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This is an excellent article that I had to include here. Just the kind of thing I've been looking for.

By Will Brink, author of:
Muscle Building Nutrition
http://musclebuildingnutrition. Joint Troubles com
Muscle Gaining Diet, Training Routines by Charles Poliquin & Bodybuilding Supplement Review
Diet Supplements Revealed
http://aboutsupplements.com
Real World Fat Loss Diet & Weight Loss Supplement Review


“Joint Troubles”
One of the most common problems faced by strength training athletes is joint pain. "Oh my shoulder is killing me" or "my knee has been bothering me for months" or "I have been living on pain killers to get rid of this ache in my elbow" are common complaints that can be heard in any gym at any time. Oddly enough however, this topic is not covered very often in most bodybuilding/fitness magazines. Maybe the topic is just not all that "sexy" or "cutting edge," but if you're one of the thousands of people whose gains in muscle are being side tracked by joint troubles, then you don't give a damn about sexy or cutting edge-you just want relief!

In the past few years I have noticed an increase in letters and e-mail from people complaining about their joints. In all honesty, I would estimate 80% or more of most bodybuilders joint pain is totally avoidable. If you look at people who have chronic joint pain, nine out of ten times you can see why they would have an aching appendage that causes them pain. More often that not, they (1) rarely warm up adequately, (2) they train too long and/or too often, (3) they use overly heavy weights/low reps more often than they should, (4) they don't take time off to allow their joints, tendons, muscles, etc., to recuperate from heavy workouts, (5) they use less than perfect form during heavy lifts, (6) they don't take in adequate nutrients, or (7) all of the above!

Now of course we have all had an ache or pain in a knee, elbow , or other joint at times, but chronic long term pain is another story. This article is going to assume that the reader has joint pain NOT because he (or she) is doing any one of the above seven common mistakes, but has joint pain due to some other factor out of their control. If you warm up and stretch thoroughly, train for no longer than an hour three-four days per week, cycle your weights and reps, take time off when you need it, have good form, take in adequate nutrients, and still have joint problems... then this might be the article for you.

Types of joint problems
There are of course different types of problems that cause common joint pain in athletes and "normal" people alike. Bursitis, tendinitis, various types of arthritis, and other afflictions, can be the cause of a person's aching joints. Briefly, here is a description of the most common types and causes of joint pain that afflict athletes:

Arthritis: There are many different forms of arthritis. The two most common are osteoarthritis and rheumatoid arthritis. Of the two, osteoarthritis is by far the most common to bodybuilders and other athletes. Caused by wear and tear on the joints, osteoarthritis is characterized by a deterioration of the cartilage at the ends of the bones. The once smooth cartilage becomes rough thus causing more and more friction and pain. Left untreated and unchecked, this can become very debilitating for the hard training athlete. Chronic osteoarthritis has ended the career of numerous athletes.

Bursitis: In our joints there are small fluid filled sacks called bursae. The bursae's job is to assist in the muscle/joints movement by cushioning the joints and bones against friction. If these sacks become inflamed and/or injured due to various causes (see above training mistakes), a chronic pain called "bursitis" can result. It's most often found in the shoulder or elbow (A.K.A tennis elbow) but can also be found in other joints of the body. It hurts like hell and can ruin a workout quickly if left untreated.

Tendonitis: Tendonitis is probably the most common cause of pain to bodybuilders and other athletes and is (luckily) the easiest to treat. However, if left untreated and the person just "works through the pain," it can become a real problem that will put a quick end to your gains in muscle. Basically, tendinitis just means the tendon(s) around a joint have become severely inflamed from overuse, micro injury, etc. Though it might sound simple enough, for people who suffer from chronic tendinitis it's no joke and a real pain in the...joint!

Treatment options
Again, this article is going to assume that the reader warms up properly before working out, does not severely overtrain, yada, yada, yada, as mentioned in the beginning of this article. If the reader (you?) is in the gym all day, thinks one set on the bench press is a warm up, and feels anything over 3 reps is high rep training, than you need go no further to find the answers to what's bothering your joints!

The treatment options we are going to look at relate to natural compounds, or mixtures of natural compounds, that could save a person with aching joints years of pain and possibly even more. Unfortunately, the treatments offered by traditional medicine at this time are generally of little use to highly active people. Most of the treatments for joint problems address the symptoms (pain, swelling, etc) rather than the cause and can often make the problem worse in the long run. Non-steroidal anti- inflammatories, cortical steroid injections, joint replacement, and the always useful "stay off it" advice does not tend to yield the results most athletes want.

If you look at the names of the aforementioned types of joint problems, you will notice they all end with the term "itis," as in tendin-itis, arthr-itis, and burs-itis. The suffix "-itis" means "inflammation of " according to The American Medical Association Encyclopedia of Medicine. Knowing this, you can see that bursitis means inflammation of the bursea sack, tendinitis means inflammation of the tendons, and arthritis means....well you get the point. Medical terms for afflictions that end in "-itis" tell us that though the causes and manifestations are different, the final problems is one of inflammation. Inflammation is characterized by pain, swelling, redness, and less obvious symptoms. This leads us finally to our list of natural compounds/products that might just save the joints of the person reading this article who thought their workouts would never be the same because their joints are giving them so much trouble. These products tend to address not only the symptoms of the problem-that is the inflammation-but the underlying causes as well.

Jello Anyone?
As strange as it might seem, the main ingredient (gelatin) in good old Jello might be just what the doctor ordered for painful joints. Gelatin has been market world wide for many years as a food and as a supplement. Gelatin is made from animal collagen. In all animals-including man- collagen is an essential structural protein that forms an important part of bones, tendons, and connective tissues. It is a tough insoluble protein that is essential for keeping the many cells and tissues of the body together.

Gelatin contains an exceptionally high content of two amino acids which play an important part in collagen formation, namely proline and glycine.
In fact, it takes 43 grams of dried egg whites or 35 grams of dried non fat milk or 89 grams of lean beef to equal the amount of proline in just 10 grams of hydrolyzed gelatin. Though the body can form these two amino acids on its own, it has been suggested that under certain conditions the rate of synthesis may be insufficient to provide essential body requirements and degradation can exceed synthetic processes (i.e. there is a steady loss of body collagen). The intake of hydrolyzed gelatin appears to be an alternative route to getting chondrocytes (cartilage producing cells) and osteoblasts (bone forming cells) of the body sufficient amounts of these important amino acids for making structural proteins. Although chondrocytes are critical for collagen formation, their number is limited and their ability to form this much needed protein is influenced by heredity, age, physical activity (too little or too much), injury, and availability of nutrients.

Although bone metabolism is quite complex and not fully understood, there is a growing number of studies showing the intake of just ten grams per day of hydrolyzed gelatin is effective in greatly reducing pain, improving mobility and overall bone/cartilage health. Several randomized, double-blinded, crossover trials have shown improvements in symptoms related to joint pain (Adem et. al. Therapiewoche, 1991). The people at Knox (the Jello people) have made a product specifically for bone health and joints called NutraJoint. It contains hydrolyzed gelatin, calcium , and vitamin C. Calcium is of obvious importance to bone health and vitamin C is an essential and limiting nutrient for connective tissue formation. NutraJoint is cheap, has no side effects, and tastes good. I recommend one packet mixed with OJ with breakfast for people suffering from joint pain.

Cetyl Myrist..what?
A fatty acid with the long and hard to pronounce name of Cetyl Myristoleate has been receiving a good deal of attention by researchers concerned with joint pain and health. Being it's difficult for the reader to pronounce-or for me to write for that matter-I will just call it CMT for the remainder of this article, OK?

Discovered by a researcher at the National Institutes of Health (NIH), CMT looks very promising as a compound that greatly reduces joint pain due to a variety of causes. In animals CMT was found to be very protective of joints from different chemicals that would normally cause arthritis in these animals. Though the human research at this time is not as solid as we would like, CMT has already developed a following with some alternative medical practitioners and by those who suffer from joint pain. Several bodybuilders I work with swear by the stuff though I cant vouch for it at this time as I have had no personal experience with this product. Also, its effects seem to work rather quickly and relatively small amounts can be used. 12-15 grams spread out over an entire month appear to be effective. Exactly how CMT works is unclear but it might have something to do with a reduction in pro-inflammatory prostaglandins (see below) or some other mechanism. EHP Products Inc. makes a CMT product that is endorsed by the researcher who discovered it. They can be reached at 888-EHP-0100. A company called G nS Marketing also sells CMT (they call it CMO) and can be contacted by calling 800-829-1514.

