or to Pull for Patellofemoral Pain Syndrome

Dear Rick Kaselj,

I am 32 years old from Israel (so sorry on my broken English). Anyway I’m
struggling/ suffering from patellofemoral pain syndrome more than 2 years..I tried almost everything although I had better times, so I am trying to get there again with a new rehabilitation program.

My question is about the squats on the study (*The effect of closed-kinetic chain exercises and open-kinetic chain exercise on the muscle activity of vastus medialis oblique and vastus lateralis. J Strength Cond Res. 2010 May;24(5):1256-62.)

On the study they perform a squat with a pillow between knees to work on the hip adduction too, but most of the programs include your Patellofemoral Syndrome Solution suggest to do the squats with band around the knees which mean the opposite ( hip lateral rotators group / obturator)

Can you tell me which one is better for patellofemoral pain syndrome?

Sincerely yours,

Best regards

SN

SN,

Thanks for emailing me.

Very cool that you have dug in the research to see what is best for yourself.

My suggestion would be to do the the tubing around the knees.

If you want more details, have a look at my articles:

• The Best Exercise for Patellofemoral Pain Syndrome
• What is New with Patellofemoral Pain Syndrome (PFPS)
• Can Gait Training Help with Running Mechanics with those with PFPS?
• Runners Knee Exercise Program

About Your Gluteus Medius Exercise Article

Hi Rick,

Wondering if you might like to look back at your superb research post on best glute medius exercises for hip replacements and look to do a video post on each of the selected, effective exercises.

As you know there are lots of ways to execute each of these individual exercises and we also sometimes call different exercises different names.

I think a lot of your readers would find this most useful and helpful in order to make sure that we are giving the correct exercise and that the exercise is done in the manor that the research shows was most effective.

I am still away on sabbatical touring North America and enjoying it immensely…will look forward to touching base with you in the spring when I am near Vancouver or in the summer when I return home, as I would like to purchase a few of your products. All the best to you…out for a dessert hike with the dogs…we are in southern Texas on the Mexico border…very desolate countryside, but beautiful. Thanks for considering my glute medius request.

CN

CN, great to hear from you.

Thanks for taking the time to contact me and give me some feedback.

A few people have mentioned this to me.  I will work on getting this done.

I looked over the gluteus medius exercise post and a few videos would have helped a lot.

(CN, rough life girl.)

Do You Have any Pre-Surgery Stuff?

Rick,

I have seen your website and saw your Spinal Fusion Exercise Program.
I am waiting to be called for spinal fusion surgery.
I have been on a specialist’s list for just over a year now, and I waited 14 months to get in to see him!

I see you have a lot of exercises for post surgery.
Do you have some specific exercises for pre-surgery?

I would appreciate hearing from you

thank you

M

Excellent point, M. At this time, I do not have any specific to pre-surgery.

A lot of what is covered the the post-surgery is what I would give someone for pre-surgery.

I would suggest you take a look at the Spinal Fusion Exercise Program.

The fitter you can have yourself enter the surgery, the faster your recovery will be.  That is one of the reasons why professional athletes have such fast recovery times compared the the regular population.

All the best M.

Rick Kaselj, MS

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Nothing is as scary or as debilitating as a knee injury. Yet everyone—athletes and fitness enthusiasts alike—constantly ignore chronic knee pain. And I was one of them. There came a point when walking up steps was a death sentence. But there was no way I was going to miss my squatting session, even if the pain reached a new high. I just thought it was the nature of the beast—that there was nothing I could do to fix it. So I saw it as a badge of honor. It was more like a badge of stupidity.

Sometime in 2009 I posted a rather gruesome video to YouTube. No, no heads were chopped off. And no, blood wasn’t spewing into the next county. It was just a close up of my knee being flexed and extended while all sorts of nasty clicks, pops, and cracks radiated from my patellar tendon. Although I knew it wasn’t exactly “healthy,” I knew that my knee—for all intents and purposes—was structurally sound. There were no torn ligaments. No mangled menisci. But my patellar tendon was on the fritz, and I had no idea why.

Instead of idly accepting a life of chronic knee pain, I made dramatic lifestyle changes. I didn’t want to struggle getting in and out of cars at the age 21. So, I experimented. About six months into my quest, I knew I had something. And one year later I collected and organized what I found into a grand theory and accompanying routine so that I could test it on others.

