Monthly Archives: September 2012

Shin Splints

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Most trainees will benefit from some type of conditioning in their program once or twice a week. It’ll prevent them from becoming too unadapted to things they might need or want to do. That could include playing rec sports, chasing a dog, going on a hike, or running away from zombies and/or nuclear fallout.

Some trainees forgo conditioning because they hate it, are bulking, or are doing a linear progression. Then they’ll jump back into conditioning as if the layoff never occurred. This can easily result in irritated joints, strains, or muscle pulls, especially in “older” trainees. One common irritation is the shin splint.

Generic sources say that shin splints are caused by doing too much and give equally generic rehab advice. This post will teach you what mechanical issues lead to shin splints, how to avoid them, and how to treat them.

Causes of Shin Splints

“Doing too much” is a gross over generalization. Yes, subjecting your structures to stresses that they aren’t adapted to will have negative repercussions. In all of my books I’ve pointed out how new activities, especially conditioning stuff, needs to be easily progressed. If you haven’t been running, don’t sprint. If you haven’t been walking, don’t run. It’s pretty simple, but the “Tommy Tough Guy” mentality is prevalent. It’s better to ease into activity than inhibit training because of a stupid strain.

The same goes for “easing into more volume or intensity in a program”, especially with movements that you aren’t adapted to. I pointed this out in the “Transitioning to Olympic Weightlifting” post, yet I still know a lot of people who ignored the advice, had a high frequency of doing the Olympic lifts, and had elbow or shoulder irritations as a result. For example, don’t jump into a lot of running mileage to prepare for your PT test; ramp it up over several weeks.

Mechanics

Shin splints specifically arise from having poor mechanics, and this inefficiency is only exacerbated by ‘doing too much too soon’. To understand poor mechanics, you must understand foot anatomy. In Anatomy Without A Scalpel, Dr. Kilgore points out how Isaac Newton said, “The human foot is a masterpiece of engineering and a work of art.” It’s perfectly constructed — through natural selective evolution — to carry out it’s function of bipedal ambulation (i.e. two legged walking).

In the “Foot Awareness” post, I talk about how “navicular drop” (AKA flat feet that are probably habitually rotated out) has an effect on squatting, yet it also creates an inefficient loading on the foot and lower leg during movement. Running and hiking/rucking are activities where trainees usually see problems. Navicular drop is typically called “pronation of the ankle”. By looking at the picture (right), you can see that having a severe angle between the foot and shin would be problematic to efficient force distribution.

Even if the ankle is a healthy “neutral”, there still can be some mechanical issues. Dorsiflexion is when the toes are pulled up towards the knee. Plantarflexion is when the toes are pointed away, as if you are pushing down a gas pedal (see these and more in this beardless “Anatomy Motion Explained” video).

When running (with poor technique) or rucking, heel striking occurs with the ankle in dorsiflexion and the foot out in front of the center of mass. When the body shifts forward to be over the foot, the ankle plantarflexes, yet the dorsiflexion muscles on the front of the shin resist the motion (if they didn’t resist, then your foot would just flop to the ground uncontrollably). Said another way, the dorsiflexion muscles are eccentrically acting — the fibers are being elongated under a load. Eccentric muscle action is the most stressful, damaging kind and makes the muscle very sore.

Imagine doing several thousands of repetitions of a movement that eccentrically acts on the front of the shin. Now imagine that there is a significant additional force. Running slow applies three to four times the force of body weight (the fore foot phase can be between four and seven times body weight) whereas rucking is going to apply a force that is a multiple of the sum of body weight and the weight being carried. Now imagine being unadapted to this type of force in one instance of exposure. Now imagine being exposed to this several times a day, every day, until there’s a problem. It’s easy to see how people will develop shin problems, huh? I know a fella who was medically dropped from phase one of BUD/S (Navy SEALs’ selection and training) because he had severe shin splints…twice. They run six miles a every day just to go to the chow hall (one mile to and from), then whatever else they do that day. Yikes.

Ignore the “tibialis posterior” — that’s on the back of the leg and not labeled well. This ankle is pronated pretty bad.

Let’s specifically look at the musculoskeletal anatomy involved. The muscles that dorsiflex are the tibialis anterior and the muscles that extend (or pull “up”) all five of the toes (note that the big toe, the hallucis, has it’s own muscle that is separate from the other digits). This collection of muscles originate along the tibia (the bigger shin bone on the medial side), the fibula (the smaller shin bone on the lateral side), and the interosseus membrane (a fibrous tissue that fills the space between the tibia and fibula). The tibialis anterior is easy to see and palpate; simply dorsiflex your ankle and look at the muscle that bulges up a few inches below your knee.

