The benefits of interval training

We have all heard of interval training before.  There is a plethora of combinations and permutations to set up interval workouts with, and each has its advantage depending on what you are training for. That being said, they all involve the same basic concept: run really hard, recover, repeat.

If you’ve heard of interval training, you also have probably heard that it is a good use of your
training time.  The downside is that it is a little more painful than a normal run.  Because of the added discomfort, runners will often avoid interval training, or not push themselves to a high-end pace during the workout.  If your goal is to see results, this is a mistake.  Interval training is not only a good use of your time, but it is the best use of your time.

Just how good are intervals?

Take for instance this 2011 study.  In the study, subjects were divided into 2 groups that did 6 weeks of training.

CLICK HERE to read the rest on the WRS blog.

Improve runners' knee by decreasing variability of motion

Last weekend I went to a "Run Faster" conference put on by the Royal College of Chiropractic Sports Science.  Topics ranging from running technique and coaching to nutrition and injury management were discussed.

One presentation that was exceptionally interesting to me was put on by Dr. Reed Ferber from the University of Calgary.  He also has a website that is an amazing, evidence-based, resource for any runner- click here to check it out.

Patella femoral pain (PFP)

While Ferber researches an array of topics, one focus of his talk involved a new look at how to not only manage PFP, but how to THINK about PFP.

As many of you know, PFP is a condition that involves pain at the front of the knee, directly under the knee cap.  It typically kicks in early into runs, and progressively gets worse as we keep running.  It also often hurts to keep the knee in sustained flexion (i.e. sitting for long periods of time), and can be quite stiff when it comes time to straighten the knee out again.

The cause of this pain is thought to be an irritation to the soft tissues underneath the knee cap as we move.  If things are moving smoothly, the tissues don't become irritated, and pain does not occur.  However, if things are not moving well, then friction, tears, inflammation and irritation to those tissues can occur, and pain follows.

Why does this irritation occur?  It is suspected that, in many cases, this is happening because of a knee position known as genu valgum, or being knock kneed (see right).

If you imagine the knee cap normally sitting within two grooves when the knee is straight, it only make sense that genu valgum would cause issues.  Rather then the knee cap being centered every time we take a step, having genu valgum will cause the knee cap to be forced up against one side of those grooves, resulting in a pinching of the tissues underneath with every step.

So why does genu valgum happen?  There are a few causes.  Sometimes it is due to the shape of our bony anatomy, other times it may be due to a muscular deficiency.  One common area that therapists link PFP to is weakness of one of the main pelvic stabilizers: glut med (see right).

Glut med's job is hip abduction if you are lying on your side, but it functions to keep your hips from dropping as you run or walk.  Somebody with good glut med strength will be able to maintain level hips, while somebody who has a weaker glut med will tend to sway and drop their hips as they run.


For instance, look at the picture on the right.  Picture (a) shows a runner with good glut med strength and good pelvic stability.  Then, picture (b) shows somebody with weak glut med strength, which as a result, is causing the hip to swing out to the side.  You can see that as the hip swings out to the side, this is going to put a force on the knee that encourages genu valgum.

So, our injury sequence: weak glut med...hip drop...genu valgum...then PFP.

Correct the genu valgum, correct the PFP, RIGHT?  Maybe not...


Ferber's new look on PFP

In one of Ferber's studies, he took a group of runners with PFP to test the above.  He had them do exercises to strengthen their hip abduction (glut med) for 15 minutes/day.  The exercise was simple: attach a resistance band to your ankle, and move your leg to the side for 10 reps, 3 sets, daily, for 3 weeks.

Here are the results:

The great news:

• Pain (red bar) went down by over 40% 
• Strength of hip addiction (blue bar) went up almost 40%

The "bad" news:

• Knee position/ peak knee angle (black bar) didn't really change AT ALL.

So these athletes had PFP, they had weak hip abduction, they corrected that weakness, their pain got better...but their knee position did not change.  This is where it gets interesting.  

Ferber's study also looked at another component of motion: variability.  In other words, when we take a step, our legs move around in subtle ranges of motion (i.e side to side, rotation) that we don't really realize.  So if a runner is settling into a genu valgum position at foot strike, there is a number of different ways the knee can get there.  

Ferber thinks is that if that variability in motion is reduced, this is what MAY explain the change in PFP they saw without changing the knee position/ peak angle.  This is what they found:

Each line on this graph represents a foot strike.  So as you can see, on the pre-rehab graph on the left, the lines are random, and going all over the place.  By comparison, the post-rehab lines are very consistent.  YES, the subjects' peak knee angles are the same, but the movement to get there is no longer variable and unpredictable.  The researchers believe that this drop in variability is what gives tissues the type of load during running they need to heal.