KNEE = ELBOW

One thing that sparked my interest—and paved my road of rehabilitation—was understanding that the lower limb shares a lot of similarities with the upper limb. The ankle and wrist are mobile yet fragile. The knee and elbow are facilitators—strong links in a connected chain. And the hip and shoulder are the complex, powerful, and responsible joints that connect the limbs to the body.

After being around the strength and health world for a while, you notice things. At that point I had done a boatload of interning and personal studies, so I was pretty in-tune with industry.

The elbow was (and still is) a hot spot for lifters. Golfer’s elbow became a frequent topic of discussion among general fitness trainees. 99% of the remedies for golfer’s elbow involved ditching the straight bar and moving something that allowed a hammer or neutral grip. This advice holds true to this day.

It took me a while to be able to step back far enough to conceptualize this, but this advice basically says that elbow health is determined by the position of the wrist. There were no super-secret rehab exercises. Just simply avoiding straight bars in an effort to stop putting the elbow in a compromised position.

I paralleled this with my knee rehab, which consisted of bunches of TKE’s, Petersen step ups, leg extensions, hamstring curls, hamstring stretches, and quad stretches—all things that focus directly on the knee.

But if the elbow didn’t need direct rehab, why would the knee? This made sense to me at the time because my knee was getting worse. And now that I’ve helped many people, I notice that TKE’s and like movements don’t work with more severe cases of tendonitis.

THE EQUATION OF LEGEND

In cases of chronic knee pain, from the crudest look, the patellar tendon hates life. It’s your job to find out why, and how to fix it. Most times, the answer isn’t to pound it with more dysfunctional movement. If your knee hurts when you squat, and you keep squatting through the pain, you’re never going to be healthy.

The knee can rotate somewhat and is a rather special joint, but when compared to the hip and shoulder it’s boring. (It’s funny how so much dysfunction can manifest itself in such a simple structure.) So I made a bold prediction, and one I still believe in: most chronic knee pain has nothing to do with the knee itself.

Overall movement of the knee depends on both the hip and ankle. Don’t believe me? Rotate your ankle and stand on the side of your foot (invert your ankle). Try to collapse your knee inward. It’s not going to happen. There are more examples, but the idea is that the knee—and the elbow—are facilitators when used in larger compound movements. They connect the powerhouse of the chain (hips and shoulders) to the distributors and manipulators of the chain (hands and feet).

So I created this mega fancy calculus like complicated equation to explain this Einstein like phenomenon, and it goes something like this:

FOOT + HIP = KNEE

While I’m sure this holds truth in most knee injuries—even the severe ones—this recipe is primarily targeted to chronic issues such as tendonitis, tendonosis (jumper’s knee), and even patellar tracking problems. They are all born from similar dysfunctions.

AN ATHLETE’S GUIDE TO CHRONIC KNEE PAIN

Suffering from tendonitis as a college basketball tryout, my 19 year old self wished there was a guide written specifically for athletes and debilitating chronic knee pain. Fast forward to now, I confidently hold the systematic and structured system I once wished I had.

There’s an abundance of knee information out there, but not much narrowing in on the chronic troubles that athletes face—the stuff that’s not serious enough for surgery, yet still bothersome in life and on the field. And let’s face it: recovery from a torn meniscus is going to be different than recovery from tendonitis. I wanted to focus on those nagging chronic knee issues that athletes face because I was once in their shoes.

Athlete’s Guide to Chronic Knee Pain: Theories and Solutions for Patellar Tendonitis, Jumper’s Knee, and Patellar Tracking begins with a small memoir so that readers can immediately tell whether or not they can benefit from the information. Followed are the theories and solutions for beating chronic knee pain, ending with an eight week rehabilitation program to follow.

It’s only a matter of time before this theory is widely accepted as the research is slowly emerging to support it. There are a lot of studies out there, but here’s a handful:

Chester, R, Smith, TO, Sweeting, J, Dixon, D, Wood, S, & Song, F. (2008). The relative timing of vmo and vl in the aetiology of anterior knee pain: a systematic review and meta-analysis. BMC Musculoskelet Disord., 1(9), 64.

Dolak, KL, Silkman, C, McKeon, J, Hosey, RG, Lattermann, C, & Uhl, TL. (2011). Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther, 41(8), 560-70.

Karst, GM, & Willet, GM. (1995). Onset timing of electromyographic activity in the vastus medialis oblique and vastus lateralis muscles in subjects with and without patellofemoral pain syndrome. Phys Ther, 75(9), 813-23.

