Intelligent Training Systems

It seems that almost every piece of research that comes out contradicts another, and sometimes with completely opposite conclusions. How does this helps us, when we need to make clear, concise and accurate decisions for our clients and patients and when we’re constantly being told that evidence based programming is the way forward? If that ‘evidence’ constantly contradicts itself, where does that leave us?

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An example is some work published by Stuart McGill, Professor of Professor of Spine Biomechanics, University of Waterloo in Canada. In his book he refers to ratios of the trunk musculature and suggests that if the ratios are not correct that the spine is unstable and potentially vulnerable to injury. In his book he refers to the flexion/extension ratios for males and concludes that the flexors should be 86% the strength* of the extensors for safe and effective function of the spine. Then in a paper which was published some time later, another population was tested and they concluded that the best ratio is 99%. So what are we aiming for when we test our clients? I emailed Stuart, who was as always very helpful and his conclusion was that as long as the extensors are stronger* than the flexors in this example that’s fine, and incidentally there will be much more work on this published in the next 2 years. OK, so not all researchers are as quick to reply and apply their work as Stuart, but this still leaves us with a dilemma.

I was speaking with Robert Guntzberg (former Chair of the European Lumbar Spine Society) and like many, he believes that we should be moving quickly towards an evidence based fitness and medical approach, but he agreed that there was often no evidence to help us through particular problems with a client or patient, so how can we prescribe evidence based programing when none exists in that particular example. Well he came up with a very interesting idea. He maintains that a true expert combines evidence base with their experience to provide clients and patient with genuine expertise. That makes sense to me.

So when a research paper makes a particular assertion, let’s just step back a moment and look at the population, the context of the paper, how many people were used in the research, the bias and the relevance to current thinking, before we trash the work we’re doing and adopt a new approach. Just because one research paper or an authority says the world is flat, doesn’t make it so. It’s the weight of evidence that we need, not just one paper, but instead getting a group of research papers, researchers or experts to agree on a direction. But this is of course a challenge in itself and it’s usually the guy who shouts loudest who gets heard…..and in our industry there are a number of those.

Listen to those who shout loudly should at your peril!

Martin Haines

We’re off to Essen in Germany on Wednesday to attend FIBO.  Rach will be coming too and we’ll be meeting one of our other Programme Directors there; Sarah Morelli.  Its the first time i’ve been there, so i’m looking forward to seeing the scale of the show as well as understand the value that it can bring to ITS.

We have several meetings arranged already with US and European businesses, so lets try and make something work there.  i’ll blog and let you know how it went and a bit about the show.

Sadly I couldnt be at the FitPro spring convention this year, but the ITS team was there in force.  we had 16 of our Biomechanics Coaches and Tutors working at the event performing screens on over 200 people over the weekend.  I wish I could have been there!  the weather was so good that they took a load of couches out side to run the screens out on grass, so they were fighting who would be outside to work on their tans!!!

We always get a great deal of intetest in our work, but this year went crazy. we had intetest in our Biomechanics Coaching diploma and also our other most popular courses which are the Biomechanics Coach; low back specialist course (which takes you up to L4 on the REPs register) and our sports massage courses which also qualify you as Biomechanics Trainers.

We had our office manager on the stand all weekend too, so she could take contact details down so the guys could concentrate on the techncial side of things, which worked really well.

Sorry for the poor number of blogs recently, i am now going to be blogging at least weekly, so please do come back and check out what is going on.

I was at IHRSA last month in san Franscisco, which was a great networking event for ITS.  i had 12 meetings in 2 days, quite literally back to back.  Opportunities for our training programmes in the US and Middle East and our new online biomechanical screening programmes attracted major interest from everyone!  more about the online programme when its finished in a week or so.

more to follow…………..

On Friday 19th November we hosted the inaugural UK Biomechanics Coaching Association (UKBCA) Conference at the Hilton Hotel in Leicester. There were 45 fully qualified Biomechanics Coaches, who were treated to a day of technical and practical wokrshops in many of the Biomechanical Coaching techniques that have been developed. Lectures and presentations were given by Master Biomechanics Coaches Jo Rainsley, Rachel France and Mike Grice. There was unanimous agreement that the UKBCA should be set up and run as an autonomous and governing body for all Biomechanics Coaches and a Board and Management Team identified. We will be providing more updates on my blog and on the ITS web site www.intelligenttrainingsystems.com in the news section of that site.