Practical Applications

The practical applications, in mind, are quite significant.  There are three major reasons I say this.

• If you suffer from an anatomical genu valgum that just does not seem to be reversible, this research shows it just might not matter.  If you have genu valgum, and PFP, correcting your genu valgum does not necessarily need to be your focus.  If you work on pelvic stability in general, and your variability of motion goes down, it is quite possible to get ride of the pain without changing the angle of your knee.
• This research does not change what therapists should prescribe from a rehab standpoint.  Even if you think you are correcting genu valgum, hip abduction strength work would be prescribed.  So it's the same intervention, just expectations and outcome measures must be changed.  Decreased pain, hip abduction strength and variability of motion (if you have the fancy equipment), must be valued over knee position since knee position seems like it CAN be independent of those who suffer from PFP.    
• Finally, it also puts into question the specificity of exercise prescription.  If you are not correcting genu valgum with hip abduction strength worth, then why is it better than something else?  Couldn't other exercises and interventions decrease variability of motion just as much?  Well, that is something the Ferber lab is looking into (and already has with looking at quad exercises which achieved similar results).  More to come on this!

That's it for now, thanks for reading, and thanks to Dr. Ferber for presenting such interesting work.  

Conquering exercise associated muscle cramping

Good news readers: I have recently started writing for the Waterloo Running Series blog with a regular column: The Science of Training and Performance.  The column will look at what the latest research is showing you can do to make yourself a better athlete.  There is a lot of misinformation out there, and hopefully this will act as a good, evidence based, honest information source.  If you have any requests for the column, do not hesitate to contact me:

seandelanghe@gmail.com

@DrSeanDelanghe

CONQUERING EXERCISE ASSOCIATED MUSCLE CRAMPING

Well my running friends, the fall racing season has come and gone. Congratulations on your season of hard work and dedication! Now it is time to recover, start planning the 2014 schedule, and initiate some good-old base training.

If you did not reach your target time in 2013, one of the reasons may have been related to a strong muscle spasm that just would not let up; something we like to call ‘exercise associated muscle cramping’ (EAMC). EAMC is a frustrating and ridiculously painful experience. They are frustrating because often athletes feel as though they got cheated out of a good result. These spasms can happen without being at the limit of your cardiovascular fitness- the energy and desire to compete can be there but the legs just won’t respond. Why does this happen?

The Cause

So what causes these spasms, and how do we get rid of them? Often it is assumed that it is a result of an electrolyte/hydration issue. Is this true?

CLICK HERE to read the rest on the Waterloo Running Series blog.

Naturally enhancing sleep

When we were kids, our biggest enemy was sleep.  I, for one, saw afternoon naps as a complete waste of time, and bedtime was typically too early by 3-4 hours.

We should have enjoyed it while it lasted...

Now, sleep seems to be the one thing we can't get enough of.  Often we're limited by time, but the most frustrating thing is when we lose sleep simply because of a complete inability to fall asleep.

Recently, I wrote an article for Canadian Running looking at the impact of sleep deprivation on weight gain.  While writing this article, I came across a number of studies on what you can do from a nutritional/natural standpoint to help you to fully take advantage of whatever amount of time you have to sleep.  Here are some of the best-researched, natural ways you can enhance your shut-eye:

Tryptophan

Tryptophan is an amino acid (a building block of proteins) we all know the effects of (aka the post-thanksgiving dinner nap).  Exploiting tryptophan's sleep inducing influences was one of the strategies Jerry Seinfeld used when trying to play with a friend's classic toy collection- and all he did was feed her excessive amounts of turkey!

The reason why tryptophan helps improve sleep onset latency (makes us fall asleep faster) is because it is a precursor to the hormone melatonin.  As many of you know, an increase in melatonin is what causes us to fall asleep.

Take a look at the above diagram.  Ignore everything on the left.  The oval labeled "Pinealocyte," represents a cell in our pineal gland- a part of our brain where melatonin is produced.  As you can see, tryptophan (at the top of the oval) comes in from the blood stream, goes through a few steps, and produces the melatonin we need to fall asleep.

An interesting side note- this diagram also explains the importance of sleeping in a dark environment.  Without getting into to the details, light that reaches our retina actually signals a stop in production of melatonin.  By contrast, a dark environment will allow tryptophan to be converted to melatonin.  So if you're sitting in bed reading this on your computer, and you can't fall asleep- it makes sense because the light emitted from the monitor is inhibiting melatonin production.

Back to tryptophan: we know from experience that this amino acid makes us feel tired- but does it actually work as a treatment?  Well, in short, the research says yes.  This 2010 review study showed that even taking as little as 1g of the amino acid can enhance sleep latency, making it easier for us to fall asleep.  As always, it's better to get this from dietary sources.  Try turkey, or, perfect for this time of year, pumpkin seeds 1 hour before bed.

