The Greatest Superfood Supershake In The World Ever (probably)

Here's a supershake that you can have for breakfast, or pre-breakfast or post workout or whenever. I normally have it post workout.

The ingredients are flexible depending on what you have available, needless to say I have tried all the ingredients listed below at some point. After outlining the super awesome ingredients I will give a brief outline of what they are.

Basic Shake - suitable for just about everyone - Vegans & Raw Food People Included

300-400ml Almond Milk
1 x tablespoon ground up flaxseeds
1 x tablespoon tocotrienols
1 x tablespoon hemp protein
1 x teaspoon of Maca

In the kitchen - ready to blend

Hemp Protein - good work Canada

Add in some fruit if you like and blend. If you're into the whole only eat seasonal, local produce and want to reduce food miles, then pick a fruit that matches this goal. However, in England this can be tricky as Pears and Rhubarb don't blend that well. If you live in Hawaii blend in a pineapple. If you're not bothered about this blend in a banana or some frozen berries.

If you are a vegan you can leave it at that. (Though why you would want to be a vegan I don't know, remember Gillian McKeith looked terrible before she went into the jungle and according to Wikipedia she's only one year older than Linford Christie though she looks old enough to be his grandmother). However lets not forget that Scott Jurek, one of the greatest ultrarunners of all time is a vegan, as is kettlebell guy Mike Mahler, and see this clip of  New Zealand fitness model Raechelle Chase who just became a raw food vegan convert (although her nutritionists contention that vegetables have more protein in than meat is a bit bizarre): in short maybe I was a tad unfair to vegans! However, I don't think its possible to get the full nutrient spectrum on a vegan diet, I think it can be done with a vegetarian one just about, and for the record I'm an omnivore.

Raechelle Chase - kiwi fitness model. Thankfully not all raw food vegans look like Gillian McKeith

Optional extras you can add in to the shake: suitable for vegetarians

1 x Scoop of whey and/or micellar casein/ milk  protein (currently i use the brand pictured, but use whatever brand you like/trust - I've used Reflex etc in the past)

Whey protein, micellar casein, boditronics, reflex etc

1 x pot of natural Greek yoghurt, like Total
1x teaspoon of coconut oil - if you want extra calories, though I find this leaves a foam 'head' on the shake, so I don't personally do this now
1 x tablespoon of cacao nibs

Cacao nibs - not as tasty as a bar of dairy milk but good for you

Options if you don't like almond milk, are not lactose intolerant and really want to bulk up and get some quality nutrients

300-400ml raw whole milk (if you can get it where you live)
200-300ml of raw kefir

Raw milk & kefir

But for the love of all that is right with the world don't use soya milk.

The ingredients - quick explanation

Almond milk - gives the shake a nice taste, suitable for nearly everyone. Available in Holland & Barrett and Waitrose. Can be a bit expensive. If you're into the whole raw food thing then you can make your own (if however you can think of better things to be doing with your time - like hanging out in coffee shops drinking cappuccinos - then just go and buy some).

Flaxseeds - source of fibre, and the lignans in it may have other benefits. Essential fats as well (though still take you fish oil and eat oily fish). Can buy it pre-milled like the pack in the picture, or buy the whole seeds and mill yourself using a coffee grinder attachment to your blender (this takes about 10 seconds, this is the method I have used most)

Tocotrienols - much like Princess Leia and Luke Skywalker, Tocotrienols are the secret sister of tocopherols. Nearly all vitamin E sold is in the form of tocopherols. In the words of Yoda 'There is another'. In recent years tocotrienols have got more exposure, and a quick search on pub med shows there is a lot of research going on at the moment studying their possible anti-cancer and immune enhancing properties. See this link here on immune enhancement effects.

Hemp Protein - protein for vegans, also contains essential fats, tocopherols & tocotrienols & help the Canadian economy.

Maca - I don't have any of this at the moment, but have used it in the past. Having read this study though, I think I'll get some more. It supposedly increased endurance performance and sexual desire, okay they may have only studied 8 people over only 14 days, but I'm sold - on the endurance effects only of course.

Cacao nibs/ raw chocolate - source of magnesium, sulphur and antioxidants , has  a very high ORAC (oxygen radical absorbance capacity) score. I've found the cacao nibs don't blend that well, so you're probably better off getting some raw chocolate powder to make your shake more 'chocolatie'.