I have been contacted by a physiotherapist from New Zealand who read my blog some time ago and was fascinated by the thought that early engagement of Trans Abs might widen the diastasis.  Interestingly, since then she has been working on different cues for modified curls and she quotes “I recently had 3 postpartum women with large diastasis immediately post delivery, the only thing I started them on was a small head lift 10 reps 3 x day supine crook lying,  along with the usual education.  All three responded very well and were all less than 2 fingers widths wide within 2 weeks”.  She then goes on to say “if a cue to add a pelvic floor contraction and initiate TA was used, the gap widened on a modified curl using the same basic technique as before”. She has also questioned the timing of introducing Trans Abs work with a famous biomechanics researcher at a recent seminar in New Zealand, “I recently attended a workshop with Andre Vleeming on lumbo-pelvic pain in NZ and we asked him his thoughts having just finished a lecture on fascia and the abdominal wall, and he felt it was not appropriate to initiate TA for the same reasons you mentioned Martin about pulling the rectus bellies apart rather than helping approximate them”. 

So clearly the jury is still out, and we’re absolutely not saying that going back to doing sit ups is where we want to be with these people (or anyone for that matter), but as yet there is insufficient evidence that what we are currently doing in the fitness industry is correct regarding the timing of engaging Trans Abs in our rehab of this group.  There are far too many unanswered questions before we can say we are giving them the most relevant and effective conditioning programme.

Diastasis recti is a separation between the left and right side of the rectus abdominus muscle, which covers the front surface of the belly area. Another name for the more commonly described separated rectus abdominus, it is usually caused by pregnancy and the rectus muscle being stretched by the baby in the uterus. This condition is most common in the later trimesters and more so with multiple births or repeated pregnancies.

A diastasis recti looks like a ridge that runs down the middle of the abdominals. It stretches from the sternum to the navel and increases with abdominal muscle contraction. In the later part of pregnancy and in extreme cases, the top of the pregnant uterus can be seen bulging out of the abdominal wall when the rectus is engaged. Post natally, to check if your client has diastasis recti, have her lie supine with knees bent and ask her to raise her head. You commonly see a central ridge protrude in the centre of rectus abdominus, and if you carefully palpate above the navel, you should feel a soft gap between two hard muscles. Measure the space of the gap using your fingers (this is called a rec check). If the gap is greater than two finger-widths, your client may be suffering from separated muscles.

No treatment as such will help pregnant women with this condition, although exercise may help, but there is limited evidence that exercise will resolve the problem. However, post natally, conventional wisdom suggests that after any discomfort has settled, it is reasonable to start some light abdominal work, focusing on the core.

Understanding their origin and insertions reveal any oblique contraction will most likely exaggerate the split of rectus. We have performed ultrasound scans on this population and have found that engaging these muscles actually increases the separation. 

Until more work has been done on this, we recommend starting with pelvic floor work and stabilizing work with the pelvis in as close to the correct position as you can, while engaging rectus abdominus to minimise the degree of separation.  Please note that the production of relaxin (a hormone that is secreted in abundance in pregnancy) affects the collagen make up in the linae alba (the central tendon in rectus abdominus) and may be a cause of the diastasis. As soon as the placenta is delivered, the increased secretion of relaxin reduces to normal.  At this point another hormone called prolactin is secreted, it has the same effect as relaxin and they can last for up to five months. Breastfeeding will keep it higher than normal until your client has stopped. This may affect how quickly the diastasis recti will reduce.

Please also be careful while working the transverse abdominus. While conventional wisdom is sometimes right, it sometimes isn’t. Let’s challenge it now. If you look at the origin and insertion of the transverse abdominus and consider its function, logically when it contracts it will pull the rectus apart further, much the same as contracting the obliques would. There is no evidence to suggest that doing trans abs work is the right thing to do. It’s just something that we all do without, it seems, much thought as to why. Just think, if the trans abs inserts into the aponeurosis of rectus (anteriorly below the navel and posteriorly above the navel), any trans abs contraction should pull the rectus apart further.

So why do we work trans abs initially with a diastasis recti?

Are we suggesting going back to the days of doing sit ups? Probably not, but more work needs to be done before we know working trans abs is right for these ladies in the early stages.

If you have any thoughts or opinions, please note them in the comments section below!

Cross Trainers are a great alternative cardiovascular workout.  We do get a number of PTs however who say that some of their clients get numb feet towards the end of a longer workout and nothing they seem to do helps.