Melatonin

So if tryptophan, a precursor to melatonin, improves sleep latency, then why not just take melatonin itself?  Researchers think that melatonin works, but not that well (and not conclusively).  This nice 2012 review of insomnia discusses how more research is needed.  They reference a 2005 study which showed that melatonin allowed for subjects to fall asleep 7.2 minutes sooner- so it should do something to help you sleep, just not that much!

If you don't want to supplement, try cherry juice.  A few studies, like this one, have shown that it helps to raise melatonin levels, and improve sleep.

Valerian Root Extract

Another common supplement that is often suggested for aiding with sleep is valerian root extract.  It is not fully understood why valerian helps, but it is thought to be involved with impacting the part of our nervous system that helps us to calm down- the GABA neurotransmitter receptor system.  Long story short, when GABA binds to its receptor, it has an inhibitory effect, and our excited nervous system calms down.  It is thought that something in valerian root helps to enhance the inhibitory effect of GABA.

So does it work?  There is some good research out there showing that valerian does help us to improve how much time you spend in the deepest phase of sleep.  This is a little different than melatonin and tryptophan because they help us to actually fall asleep in the first place, while valerian simply improves the quality of sleep.  Once again, more research is needed to know exactly how well valerian works, and what type of dose is optimal.  

Dietary Manipulation

This topic is a little tricky because they way dietary interventions are studied is not always easily applied (or practical when considering other factors like weight loss).  For instance, researchers know that consuming carbohydrates 1 hour before bed will improve sleep onset latency.  Good for falling asleep, bad for weight loss.

Researchers also know that a regular diet that is high in protein will result in subjects spending more time in the deepest, most restorative phase of sleep.  

What should I do?

So there you have it- a few ideas to help you take advantage of the time in your schedule allotted to sleep.  It is important to keep in mind that these are only some of the many natural ideas that can help.  It does not even begin to address the importance of good sleep habits that should be mastered first (i.e. sleeping in dark, quite environments and sticking to a regular schedule).  But if you are running out of ideas, and you want to try some natural, nutritional strategies, use this as a guideline:

I am having a hard time falling asleep

• Try tryptophan (starting with dietary sources like turkey and pumpkin seeds)
• Try melatonin
• Try consuming a healthy carbohydrate snack 1 hour before bed

I am having trouble staying asleep, or feeling restored

• Is your diet low in protein?  Try increasing the percentage of your caloric intake that comes from lean protein sources (chicken breast, fish)
• Try valerian root extract

*I also should mention that everybody has unique needs, and risk factors.  Make sure to talk to a professional before trying any of these interventions!

Well, that was a longer article than normal.  If the tryptophan didn't put you to sleep, maybe the article did.  Happy napping!

Gastrointestinal upset when we excercise

There really is no debate- in order to perform at your best during endurance exercise, you need to fuel properly.  For events lasting 45 minutes or more, that means taking in some carbs throughout the event (usually 30-60g/hour).

While most people know this, in practice it's not always possible to take in enough sugar because of GI upset.  Do not fret- hope is not lost!  There are measures that can be taken to try to decrease the odds of experiencing stomach problems.

Causes:

First, it is important to understand that not all causes of GI upset are related to dietary issues.  Some common reasons athletes have issues that are NOT related to diet include: decreased blood flow to the organs (aka splanchnic hypoperfusion), a decreased ability of our intestines to move food through our system, and even pure mechanical damage to the intestines.  For instance, the jarring and pounding motion of running can directly cause damage to the epithelium that lines our intestines.  

Nutrition:

The above causes of GI upset are a little harder to manipulate, but nutrition is definitely something that can be changed and influenced to decrease the odds of GI upset.

There is no doubt that some athletes respond better than others to eating while exercising   That being said, researchers know that EVERYBODY has the ability to adapt and improve.  The key concept in reducing GI upset is this:

Reduce the amount of time whatever you are taking in stays in the intestines.  

The longer the food we ingest stays in our intestines, the more likely water will travel into our intestines.  As these guys discuss, if we can absorb our food quickly, the probability of GI upset goes down.  So how do we do that?

Rule #1: Avoid foods that do not absorb quickly.

Fats, proteins and fibres are important components to a complete and healthy diet.  But, there is just no reason to be ingesting them during competition.  They are difficult to absorb and digest (or in the case of fibre, not digestible at all).  This results in increased time spent in the intestines, which accelerates water loss, and predisposes us to GI problems.  More importantly, they provide no additional benefit to performance over simple carbs- it's just a more challenging way to fuel your activity.  So get rid of the gels, powerbars and everything else with protein and fat- it's not helping (I seriously hope there isn't a gel out there with fibre).