Flax oil for everything!
Many bodybuilders and other athletes are starting to see the many benefits of flax oil for all sorts of uses. One obvious use of flax oil is a reduction in pain due to any type of inflammatory condition, including joint troubles. To understand why this is so, the reader must now endure a crash course in the topic of essential fatty acids and the many products made by these fatty acids found in the body. If you already know all this stuff you can skip over this material, but if you don't know it, you will need this information for the rest of the article.

The definition of an essential nutrient is anything the body cannot make itself and therefore must be obtained from the diet. We need to eat an assortment of vitamins and minerals, approximately nine to eleven amino acids, and two fatty acids to stay alive and healthy. The two essential fatty acids (EFAS) are called linoleic acid and alpha-linolenic acid. The first being an Omega-6 fatty acid and the latter being an Omega-3 fatty acid. If the term "Omega-3 fatty acid" rings a bell for you it should. Fish oils are also well publicized and researched Omega-3 fatty acids (see below) that have been shown to have many benefits. "So what does all this have to do with my aching joints?" you are thinking. Ok, here is the skinny on why you had to endure that previous section. Flax oil is exceptionally high in Omega-3 fatty acids (alpha-linolenic acid). Omega-3 fatty acids, from fish, flax, etc., have been shown in the scientific/medical literature to reduce inflammation of any kind.

Remember the "-itis" part of the word relating to joint problems? How do you think non- steroidal anti- inflammatories work? They reduce inflammation, but they also come with potential side effects and health problems. So how does flax oil do this wonderful thing? From both of the essential fatty acids the body makes something called prostaglandins. Prostaglandins are very short lived hormone-like substances that regulate cellular activity on a moment to moment basis. Prostaglandins are directly involved with regulating blood pressure,inflammatory responses, insulin sensitivity, immune responses, anabolic/catabolic processes, and hundreds of other functions known and yet unknown. The long and the short of all this, without going into a long and boring biochemical explanation, is: Omega 3 fatty acids are responsible for forming the anti -inflammatory prostaglandins and the Omega 6 prostaglandins are responsible for making many of the pro-inflammatory prostaglandins, and other products derived from EFAS. A high intake of Omega 3 oils reduces inflammation (and pain) by this mechanism. Obviously, it's a lot more complicated than that, but hey, I only have so much space to write.

People who add in 1-3 tablespoons a day of flax oil to a protein drink, or over a salad, often notice a reduction in pain in their joints, not to mention all the other great things EFAS can do for the hard training bodybuilder. Flax oil can be found in any large health food store under such brands as Flora, Omega, Barleans, and several other names (Even better than flax perhaps, Udo's Choice oil is a great blend of different oils. More info can be found at Udo's site connected to the links section of this web page).

High quality kitchen sink formulas
I call these products "kitchen sink formulas" because they add in just about everything you could want in a formula for painful joints. Two high quality product of this type that come to mind are the Natural Pain Relief products by Inholtra and The Life Extension Foundation. These products contain Glucosamine(s), Chondroitin Sulphate, the fish oils EPA/DHA, Gamma-linoleic acid (GLA), vitamin E, fat soluble vitamin C (ascorbyl palmitate), and Manganese aspartate. "So what does all this stuff do?" you are asking yourself. Briefly:

Glucosamine is considered by many as one of the best natural products for the treatment and prevention of cartilage degeneration. It is in essential part of cartilage, synovial fluid, and other components of joints. Chondroitin sulphate is related to glucosamine and is part of a family of modified sugars that form structural molecules in cartilage. As mentioned previously, the Omega 3 fish oils (EPA/DHA) are renowned for improving pain and inflammation in joints and other areas of the body. GLA is a fatty acid derived from the Omega-6 class of fatty acids but has been shown to have many properties similar to that of the fish oils/flax oil in its ability to reduce inflammation through the production of the favorable anti-inflammatory/anti-auto immune prostaglandins.

The anti - oxidants vitamin E and C are added because it is well known that free radical pathology is part of the damage that takes place in the joints. Finally, the trace element manganese is needed as a co- factor in many enzymatic processes related to cartilage synthesis and cartilage integrity. Now you know why I call them kitchen sink formulas! Taken singularly, the above ingredients appear to have marginal effectiveness. Taken as a complex, they appear to be very synergistic.

These are very well rounded and complete-though slightly different-formulas for people looking for some relief to their joint troubles, or any chronic inflammatory condition for that matter. However, I have found most people will need to take more than the manufacturer recommends to see real results, though this is not true 100% of the time. The Life Extension Foundation can be contacted by calling 800-826-2114 or http://www.lef.org

Conclusion and Recommendations
If you are one of the millions of people who suffer from chronic joint pain when you hit the gym, first make sure you are not making any of the most common mistakes outlined in the beginning of this article. Secondly, get an opinion from a good sports medicine doctor as to exactly what your problem is. You don't want to self diagnose what could be a serious problem. Finally, start with one of the above products and see if it improves your condition. Wait at least a few months before you make your assessment. Add in a second or third product if you don't think you are getting the results you want, which would be of course less pain and greater mobility through the joint in question. Hey, I never said it was going to be cheap and easy, but if serious joint pain is taking all the fun out of your workouts, it will be worth your time and money. See you in the gym...

Diehl-HW and May EL. "Cetyl myristoleate isolated from Swiss albino mice: an apparent protective agent against adjuvant arthritis in rats." J. Pharm-Sci, 83(3):296-9, 1994.
Cochran C. and Dent R., "Cetyl Myristoleate - A unique natural compound valuable in arthritis conditions." Townsend Letter for doctors, #168:70-74, 1997.

About the Author - William D. Brink
Will Brink is a columnist, contributing consultant, and writer for various health/fitness, medical, and bodybuilding publications. His articles relating to nutrition, supplements, weight loss, exercise and medicine can be found in such publications as Lets Live, Muscle Media 2000, MuscleMag International, The Life Extension Magazine, Muscle n Fitness, Inside Karate, Exercise For Men Only, Body International, Power, Oxygen, Penthouse, Women’s World and The Townsend Letter For Doctors.
He is the author of Priming The Anabolic Environment and Weight Loss Nutrients Revealed. He is the Consulting Sports Nutrition Editor and a monthly columnist for Physical magazine and an Editor at Large for Power magazine. Will graduated from Harvard University with a concentration in the natural sciences, and is a consultant to major supplement, dairy, and pharmaceutical companies.

He has been co author of several studies relating to sports nutrition and health found in peer reviewed academic journals, as well as having commentary published in JAMA. He runs the highly popular web site BrinkZone.com which is strategically positioned to fulfill the needs and interests of people with diverse backgrounds and knowledge. The BrinkZone site has a following with many sports nutrition enthusiasts, athletes, fitness professionals, scientists, medical doctors, nutritionists, and interested lay people. William has been invited to lecture on the benefits of weight training and nutrition at conventions and symposiums around the U.S. and Canada, and has appeared on numerous radio and television programs.

William has worked with athletes ranging from professional bodybuilders, golfers, fitness contestants, to police and military personnel.

Article References:
(1) Farnsworth E, Luscombe ND, Noakes M, Wittert G, Argyiou E, Clifton PM. Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women. Am J Clin Nutr. 2003 Jul;78(1):31-9.
(2) Baba NH, Sawaya S, Torbay N, Habbal Z, Azar S, Hashim SA. High protein vs high carbohydrate hypoenergetic diet for the treatment of obese hyperinsulinemic subjects. Int J Obes Relat Metab Disord. 1999 Nov;23(11):1202-6.
(3) Parker B, Noakes M, Luscombe N, Clifton P. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care. 2002 Mar;25(3):425-30.
(4) Skov AR, Toubro S, Ronn B, Holm L, Astrup A.Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity. Int J Obes Relat Metab Disord. 1999 May;23(5):528-36.
(5) Piatti PM, Monti F, Fermo I, Baruffaldi L, Nasser R, Santambrogio G, Librenti MC, Galli-Kienle M, Pontiroli AE, Pozza G. Hypocaloric high-protein diet improves glucose oxidation and spares lean body mass: comparison to hypocaloric high-carbohydrate diet. Metabolism. 1994 Dec;43(12):1481-7.
(6) Layman DK, Boileau RA, Erickson DJ, Painter JE, Shiue H, Sather C, Christou DD. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr. 2003 Feb;133(2):411-7.
(7) Golay A, Eigenheer C, Morel Y, Kujawski P, Lehmann T, de Tonnac N. Weight-loss with low or high carbohydrate diet? Int J Obes Relat Metab Disord. 1996 Dec;20(12):1067-72.
(8) Meckling KA, Gauthier M, Grubb R, Sanford J. Effects of a hypocaloric, low-carbohydrate diet on weight loss, blood lipids, blood pressure, glucose tolerance, and body composition in free-living overweight women. Can J Physiol Pharmacol. 2002 Nov;80(11):1095-105.