Nutrient Breakdown:

Calories: no idea
Carbs: no idea
Fat: no idea, essential fats from flaxseeds & hemp
Protein: about 20g in the basic shake, 50g with the whey protein, and probably 80g with raw milk & yoghurt
Fibre: Yes, from the flaxseeds
Supernutrient rating: Awesome, hell yeah, get some!

Feel free to add in any ingredients you like, if you're a Hank Hill style omnivore blend in a cow or whatever you want.

There you go, get blending.

Hank Hill - "Faux fu, for the tofu intolerant?!" - one of the greatest lines ever

Essential Recovery Tools for Runners and Weight trainers (and everyone else in between)

You can probably tell that I've taken a few days off work this week, hence my unprecedented three blog posts in one week.

I thought I would share some of the tools and things that I consider essential for recovery, to prevent injury and generally help your tissue quality. These are just things I like and that have worked for me, no science or research links in this post.

Now, I should point out if you have a recent acute injury, do the sensible thing first - rest, ice, take some anti-inflammatories if you have to, load up on fish oil and anti-inflammatory foods like tumeric.

Many strength coaches have a tendency to bash endurance activities like running, citing the high injury rate. In my experience though I have managed to injure myself equally from running, weight training and falling over drunk. Before you say that I probably don't run the same volume as the average runner, I've run some pretty reasonable distances, on trail, carrying a rucksack and at night as well. Most running injuries tend to be from over use or rubbing, the classic blisters and knee problems (technical and muscle activation issues contribute). Whereas strength training injuries can be from lifting too heavy (pec tear, disc pops), lifting incorrectly and possibly too heavy (shoulder issues), overuse and incorrectly (elbow problems). I've met as many guys who weight train with injuries as I have runners, the weight training guys tend to have upper body problems, the runner lower body problems, and everyone can end up with back problems. And all these issues can be compounded in all activities by stiff muscles, trigger points and mobility issues.

Without further ado, and in no particular order, here are the essential tools and methods to help you recover, restore and regenerate.

Foam Roller

Chances are you aren't a pro cyclist with a massage therapist on hand and you probably don't have Tom Myers on speed dial. Good manual therapy and massage really helps but we don't all have the money for this or access to a good sports massage therapist.

If you can't get massage or in between massage sessions, foam roll. Even though foam rolling is all over the internet, most commercial gyms still don't have any, or one poor crushed one in the corner. In which case, buy your own and do it at home while watching TV. And if you're feeling hardcore or don't want to spend more than you have to - buy a piece of pvc pipe. I roll my t-spine, and my adductors and ITBs, concentrate on the areas you need to.

Foam Roller

PVC Pipe, if you don't want to buy a piece of foam, and if you want a deeper massage effect

Sudocrem

Thanks to Tiss Tanner for introducing me to the wonders of sudocrem. If you run or cycle long distances, chances are something somewhere is going to start rubbing. Enter sudocrem, apply liberally. And If you are a douche like me and manage to scrape half the skin of your C7 neck area doing behind the head jerks with the Olympic bar, sudocrem can help this is well.

A friend of mine (who's name begins with P and ends with ul) has to lube up with an industrial vat of vaseline before any running event. I wouldn't suggest using sudocrem like this, use it when you have to, to soothe areas that may have undergone excessive chaffing. If you are using sudocrem on a daily basis you've got issues I can't help you with.

Miracle cream of the gods, this stuff is like ambrosia (not the rice pudding or custard, the food of the ancient Greek gods) to ultrarunners. Can also be used for napkin rash apparently

Theracane

I bought my theracane about 5 years ago after reading The Trigger Point Therapy Workbook. Good to target those hard to reach trigger points on your back, it's a good hurt. Again, do it while watching TV. I need to use my theracane more. Also, you can pretend you're Jackie Chan with it when no one is looking.

Theracane: for those hard to reach trigger points and for practicing Jackie Chan moves with

Two Tennis Balls taped together and a bouncy ball

If you don't want to buy a theracane, tape to tennis balls together and roll either side of your t-spine to get a more targeted effect than the foam roller will give. (Yes, I taped the tennis balls together with hazard tape - deal with it). Also, a hard rubber ball or bouncy ball will let you target areas more in the back, glutes and especially on the plantar fascia - on the foot.