In addition to fats, protein and fibre, it is also crucial to avoid the wrong types carbohydrates.  While complex carbohydrates (i.e. the type of carbs found in our multi-grain bread, pastas etc) are good for daily use, they are harder to absorb.  Even fructose, the sugar found in fruit, is a different shape then glucose, and is more difficult to absorb.  While you race, this is the one time in your life where simple glucose is best.  There is some research pointing to the combination of fructose and glucose being an effective strategy, but when in doubt, stick to glucose.

Rule #2: Practice 

It seems like common sense, but not everybody does it.  If you plan on racing while ingesting carbohydrates, then you better practice.  Studies show that the more you train with carbohydrates, the more efficiently your body will adapt to utilizing them.  

For instance, this 2010 study looked at 16 cyclists and how they adapted to two nutritional regimes; a low carb and high carb protocol.  After getting used to their nutritional plan, the athletes were put through a 100 minute steady ride.  The researchers found that the high-carb fueled athletes showed an increase from 54.6g of glucose use during the earlier trials, to up to 63.6g by the end.  By contrast, the low-carb fueled group showed no increase in glucose use when comparing their initial and final 100 minute ride.  What this indicates is that with practice, your ability to utilize carbs during exercise improves, and thus the risk of GI upset should decrease along with it.

Rule #3: Stop taking NSAIDs

It's something that most athletes know- NSAIDs (non-steroidal anti-inflammatories) such as Ibuprofen, significantly increase the odds of GI upset and intestinal bleeding, as this study shows.

Heck, Ibuprofen can even cause more serious consequences, like it did for this UK gentleman.  The man died, in part because of the NSAIDs he was taking.

The death part is unlikely, but the GI upset is common.  The answer is simple: don't use NSAIDs, especially during your race.

Rule #4: Stay hydrated

This is an obvious one- but at the same time you don't want to consume too much.  How much are you supposed to drink?  I wrote about that HERE.

So what to do?

Some are lucky and don't suffer GI issues, while others constantly struggle with it.  That being said, we all can improve, and here's how:

• Avoid fats, proteins and fibres during
• Avoid complex carbs during
• Practice with your simple carbs DURING
• Stay away form NSAIDs
• Drink enough water

Follow these tips, and you will be thinking: "Gee, I think my GI issues have never felt better."

Is it good to train in the heat?

So, I guess it's hot out.  And as a result, training has been tough.  In addition, my AC isn't working, so I'm a little extra discombobulated.  I've heard that there is a strong correlation between high temperatures and violent crimes; is this true?  If not, it should be!

But one positive thing may come out of all of this agony: the heat may be making me faster.

It's a question that I've thought about many times.  Training in the heat should help one perform better in the heat.  Even from a mental standpoint, getting used to having the sun beating down on you while you push your limits intuitively seems important.

However, does training in the heat help overall performance?  I have (wrongfully) assumed it was better to train in more comfortable temperatures to allow for a higher level of exertion without having to worry about hydration, overheating, or the sheer mental strain.

However, there is some research out there showing that it may actually be a good idea to train in the heat- even if you are planning on competing in the cold.

Study #1

Take, for instance, this 2010 study.  In the study, a group of cyclists underwent a 10-day heat acclimation process.  Basically, they rode pretty easy (50% of their max) in a hot environment (40 degrees C).

Their change in V02max (maximum ability to consume oxygen), time trial results, cardiac output (how much blood the heart can pump per unit of time), and lactate threshold (the effort level when you start producing lactic acid) were measured.

To no surprise, they athletes showed an improvement in all parameters when re-tested in a hot environment.

However, when re-tested in a cool environment, the athletes amazingly showed significant improvements in all categories: V02max (5% improvement), time trial results (6% improvement), cardiac output (9.1% improvement+/- 3.4%), and lactate threshold (5% improvement).

So, simply put, these athletes had more efficient circulatory systems, and went faster because they rode in the heat.  The best part is they didn't even have to push hard in the heat- all they did was follow a protocol that kept them at 50% of their max effort.

Study #2

It's not as though the above research is the only body of evidence showing this type of positive change.  Take for instance, this study.  Long story short, the subjects consisted of 8 high-end rowers.  They were given no fluids and did a series of rowing activities over the course of 5 days in a hot environment (once again, going pretty easy).  This was then followed by a 2K time trial.

By the 5th day, the rowers showed a 4s improvement in their TT.  Interestingly, they ended up losing more weight in that last day's effort (3%) then their first day of testing (2.1%).  However, the fluid content of the blood (plasma) actually increased form day to day.

Once again, by going easy in the heat and allowing for some dehydration, the athletes saw an acute improvement in performance.

Why does it work?