There are 2 categories of causes for this; extrinsic and intrinsic.  Extrinsic causes are things like inappropriate shoes and poor technique.  If the shoe profile doesn’t fit the client’s type of foot or its ill-fitting, then this can compromise circulation to the feet and importantly to their nerve supply, causing the numbness.  Technically if the heels are kept on the cross trainer foot plates then this prolonged pressure can cause the numbness too.  It is important to encourage your clients to let their heels lift as they would in normal gait to alleviate the pressure on their feet.  Working at different speeds and intensities during their workout can also help.

Intrinsic causes should also be considered.  From a musculo-skeletal perspective, numbness is usually due to nerve and/or circulatory issues, so its important to check your client’s sciatic nerve mobility.  If the nerve is tethered or tight then this can have the effect of sending the feet numb during cross training.  Try the SLR test to see if this could be a problem for your clients. Lay your client supine and slowly lift their leg until they feel tension, tingling, discomfort or a stretch in their leg.  At this point establish where they feel that sensation.  If its in their hamstring, we are not sure at this point whether its their hamstring or their sciatic nerve that is tight.  Slowly adduct the leg across the mid-line (without letting their leg lower) until the inside of their foot reaches the outside of their opposite leg.  If the tension they previously felt changes in any way (increases, decreases or changes position) then the problem is a tight sciatic nerve and not hamstring.  If when you lift their leg they feel the tension or discomfort outside of the hamstring area, i.e. in their calf or foot, then the test is immediately positive for sciatic nerve tension.

So if your client does have positive nerve tension signs for sciatic nerve then try mobilising it as part of their warm up to prepare them for the cross trainer workout, it may well give them the capacity to perform the exercise with less numbness.  If it doesn’t change their symptoms, then its clearly something else, work through the list of possible causes and work it out by a process of elimination.

One thing also to note about the Cross Trainer is that if your clients have a dysfunctional pelvis or rotated pelvis, then the cross trainer will probably aggravate it.  This is usually due to the feet being in a fixed position and reducing the legs ability to compensate for the abnormal pelvic mechanics.  Pay particular attention to female clients who have recently had a baby, if it was more than 8lbs then they are very likely to have rotated or dysfunctional pelvis, so be aware of putting them on the cross trainer.

The performance of the human body can be likened to a motor car.  It would not however be a model T-ford, where the brakes work independently of the engine or the steering.  It would instead be like a formula 1 car, in which each system (brakes, steering and engine) all rely on each other and feedback information to each other and the engine management chip.  In humans this is the equivalent of the nervous system.  Engine output is altered by braking as the two systems work in harmony.  It is however worth bearing in mind that there is a price to pay for this synergy which improves performance – that is the formula 1 car’s engine usually only lasts for a single race before needing replacement.  Likewise human beings cannot make the transition to high performance without similar regular monitoring and repairing.

Understanding nerves

To be able to understand this more thoroughly we have to understand about ‘nerve tension’ and ‘Adverse Neural Tension’.  These concepts have been recognised for over 100 years in terms of treating patients clinically, but their full potential has never been understood until now. An analogy with the invention of the wheel is an interesting one.  The discovery of nerve tension and it being used for the treatment of injuries is like the wheel being invented and placing it on its side, putting 4 legs around the underside and using it as a table.  It makes a great table, but the idea to use it as a wheel was ground breaking.  The same applies to nerve tension and its application to athletic performance. 

To help you understand.  The entire nervous system, is a single continuous tract, so it follows that if any part of this continuous tract is trapped or tethered (as with an injury) then it also follows that there will be some restriction of the mobility of other parts of the nerve system.  So a problem with one part of the nerve can cause pain in another – this is the clinical application.  However, we have discovered that this is not always represented by pain but by a reduction of joint range of movement, altered joint biomechanics which affects a whole host of problems that can cause restricted performance and may ultimately lead to injury.  Moreover, with the increased muscle spasm and associated factors, local fatigue increases and so understanding these principles can lead to benefits not only in human performance but also fatigue.

Research

We know this happens from research performed at Liverpool Hope University College (Barrow 2002) and studies there demonstrate astonishing results.  One experiment showed that a muscle can increase its force output by 14% after a brief preliminary warm-up (just one 15 second workout using this concept).  Another experiment showed that by following the same concept a 2 minute programme performed daily for 10 days increases muscle output by over 50%.  By understanding the importance of the interaction of individual body systems with each other, we have established the world’s largest database of its kind and have therefore been able to develop a series of courses that help you understand the relationship.  These courses show you how you can test your ‘nerve tension’ and prescribe movement patterns to enhance the coordinated output of your body’s systems.  These studies have been validated at the highest level.  A paper was submitted at the 6^Th Asian Biomechanics Congress (one of the world’s most credited) by Nicholas Barrow and was enthusiastically received.  In a practical sense the programmes have been rigorously tested by people such as Olympic athletes through to workers on a product line and hospital health trusts.