Yes, that is two tennis balls taped together with hazard tape next to a red rubber ball

Magnesium Spray

Magnesium is a muscle relaxant and apparently can be absorbed through the skin. Think I first read about this on Mike Mahlers website or facebook page, can't remember exactly.Who knows if this works or not, but it makes me feel better. Spray on before bed to help sleep and relax muscles. I also spray it directly onto injured areas. I've used the straight magnesium spray and the one in the picture which has some nice aromatherapy oils in it (that's the way I roll). It last ages unless you spray on 100 pumps a night.

Magnesium Oil spray

The Stick

I bought this at the London triathlon this year, bizarrely from a guy who had come all the way from Atlanta, Georgia. To be honest, it's expensive for what it is, but I like rolling the adductors and around the knee with it, and if you have a friendly partner they can do your upper back and traps and neck. Again, you could just use a rolling pin for free, and you don't necessarily need to own a foam roller, theracane, stick, and tennis balls - but they all help to target different areas.

The stick also happens to be exactly the right size to practice your light saber technique and pretend you're Ghost Dog. When you neighbours catch site of you through the window they are bound to think that you're awesome and not some weirdo waving a piece of plastic around.

The Stick

Ghost Dog: Practice your samurai moves with The Stick in between rolling

Dead Sea Salts/ Epsom Salts

I've tried both, I prefer the dead sea salt magic. Much like the magnesium spray, the salts are a muscle relaxant and can be absorbed through the skin. Also be warned if go to your local friendly Boots pharmacy in this country to buy Epsom salts, the conversation will go something like this

Me: Do you sell Epsom salts?
Shop Assistant: Do you know its a laxative for people with constipation?
Me: I'm not going to drink it, I want it to bath in
Shop Assistant: Why?
Me: Because I'm using an East European recovery technique
Shop Assistant: Oh, I see (unbelieving, thinking crazy fool), what size do you want?
Me: The largest one (thinking: hurry up, all those pensioners waiting for their prescription are staring at me)

Okay, I'm exaggerating to, but to avoid this conversations go and buy the dead sea salt magic instead.

You don't need to use these all the time, and especially in the warmer months you are unlikely to want to jump into a hot bath after a run. But on a cold winter day, after a hard training run, when all your muscles are aching, tight and tired, a dead sea salt bath seems to have restorative properties even if it's purely psychological and helping you relax, it's worth doing.

Nigella Lawson with a tray of drinks and snacks

Berries are good for you

Post workout recovery drink, anyone?

Ok, Nigella probably isn't going to pop 'round with a tray of drinks and snacks to help you recover, but I can but dream.

There it is. Obviously still do your warm ups, mobility exercises, dynamic stretches, corrective exercise if needed, stretches etc. But the above tools all help. Some you are only going to use when things go a bit pair shaped (hopefully you won't need to sudocrem up every day!), Some you should be doing everyday (some kind of foam roll or trigger point work if needed), some you can make part of your daily routine (magnesium spray at night).

Hopefully, these tools will help you deal with minor niggles as they arise and help prevent some major problems developing along the way

Young Guns Working on the Guns

      Certain things are gym lore, these are almost universal truths. For example, Monday is international chest and bench day, 9 out of 10 women will start their workout on a cross trainer, most endurance athletes would rather squirt energy gel into their eyeballs than do any strength training, 50% of guys are unable to do any leg training because they already play football (that's soccer if you are an Americano) and they have a mysterious knee injury which will result in their legs exploding if they do a squat or deadlift; and most young guys want to work on their chest and arms.

Some young guns make it and some end up getting arrested in hotel rooms free-basing with a hooker

Now, making the decision to come to the gym or starting weight training is a laudable decision, especially for a young guy with so many distractions, and some come along to improve for a sport but most just want to get big. Same as it ever was. It seems in recent years more and more young guys (and by this I mean 14 -18 year olds) have been subjected to peer pressure and media pressure to have a certain body shape (i.e. get muscles, get hooge, get buff) whereas most girls want to lose weight regardless of how much they weigh (but that's a whole other story).