Imagine those muscles attaching along the shin bones and the fibrous tissue in between them. The “heel strike followed by resisting the toes to the ground” eccentric movement is repeatedly yanking on those origin attachments. If you repeatedly yanked on a rope tied to a wall, eventually something is going to give, whether it’s the wall or the rope. The same thing happens with the muscles, except with repetitive stress the attachment sites are what get irritated. In this case, the interosseous membrane and the tendon/bone sites are stressed repeatedly and continued exposure prevents them from repairing the damage. Compounding harmful stress without recovery results in achy pain, and can continue to be extremely painful when more significant structural damage occurs. Without time to recover, the yanking tension will actually create little fractures on the shin called “stress fractures”. Worst case scenario it can get more damaged, reduce circulation, and cause anterior compartment syndrome where tissues die. And that, my friends, is the pain you call “shin splints”.

Note that this area can get sore from a single exposure, especially when the trainee isn’t adapted to it. Merely one exposure won’t be enough to cause long-term problems, but it can interfere with training if it’s really sore. Overt pain can alter mechanics since the body instinctually tries to avoid pain (e.g. limping is something that pulls weight off a sore joint). Also, sore and damaged muscles won’t be able to exert force as well as fresh, healthy muscles.

The above explanation focusing on dorsiflexion is the simple version, because when you add in the likelihood of the ankle being pronated, the arch being collapsed, and the toes pointed out, it will only make all of this worse. Especially with heel striking. Heel striking shoots the force right through the structures, and when the structures are out of alignment because of poor foot mechanics, it isn’t distributed up the leg and dispersed through the thighs and hips; it’s sent right into the foot and shin. Cleaning up foot and ankle mechanics can reduce the chance of injury.

Treatment

The best way to treat shin splints is to prevent them to begin with. Work to correct foot mechanics (“Foot Awareness“) and use exercises to help re-develop the arch and lower leg muscles (“Foot Drills“). Progress into new activity that would put a lot of pounding on the lower legs. If you know that stressful activity is imminent ahead of time, start a train-up program to prepare yourself (i.e. pepper your angus).

As for treating shin splints, you’ll have two likely scenarios: a) you did something stupid once and are sore or b) repetitive stress was applied. With the former, you should cease or reduce the activity that caused it, massage the area (including trigger point work), and ice. If you’re already sore, then the window for effective icing might be past, but it’s not really going to be harmful. If this is a “repetitive stress” issue, then also cease or reduce the activity significantly, and massage the hell out of the area. Focus on the muscle bellies all the way up and down the shin and dig into them with at least ten purposeful strokes with a hard object. Follow it up with the foot drills (links above) and ice after. This process could occur several times a day, every day. Feel free to use any ankle rehab exercises, especially ones that work dorsiflexion. Do ankle circles as much as you can, especially before activity.

Shin splints are usually an indication that you were unprepared. Now that you know how they are caused, prepare thyself. If you want or need to do a lot of running, learn the POSE/Chi/forefoot running technique (progress that slowly, too). If you want or need to do a lot of hiking/rucking, then introduce it several months before you hit the longer or heavier stuff. You can mitigate the problems from shin splints by strengthening your feet and lower leg muscles with the above drills. If you’re in a situation where you cannot help the activity, (BUD/S, Ranger School, multi-day backpacking, etc.), then massage the muscles whenever you’re off your feet and do your best. Remember: the best treatment is prevention.

Edit: For more on shin splints, read this post. 

 

Remembering 9/11

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On this day 11 years ago the world was changed.

Families were broken, people passed away, others survived, and we all felt the pain of those heartless terrorist attacks. If you lost someone on that day, then I am sorry that you must go through the public pain every year of remembering history’s events.

I’ve toured the FBI building in Washington D.C., and they have a special room dedicated to this day. I was there in June for the second time. Upon entering there is a Star Spangled Banner, an American flag…that was pulled from the wreckage of the twin towers. My heart sinks thinking about walking into that room, knowing it would be there and seeing how dirty, torn, and tattered the flag is. Tears well in my eyes as I write this thinking of the survivors taking that beaten flag and thrusting it high into the air. This flag says that we were knocked down, but Americans always get back up.

The flag that was pulled from the twin tower wreckage on display in the FBI building

Across the room, there are pieces of one of the planes that hit the towers. I touched this twisted steel unemotionally knowing that it played a part in destruction. Across the room there are two murals for the fallen. One of them has the names listed in very small font. Thousands of names. The other has a small thumbnail picture of their face. There are so many faces, and once you lean closer, you can see each and every one of them. They are regular people. Fathers. Mothers. Daughters. Sons. A moustached man with glasses drinking a beer. A black woman with her children. A young, pretty blonde woman. I couldn’t take it, I had to walk away. These were normal people who were slaughtered because of an extreme ideology.