So why is there this spike in performance?  Researchers believe the answer comes down to that increase in plasma volume shown in the second study. This review article does a great job of summarizing the topic.

An increase in plasma in our blood is not related with an increase in red blood cells, so why does the oxygen transporting capacity, and more importantly our performance, improve with a plasma increase?

When we become dehydrated, our bodies quickly learn to adapt to the stress they are being put through.  As a result, we retrain excess fluid in our blood (more than we otherwise would), a state which is logically named hypervolemia.

The authors explain, "Hypervolaemia serves to minimize cardiovascular stress by preventing significant reductions in mean arterial pressure, central venous pressure, and cardiac filling, thereby maintaining or improving stroke volume."

In short, the added fluid volume in our blood vessels helps us to pump more blood through our circulatory system.  It also helps to maintain a healthy blood pressure as we hammer away.

Practical Application 

The bottom line of this research is consistent with what is common sense for most of us- we train hard and beat ourselves down as much as we can (provided we can recover and avoid injury), and our bodies will adapt and perform better as a result.  However, just like mileage and intensity, there are limits to training in the heat (which you can very easily figure out, as I wrote about here).

It's hard to train in the heat,  there's no doubting that.  That being said, this research shows you really should not avoid it.  Just like the exertion of a tough interval session, this added discomfort of suffering through a sweltering workout will pay dividends whether you are racing in the heat or on a cooler day.

Intro to scoliosis

For my June article in the New Hamburg Independent, I wrote about the often misunderstood condition known as scoliosis.  As per usual with these articles, it is more of an introduction into the topic.  If you have additional questions, do not hesitate to contact me!

The truth about treating scoliosis

Scoliosis is a medical condition where the spine curves from side to side rather than sticking to its normal, centralized position.   It impacts about 1.5-3% of our population, so is a relatively common condition.  Despite how common the condition is, there still seems to be an abundance of confusion and miss information on what causes it, and more importantly, how to manage it.

So what exactly does make a spine to curve from side to side?  There are three major reasons; (1) it’s congenital (you were born with it), (2) it is secondary to other diseases or conditions (such as cerebral palsy or trauma), or (3) idiopathic (in other words, we do not know).  Surprisingly, the majority of cases are idiopathic.  More often than not, the curves develop for no apparent reason.

 It is important to note that all three of these examples are different from the tilt we sometimes get in response to an acute back injury.  In these instances, muscles can be asymmetrically tight, nerves may be pinched, or the soft discs that separate our vertebrae may be damaged.  These types of injuries may result in discomfort when trying to stand upright, and therefore we tend to lean to the side that feels the best.  This is not a sign of a true scoliosis, and as soon as the cause for that back pain is fixed, the lateral bending in the spine will disappear.  

The best way to diagnose scoliosis is with a detailed physical exam, history and radiographs to measure the extent of the curvature.  The type and extent of the curvature will have a strong impact on how the condition is treated.

When deciding how to treat the condition, it is important to note if the patient is skeletally mature.  This is important because if the spine has stopped growing, the risk of the curve progressing is very low.  However, if the spine still has potential to grow, then there is also a much higher likelihood of the curve getting worse.

Other important risk factors include if the patient is female and if the curve is located in the mid-back.  These are two additional factors that are associated with a higher risk of curve progression.

In terms of treatment, there are three major approaches; (1) physical therapy, (2) bracing and (3) surgery.

The goal of any scoliosis physical therapy plan is to correct the biomechanical issues that arise from the curve.  There is conflicting evidence in the literature of if an exercise plan can reverse a curve, or even slow its progression.  However, what exercise can do is maintain function along with range of motion, and have an extremely positive impact on quality of life.  These exercise protocols should be prescribed by a properly trained manual therapist, and can be complimented with soft tissue work and other treatment modalities.  Physical therapy is the absolute most important approach in mild to moderate cases of scoliosis.

Bracing, by contrast, is typically used only in more advanced instances of scoliosis in patients who are not yet skeletally mature.  There are a few different types, but the basic mechanism of each is to apply external support to slow the progression of the curve.  These external braces are not associated with a high degree of success typically as a result of how hard they are to use.  They must be worn 22-23 hours per day, and are so tight that they restrict breathing and the ability to move normally.  It should be no surprise that compliance with these braces is often low.

Finally, the last resort treatment for those suffering from scoliosis is surgery.  Again, this option is typically reserved for those who are not yet skeletally mature and/or have advanced forms of scoliosis.  There are a few surgical options, but the most common is to attach steel rods to the spine, and fuse the vertebrae together.   This provides mechanical support to prevent the curve from progressing, but should only be used in high-risk and more advanced cases.