M¿lgaard, C, Rathleff, MS, & Simonsen, O. (2011). Patellofemoral pain syndrome and its association with hip, ankle, and foot function in 16- to 18-year-old high school students: a single-blind case-control study. J Am Podiatr Med Assoc, 101(3), 215-22.

Smith, TO, Bowyer, D, Dixon, J, Stephenson, R, Chester, R, & Donell, ST. (2009). Can vastus medialis oblique be preferentially activated? a systematic review of electromyographic studies. Physiother Theory Pract, 25(2), 69-98.

Sheehy, P, Burdett, RG, Irrgang, JJ, & VanSwearingen, J. (1998). An electromyographic study of vastus medialis oblique and vastus lateralis activity while ascending and descending steps. J Orthop Sports Phys Ther, 27(6), 423-9.

Willson, JD, Kernozek, TW, Arndt, RL, Reznichek, DA, & Straker, J. (2011). Gluteal muscle activation during running in females with and without patellofemoral pain syndrome.Clin Biomech (Bristol, Avon), 26(7), 735-40.

So if either you or one of your athletes is suffering from chronic knee pain, check out An Athlete’s Guide to Chronic Knee Pain. Or you can live with the regret of failing to reach your athletic peak, hating life every day, and slouching your way through pain. Just saying.

By Anthony Mychal

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Do you have clients who find it difficult to exercise because they have injuries?

Want to know how to work with them to recover and get them back to optimal performance?

One of the fitness industry’s foremost experts on injuries, Rick Kaselj, MS, is coming to Windsor on 28th April, for a full day workshop worth 4 Can Fit Pro PTS CEC’s!

This will be a hands-on workshop for Personal Trainers. The day will be split into 3 distinct sections, focusing on exercise rehabilitation for the shoulder, lower back and knee.

Trainers will walk away with an understanding of the following:

• Functional anatomy of the musculature and supporting structures of the shoulder, lower back and knees
• Evaluation of the shoulder joint, lower back and knee
• Common injuries for each region, key points of each injury and how to rehabilitate them
• Rehabilitative exercises using the stability ball, body weight, tubing and free weights

An understanding of these areas will allow trainers to benefit by:

• Helping their clients recover from injuries quicker
• Allowing Trainers to work closely with other injuries experts and get the client back to optimal performance as soon as possible
• Expanding their knowledge base to gain a better understanding of common injuries
• Marketing themselves as a Post Rehab Injuries Specialist
• Gaining an understanding of when clients should be referred to other therapists that work outside of a Personal Trainers scope of practice.

Date:  Saturday 28th April 2012 (9am-6pm)

Location:

CECs:  4 Can Fit Pro PTS CEC’s

Cost:

• Before 29th February – Early Bird Rate of $299 (&HST)
• After March 1, the price is $349 (&HST).

It is possible to pay for this in two instalments.

There will be no refunds after 15th March.

To Register:

To register, or ask any questions, please call Refine Fitness Studio on 519-253-9400. We look forward to working with you soon.

Rick Kaselj, MS

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As you know, last month’s Injury of the Month was tennis elbow.

It has been a few weeks and I am starting to get feedback on the program.  One person has been having issues with their tennis elbow pain and the program has made it worse.  She has asked me if I could help.  We have been emailing back and forth.  Here are some clips from our email conversation.

“I think my pain has increased a bit so I’m cutting back in intensity but I’m hoping that if I keep at it, it will eventually go away. Bursitis in my shoulder really flared up after starting the program. Not sure if it is related but that is the only thing different that I was doing.”

This brings up a number of points to remember about injuries.  They apply to tennis elbow but to all injuries when you are using exercise to help them recover.

4 Key Things to Remember when Exercising for an Injury

• Intensity – How aggressively you do the exercises has an effect on your injury recovery.  I always suggest to be conservative when staring an exercise program for an injury.  Go easy and light.  See how things feel after the exercises, a few hours after the exercises and the next day.  You should feel like you have done something but your symptoms should not increase.
• Resistance – Once again, the resistance you use will determine the stress put on the injured area.  We want to stress the injury but not irritate it.  It is a fine balance.  Once again, start off light and see how it feels.
• Cumulative Stress – If you are doing exercises for an injured area, you are adding more stress to that area.  If you do not decrease or eliminate other things you are doing that add stress to the injury, this will lead to more irritation and pain.  Make sure to look at things that are putting stress on your injured area and decrease or eliminate them.
• Pain Techniques – Do the pain techniques in the evening.  Doing the ice, stretching and self massage are most effective before you go to bed or a few hours before you go to bed.  It relaxes the tissues and then the tissues get a chance to heal while you are sleeping.
• Nutrition – Staying hydrated, properly fueled and focusing on inflammation lowering food is important as well.  This will help you in your injury recovery.