On the other side of the room, there is a letter. It wasn’t a letter from the fallen or a survivor. It was the letter given to the hijackers with their explicit orders on what to do. It explained how if they felt fear, that they should pray and rejoice in their martyrdom. It talked about the ritual in cleaning their knives, shaving their bodies, and oiling their skin. It explained how they should, before impact of their target, open their shirts and give themselves to Allah. Six pages of this. As I read, I broiled.

Later that day, I stood in the Pentagon looking out a window at the exact flight line the plane took to crash into the building. The room I was in is now a memorial room, but 11 years ago today it was completely destroyed. Majors and Colonels and office aides were killed. Some survived on the mere chance that they got up to refill their coffee or use the bathroom. Others sat at their desk and were relatively unhurt. Death was random, sporadic. Earlier in the day I touched a piece of the Pentagon wreckage in the 9/11 room in the FBI building. Then I stood in the building, imagining some of the world’s leaders wiped away in an instant. As I stood, I broiled.

America will forever remember this day, the eleventh of September. But I hope that you remember why it occurred and what it still means ever year. I don’t intend for this to be political, but what we call “Nine Eleven” occurred because there are bad people in the world who actively want to do bad things to western society, especially America.

This hate didn’t begin in 2001, and the hijacked planes were not the first attempt at killing Americans. There was the 1993 World Trade Center bombing, the 1998 African embassy bombings, and the 2000 bombing of the USS Cole that preceded the 11 September 2011 attacks (and many more smaller, uncharted attacks). The toppling of the towers and the crash into the Pentagon were the final straw for the American people. We went to war.

More to the point, the Afghanistan war is not over; the conflict against terrorist organizations is not over. Conventional forces try to secure regions and nation build. Special Operations hunt the bad guys down. ‘Other’ personnel support it all in their own way. Every week a soldier dies. Every week more than one soldier loses a leg from IED detonations. There are fire fights, there are victories, and there are deaths. It’s a forgotten war. Many are quick to clamor that we don’t have any business in Afghanistan, that it’s a lost cause. Yet the Taliban and other terrorist organizations are poised to once again take control if we let them. There’s benefit in having allies in the Middle East, especially when Iraq and Afghanistan are pivots in the midst of a callous region.

We are comfortable in our lives. The economy slowly grows, we have a new election that focuses on class warfare instead of worrying about the national debt or how events across the world could have a bigger impact on our economy. We have that luxury because we are free. Yet too many people forget that there are bad people actively trying to kill us every day. 

And there are bad mother fuckers — Americans, Australians, Brits, Canadians, and more — who are hunting them down.

And there are lesser known individuals, members of other government agencies who protect us too. I’ve seen the recent cases on display of the terrorists the FBI have thwarted. One case includes American citizens who bought into extremist cause to bring death and destruction to other innocent Americans. It happens regularly. Even the Ft. Hood shooter was in contact with Al Queda leaders.

We have a false sense of security because a) we have become complacent in the long years since 2001 and b) there are men and women — military, government, civilian, or otherwise — who successfully protect this and other countries.

Today we shall remember the fallen. However, as we sit nice and cozy at our computers, remember that the war isn’t over. Americans die daily, and yes, it is indirectly to protect you and I. Remember the warriors — whether they wield keyboards or guns — that have and will make it possible for us to only have one memorial from a terrorist attack each year.

Lest we forget…

Estrogen, Birth Control, and Women

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Mondays are devoted to female topics. 

Women are complicated. If the hormone function of a male is complex, then the function of a female is worse than quantum physics. This isn’t a dig on women; it’s just that biochemistry and endocrinology are incredibly dense and not fully understood, and the nature of the female gender makes it even more opaque. Despite all the things we know about life and the human body, there is a still a lot of unknown.

Biochemistry of the Human Cell: Schematic diagram shows its biochemical/metabolic pathways. Yikes.

 

Prescribing drugs and medications has become the norm in modern “health”. A drug may have an effect on one thing, but undoubtedly fiddles with other biochemistry to produce ill side effects. Drugs can work on neurotransmitters, hormones, or hundreds of other functions like enzymatic processes. When going on or off drugs, it can take several months for the body to normalize into a new ‘concept’ of homeostasis. Remember that the “stress/adaptation” process is constantly occurring, and an adaptive stress is basically “the sub-lethal dose, or lack thereof, of something that is different than the currently adapted homeostasis”.