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If you act sanctimonious I will just list out your logical fallacies until you get pissed off and spew blasphemous remarks.

Shoulder Rehabilitation

by Dr. David T. Ryan,
Winner of the Cecil Award, National Arthritis Foundation

Introduction

The most common question that I get asked is how to strengthen an injured shoulder. Some athletes train around a shoulder injury for years, others try every insane treatment, including magnets and various injectables, instead of realizing they can correct the problem with proper training.

The shoulder is the most complicated joint in the body to rehabilitate. Why? It has more mobility and speed than any other joint in the body. The shoulder moves at 5730 degrees per second (dps), approximately 80% faster than the knee at top speed (2000 dps).

Because of its seemingly complex nature, most individuals take up knitting or 12 ounce curls to avoiding training. Recently, I returned a professional hockey player to the ice in just 10 days with a shoulder separation. Previous attempts at shoulder surgery failed to provide shoulder stability, the injury was reviewed and an intense training schedule mixed with some ultrasound and medications was implemented. That's right, a step by step exercise program to increase flexibility and strength. Injuries to the shoulders supraspinatous muscle are the most common sports medical injury.

Many times the shoulder injury will have several additional components, including the back/neck/shoulder girdle, etc. Most good orthopedic surgeons are very reserved about attempting surgery unless there is a major tear, since there is a better chance to rehab the shoulder. For example, when trying to repair a torn pec tendon is associated with how it is made. Most tendons are very fibrous and thick, but the pec tendon looks like Jello flattened out by a rolling pin with parallel strings running through it. Your best chance at repairing partial tears is by rehabilitating the tissue and doing it the right way with plyometric/speed training.

This article will instruct you on how to increase range of motion and strengthen the shoulder area. This article will not allow you to begin diagnosing your lifting pals. It is best to see a chiropractic physician or a good orthopedic surgeon who specializes in shoulders. Beware that not all orthopedic surgeons or chiropractic physicians are created equally. A good general rule is if you don’t see improvement in a couple of weeks, then move on. Try another type of doctor or physical therapist or acupuncturist, etc.

Find a Chiropractic Physician at www.chiroweb.com

Find an Orthopedic Physician at http://www.aaos.org

When a doctor tells you to quit lifting and get on NSAIDS (Non Steroidal Anti-Inflammatory Drugs). Well, since over 16,500 people died in the US from reactions from those drugs you might want to consider using a non-drug approach. (British Medical Journal, June, 1999.) Short-term use of Advil, Aleve, Nuprin, Motrin, Asprin (white willow bark) and other NSAIDS (less than three weeks) are usually safe, but continued use will distroy your protective lining of your stomach and your heart. I have seen several athletes who have been unable to compete or came close to death with long term NSAID use. One of the best NSAIDs - Bextra is one of the safest anti-inflammatory drugs you can use, ask your doctor about it. It is 4000 times more selective, which means it leaves your heart and stomach alone.

Read this article and then take it to your healthcare professional and have them read it.
Please note that most physicians don’t have any training in rehabilitation. Some chiropractors do and most physical therapist are a good place to start then apply other references of this article to your training.

Take on the shoulder Step by Step. Try to workout without passing the 60% pain level. In time your strength will improve and your pain level will reduce.

One of the first steps to understanding shoulder rehabilitation is
learning anatomy. I know it might not be fun, but it is necessary.

BONES 1. Bones of the shoulder
A. Clavicle (Commonly known as the collar bone)
B. Scapula (Also known as the wing bone)
C. Humerus (The upper bone in your arm)

JOINTS 2. There are three joints (where bones come together) of the shoulder region.
The first two listed below make up the shoulder girdle.

A. Acromioclavicular (A-C joint) -- this joint is formed by the upper part of the scapula and the clavicle. Mainly it is active with shrugging movements. When this joint is injured a grading scale of 1 (minor) through 3 (severe) is used to evaluate the degree of separation as seen on a x-ray.

B. Glenohumeral -- the combination of the upper arm bone and the
outside area of the scapula make up this joint. This joint is responsible for most all the movements of the shoulder. Shoulder dislocation always refers to this joint. These can occur in any direction, but the anterior-inferior (forward and down) normally occurs the most frequent.

C. Sternoclavical -- composed of the clavicle (collar bone) and the
sternum (breast bone). This joint primarily operates during the shrugs, although, part of its function is to stabilize the shoulder girdle in place. Normally, this area becomes injured when the entire shoulder girdle is forced backwards or towards the center of the body (like getting slammed into the wall in Hockey).

MUSCLE 3. Muscles of the shoulder.
Here is a simple definition of what they do, in particular how they effect the more common movements such as the bench press.

The rotator cuff (SITS) Supraspinatus, Infraspinatus, Teres Minor, Subscapularis, others muscles of the shoulder include
the Teres Major, Latissimus Dorsi, Trapezius, Pectoriallis Major and Minor; corico- brachiallis, Biceps, Deltoid, Sternocleidomastoid, Rhomboid Minor and Major, Serratus Anterior.

SOME KINESIOLOGY WITH YOUR EGGS?
The humerus (your upper arm) is flexed (drawn forward, bench press) by the Pectoralis major, anterior fibers of the Deltoideus, Coracobachialis, and when the forearm is flexed, by the Biceps brachii; extended (drawn backward, bent-over rows) by the Latissimus Dorsi, Teres major, Posterior fibers of the Deltoideus and when the forearm is extended, by the Triceps brachii; it is abducted (arm drawn away from the body, lateral raises) by the Deltoideus and Supraspinatus; it is adducted (arm is drawn toward the side of the body, like one arm rows) by the Subscapularis, Pectoralis major, and by the weight of the limb; it is rotated outward /external rotation (similar to bent-over lateral raises) by the Infraspinatus and Teres Minor; and it is rotated inward /internal rotation (cable cross-overs) by the Subscapularis, Latissimus Dorsi, Teres major, Pectoralis major, and the anterior fibers of the Deltodeus.1 With the arm over head, any motion is stabilized or controlled by the Coracobachialis. Circumduction (similar to a underarm throw in fast pitch softball) is the combination of the above movements to allow the greatest degree of movement of any joint.

IMPORTANT POINTS ABOUT THESE MUSCLES
•Some muscles are major movers of the joints, others only stabilize.

•If you were to cut away the tendons of the rotator cuff, the
Glenohumeral joint goes from completely closed to a 2.5 cm gap. Now you can
understand how important the rotator cuff muscles are in stabilization of the
shoulder. Some of the research done by Dr. Richard Fisher at OSU (also
Director of Orthopedics, Arnold Fitness/Classic Expo) showed,
the more weight placed on the shoulder in the bench press resulted in a more
stablization of the glenohumeral joint. Less shifting with more weight!

•Muscles are accompanied by surrounding soft tissue, these include bursa sacs,
major ligaments, nerves and arteries. It is possible to have scar tissue associated on any of these structures. It may be necessary in some cases to have a surgical procedure to remove that scar tissue.

Now that we have a clear understanding of anatomy and how it works the next step is learning the steps to evaluating your problem.
Your physician/physical therapist must help you with this phase.

The First step: Find the limited movement.

Movement of a joint is called Range Of Motion (ROM). There are standards or normal movement ranges. Comparing the normal side to the damaged side is an easy way to determine your limits. Some individuals who have injuries on both sides must have a physician or physical therapists assist them in discovering their limits of motion.

There are two forms of ROM:
ACTIVE (AROM)--where you move the joint.
PASSIVE (PROM)--where the doctor moves the joint for you while you relax.

NOTE WHERE THE PAIN OCCURS DURING THE RANGE OF MOTION TESTING, RECORD THAT FOR COMPARISON LATER.

The ranges of motion to be examined are:

• Abduction and Adduction: With the arms straight at your side
raise the arms over your head. (Fig. 1)
• External rotation and Abduction: reach behind your head and
touch the top of the opposite scapula.
• Adduction and Internal rotation: reach in front of your head
and touch the opposite shoulder.
• Internal rotation and Adduction: reach behind your lower back
and raise the arm to the bottom of the scapula.
• Scapular movement: 2:1 ratio of arm abduction to scapular
movement. For every 2° of arm abduction 1° of scapular
movement should also occur. This important area is commonly
overlooked during examination. Frozen shoulder syndrome starts here.