The initial conversation between the instructor and the young gun normally goes something like this:

World Weary Fitness Instructor: So, what would you like to achieve?
Young Gun: Improve my fitness and work on my chest and biceps
WWFI: Ok, have you done any weight training before?
YG: I've got some weights at home, I do some bicep curls & chest work
WWFI: Do you do any leg work, do you want to work on any other body parts?
YG: I play football so I don't really need to do any leg work and/or I have this knee injury which means I can't really do any weights for my legs. Mainly want to work on getting my upper body bigger and do some running for my fitness.
WWFI: I see, exercises like squats and deadlifts are really total body exercises that are going to help your whole body bigger & stronger....
YG: (Blank look)
WWFI: Ok, lets have a look at your nutrition, what would you normally eat throughout the day
YG: Cheerios for breakfast, then maybe a Dr.Pepper and a bag of quavers mid morning, a sandwich if I remember, whatever my mum makes for dinner and a bottle of lucozade during football training.
WWFI: If you want to put on muscle you really need to eat more, like double the amount of calories your eating now. Try and eat protein and vegetables at every meal.
YG: I don't want to get fat though, I want to keep my six pack
WWFI: With your body shape and type it's going to be pretty difficult to put on muscle without going into calorie surplus and maybe putting on some fat, I mean currently your bodyfat is like 8% and with all that football training and running you want to do it's going to be hard without eating a lot more.
YG: Hmm, I see, so what you're saying is I need to take creatine and buy a protein supplement
WWFI: No. you need to eat more and eat better first, and maybe focus on one goal at a time. If you get stronger you're probably going to be increasing muscle mass at the same time, but you need the nutrients for your muscles to grow.........(pause/silence). So how many times a week do you want to come to the gym
YG: Maybe 2 times week, maybe 3 times, I was thinking everyday to begin with.
WWFI: Ok, well if we aim for weight training 3 times a week that's a good place to start. We can go for a total body routine, using mainly compound movements, all the research and years of experience from old time lifters show that you should hit a muscle twice a week for optimal results. So we might hit chest on Monday with some flat bench press and low reps and then maybe hit again on Friday with some incline dumbbell presses with the classic 3 x 8-12. Same with back and shoulders and legs.
YG: Hmm, but I read in Muscular Numbnut magazine that I need to split my routine up and do chest one day, and back another day and biceps and triceps.
WWFI: Yeah you can do split routines but then you are only hitting your chest once a week. All the research shows you can hit it twice, and you maybe only need 1 or 2 exercises per body part per session. There are loads of ways of splitting your routine, total body, upper/lower body split, push/pull etc. And yeah, maybe if you want you can throw in a few sets of bicep curls at the end of your session, but I really wouldn't bother with much more than that for biceps to begin with. Focus on the basic, big compound lifts and get good at them. And most of those 6 day split routines are done by genetically gifted guys on anabolic steroids, they can practically do anything and get results. Anyway, we better hit the gym floor and do some exercise.

etc etc and so it goes.

Now at this point we get round to the routine. Now I know that there are quite a few basic routines that are going to work, the basic strength routine outlined by Rippetoe consisting of basically squats, bench press, press and deadlifts, any 5 x 5 variation, all the things outlined by Brooks Kubik in Dinosaur Training, some of the deceptively simple training routines outlined by Marty Gallagher in The Purposeful Primitive - some of which were used by the best of the best in the pre-steroid era, and some of the ideas outlined by Stuart McRobert in Beyond Brawn for the ectomorph hardgainer.

And I also know what the research shows. (If you haven't got a couple of years spare to read Supertraining or trawl pub med  I would recommend reading Lyle McDonalds series on weight training which encapsulates it nicely or get Matt Perrymans ebook - which is free if you don't feel like donating to him you cheap skates).

And I also know that if you are young and untrained, pretty much anything will work if you train with the right intensity, progressively overload and eat enough. 

BUT, I'm also not naive and I'm realistic. Doing only deadlifts, squats and presses can be boring when you've got a gym full of equipment around you. And nearly everyone is going to throw in some bicep curls and tricep isolation work whether it's on their program or not. And to be honest, anyone I ever met with decent biceps did some isolation work at some point (Hey, we all like to do a few bicep curls on a Sunday, it's beach muscle day, okay 4 different exercises for biceps using the cable, dumbbells, barbells and preacher bench, oh lord I want 20 inch guns, the preacher curl bench is a cruel mistress, it promises so much and delivers so little!).

The preacher curl - a cruel mistress

And the other factors to consider are the lack of strength and mobility I encounter with this population. These are not necessarily overweight kids, but your typical skinny ectomorph, its surprising how many of these can't do a decent press up or bodyweight squat, and most can't do a bodyweight pull up or chin up. I think some of the awkwardness displayed with the squat might be because they are still growing, the 14-15 year old can look like they have legs or a torso that is too long for the rest of their body, because they haven't finished growing yet. And many have hyper-kyphotic postures (I was that kid, so I know what it's like). This all informs the exercises I prescribe.