Now let’s get to the shoulder bursitis.

I am not sure what the cause is of the shoulder bursitis (inflammation of the bursa in the shoulder).  I would focus on shoulder position, rotator cuff exercises and scapular stabilization exercises.

When it come to tennis elbow pain exercises leading to shoulder pain, I cover this in the video presentation of Tennis Elbow Pain Solution but also Stasinopoulos 2011 says it well:

“If the affected arm is not supported, our experience has
shown that patients complain of pain in other anatomical
areas distant from elbow joint, such as the shoulder, neck,
and scapula.”

I would suggest you do the tennis elbow pain exercises with your arms supported.  You can look at the exercise descriptions and videos for Exercises 9b and 10b in the program.

“Regarding my bursitis – I took a break this past weekend from exercise and the tennis elbow program and it seemed to be less painful.

I am doing mostly stage 2 exercises but am sticking with a modification of scapular exercises #6.”

It has only been a week or two since you have got the program. You might not be ready for stage 2 exercises.

If you are getting elbow pain from the exercises, look in the exercise descriptions and I give you ideas of what you can do if you get pain from the exercises.  Here are a few things to remember:

• Conditioning – If you are getting elbow pain from doing the exercises, do exercise #3 for two to three weeks.  This will help work on the conditioning of your elbow muscles.  By being in stage 2 so early, you are getting pain because of the points that I covered at the top of this article.
• Posture – Look at your posture when you are doing the exercise. Make sure it is ideal which is ear-shoulder-hip in a straight line.  Being out of alignment puts greater stress on the shoulder.
• Technique – If an exercise is irritating, go back and make sure you are doing the exercise correctly.  Look at the exercise description and watch the video of the exercise.

“My left elbow and left shoulder are super tight. When I do the tennis elbow program my arm feels worse. Should I work on my shoulder first? Should I stop? Would be happy to have your feedback!”

Follow what I wrote above.

What caused what:  What I have seen in many people is a shoulder injury leads to your tennis elbow pain.

I know you have the Shoulder Pain Solved program of mine.  Make sure to the pain techniques that I talk about in that program for your shoulder but remember the key points that I talked about above.  They are very applicable to all injuries.

“Does my tennis elbow cause my shoulder pain or does my shoulder pain cause my tennis elbow? Is it possible to work on both at the same time or should I focus on one first and then the other? If so, which should I focus on first? Which program would be most helpful – tennis elbow, shoulder, scapula?”

From my experience, one injury often times leads to others.

I feel you can do both but follow what I said above in the article.

If what I said above does not help, go get your diagnosis confirmed by a qualified health professional and have them rule out that there is something else going on.  Then take the programs to someone that can help you with the program.  You can go to a fitness professional that focuses on injuries or another health professional.  The key thing is that they will spend the time with you to go through the exercises.

Remember the points that I said above.

These would be your priorities:

• Work on your scapular stabilizing exercises as this will provide stability for your shoulder and decrease the stress on your elbow.
• Work on improving your posture as this will decrease the stress on your shoulder and elbow.
• Work on the pain techniques in order to relax the muscles around the shoulder and elbows.
• Work on strengthening the shoulder and elbow as per the Shoulder Pain Solved and Tennis Elbow Pain Solution program.

Thank you for your question Chris, all the best.

Rick Kaselj, MS

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Today, I have some info on workout finishers.  Something new that trainers have been chatting about.

I went to the person that has started the workout finisher craze, Mike Whitfield.

How Workout Finishers Can Help Fitness Professionals Get Better Results with Their Clients

Rick: Let people know a little more about yourself

Mike: I am Mike Whitfield, a Certified Turbulence Trainer in Acworth, GA.  I specialize in fat loss using Turbulence Training style workouts and metabolic workout finishers.  The whole reason I got into fitness is because I have lost over 100 lbs, which helps me connect with my clients.  It also allows me to love what I do, because I can certainly share in the clients’ success.

Rick: What is a workout finisher and why is it important?