There are other areas of ROM, but these will be uncovered during the next section of muscle testing.

Note any deficiencies or improvement in your journal. Check your progress in the future by comparing your good side to your injured side in a mirror.

The Second step: Begin testing your muscles in particular movements. Realize some of your strength testing can be done in the gym during your workout. You may need to adapt your exercises and use dumbbells to compare one side to the other; However, during rehabilitation bilateral movements (using a barbell) promotes faster strength gains.

The nine motions we are going to test are: Flexion, extension, abduction, adduction, external rotation, internal rotation, scapular elevation (shoulder shrug), scapular retraction (position of attention), shoulder protraction (reaching) and overhead flexion (throwing a ball).

Test these movements with the following exercises

Flexion & scapular protraction: Reverse grip-bench press.
Extension: One-arm bent over rows
Abduction & external rotation: Lateral shoulder raises
Adduction & internal rotation: Cable cross-overs/ Dips
Scapular elevation & retraction: Dumbbell shrugs up and back
Overhead flexion: One-arm dumbbell pull-overs.

Another excellent exercise to consider is the "Rotator Cuff Shoulder Roll." Performed with your arm holding a dumbbell, elbow bent at 90 degrees, upper arm perpendicular to the bench, midway down on a flat bench, only the shoulder blade (Scapula) touching the bench; keep your thumb pointing to the ground as you move the dumbbell from above your head to below your shoulder. (SEE ILLUSTRATION-1) A more advanced way to do this exercise is with a barbell. Grab the barbell a little wider than shoulder width with palms facing inward. Now raise your elbows (keeping your upper arm only rolling- your upper arm is parallel with the ground) start with your forearms pointing down to the ground (like a scar crow). Now raise the forearm in a circular motion, in that you rotate the upper arm, making a half circle as you raise the bar over your head. Keep your elbow at the same height throughout the movement. (SEE ILLUSTRATION-2)

I would strongly discourage you from doing any behind the neck military presses below the earlobe. They tend to separate the shoulder joint to an abnormal degree. Do military presses in front of the neck and not lower than the earlobe.

STAY BALANCED
With all your exercises work on balancing the strength of the joint equally in all directions. An unbalanced joint, especially the shoulder, will eventually cause further injury or ligamentous laxity and osteoarthritis. The head of the humerous will wear on the ball and socket joint and eventually tear the Teflon-like covering in joint called the glenoid labrum.

Write Down your weaknesses in a journal and we’ll cover the correct exercises to

The Third Step: Work on increasing your range of motion.

When your tissue is injured it heals with scar tissue, not fresh new cells, just protein branches called collagen. For about the first three weeks scar tissue is forming therefore, lifting weight too early is counter productive; however, it is quite essential to work on passive then active ROM. You should be aware that once the scar tissue has stabilized you must begin exercising the area with weights as soon as possible. Please note that some research has shown that use of NSAIDS on a repetitive basis results in additional scar tissue formation. Additional research indicates that cross frictional massage and deep tissue massage to the tendon, helps promote new blood vessel growth and speed healing.

INJURY EVALUATION

At this point you should be past the initial 48 hours of ice treatment. Also, you should have been seen by a health care professional to properly assess your injury. After that point, we will discuss each level relative to your range of motion improvement. In other words the more movement without pain the better you are. Your Physician will usually grade your injury as severe, moderate or mild. Remember any NUMBNESS should be evaluated by a doctor immediately. Long term radiating pain or numbness (over six weeks) should be evaluated by a Neurologist prior to exercise. Never train with pain greater than 6 on a scale of 0-no pain to 10-worst pain possible.

Many doctors use several evaluating levels to rate your injury.
If your injury is rated as:

Severe: (As evaluated by a professional).
If this is your diagnosis discuss your use of:
Passive Range of Motion (PROM): Injured joint is moved through a painful range of motion by another person, usually a licensed Physical Therapist. PROM is done for three weeks. Do not lift on that joint for three weeks. You may even need to get manipulated under anesthesia. You can still do isometric exercises twice a day. Contract the muscle for 12 seconds at 60% of your maximum ability for 6 sets. Do 6 different positions in the range of movement.
Then re-evaluate, if your PROM is within 80% when compared to your uninjured side you can begin speed training, if not, you must complete two more weeks of PROM and isometrics until you meet that 80% range. Then move on to speed training.

Moderate: (As evaluated by a professional).
Passive Range of Motion (PROM) for two weeks. You can still do isometric exercises twice a day. Contract the muscle for 12 seconds at 60% of your maximum ability for 6 sets. Do 6 different positions in the range of movement.
Then re-evaluate, if your PROM is within 80% when compared to your uninjured side you can begin speed training, if not, you must complete two more weeks of PROM and isometrics until you meet that 80% range. Then move on to speed training.

Mild: (As evaluated by a professional).

PROM for one week: You should be within 80% of the unaffected side. You should continue to lift, but not if your pain is greater than 6 (scale 0-10) Once your range of motion has returned to normal compared to the opposite side, it is time to begin the speed program.

Keep in mind you are still healing so you need to continue stretching (after a workout is best since the area is warm). The stretch should be held steady for 15-20 seconds and repeated three times. Continued three times a week for the rest of your life. Yes, the rest of your life. When you injure the ligament and muscle, these areas heal with scar tissue. That scar tissue needs to be kept mobile. Over time, with inactivity, the scar tissue will form adhesions and loose what little blood supply it has. Flexibility is just like strength, it is easier to keep the flexibility than trying to regain range of motion. Manipulation or chiropractic adjustments provide maximum full range of motion in the spine and/or extremities, but are no substitute for the athlete doing self-stretching.

Always continue to train the opposite side even though you can't train the injured side. This actually helps you recover the injured side quicker. 4

STRETCHING REHAB
Various forms of stretching are rather aggressive. Propreoceptive Neurofacilitation (PNF) is one of the best ways to overcome many chronic limited range of motion. This is a type of stretch where you contract the muscle very hard to cause it to fatique and then you use the antognistic reflex to allow the muscle to lengthen. Sound confusing? There are two references at the end of the article for text on stretching; get them, read them, do them. More than half of the chronic athletic injuries out there could be helped by simply having the person begin a prescriptive PNF stretching program.

STRENGTH REHAB
Strength: (Rehabilitation) To begin only after a professional consultation and return to exercise has been approved by your physician. ROM should be 80% of the unaffected side or of normal range of motion.

PUTTING IT ALL TOGETHER

Now, if you thought the previous part was tough, get up, pour a glass of filtered water with ice and get ready. With rehabilitation various parameters of the lift allows you to control the level of rehabilitation you are in. These parameters include:

1. Frequency: How often you lift.
2. Sets: A group of repetitions.
3. Repetitions: Lifting through a range of motions and return to the starting position.
4. Weight: Using less is better. Better to contract the muscles in the shoulder while performing the
movement.
5. Speed of movement: Speed of reps. Slower is better in the early phase.
Increased speed must be explosive as you progress.
6. Rest period: Time between sets. More rest between sets at the early phase, less at the end.
7. Amount of movement (Range of motion): Detailed later in this article
8. Intensity: How hard you try

The most common mistake that everybody makes is lifting too much weight too early and doing reps too fast. We will review the two most commonly misused parameters for rehabilitation with weights; speed and ROM. Follow the advice to the letter if you want to continue to improve your strength. If you don't follow the protocol, you will eventually plateau off in your strength prior to your maximum pre-injury strength. If you have already plateaued in lifting strength, start by dropping your weight in half and follow one of the following protocols to regain and improve your strength. Just a brief mention to you employers out there: (QUICK HINT) Have some type of light duty work available to your workers, it allows them to return to full duty quicker.

REHAB LEVEL ONE – RANGE OF MOTION (ROM)
The first variable we will adapt is the ROM. When an injury occurs the body splints the area with muscle spasm to prevent further injury. This spasm restricts the range of motion. You must regain as much joint mobility as possible after an injury to prevent the onset of arthritis and/or athropy. Osteoarthritis (Os-tea-O-arth-ri-tis) is the most common form of arthritis. It is merely the body forming calcium growths to stabilize an unstable area. Arthritic changes can begin as early as one week after an injury. Unnecessary immobilization of the shoulder can arthritic changes as quickly as two days. 5

Most physical therapists recognize five phases of rehabilitation. Range of motion is closely coordinated with the progression of exercise.