I trained a kid who had hyperthyroid syndrome. He was prescribed propylthiouracil (PTU) to stop the thyroid from making it’s hormone. It’s pretty toxic to the liver, so his dosage was always being modified by his doctor. When it significantly blunted his thyroid, his strength and body weight gains were impressive. When his dosage went down, his strength and weight suffered. However, it took about six weeks or so for the changes to occur after his dosage was changed; the effect wasn’t immediate. This is an extreme example of the body undergoing a significant change, yet taking time to actually have a response.

This same concept can be applied to female trainees and their prescriptions. The most common drug will be some kind of hormonal birth control AKA “the pill”. There are different types of drugs, but they essentially inhibit ovulation and fertilization. These pills usually consist of estrogen and progestin, which are female hormones. In practice, hormonal birth control seems to have a negative effect on training. 

I’m not going to pretend to know a lot about the exact performance change from a fluctuation of female hormones . In sooth, nobody really does. Yet it’s generally accepted with practitioners that too much estrogen is a bad thing for training females. And when you think about it in simple terms, it makes sense: The female body has adapted to have a certain hormonal fluctuation throughout a month. When that is significantly altered, things will, at the very least, not be as efficient. Gals who take birth control seem to carry more body fat, especially in the hips and legs, aren’t as lean, and seem to make strength gains slower (sleeping problems may be common enough to include here).

Instead of trying to make a definitive statement about birth control and estrogen, I want to do two things. First, here are some resources I found on the internet about this topic.

a) Robb Wolf podcast with Brad Davidson. I listened to this a couple of months ago and Brad works with females, especially figure competitors and helps them clear excessive estrogen out of their system to help them lean out for their shows. Since he trains them in the gym, it has an effect on their gains. I’m simplifying, so listen to the podcast to hear what he has to say about it. There seems to be more than one source talking about a) reducing exposure to estrogens and b) clearing them from the system.

b) Mark’s Daily Apple: Estrogen. Mark’s website is easily my favorite nutrition site. He is a good writer, mixes logic with available research, and is an intelligent hombre. I’m not a perfect writer, but I really appreciate the “good writing” part. I also think Mark is interesting and if I ever chatted with him I’d make fun of his reading choices because JESUS CHRIST THEY ARE BORING. Then we’d do some push-ups on the beach and talk about living until we’re 150 years old (Mark undoubtedly will; I’ll probably get shot before then). Here’s the opening paragraph of this estrogen post:

The human endocrine system exists in a state of delicate balance. None of its constituents function in a vacuum, and trying to explain every hormonal interrelationship would take volumes, but one statement is fairly safe to make: one hormone affects another. Secreting one often inhibits the next, which in turn sets off an entirely different chain reaction of hormonal secretions, inhibitions, and syntheses. I almost feel like trying to micromanage your entire endocrine system is tedious and counterproductive (and probably impossible to do effectively). I much prefer to simply eat right, exercise smart, get good sleep, normalize stress, and take advantage of simple lifestyle hacks. Still, it doesn’t hurt to understand some of the major hormonal players, especially one as widely maligned by the strength and fitness community as estrogen.

 

I really don’t need to say anything else; this is exactly what I was going to write for my conclusion.

c) Charles Poloquin on reducing estrogen. Poloquin talks a lot about this topic and he is referenced in the above Robb Wolf podcast episode. The interesting thing in this article is the mention of phytoestrogens. I’ve seen stuff go back and forth on these — saying they are harmful or helpful — but you can see Poloquin’s take on them.

d) Speaking of phytoestrogens, this “Paleo for Women” post may shed some more light on them.  I’ve never read this site, but this post had some good basic information that should help you gals. Then there’s this other article from the same site on estrogen and weight loss. Then there’s this detailed and lengthy post about birth control.

I think it’s kind of hard to get a gauge on phytoestrogens and estrogen supplementation since some sources talk about the benefits (on estrogen) and drawbacks (on phytoestrogens). And then there’s the issue of birth control itself. In actuality, I agree with Mark above: a low inflammatory diet, low stress, good sleep, and exercising regularly are the keys to creating a healthy and optimal homeostasis regardless of gender.

The second thing I want to do is ask all of the female readers if you or anyone you know takes hormonal birth control and how do you think it affects your training.

Note that some women take birth control because their menstruation periods are incredibly awful and painful. Also note that these same women may be unhealthy, do not exercise, sleep poorly, are constantly stressed, and won’t eat a low inflammatory diet that is high in nutrients and protein. I’d be curious to see if this is what you guys see.

Invite your friends to comment on this interesting issue. Please comment on a) strength training gains, b) conditioning gains, c) body composition, and d) any other life factors like sleep or stress. Also note how long it took for you to see a change in your body or body functioning when going on or off the drugs. Maybe we can come to a conclusion that will influence how females structure their training or lifestyle.