Mike: I have been experimenting with workout finishers for almost 3 years.  They are basically a way to replace interval training.  They are short, intense “mini-workouts” that can be done at the end of any workout program.  I found that my clients and campers enjoy them more than interval training.  They typically use all major muscle groups, which burns more calories.  We all know how interval training can help with fat loss.  I just wanted to take interval training to the next level.  They can be more “fun” than intervals, which helps you stay consistent.  I’m a big believer in consistency for fat loss.  One of my favorite finishers is the “Upper/Lower Countdown“:

Do the following superset resting only when needed.  In the first superset, you will perform 10 reps of each exercise.  In the next superset, you will perform 9 reps.  Continue in this fashion until you complete 1 rep of each exercise.

• 1A) Lunge Jumps (starting with 10 reps on each side)
• 1B) Push-ups (starting with 10 reps)

Good times.

Rick: Let’s go bac to when you were 100 lbs heavier. When you were that big, how did you start exercises?

Mike: I remember starting out, I was pretty conservative because I was nervous. I was also really out of shape.

I remember walking around the track at my old high school for one lap and being exhausted. But that’s why I started. I was sick of feeling that sluggish.

As for a finisher – I certainly wouldn’t do one like the one above. I would have substituted the lunge jumps for total body extensions, where you basically partially squat down, bring your arms behind you, then stand up and extend your arms over your head.

I also would probably start at 6 instead of 10.

For beginners, a kneeling or incline pushup could be used instead of normal pushups.

Finishers really came into play when I lost the last 30 lbs. We all know the pain of a plateau. I have found that finishers can fix that, helping me lose the 105 lbs all together.

BREAK TIME – I met Mike in Las Vegas at a fitness conference.  Here we are after one of the sessions:

Rick: Where did the idea of Workout Finishers come from?

Mike: It’s funny because I was actually “under pressure” to come up with finishers.

My clients were getting results from interval training, but one of two things were happening was:

1. The cardio equipment would be taken up and they couldn’t get to them for the interval training
2. They were looking for something to replace interval training because they wanted something different

That’s when I would put together a “mini-workout” to replace the intervals. I purposely put in a mix of exercises with short rest periods to mimic intervals. But the results were my clients getting leaner faster, and they would stick to doing finishers better then intervals. Then it hit me. Why not better results? We’re using more muscle, burning more calories. That’s when I started to implement finishers on a regular basis.

This is Mike and his son, Champ (Yes, Champ).

Rick: Do you need any equipment to do workout finishers?

Mike: Some finishers use simple things like dumbbells and stability balls, but many of them just use bodyweight.

Rick: How would you add Workout Finishers into a bootcamp?

Mike: I love incorporating workout finishers into my fitness camps.

But with my camps, I have a variety of fitness levels to work with.  So instead of using a specific rep scheme, I would use timed sets using a stopwatch or a gymboss.  I also like to offer substitution exercises.

For example, I would have some people perform Spiderman Push-ups for 30 seconds, while some are performing Kneeling Push-ups for the same amount of time.  That way, people of all fitness levels get the benefits from finishers.

Rick: How would you add a Workout Finisher to a personal training session?

Mike: Once they are done with their main workout, I’ll take my clients through a finisher based on their goals and fitness level.

If they are at the gym without me, they have one written down to follow – trust me (ha-ha).  It’s a staple in my clients’ programs and they expect it.  That’s why I wrote an easier version of each finisher in the program because I know everyone has different fitness levels.

Here is an example of Mike in action doing a Workout Finisher with John Rominello:

Rick: Can someone just do Workout Finishers if they do not have time to do a bootcamp class or a full workout?

Mike: Any exercise is better than no exercise.  If you’re really tight on time, you can look at this program or finishers as a fast workout.  But it’s certainly designed to complement a main workout and not replace one.

Rick: How can a Workout Finisher help you prevent injuries?

Mike: The way I look at it is this – let’s say you have someone that chooses treadmill intervals after their workouts.  All those repeated reps are done with the legs, which can lead to over-use injury.  But what if we did some bodyweight movements, including upper body moves like push-ups and inverted rows instead?  You use more muscle groups, burn more calories and take some work load away from the legs.

Rick: Where can people get more information about yourself?

Mike: They can get more info about workout finishers at www.workoutfinishers.com and my fat loss blog is at www.cranktraining.com

Thanks a lot Mike for the Q&A.

Rick Kaselj, MS

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