Finally, it is important to keep in mind that in a vast majority of cases, scoliosis does not have any long term health implications.  One recent large-scale study showed that after a 50 year follow up, scoliosis patients had the same cardiac health, mental health, lung function and neurological function as those without scoliosis.  

With whatever type and degree of scoliosis that you have, it is never a mistake to seek opinions from multiple health care practitioners.  While scoliosis typically is not a serious condition, it should not be ignored.  If you or somebody you know suffers from it, it is important to have a properly trained medical progression examine it sooner rather than later.

It's not fair: The impact of perceived injustice on healing

We all get injured.  Muscle strains.  Headaches. Broken bones. Tendinitis. Whiplash.  Experiencing and getting through these aches and pains is part of life.  For the most part, we all want to get through them as quickly as possible.

Yet, doesn't it seem that certain people recover faster from injury than others?  Even if two people have exactly the same injury, and do exactly the same things to manage it, the healing time can still be drastically different.

So what separates us?  There is no doubting that physical characteristics, such as age and level of fitness, can impact recovery time.  However, if all things physical are held equal, healing times for the same injury can STILL differ drastically.  

Why is this? One possible explanation: the influence of the mind.

Researchers now clearly understand that injuries and recovery time are highly dependent on what is going on with a person's psychology.  We now know that pain is 100% of the time experienced in the brain.  This pain is processed in the emotional center of our mind, and depending on the state of the center, the pain we perceive can drastically change (a topic I blogged about here).

Studies (such as what is discussed here) even show that chronic back pain is more easily predicted by psycho-social factors (like depression), rather than stuff we can see with MRIs.

Or even take the classic example of chronic tendon pain (which I blogged about here).  In short, the nervous system is more of a player than the damaged tendon itself in terms of the symptoms we feel.

So it's clear that it's not just the extent of the tissue damage that dictates recovery time.  The mind and nervous system are important.  And while there are many psychological traits that impact recovery, one that has a huge influence starts with simple thought: "this isn't fair."

Perceived Injustice

Researchers now understand that perceived injustice plays a very crucial role in recovery time with any injury.  Injustice, in essence, is the sense that someone has wronged you and retribution is warranted.  In other words: you think your injury is somebody else's fault, and you want to get even.  

So does wanting to "get even" impact recovery?  This study not only explores the issue, but also looks at how a simple survey can predict the magnitude of influence that perceived injustice has.

In one part of the study, a group of patients injured either at work or a motor-vehicle accident were examined.  The patients were asked to complete the Injustice Experience Questionnaire (IEQ), rating each question (below) on a scale of 0-4 (0- never, 4- all the time).

Here are the questions in the IEQ:

• I am suffering because of someone else’s negligence
• It all seems so unfair 
• Nothing will ever make up for what I have gone through
• I feel as if I have been robbed of something very precious
• I am troubled by fears that I may never achieve my dreams 
• I can’t believe this has happened to me 
• Most people don’t understand how severe my condition is 
• My life will never be the same 
• No one should have to live this way 
• I just want my life back 
• I feel that this has affected me in a permanent way
• I worry that my condition is not being taken seriously

Then, the researchers took the results of this IEQ, and looked to see if there was any correlation with factors such as; depression, disability, return to work and pain levels.  They found that the subjects with higher IEQ scores were strongly correlated with the following:

• An increase in catastrophic thinking (i.e. ruminating, exaggerating, thinking of worst-case scenarios)
• Fear of movement and re-injury 
• Higher levels of depression
• Higher pain severity
• The IEQ could even predict how quickly the subjects returned to work.  

If you're injured, take a look at the above questions in the IEQ- are you applying a score of 3 or 4 to many or most of them?  If you are, there's no doubting that you are angry, and feel as though what has happened is unfair. Unfortunately, this also means that you are more likely to be depressed, to feel more pain, and to have a slower return to work (compared to somebody with the same injury and a lower IEQ score). 

At the end of the day, if you are injured as a result of somebody else's negligence, it is completely normal to relate to some of the questions in the IEQ.  However, when too much focus is on being angry and getting even, the research is clear: we stay angry and we do not heal.  

How do we get better as quickly as possible?  There is no doubt that more than the body matters when recovering from injury.  Our attitudes, emotions, and even perceptions of pain also must be addressed to maximize recovery time.  

So to get better as quickly as possible, my advice is simple: focus on moving on, focus on healing, believe you will get better, and work toward living a life that makes you happy.

Sugary mouthwash might make you faster

It is no secret that the key to success in endurance sports, from a nutritional standpoint, is carbs.  I have blogged about them in the past, and it is clear that you can really make or break your race with how many carbs you have taken in.

Now, a new line if research is showing it is not only important to ingest enough carbs, but that it can also be beneficial to trick your brain into THINKING carbs are being ingested.  