Listen carefully young padawan (warning: star wars reference)

So this might be heresy to some strength coaches, but I normally end up using a combination of machines, bodyweight and freeweight exercises. If I'm feeling really optimistic I might even do some mobility work like scapula wall slides and prisoner squats and hip bridges and hip flexor stretches - though mostly I'm wasting my time here because I know the young padawan is not going to do any of this when they train by themselves. Then I might do some goblet squats for to groove that technique in and work on their squat pattern before going near a barbell or I might even do some lunges or step ups. Then there will be some basics, if they can't deadlift from the floor without rounding the back, I might start with rack deadlifts, and there will be the bench press or dumbbell press in there somewhere. And for back there might be some assisted chins and pull ups on one day, and the latpulldown on another and then either the machine row or dumbbell row on another day, and maybe some cable face pulls for posture. And even one bicep exercise to keep them happy and some dips or assisted dips. And one day might be a strength day, down at 5 reps and another a classic 3 x 10 with some different exercises and another maybe some bodyweight press ups, lunges, and some plank to press ups to strengthen the core etc. Not normally anymore than 4 to 6 exercises in a workout.

And then I tell them to go and train hard and stick to the basics and progress on the compound lifts, and don't be drawn into doing loads of pointless isolation work and not to be swayed by their friends and get sucked into endless bicep curls and partial movements.

And two weeks pass and it's welcome to the gun show.

At this point collective teenage wisdom and group think have kicked in. And now there are group of them doing synchronised bicep curls (or more like synchronised partial rep, disc herniation, erector spinae curls). The rationale being: If I haven't seen results in two weeks then there must be something wrong with the routine and I need to do more. The weekly training split now looks like this

Monday: Chest & Triceps (except the bench is really busy, so throw in some bicep curls while waiting
Tuesday: Back & Biceps, must use lifting straps in the latpulldown
Wednesday: Leg day (which means football training), before football training go to the gym and do traps, (because can't quite decide whether it should be done on back or shoulder day), throw in some wrist curls for forearms as well
Thursday: Shoulders, man alive shoulders are complicated, need to do side, front, rear raises, as well as dumbbell press, Arnie press, machine press and as many redundant exercises as I can think of. Biceps are looking small do some more curls
Friday: Pre night out pump, curl and bench press high reps to get pumped up for night out
Saturday: Man, I drunk too much last night and eat that kebab, looking fat, need to go to gym to sweat toxins out and burn off those calories, 30 min treadmill run and 1000 crunches should do it
Sunday: Play football, this counts as a leg workout
 

when in doubt, load up the weight and go partial (image staged for dramatic purposes)

And then at some point it becomes about how much weight you can lift with terrible form. Hmm, just can't seem to lift anymore on the flat bench press... hang on why not do a decline smith machine partial rep partner assisted press? Bingo! I just increased my one rep max, my chest is bound to get bigger now. (It's a well known fact that both Arnie & Ed Coan used the decline partial rep smith machine press - that's a joke by the way).

Decline smith machine partial rep partner assisted press. Partner shouting 'It's all you' is optional. Recreated here purely for dramatic purposes, don't try this at home kids!

Then they come and say something like this to you. "I don't think I'm doing enough for my chest, I read on anabolicarsehole.com that to really shape my lower outer pec I need to do cable flyes angled at 37 degrees" And you say "Kid, you ain't got no pecs yet, you're shaping bone, go and do some full range presses and drink some chocolate milk."

At this point you know they've been lost to the cause. Maybe they'll see the error of their ways in a few years time, maybe they'll get chatting to a guy in the gym who's been training the right way and looks the part, maybe they'll see something on the Internet or maybe they'll be watching Anchorman and something in their brain will click.

Ron Burgundy training: Much like Sex Panther, the concentration curl is actually illegal in 9 countries

Or they'll stop playing football because their knees hurt, and realise their legs look like a couple of pipe cleaners and then maybe they'll think about doing some squatting

It seems hard to believe in this day and age that people can't access the right information on training. When I was younger all there was was Muscle and Fitness and Flex magazine and Joe Weider, all you read about were split routines and bodybuilders. The information about how old time strongmen and athletes trained just wasn't available, those books weren't in the shops, there was no internet to find them on, to research anything you had to have access to an academic library. Now, all that information is readily available but still in gym culture young guys gravitate to the bodybuilder split routines, one body part per week. And there is a time and a place for these routines, but as outline there are other ways and roads, some quicker and more direct for the non drug using trainee. But sometimes the right path is the hardest. Is there too much information available now, too much info, not enough knowledge, it's difficult to know who to believe if you're new to the whole thing.