Phase 1: Forming complete passive range of motion
Phase 2: Initiating movement, muscular contraction
Phase 3: Initiating movement with full active range of motion
Phase 4: Strengthening with full range of motion
Phase 5: Functional rehabilitation: The special action of retraining the athlete to their level of previous competition speed.

REHAB LEVEL TWO – SPEED OF MOVEMENT
As range of motion improves, you will need to improve the joints speed of improvement without pain. As movement begins with weight we usually follow these steps:

Phase 1-3 Slow - partial movement (isometric)
Avoid training painful areas with weight. Begin by contracting the muscle (isometrically) for six seconds at 60% (a little more than half of what you can do before you feel pain begin). Repeat for 6 sets resting one minute between sets. Train around the painful area of movement. By training around the areas of pain this allows you to actually effect the injured area since there is a physiologic overlap of about 15 degrees beyond the ROM, to each side of the area you training. 6 Once you have obtained 80% of your AROM most physicians will instruct you to proceed to the next phase.

Phase 4 Slow - complete movement (isotonic)
Fast - partial movement (isokinetic)
Slow movement with weight, full range of motion. Then shorter movements with quick contractions in the middle of the ROM.
See illustration (a picture here of a curl with the whole ROM in blue, like a sweep, with a middle range of motion in red would-demonstraighting movement in the center about 60 degrees, would be easiest to understand)

Phase 5 Fast - complete movement (isokinetic)
Special machines called Orthotrons (Orth-o-trons) are designed to allow you to exercise over a particular range of motion at a particular speed. This is where the value of a well equipped rehab facility and a well trained physical therapist is judged. You aren’t likely to find machines like this in a gym, they are very expensive.

Slow movement (six seconds concentric-up, six seconds eccentric-down).
mid-Fast movement (two seconds concentric, two seconds eccentric).
Fast movement (less than one second concentric, less than one second eccentric).

~~Wondering if the slow movement (Constant motion-NO SHOCK) really works, Joe Montana returned to the football field very quickly when it was used on his lower back injury. ~~

Eventually you want to move explosively fast, slowly increase your speed as well. This helps coordinate the muscles to work together at faster speeds which resembles true athletic activity and causes the muscles to grow in a way that strengthens there connective tissue. Realistically, you should train like this at least once a month for the rest of your life to work on only explosive (plyometric) movements. For example if you typically bench 315 then you should try doing 135 for 8 sets of 8 reps with only 30 seconds between sets. Moving the bench press so fast that you are doing about two reps per second. This plyometric training thickens the ligaments and tendons. It is necessary to do this to improve the strength of the area. You can also judge it by doing a push up and trying to clap your hands after you have pushed yourself off the ground. As you improve you can try to clap your hands twice before lowering back to the ground. I have never seen a shoulder problem exist after an athlete can clap twice on a push up for 25 reps.

USING STRAPS FOR SPEED
Training with rubber straps will allow for constant tension during high speed training. You must have some experience using them and one of the best groups around to explain this is Westside Barbell and Elete Fitness Systems. Look you can either buy the straps for less than a hundred bucks or buy an Orthotron machine starting around $200,000.
Contact them at http://www.elitefitnesssystems.com/

Lastly, the importance of training for speed is involved with the speed of the shoulder. You need to coordinate your muscles to work at higher speeds. Explosiveness is more important than strength in any sport. Ever try to stop a tiny “speeding” bullet?


Putting together your functional rehabilitation program

Weight, Sets and Reps: Get out the calculator and the pencil cause here comes the math. Start with how often you should train an injured joint? In a study done by Matthews in 1957 and redone in 1981, research found that if you rehabilitate 5 days a week is more beneficial than only training 4 or 3 days a week. Both studies only used a five day work week not a six or seven day program (couldn’t get the researchers to work weekends). Since Dr. Don Matthews was a professor and friend of mine, I feel that I can extrapolate off this study and suggest that you work the injured area 7 days a week until you reach phase 5, then reduce to 3 then 2 days a week. You can train more frequent due to the reduced intensity of rehabilitation and your body will recover much faster than doing high intensity body- building.

More technical stuff

Zinovieff, DeLorme-Watkin and McQueen are just a few of the techniques that explain how many Sets, Reps and the amount of weight you should use. They all base their principles on the progressive resistive theory. In general, most recommend ten repetition maximum. As far as how much weight to use? Enough to just get ten reps! Real tough, Huh? Some of the best results increase the number of sets you perform as your shoulder strengthens. In other words, you start with doing 3 sets, once you are able to perform 11 reps on your last set, simply add a set until you are doing 5 sets. When you can perform 11 reps on your last set, then add 1 to 1.5 pounds and drop your sets back to 3. This allows you to work on strength first and then develop speed and endurance. One of the important factors in healing an injury is to promote increased circulation in the scar tissue. Remember, if you are board with your rehab program, you are probably right on track. You should always leave and feel that you could do more.

Here is an example of how a program should progress:

Exercises: Dips, cable cross-overs, reverse bench press and Pullovers.

Day 1 2 3 4 5 6 7
Weight (#'s) 10 10 10 10 11 11 11
Sets 3 4 4 5 3 3 4
Reps 10-10-11 10-10-10-8 10-10-10-10 10-10-10-10-11 10-10-8 10-10-10 10-10-10-10
Speed slow slow slow slow faster fast fast

OTHER EXERCISES THAT ARE USEFUL ARE:
Floor Presses are done by lying on the floor with your legs straight, lowering the weight and resting/relaxing on the elbows for a second then pushing the weight up. Similar to box squats. It is sort of a plyometric training that allows for increased coordination of the muscles and increased fiber recruitment. This exercise can be modified by returning to the bench and placing various thickness of boards on your chest and resting the weight on the board, then quickly pressing the weight off. This technique is commonly used by the members of Lou Simmons's West Side Barbell (Where most world record holders train), who also constantly vary their grip. Simply find your weak point in the movement of the bench press or military press and work on the plyometric program from there. This is also sometimes referred to as pin presses however the use of a cage and pins is not as realistic as the free form bench press movement. Remember that this is a quick movement and requires you to be in the Phase 5 level of rehab. You must lower the weight slowly to the floor and then explode the weight to the top. This is great for a majority of injuries such as the Torn Pec, separated A-C, rotator cuff tear, etc.

Use bands to train

Pullovers- (Straight Arm) exercise works the coricobachialis, which is responsible for a majority of the stabilization of the A-C joint.

Bicep Curls- should be modified to bring the bar to your forehead at the end of the movement. The bicep helps stabilize the A-C joint better when the arc of the movement ends with the bar at your eyebrows.

Rotator Cuff Roll - see prior description in this article.

Reverse grip Bench press-Like it says your grip is backwards, this forces you to keep your elbows in to your sides and lower the bar to your stomach, (hint, this movement will help you overcome bad bench techniques which halt your progress) varied width is also used on this movement.

Dumbbell Fly/Press- which ever hurts the most.
Once your strength is approximately 80% of your preinjury strength it is time to increase your speed of movement (phase 4).

Partial movements/Lock-outs Bench press- by simply holding more weight than you normally bench as a PR, you build psychological confidence and you will stabilize the golgi-tendon organs (little switches located in your tendons that tell your brain that the weight is to heavy and cause your muscle to let go). It is very important to overload after an injury since the golgi-tendon organ is very hypersensitive to weight.

That's it No tricks, No gimmicks, just hard work and lots of it. Each program requires some modification so check with your physician if you note any of the following:
•Pain in the chest (clutching-type pain)
•Radiating pain in the arms, wrist or hands.
•Any numbness
•If your strength doesn't increase 14% in 4 weeks

Continue utilizing the suggested exercises until you die or the take the evening news off the air, which ever comes first. You may be avoiding Bench day or hate shoulder day since the strength is gone or the pain is too much. Try the above stated program in its entirety; you have a lot to lose if you don't. Many of the principles explained will apply to the rehabilitation of all the joints after injury. I recommend that you discuss you progress with your physician to best accommodate your exercise program.