Remember in most cases we are not even aware we have a problem, but even so you can still achieve these remarkable results. Just imagine what these figures could do you for your performance in your sport.

Terminology

So when it comes to exercise programming our holistic approach, which is commonly described but rarely understood and demonstrated, takes into consideration all of the body’s systems, and it has a deep understanding of how they interact and are guided by our nervous system.  Description terms such as strength and power in this model are inadequate, so when we talk about exercises in these terms, we should be talking in terms of  movement patterns, which are used to enhance a given set of functional movements, not stretches or strengthening exercises, as the latter do not give credit for the full implications of the programming. 

Example

Lets take a hamstring stretch as an example, we are not trying to stretch the hamstrings when we extend the leg out in front of us, we are trying to improve the range of hip flexion and knee extension by stretching the structures on the back of the leg and back.  This brings in more than just the hamstrings, it can also be limited by a tight sciatic nerve, a rotated sacro-iliac joint in the lower back, tight gastrocnemius, tight spinal cord and indeed almost any nerve in the chain given the continuum concept described earlier.  How many times have you stretched your hamstrings using the generally accepted methods only to find that their flexibility continues to be stubborn and often returns to their standard length very soon?  Many people experience this phenomenon.  The reason is often due to them stretching only one of the structures that limit the movement, i.e. the hamstrings.  If they do not stretch the other structures as well, of course they will not be affected and so the limited range will usually return.  So we are trying to acquire a pattern of movement, not just stretching the hamstrings. 

So, does stretching get on your nerves?  Hopefully now you understand a little more about how are systems work together, stretching and any other type of exercise you do, won’t be quite so ‘nerve wrecking’.  To find out more become a biomechanics coach.

The skills of the personal trainer have increased dramatically over recent years.  The demand of their clients has driven their development down paths that hadn’t previously been considered.  Clients generally go to personal trainers to get fitter or lose weight, but as consumers have become more intelligent, sophisticated and more demanding, so their needs have evolved.  Now clients will commonly expect you to provide ‘some exercises for my back, as it’s a bit sore today’.  Also you will hear them ask for advice and exercises for a knee problem they felt while training for example.

 This evolving role will likely increase further as the credit crunch escalates.  This will likely result in people being even less likely to want to spend extra money on seeing a health professional for what they perceive to be a ‘niggle’ and not want to go to the expense or hassle of seeing anyone else.  As personal training qualifications develop, we must be careful here that we don’t train ‘jack-of-all-trades’ who know only enough to be dangerous, but with the new methods of screening coming up like functional and biomechanical screening, there is much personal trainers can do to help in a very real way while retaining their professional integrity and not becoming ‘pseudo-physios’.

The body is an integrated system, each of its component parts links together to provide coordinated movement as we move in our daily lives.  Functional training helps us prepare each unit for these tasks and engrains the correct movement patterns that our brains are used to rather than by training ‘muscles’ as we used to a few years ago.

Functional training has its origins in rehabilitation and has been around for 40 years or more. In this time we have established that it can help your client’s performance and preparation for their common tasks, and possibly also reduce their risk of injury.   

Over the time that functional training has been around in rehabilitation, we have found that biomechanical screening is a critical precursor to functional screening and functional training, otherwise the foundations for the movement patterns can be flawed and although they may cosmetically look OK, intrinsically the body can be working hard to compensate for flaws in the system that functional screening doesn’t pick up.

As the functional concepts start to become more widely accepted in fitness and conditioning, it is important to recognize that the biomechanical screening has not yet followed into these arenas.  Functional and biomechanical screening and training are very important aspects of an overall conditioning programme for any sport or activity and are complimentary in every way. For example, there are many people who pass a functional screen, yet fail a biomechanical screen.  They detect different factors, both of which are important to the trainer.

Specifically we need to develop our understanding into nerve biomechanics and the biomechanics of specific joints, like the pelvis, spine, shoulder and knee.  Once we understand these principles and how to screen our clients with them in mind, we can prescribe very precise exercises that relate specifically to their problems and goals.  Once these biomechanical issues have been resolved then functional training or any other form of training you may wish to do has more chance of being successful and there is less risk of your client becoming injured.