How do we do this?  We rinse with a sugary solution. 

Quick background

For any short duration activity (like a golf swing, or quick sprints), carbohydrates are not the primary source of fuel.  However, once you get to an activity duration of around 5 minutes at a decent intensity, you start to tap into glycogen- the chains of sugar stored in your muscles.

So whether you are running a few miles or running a marathon, glycogen is important.  We can top these glycogen stores up by making sure we consume sufficient amounts of carbohydrates in the days leading up an event- there is no mystery here.  

Unfortunately, these glycogen stores are not always enough.  Scientists have consistently shown that if the activity is long enough, that glycogen source will become depleted and performance will plummet   

So what do we do?  Eat carbs during an event.  

Interestingly, it is not the size of the person that dictates how much to consume.  Instead, we are limited by how quickly carbs can be absorbed in the intestines.  So whether you are 5'2 or 6'2, this number (for glucose) is about 1g per minute.  So really, the max glucose you are going to be able to take in during an event is 60g/hour (there are ways to ingest more, but that is for another day).  

However, for shorter events, 60g/hour is excessive, especially for events under an hour in duration.  If your body is constantly fed carbs in close proximity to the start of an event, insulin will spike.  This will result in a decreased ability to access the glycogen and fat already stored in your body, and once again, performance will suffer.

That does not mean there is nothing you can to do enhance your performance with carbs during events under an hour.  The answer: a sugary mouth wash.

Study

This 2010 summary article does a great job of breaking down a new(er) line of carb research: the benefits of rinsing your mouth with sugar and spitting it out.

The basic idea is this: your brain controls your performance partially in anticipation of what is GOING to happen to the body.  For instance, studies like this one show that when the temperature goes up, we slow down BEFORE our body temperature goes up - in other words, our mind FIRST slows us down to try to prevent overheating, not in response to it.

The same concept applies to the sugary mouth wash.  The thought is that when sugar is sensed in the mouth, the reward system in the brain is activated; the brain thinks food is coming, and as a result our body gets the green light to hammer away.  We are able to go faster not because we are actually fed, but because we are anticipating we WILL be fed.  

And whether we fully understand the mechanism or not, the fact is, a sugary mouthwash seems to work.  Check out these results  from the study.  The first one shows a 2.9% improvement in a cycling time trial.  The third study shows a 1.7% increase in distance traveled during a 30 minute run...you get the idea.  These results are pretty impressive because there is no actual impact on the body's physical ability to perform; just the mind is giving the body a message to push harder.

Some practical notes

The most important note about this line of research is that this strategy only works for activities at a particular duration.  The range for this is usually quoted to be for activities that are about 30-75 minutes in duration.  Once you get over this 75 minute mark (or even for events over 1 hour), carbs definitely need to be ingested to maximize performance.  Once your glycogen is low, you can rinse all you want with sugar, but without fuel you will be unable to continue!

So, if you are trying to break that 50 minute mark for the 10K for the first time, it may be a good idea to try this mouth-rinsing strategy.  The science suggests you will get the energy boost of carbs without actually having to swallow them and risk getting an upset stomach!  However, when running that half or full marathon, you're better off to actually swallow 30-60g of carbs/hour.

Cervicogenic Headaches

Here is my article from this month's health section of the New Hamburg Independent. It takes a brief look at the best treatments for headaches that originate from the neck. As per usual with the limited space, this is more of a introduction to the topic rather than an all-inclusive explanation. Feel free to message me with your questions or comments!

New research points to exercise and spinal manipulation for certain headaches

Headaches are an extremely common and often debilitating disorder that people in our society suffer from. In fact, some research has shown that only 10% of our population is lucky enough to go headache-free over the course of one year.

So how do you get rid of these annoyances? First it is important to understand what is causing your discomfort. Common examples of headache types include migraines, tension headaches and cluster headaches. In this article, we will be talking about how to treat a specific type of headache that accounts for 15-20% of all cases: cervicogenic.

Cervicogenic headaches occur when there is damaged tissue in the neck that refers pain to the head. With a headache that is purely cervicogenic in origin, there is no actual pain being generated in the head itself; it is exclusively injured tissue in the neck that causes pain to travel into the head, and as a result, a headache is perceived. Most commonly, the tissues that can refer pain into the head include muscles, joints, ligaments and nerves.

Since cervicogenic headaches originate at the neck, it should be no surprise that the research shows treatment to the neck works best.

For instance, a 2010 study published in the Journal of Rehabilitation Medicine looked at the role of exercise in the management of these headaches. Subjects were either put into a neck strength exercise group, an endurance exercise group, or a control group where no specific exercise was completed.

At the 1 year mark, the strength group had shown a 69% overall improvement, the endurance group showed a 58% improvement, and the control group had only improved by 37%. Neck exercises clearly helped these individuals with their headaches.