But I see glimmers of hope, guys using the power rack more, women lifting weights, Olympic lifting rising from the underground and instructors who want to coach rather than press quickstart. Time will tell. One things for sure though, the bicep curl is here to stay!

Now, go and watch this clip of the film Network, just because

The Back Pain Show 2010 (tales of knee side to side, abdominal hollowing, swiss balls & faith healing)

A few weeks ago I attended The Back Pain Show in London with my colleague Pablo (ok, that's not his real name, I am concealing his identity to protect the innocent). In case you haven't guessed it's an expo all about back pain and attracts physios, chiropractors, osteopaths and the now ubiquitous vibram five finger stand. As well as the stands and people trying to sell you stuff it has free seminars about back pain, exercise, how to manage it, as well as exercise demonstration sessions.

I waited a few weeks before I wrote this review to allow myself to calm down and consider whether I had harshly judged what I witnessed. Having given it some thought I can say that my views of what I saw haven't changed, and the state of back pain care in this country is saddening. Now, I'm sure people are doing things with the best of intentions, but that's no excuse when so much research and information is readily available.

I have an interest in lower back pain, me and my colleague Pablo (ok, he's actually called Nick) run classes for people with chronic lower back pain, as well as doing one to one sessions. And without blowing our own trumpet we have had a fair amount of success in helping people. We generally follow the evidence based approach outlined by Stuart McGill in his two books and his two dvds. This forms the base structure of our approach if you will, and then we will build on that using methods that we think are appropriate to that individual, always trying to use logic and evidence based exercise as our guide.

Before I start remember that I am talking about a show that is aimed at practitioners working with people who have back pain (specifically in most cases, lower back pain), not the general population. The show also attracts lay people and members of the public who have lower back pain, they are looking for answers. Also, I have left out the names of people and organisations as it is not my intentions to bash individual people or make them look bad, and also I don't want to get sued! Though, I can back up everything I'm about to say.


Swiss Balls, Spinal Mobility & Knee Side to Side

The first seminar we attended was given by a physiotherapist/osteopath who also works with Olympic athletes. A good start we thought. First piece of advice is sound, avoid forward bending. This is simple but effective, it's easy to try and complicate things and get too clinical, but people with back pain really just want to know what to do to make the pain go away. And this is supported by McGills work

"It is becoming clearer that repeated spine flexion - even in the absence of moderate load - will lead to discogenic troubles." (McGill, 2002:127)

In short stop bending over and stop crunches as well fools.

The next point our friendly physio makes is that a lot of people with back problems have poor mobility and need to increase their spinal mobility & flexibility, cue demonstration of lateral flexion and then a picture of someone on a swiss ball hitching their hips side to side. Hmmm, this is more troublesome. As McGill (2002;216) states

"...greater spine mobility has been associated with lower back trouble in some cases. Further, research has shown that spine flexibility has little predictive value for future low back trouble."

The joint by joint approach outlined by Boyle (2010) seems a more logical approach to me, and clients seem to grasp the concept when explaining it to them. I have seen more people than I care to mention who had lost mobility in their hips and thoracic spine and were using their lower back to stoop down, pick up objects and get out of chairs, and who squat using only their knees. Boyle (2010;31) outlines a series of mobile and stable joints stacked on top of each other

Ankle - mobile
Knee -stable
Hip - mobile
Lumbar spine -stable
Thoracic spine -mobile
Scapula -stable
Gleno-humeral -mobile

For most people with lower back pain I would contend we need to get them more mobile in the hips & t-spine while keeping their lower back in neutral and stable.

The next classic piece of advice from the presenter was to sit on a swiss ball to help your posture throughout the day, I've heard this regurgitated numerous times. Aside from the fact that there in no one best posture, according to McGill (2002; 260) sitting on a swiss ball

"greatly elevates spine load through increase muscle coactivation. For this reason, non patients should avoid prolonged sitting on gym balls, and patients should use them only once they have achieved spine stability and increase load bearing capacity."

We then moved onto the exercises the physio/osteo recommended. The first one is of course on a swiss ball. Essentially a seated bird dog (or chair dog as I like to call it). At this point he gets a woman from the audience to demonstrate it, which of course she can't without losing her balance. Then we get a superman over the swiss ball (see the picture below, these are not from the day, they are pictures I took afterwards purely for illustrative purposes). At this point, the physio actually loses his balance and can't demonstrate the exercise properly. So, why would you give an exercise to someone with low back pain, that you can't even do yourself?!