Working out with less pain
Several other medical approaches may assist with a more painless workout.
Arthroscopic surgery-is a simple technique of cleaning off the rough edges on the tissues to allow them to work with less friction. Recovery is quick and usually uncomplicated.
Acupuncture – needles!!!! Calm down, it is painless, this technique uses the stimulation of some nerves to calm others down, this is a retraining treatment and requires several visits to work; however, you should see some improvement within a few visits. A word of caution, states vary in their requirements for license. Some of the best training is with Doctors of Oriental Medicine (DOM) and MD or DO and DC’s. Several Medical schools are beginning to teach this technique. Remember the Chinese have used this as a main form of medicine for over 11,000 years.
Supplements-Most effective from the literature and my personal experience are products with Glucosamine Sulfate and Chondrotin Sulfate and MSM (Organic Sulfur). Now please note you shouldn’t take herbs with medications unless you check with your pharmacists. Not your doctor-your pharmacist. Also note that taking NSAID’s (Advil, Motrin, Ibuprophin-containing drugs) will lower your Sulfur content and cause more scar tissue to form and also lower the effectiveness of the aforementioned chemicals. Note also that the Center for Disease Control, Atlanta, GA. Indicated that in 1998, that 16,500 deaths were associated with the use of NSAID’s. Bextra is a newer NSAID that is out, which is 4000 times more selective, meaning that it leaves your heart and stomach alone.

Bio
Dr. David Ryan, practices in Columbus, Ohio at the Columbus Chiropractic Centers and was a team physician for three of the capital cities' pro teams. Medical Director, Arnold Classic and Fitness Expo, the 1994/1995 WPC World Powerlifting Championships. Ring side Physician USA BOXING. Former assistant Strength Coach, Ohio State University. In 1994 the Arthritis Foundation honored him with a national award. He also works with professional football, basketball, rodeo and various professional and Olympic athletes. Send questions in a self addressed/stamped envelope to 5870 Cleveland Ave. Columbus, Ohio 43231

Dr. Richard Fisher (Orthopedic Surgeon) practices in Columbus, Ohio (again, thank god) he is the orthopedic director of the Arnold Classic/Expo.

Bibliography

1. Gray, H., Goss, C.M. (Ed.): GRAY'S ANATOMY, PHILADELPHIA,
PENNSYLVANIA: Lea & Frebiger, 1976.
2. O'Donaghue, D.: TREATMENT OF INJURIES TO ATHLETES,
PHILADELPHIA, PENNSYLVANIA: W.B. Saunders, 1976.
3. Hellerbandt, F.A., et al: Influence of Bilateral Exercise on
Unilateral Work Capacity. Journal of Applied Physiology, 2:
446-452, 1950.
4. Moore, J.: Excitation Overflow; An Electomyographic Investigation
Archives of Physical Medicine and Rehabilitation, 56:115-
120,1975.
5. Videman, T.: Experimental Models of Osteorthritis: Role of
Immobilization. Clinical Biomechanics, 2: 223-229, 1987
6. Davies, G.J.: Compendium of Isokinetics, S & S Publishers, 1984.

Suggested Reading

Voss. D., et al: Proprioceptive Neurofacilitation: Patterns &
Techniques. PHILADELPHIA, PENNSYLVANIA: Harper & Rowe, 1985.

Glossary

Tendon-The tissue the connects the muscle to the bone.
Rehabilitation-Scientifically designed exercise program for injuries or illnesses.
Arthritis-Deterioration of cartilage and general wear on the joint surfaces, due to a ligament's instability.
Atrophy-Shrinking of tissues like muscles.
Range of motion-The distance that a joint allows the bones to move in.
PNF- Proprioceptive Neurofacilitation, a complex stretching technique (read the book).

http://www.elitefitnesssystems.com/d...lder-rehab.htm

The repeated running cycle of pounding and push off results in muscle fatigue, which may then lead to higher forces being applied to the fascia, the attachment of fascia to bone, and finally the bone itself. Respectively, this represents a spectrum from mild to severe. On the relatively more severe end of the scale the injury may progress from stress reaction within the bone to an actual stress fracture.

In the early stage of shin splints a runner will describe a pain that is present when the training run first begins, but then disappears as running continues. The pain will often return after exercise or the following morning. As the injury progresses the athlete will experience more time with the pain, and less time without it. There is frequently a tender zone along the medial edge of the tibia that one can map out by pressing with the fingertips as they “march up” along the bone. Eventually, if ignored and training continued, the pain may become quite sharp and may focus on a very small area of the bone. If this happens a stress fracture should be considered.

The treatment for shin splints is rest. Depending upon severity it is often necessary to completely stop running for a period of time. Generally this is done until day-to-day activities are pain free. When running is resumed – and this is where many injured runners make a mistake – it must be significantly different from the routine that lead to the injury. The concept of relative rest employs lengthening the interval between training as well as decreasing the volume and intensity of training. One can often substitute cross-training activities (e.g., bicycling) for running to help increase the interval between running days. There should be a graded and gradual increase in run training, keeping an eye out for the return of any shin splint symptoms.

Stretching and strengthening the calf muscles can help prevent the injury from returning. However the most important preventive strategy is not to repeat the mistakes that lead to the injury. Examine all the training variables – surface, shoes, training volume, intensity, workout type, hills, weather conditions, etc. Seek help from a qualified trainer or coach. This all takes time and effort, but it is well worth it.

Now skip on your heels
Once the skipping exercises are comfortable, try some light skipping on your heels. Gradually build up your ability to heel-skip with toes straight ahead, pointed out, and pointed in for 20 metres at a time. Heel skipping is a great way to build dorsiflexor strength, but carry it out only on a padded or grassy surface to avoid impact injury to your heels.

5. Once you've completed your walking, jogging, and skipping routines, it's time for rhythm bounding. This isn't the kind of bounding you're probably envisioning - we don't mean progressing forward with extra-long strides, at least not at first. Rather, you should jog along with very springy, short steps, landing on the mid-foot area with each contact and springing upward after impact. As you rhythm bound, your ankles should act like coiled springs, compressing slightly as you make your mid-foot landing and then recoiling quickly - causing you to bound upward and forward. Move along for 20 metres or so with these quick, little, spring-like strides, alternating right and left feet as you would during running. After 10 to 20 metres of regular jogging, rhythm bound for 20 more metres, alternating three consecutive spring-like contacts with the right foot with three with the left. After 10 to 20 more metres of regular jogging, close the set by bounding along for the full 20 metres on your right foot only, followed by 20 metres on the left (making certain that you land on the mid-foot area with each ground contact and that your ankle area, not your knee or hip, is doing most of the work). Make sure (at least at first) that all of this is done on a padded surface or soft grass. As you become stronger and more skilled, you can increase the length and amplitude (vertical height) of each bound and include additional sets of bounds (work your way up to four sets).

6. Complete some 'dorsiflexion bounces'. To do these, simply begin jumping vertically and repetitively at close to maximal height, landing in the mid-foot area with both feet and then springing upward quickly after each contact with the ground. The interesting part of this exercise is that you should dorsiflex your ankles - pulling the tops of your feet toward your shins - on each ascent, before plummeting back toward earth and plantar flexing your ankles just before making contact with the ground. Do 10 dorsiflexion bounces, rest for 10 seconds or so, and then repeat. Over time, you can add additional sets and increase the number of reps to 30. When you are really strong and skilled, perform this exercise on just one foot at a time, but only on a low-impact surface.

7. Finally, carry out rhythm bouncing. Rhythm bouncing is actually just jumping around, but what jumping! You should start with 10 jumps in place, moderately fast, with medium height, and with maximal motion at the ankles - but little flexion and extension at the knees and hips (over time, you can work up to 30 jumps). Then, after resting for a few seconds, change the amplitude (height) of your jumps to less than an inch, and complete 20 jumps as fast as you possibly can (pretend that your feet are hitting a hot stove - so that you must minimize your impact time with the ground). Again, almost all of the action should take place at your ankles, not at your knees and hips. As you become more skilled, work up to 40 quicksilver jumps.

After resting for a few seconds, complete five 'high-impact' jumps, increasing the amplitude (vertical height) of your jumping as much as possible. Over time, progress to 30 of these maxi-jumps.

So far, all of the rhythm bounces have been carried out in place, so make things interesting by jumping forward and then backward as quickly as possible. After you have made 20 'contacts' (each time your feet strike the ground is one contact), rest for a few seconds and then jump from side to side for 20 contacts. Rest again, and then jump in a direction which is about 45 degrees from straight ahead, alternating directions (first towards the right, then towards the left) for 20 contacts as you move ahead in a zig-zag manner. Remember to use your ankle muscles to propel you, not the big muscles at the knees and hips.

As you gain skill and strength, you can increase the number of sets of each type of rhythm bouncing from one to three, and then - the fun part - carry out each type of bouncing on one foot only. Moving in different directions as you bounce increases the ability of your shin muscles to handle all of the forces created during running - the side-to-side and rotational stresses, in addition to the less-overlooked front and back forces.