Another treatment for cervicogenic headaches is manual therapy, including spinal manipulation (SMT). A separate 2010 study published in the Spine Journal took a look at how effective SMT is in the treatment of these types of headaches. The participants were separated into two groups; one received SMT, the other received a non-therapeutic “light massage.”

By the end of the 24-week study, participants who received SMT experienced 2.6 fewer cervicogenic headaches per week on average when compared to the “light massage” group. Therefore, if your headaches are originating from your neck, then SMT seems to be a viable treatment option.

While these studies are promising, it is important to keep in mind that there are many causes for headaches. In addition, just because you have one type, that does not mean you are immune from the other classifications of headaches. In fact, it is quite common to suffer from mixed-type headaches, where individuals may experience multiple types of headaches all at once.

Finally, it is also important to note that not all headaches are primary in origin. Sometimes they are secondary symptoms to a more sinister underlying condition. That is why it is important to make sure you seek a proper diagnosis from a duly trained health professional before piecing together a plan of action for your headaches.

Psychology of pain

Last week, I had the opportunity to talk to the Retired Business and Professional Men's Club about low back pain.  Over 100 members showed up, and they all asked a number of great questions.  In the end, much of what we discussed revolved around how to address chronic pain.  With this article, I am going to take a quick look at some of what we discussed.

Chronic pain is not just in the tissues, it's in the brain

What is the difference between acute and chronic pain?

With acute injuries, it is usually pretty clear why pain exists.  An injury takes place, tissues are damaged, inflammation pools into these areas, and things start to hurt.  With chronic cases, the reason why people feel pain is much more complex.  Often tissues are healed after 6 months, yet pain still persists for some reason.  A common example of that is the chronically painful Achilles tendon, which I blogged about here.

Recently, I wrote an article for the New Hamburg Independent discussing factors associated with back pain. Interestingly, psychosocial and lifestyle factors  (i.e. depression, obesity, anxiety, job dissatisfaction) were more strongly correlated to back pain than test results, such as findings on radiographs.

So why is this?  The answer, at least in part, comes down to the fact that pain is something that exists only if there is a brain there to perceive it.  If you tear a muscle, you could remove that muscle from the body, pass a current through it, and its contraction strength would be decreased compared to the healthy version of the same muscle.

However, as soon as you disconnect that muscle from the body, that muscle is no longer painful.  Pain is not an intrinsic characteristic of tissues like force of contraction is.  Pain is something that only exists if there is a brain to process the signal.

Psychology of pain

While a painful experience requires a brain, that is not to say chronic pain is all in your head.  However, it does explain why two people with very similar levels of tissue damage can have vastly different pain experiences depending on an array of factors impacting their psychology.

A great 2005 article summarized a number of different factors that contribute to how we perceive pain.  First, they explain that pain is actually processed in the limbic system, the emotional part of our brain.  When cancer patients underwent a frontal lobotomy (part of their brain was removed), these patients were still aware of the pain, but they no longer cared or considered it painful.  The same pain signal was reaching the brain, the brain  just was no longer equipped to tell the person that they are in pain.  Thus, pain no longer existed.

On a more practical note, they do a beautiful job of summarizing modifiable factors that have been shown to have an impact on the pain we perceive   Examples include how focused you are on the pain, how you learn to react to pain, the context you feel the pain in, how anxious or scared you are, and how you expect to react to the pain.  All of these are examples of things you can change to alter how much pain you feel without changing how much tissue damage is present.

An interesting example of this is how distracting patients may be an effective means to control pain.  For instance, burn patients experience excruciating levels of pain during their treatments and physical therapy.  Even with the use of opioid painkillers, the process can be unbearable.  Yet, when these same individuals are distracted using a virtual reality game, the pain they feel is significantly reduced.  There is no change in the tissue, no change in the pain signal reaching the brain; it only changes to how the brain processes that signal.

Another example discussed within the article takes a look at learned pain.  Two groups of people had their pain threshold tested.  One group observed models who were trained to react calmly and to have a stoic demeanor in response to the stimulus.  The other group of subjects observed models exhibiting poor tolerance to pain.  With no other difference between the subjects other than what they observed, those who watched the models with good pain tolerance required almost 3.5 times the stimulus until they reached their pain threshold.

What is the practical application?

At the end of the day, chronic pain is an extremely complicated issue.  It is of course important to address the specific tissues that are causing your pain, but it is also very important to look at these broad factors as pieces to the puzzle to solving your chronic pain.  Chronic pain is, by no means, all in your head.  However, altering what is going on in your head will undoubtedly have a positive impact on the pain you feel, and as a result, your quality of life.

Here is a cool video explaining chronic pain.