And why would you move someone straight onto an unstable surface when this increases spine load (McGill, 2002, 2004), and the individual could be doing the chair dog or bird dog on a stable surface, which would actually be more effective and allow them to get the technique correct; and you know, might actually help their back.

If you fall off, maybe you should try it on a chair first

Look, the chair doesn't move, good news for the 60 year old with back pain

Swiss ball supermans - if your physio falls off while demonstrating this, maybe you should get him to show you 4 point kneeling bird dog on the ground first

The next exercise is the all time classic, second only to the knee hug stretch in the list of exercises given by physios to clients with lower back pain. It's the knee side to side/ windscreen wiper mobility exercise

No instructors were harmed in the taking of this photo

At this point, me and Pablo look at each other in disbelief. We then have a question and answer session after the presentation, in between questions from the public about what size swiss ball to get I manage to ask my question. Now, I don't want to have a show down or try and call the guy out and maybe he can justify the knee side to side move, so I ask him what his thoughts are on McGills work on rotation and twisting of the spine and knee side to side, and I throw in Sahrmanns name for good measure. Now, he's only aware of  McGills work on bracing and not the work on rotation. (If want to see something cool, watch McGills latest dvd where you can see a disc bleeding when put under rotational stress). And then he gives me the all time classic line "You can get research to prove anything." Now at this point, I should say I've been in this situation before when a fit pro instructor demonstrated the exact same exercise, I asked the exact same question and got the the exact same answer. But this guy isn't a fit pro instructor he is a physiotherapist and osteopath working with back pain patients and Olympic athletes. He should be on the cutting edge of research, or at least give me some answer about spinal ligaments stabilising the spine like Gray Cook does in his primitive movement patterns dvd (though personally, I still would not give this exercise to back pain patients).

Yes, he does say the spine is designed to rotate, but this isn't the complete picture and obscures the reality from the public. I don't pursue the argument. But the anatomy should be clear to someone with that many years in formal education. The spine rotates mostly in the cervical and thoracic areas with some rotation in the L5/S1 region. But we should try to limit rotation in the lumbar spine. Sahrmann (2002;62) states

"Rotational ranges of 3 1/2 degrees have been show to tear the annulus of the disk."

 The abdominal muscles should limit rotation in the lumbar spine, they should provide anti-rotations and we should try to lock the pelvis to the ribcage

"A large percentage of low back problems occur because the abdominal muscles are not maintaining tight control over the rotation between the pelvis and the spine at the L5-S1 segment." (Sahrmann, 2002;70)

 And the final word to Sahrmann again

"Rotation of the lumbar spine is more dangerous than beneficial, and rotation of the pelvis and lower extremities to one side while the trunk remains either stable or is rotated to the opposite side is particularly dangerous." (Sahrmann, 2002;72)

 So in short, the answer given to me about you can get research to prove anything is a junk answer and a lazy answer. Notice, the texts I refer to are 8 years old. This is not recent stuff. I don't know everything and always want to learn more, and am surprised at how limited my spinal knowledge is when I read some research papers and texts. But I'm shocked that people leave physio school and never learn anything new or never questions anything they have been taught, or don't think logically or outside the bounds of clinical wisdom.

And don't get me wrong, I'm not one of those trainers who avoids lifting heavy stuff because it's dangerous. But we are talking about people with lower back pain here not 20 year old Olympic lifters.

Pilates & Physiotherapists - why are they all Australian?

This post is already longer than I wanted it to be, but I've got more ground to cover. In the exercise zone of the show I watched some Australian physio/ pilates instructors going through some exercises. They managed to combine an abdominal crunch with abdominal hollowing to give the spine extra instability while in flexion. Just in case you're wondering, see the first quote from McGill as to why you should avoid repeated flexion of the lumbar spine. Why hollowing makes it more unstable and you should probably be bracing is also pretty well documented, so I'm not going to go over that ground again. And why are they all Australian? Is it because that's where the original research was done showing transverse abdominis dysfunction with lower back pain and started everyone erroneously hollowing, because they only measured one muscle and didn't measure all the others which can also be dysfunctional. Or maybe they have too many fitness professional in the antipodes, as fitpro, bts, half these physiso and personal trainers in London seem to be Australian or Kiwis. And if I was from the land down under i'd probably live there rather than rainy old England, but maybe no ones got back pain in Oz or New Zealand because they are always out surfing or bungy jumping. But I digress.