Other considerations
Of course, carrying out these exercises doesn't mean that your risk of MTSS is zero. If you suddenly change your weekly volume of running from 25 to 75 miles because you've been bitten by the marathon bug, for example, something will have to give, and it might well be your shin muscles and tendons. So, be certain to avoid dramatic changes in the frequency, volume, or intensity of your training; always gradually progress to more difficult levels of work.

Sports-medicine experts often recommend stretching the ankle area by slowly moving the ankle to 'each' end of its range of motion in the straight-back and straight-ahead plane, eg, to the fully dorsiflexed and then completely plantar-flexed positions, holding each position for anywhere from five to 60 seconds. The problem with that, of course, is that you are only stretching your muscles in one plane of motion and thus not adequately mimicking the stretching which takes place during running. At the very least, in addition to carrying out the plantar-flexed and dorsiflexed stretches, you should also stretch each ankle by fully rotating it outward and inward - and by plantar flexing and dorsiflexing the ankle while the foot is pointed both outward and inward to various degrees - not just straight ahead.

The experts also recommend strengthening the ankle area by adding resistance to the above stretching movements with the use of surgical tubing or elastic bands. That is indeed a way to increase general strength of the ankle, and it will certainly make you stronger when you carry out surgical-tubing exercises in the future. The problem, of course, is that you run with your feet on the ground - not poised in the air in the clutches of elastic bands. So, to fully prepare your ankles and shins for the rigours of running, you're better off focussing on the specific exercises we are recommending.

Does stretching actually help to prevent MTSS? No scientific evidence indicates that it does, but the idea that stretching might be protective is a logical one (overly taut muscles seem more likely to be damaged by pulling forces, compared to relaxed fibres). Don't stretch your ankle area until after your muscles are warm, however; a good time would be after a warm-up and/or at the end of your training session.


Other lower-leg injuries
Of course, all problems in the lower part of the leg are not necessarily examples of MTSS. In particular, two conditions - compartment syndromes and tibial stress fractures - can sometimes be confused with shin splints.

Compartment syndromes owe their name and origin to the fact that the leg muscles are not simply loose straps which run from bone to bone. In reality, the muscles are often grouped together into little sections of the leg which are enclosed by a tough wrapper of connective tissue. Such an arrangement of muscles tucked into a wrapper is called a 'compartment'.

During the act of running, excess fluid can build up within one of these compartments, putting pressure on muscle fibres, nerve cells, and blood vessels - and also causing a great deal of pain. Frequently, the pain will be so severe that a runner must curtail a workout or come to a standstill during a race. And the pain will usually be accompanied by the two telltale symptoms of a compartment syndrome - numbness and weakness.

Numbness occurs because the excess pressure within a compartment hampers the activity of sensory nerves carrying messages to the brain. As a result, the runner with compartment syndrome may lose feeling in the 'web' of the foot - between the first and second toes, or the insensitivity may extend up the foot toward the ankle. Weakness is experienced because motor nerves carrying impulses towards the muscles are also damaged by the high pressures within the compartment. If a compartment in the front of the leg is involved, a runner may have trouble dorsiflexing the ankle, and the foot may seem to flop loosely. In a posterior-compartment problem involving muscles in the back of the leg, there is often weakness when an individual tries to 'toe off'.

If you truly have a compartment syndrome, you will usually observe swelling in your lower leg which tends to subside when your leg is elevated. A doctor can tell for sure if you have this troubling problem by placing a catheter into one of your compartments and measuring pressure before, during, and after running (you will usually have to run long enough to produce pain during this test).


What about stress fractures?
Stress fractures are small breakdowns in bony tissue, and tibial stress fractures, which are sometimes confused with MTSS, are the most common of all stress fractures in athletes, accounting for about 50 per cent of the total. In addition to producing a lot of pain, stress fractures can actually progress into dislocation fractures, in which two parts of the bone actually separate. Stress fractures also may be 'warning signals' for an underlying nutritional or hormonal problem.

Unfortunately, traditional X-rays often fail to detect stress fractures, so a more costly procedure called a bone scan must frequently be performed to confirm the diagnosis. In a bone scan, radioactive material is actually injected into the blood. Bony tissue which is remodelling and rebuilding itself at the site of a stress fracture will accumulate more of this infused radioisotope, causing the affected bony area to show up as a dark splotch on a 'scintigram'. While it's often said that stress fractures take two to three months to heal, up to six months may be required to restore the bone to normal and remove most traces of pain, and a few athletes need more than a year to fully recover.

Sometimes called 'crescendo pain,' the agony associated with stress fractures tends to build up steadily during running, beginning as an annoying irritation and becoming a throbbing torment as an individual continues to run. There is usually little of the numbness, weakness, and swelling associated with compartment syndrome, and pain is usually not present when an athlete is at rest. Often, the bone will hurt when it is tapped near the damaged area, and occasionally a hard nodule will appear on the surface of the bone at the trouble site.

If you're diagnosed with a stress fracture, you should be sure to have a nutritional analysis carried out (your problem might be the result of inadequate calcium intake or poor calcium absorption). In addition, athletes who develop stress fractures should get their sex-hormone levels checked (adequate testosterone concen-trations in males and oestrogen levels in females are required for optimal bone maintenance).

How can you differentiate MTSS from stress fractures and compartment syndromes? The pain of MTSS is usually less localized, compared to stress-fracture pain (it tends to run up and down a region of the lower leg near the tibia), and usually can't be produced merely by tapping on the tibia. In addition, MTSS produces none of the numbness associated with compartment syndromes.


How long does MTSS last?
If you are unfortunate enough to come down with MTSS, your recovery period will usually last from one to six weeks, depending on how severely you are stricken. If you have a mild case of MTSS (your shin hurts moderately, and only after workouts), immediately cut your weekly mileage by about 30 per cent, and start doing our recommended exercises (we're assuming that your busy schedule prevented you from carrying out the routines faithfully, allowing MTSS to crop up). Start easily with the exercises, doing only one set of each, and stop if you feel any pain. Ice the affected area down thoroughly after activity, and of course keep the whole area as loose and flexible as possible. Within a week or two, you should be able to get back to your normal training, but be sure to carry out the shin-splints-preventing exercises steadfastly.

If you have a somewhat tougher case of MTSS (mild pain crops up during workouts but doesn't seem to slow you down much), trim weekly mileage by around 50 per cent, ice and stretch religiously, consider taking non-steroidal anti-inflammatory medications (but only if you are not prone to the gastrointestinal upsets which have been linked with these compounds), and become a devotee of our shin-strengthening exercises (start gradually with them, though, since they can further inflame tender shins if overdone). Use bicycling workouts to maintain fitness. In two to three weeks, you should be ready for regular training.

If your MTSS produces sharp pain while you are training, stop all running workouts, ice and stretch, take NSAIDS as directed by your doctor, and - when pain subsides - systematically begin utilizing our exercises, starting with a few two-legged wall shin raises at first and gradually progressing to the others. Use the exercise bike to maintain fitness, and return to normal training in four to six weeks.

Remember that if you carry out our shin splints treatment routine several times a week and refrain from making bizarre and sudden changes in your training, your encounters with MTSS should drop to a frequency rate of zero.

Owen Anderson and Walt Reynolds

Here are some in depth articles on shoulder pre-hab:

Shoulder Savers Part One
Shoulder Savers Part Two
Shoulder Savers Part Three

http://www.t-nation.com/readTopic.do?id=538204

Giving Injuries the Cold Treatment
Bryant Stamford, PhD
THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 3 - MARCH 96

When you sprain your ankle or have a similar injury, tissue is stretched and torn, and swelling occurs. Swelling interferes with healing, so anything that will prevent or reduce swelling should help you recover from a minor injury more quickly.

The sooner you attend to swelling after an injury the better, and the best approach is to apply cold directly to the injured area right away. (See "A Time for Cold, a Time for Heat") Cold shrinks the blood vessels, which reduces bleeding in the area and helps to prevent swelling. It also helps prevent the muscles from going into spasm (involuntary contractions) and relieves pain.

The use of cold as a treatment is as old as the practice of medicine, dating back to Hippocrates. Today, methods of applying cold are more advanced than they were in 400 BC, but the principles and the need for precautions are the same. When you apply cold, the skin will initially feel cold, often followed by relief of pain from the injury. As icing progresses, you will feel a burning sensation, then pain in the skin, and finally numbness.

To avoid skin damage, stop when the skin begins to feel numb. (This is different, though, from the "numbness" you feel early on as the cold relieves injury pain. Keep icing after this pain subsides.) Applying too much cold for too long can cause frostbite or even nerve damage. Also, cold treatment is not for everyone (see "When to Avoid Cold Therapy").