Then I got healed

Mixed in with the chiropractors and massage therapists were a few more esoteric stands. I looked at one labelled 'healing', when asked if I had any pain I told a woman who was wearing a t-shirts that said 'healer' that I had some knee and mid back pain. Then one of her colleagues grabbed my hand and invoked the power of jesus to rid me of my pain ( I kid you not ), and then when I said it hadn't gone completely he commanded the pain to leave and for me to be 100% pain free, I then lied - said it was gone and got the hell out of there. Pablo said it was the funniest thing he had seen, the bemused look on my face said it all. Now there is a time and place for everything and people can believe whatever they want to believe and somethings are beyond the realms of science. But, faith healing seemed a tad incongruous in amongst the physios and seminars by spinal surgeons. It's a sad fact that people with back pain can be desperate, and having been let down by the standard medical profession will try anything to make the pain go away

I have to say I keep an open mind even if something hasn't been supported by research. I can see the benefits of massage, Qi Gong, meditation, relaxation, positive thinking (some of which have research behind them for certain things). But invoking faith healing is a step too far in my opinion, though probably no more bizarre than the Bowen technique.


Another Australian

Another Australian physio was there, she did an exercise class demonstration. And though I had never heard of her she had the endorsement of Prince Charles and a lot of people were watching and seemed to know who she was. She was dressed as if she was about to get on a yacht (probably paid for by her back pain clients, hey if McGill can start his dvd sitting on a boat then it's possible) and definitely knew how to market herself. Then she started to use phrases that didn't really add up, like 'increase the metabolic rate of your disks' (?what??), now you can increase disk nutrition for sure, but I was unaware that disks have their own metabolic rate?!

I watched a few exercises, including the classic knee hug and a statement that forward bending is ok (who needs research) and left.

This exercise session especially and to a lesser extent the Australian pilates one showed the power of marketing and the media. Where, people assume pilates or some other persons method is best because of the media exposure it gets and not because of research, evidence or results.  Gray Cook sums it up nicely in new book Movement, that I am currently reading

"The sad truth is that media and advertising interests have greater influence on the fitness culture than the professionals dedicated to fitness, athletic development and rehabilitation." (Cook, 2010;51)

One more physiotherapist and I finally lose respect for an entire profession

The last presentation I went to was on the ageing population and implications. Again we start with some good quotes about the benefits of strength training for the older population. Then we move onto a confusing statistic that was probably explained wrong, apparently for every additional hour of TV I watch I'm 26% more likely to get diabetes. Which begs the question, additional to what? And if I watch four hours extra I'm 104% likely to get diabetes.

Then we see if we can touch our toes and then we see how many squats we can do in a minute. Except, what the physio demonstrates aren't squats, they're more like partial knee bends with a back in forward flexion with not much hip movement combined with a toe touch. At this point we left and went to the pub (true story).

The fact someone in the business of rehabilitating people can't do a decent bodyweight squat should come as no surprise to me. I've met too many physios and medical professionals who were overweight, injured and obviously didn't exercise in any fashion. I used to think that there were some good physios out there, doing the right stuff, staying ahead of the research curve, practicing what they preached. Now... I'm not sure, it seems like an entire profession surrendered themselves to pilates because they couldn't think of anything better themselves. They then started saying any exercise was going to benefit back pain, hey you can swim or cycle, lets not bother to see if you have specific needs or issues or if you are forward flexion intolerant. But most of all, I'm shocked that they can trot out the same advice they learnt twenty years ago and which hasn't worked. Maybe, I'm being too harsh and I'm hopeful that there are still some quality professional out there.

Anyway, my back actually now hurts from sitting down so long to type this post. I will see you at the back pain show next year, where hopefully I'll have my own stand and be giving my own seminar on evidence based exercise and strategies for chronic lower back pain.

References

Boyle M (2010) Advances in Functional Training. On target publications. California, USA
Cook G (2010) Movement. On target publications. California, USA.
McGill S (2002) Low Back Disorders. Human Kinetics. Champagne, Illinois.
McGill S (2004) Ultimate Back Fitness & Performance. Wabuno Publishers. Ontario Canada
Sahrman S (2002) Diagnosis & Treatment of Movement Impairment Syndromes. Mosby. St Louis, Missouri.

Also see my recommended resources page for details of McGills dvds'