The length of time you apply cold will vary depending on the method and location of the injury (see specifics below). Areas with little body fat (like the knee, ankle, and elbow) do not tolerate cold as well as fatty areas (like the thigh and buttocks). So, for bonier areas, keep to the low end of the recommended application ranges listed below.

For best results, apply cold at regular intervals throughout the waking hours of the day, allowing a few hours between treatments. Time off will keep cooling effects from accumulating and will allow the skin to return to normal temperature. An ice bag remains—for good reason—the cool treatment of choice for most people, but several options exist:

Ice Bags
Strengths: Ice bags are the old standby for applying deep, penetrating cold. Fill a bag made of thick plastic, rubber, or moisture-proof fabric with ice and apply it directly to the skin. The cooling effect of ice bags lasts long and is more effective than some of the superficial methods like ice massage. If you use a regular plastic food bag, place a thin towel (like a dish towel) between the bag and your skin.

Weaknesses: A shortcoming is getting the bag to contour to the curves of the body for maximum application. The bag will mold better if you don't fill it completely with ice or if you use crushed ice. An alternative is to use a bag of frozen peas or corn. The bag will conform nicely to the injured part of the body. Place a thin towel between the bag and the skin.

Application time: 10 to 30 minutes, depending on the body part and comfort.

Gel Packs
Strengths: Cold gel packs contain a special gel that can be frozen and refrozen. Just store the packs in the freezer until needed. The gel remains flexible when frozen, allowing it to contour to the injured body part.

Weaknesses: Cold gel packs will cool the skin faster than ice bags and so deserve greater caution. Never apply them directly to the skin—always wrap them in a towel.

Application time: No more than 10 minutes at a time.

Chemical Cold Bags
Strengths: Chemical cold bags stay at air temperature until squeezing the bag and mixing the chemicals produces cold. They work well on the field or in the wilderness.
Weaknesses: The degree of cold produced by the chemical reaction is not great. Even so, the bags provide a good first-aid approach.

Application time: Because the temperature is not that low, a 30-minute application should not be a problem, and the bag can be applied directly to the skin.

Immersion
Strengths: Immersion entails placing the foot, hand, or elbow in icy water filled with crushed ice or ice cubes. This technique provides very complete and concentrated cold exposure to the entire injured area.

Weaknesses: Body parts besides the foot, hand, and elbow do not lend themselves to immersion, because too much of the uninjured area is exposed to the cold.

Application time: 10 to 20 minutes. Let comfort be your guide.

Ice Massage
Strengths: Ice massage involves rubbing ice on the skin with a circular motion. It is easy to apply and focuses the cold on the injured area. A useful approach is to fill a paper or foam cup with water and freeze it until needed. Then peel away the top to reveal the ice and hold the bottom of the cup to apply. Ice cubes or chunks can also be used.

Weaknesses: The cold tends not to penetrate as deeply nor last as long as the methods listed above.

Application time: When applying to bony areas such as the ankle, apply for only 7 to 10 minutes. Double the time when applying to fatty areas such as the thigh or buttocks.

Combination Treatment
To maximize the benefits of cold therapy, think RICE: rest, ice, compression, and elevation. So in addition to cold therapy, rest your injury, apply elastic wrap snugly, and keep the injured area raised. New technologies combine RICE aspects. Cold tape, for example, compresses and-because of a chemical reaction-applies cold to an injured part.

Putting Injuries on Ice
Whichever method you choose, remember to ice early, ice often. But not too often. To avoid harmful effects like frostbite, let your skin recover between cold applications, and listen to your body.

A Time for Cold, a Time for Heat
There has been controversy over the years as to when to apply cold and when to apply heat. Because heat stimulates blood flow, it promotes healing just as cold does. It can also relax muscles and ease pain.

But heat can make swelling worse. That's why cold is best right after an injury and heat is recommended for later, when swelling abates. As a rule of thumb, use ice for at least 48 hours after injury. Then, when the swelling is gone, you can apply heat.

When to Avoid Cold Therapy
Using cold therapy may not be a good idea for some people. Those who are very sensitive to cold will not be able to tolerate icing long enough to do any good. Conversely, those who have a high tolerance to cold-or who pride themselves on being "tough"-open themselves to injury by applying cold therapy too long.

People with problems in the blood vessels near the skin should avoid cold therapy, especially those with Raynaud's phenomenon (a condition in which the blood vessels in the fingers, toes, ears, and nose constrict dramatically when exposed to cold and other stimuli). If you suspect you may be at risk because of diabetes or another condition that can diminish blood flow, check with your doctor before applying cold to an injury. (Back to article)

I've heard of DMSO but have never used it. If you have anything on it (and aspirin) feel free to post it!

The inflamation question is really one of those on-going questions. Like you said it would seem necessary up to a point. The problem is where that point ends is not clear. What seems to happen is that when inflamation is blocked you seem to get faster healing and a quicker return to activities. BUT where the natural process of inflamation is allowed to run it's course you get a better long-term outcome. Provided of course proper treatment and re-hab was adhered to. Better mobility, etc. This is by no means definitive as I said.

On old injuries with build up of scar tissue you've hit the nail on the head. You have to break it down and get rid of it. But it would be more accurate to say it has to be "remodeled". And that's the rub. It could be that this remodeling process, i.e. the laying down of healthy functional tissue, if this can be accomplished at all, is mediated by the inflamatorie process.

Anyway, i'm just talking. Anything you have you feel would be of use, lay it on us!

Hey, Eric...

Here r some refs 4 DMSO...


just use the menu at left to navigate:


http://www.dmso.org/index.html


http://en.wikipedia.org/wiki/Dimethyl_sulfoxide


someone else said they had used it but with no results...since it is a solvent, and efficient at tranporting other substances to the cells, even as a topical application, i combined it with aspirin and found it 2 b effective as both an analgesic and anti-inflammatory in treating my AC strain.


-jaems

Thanks!

Ruptured Tendon Overview

A tendon is the fibrous tissue that attaches muscle to bone in the human body. The forces applied to a tendon may be more than 5 times your body weight. In some rare instances, tendons can snap or rupture. Conditions that make a rupture more likely include the injection of steroids into a tendon, certain diseases (such as gout or hyperparathyroidism), and having type O blood.

Although fairly uncommon, a tendon rupture can be a serious problem and may result in excruciating pain and permanent disability if untreated. Each type of tendon rupture has its own signs and symptoms and can be treated either surgically or medically depending on the severity of the rupture and the confidence of the surgeon.

The 4 most common areas of tendon rupture are as follows:

Quadriceps

A group of 4 muscles, the vastus lateralis, vastus medialis, vastus intermedius, and the rectus femoris, come together just above your kneecap (patella) to form the patellar tendon.

Often called the quads, this group of muscles is used to extend the leg at the knee and aids in walking, running, and jumping.

Achilles

This tendon is located on the back (posterior) portion of the foot just above the heel. It is the site of attachment of the calf muscle (gastrocnemius muscle) to the heel of the foot (the calcaneus bone).


This tendon is vital for pushing off with the foot (this motion is known as plantarflexion). The Achilles helps you stand on your tiptoes and push off when starting a foot race.


Rotator cuff


Your rotator cuff is located in the shoulder and is actually composed of 4 muscles: the supraspinatus (the most common tendon ruptured), infraspinatus, teres minor, and subscapularis.


This group of muscles functions to raise your arm out to the side, helps you rotate the arm, and keeps your shoulder from popping out of its socket.


The rotator cuff tendon is one of the most common areas in the body affected by tendon injury. Some studies of people after death have shown that 8-20% have rotator cuff tears.

Biceps

The biceps muscle of the arm functions as a flexor of the elbow. This muscle brings the hand toward the shoulder by bending at the elbow.

Ruptures of the biceps are classified into proximal (close) and distal (far) types. Distal ruptures are extremely rare. The proximal rupture is at the attachment of the biceps at the top of your shoulder.

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Ruptured Tendon Symptoms

An injury that is associated with the following signs or symptoms may be a tendon rupture.


A snap or pop you hear or feel


Severe pain


Rapid or immediate bruising


Marked weakness


Inability to use the affected arm or leg


Inability to move the area involved


Inability to bear weight


Deformity of the area


Symptoms associated with specific injuries


Achilles tendon rupture: You will be unable to support yourself on your tiptoes on the affected leg (you may be able to flex your toes downward because supporting muscles are intact).


Rotator cuff rupture: You will be unable to bring your arm out to the side.


Biceps tendon rupture: You will have decreased strength of elbow flexion and decreased ability to raise the arm out to the side when the hand is turned palm up.