Why Your Workouts May Not Be Working

Have you been exercising & not seeing the results you’re expecting? Have you developed pain or made an already painful condition worse with exercises that were supposed to help? Have you been told by a trainer or physical therapist that your glutes are not firing or that you have poor balance and you just can’t seem to correct the problem?

These are very common issues that I hear about in my practice which can have multiple causes. The first thing to examine the program itself – what exercises are being done and are they even appropriate for the individual, based on their health history and present condition. I often see people doing exercises that they should definitely not be doing because they are harmful and will cause injury. Unfortunately, I also see many trainers and specialists prescribing these same exercises.

The second thing to examine is form to determine if the exercises are being done properly. A good exercise, if done incorrectly, can also be a bad exercise. Always be meticulous with form. The purpose of exercise should be to improve our health, whether the goal is increasing strength and endurance, rehabilitating tissue, or correcting movement patterns.

The above are very obvious reasons and should always be ruled out first. However, if the exercises are appropriate & being done with correct form but the issue is still present, there may be another less obvious culprit. This hidden hijacker of a good workout results could be fascial tension.

You may have heard of fascia recently, as it getting more attention due to research. Fascia is connective tissue that literally wraps and connects every structure in the body. To visualize this, imagine removing every organ, muscle, and bone. If we were to leave all the fascia intact, we would have a 3D outline of the entire body – a completely continuous web.

Fascia transmits energy and force, in addition to holding everything together. We often think of muscles contracting independently to perform an action. For example, flexing our elbow we attribute to the biceps and brachialis muscles. But in reality, it is much more than that. Tension is created throughout the entire arm and shoulder, into the trunk and down to the hand through fascial connection. Other muscles are also performing at different levels in order to stabilize the arm. So really, everything is working, but at different levels of intensity.

We often think of muscle contraction generating force in the tendons (which attach the muscles to bones) in order to produce a movement. Studies have recently demonstrated that only 70% of the generated force of a muscle contraction is transmitted to the tendons. The other 30% is transmitted outward to the fascia surrounding the muscle by way of attachments along its entire length. Because fascia is completely continuous throughout the body, this force is transmitted to other muscles and structures. This shows that when a muscle acts, it is doing much more than its attributed movement. It is communicating with and working in conjunction with other muscles along a line.

Fascia is also a sensory organ. Another recent discovery is that there there are more sensory nerve endings in the fascia than there are in the muscle. These nerve endings provide information to the brain and spinal cord about position, tension/stretch and pressure – a sense of where we are in space and what is happening to keep us there. Keep in mind that most of this is happening without us even realizing it.

Fascia is made up of different layers that need to slide over each other in order for movement to happen, and in order to have accurate information exchange with the nervous system. If there is restriction of this sliding, usually due to a densification of hyaluronic acid, the substance that lubricates the fascial layers, overall movement can become restricted. Muscle activity can become inhibited due to the lack of efficient communication through the nerve endings that live in the altered fascia.

The densifications causing this altered function can be a result of old trauma/injuries, surgeries, scars or repetitive strain. For example, an old ankle sprain that didn’t heal properly may subtly cause dysfunction either locally in the foot/ankle, or above in the knee, hip, pelvis or even in the shoulder on the opposite side of the body. These densifications may be difficult to detect because they are often found in different areas than where the symptoms manifest. In this case it would be helpful to be evaluated by a professional who understands this process to properly determine the dysfunction and correct it.

Fascial Manipulation is a diagnostic and treatment system developed by the Stecco family in Italy. It sees the body as an interconnected network of points along the fascia that make up different motion planes. The points are centers of coordination for underlying muscles. Interestingly, many of these are also acupuncture points. Densification, or dysfunction, in these points can alter the muscle activity. Fascial Manipulation practitioners find these areas of densification and remove them through a very specific, deep massage technique. When normal sliding is restored to these points, or centers of coordination, very often pain is relieved and muscles function much more effectively with less stress. It is worth noting that Fascial Manipulation has the most scientific research behind it than any other manual soft tissue technique.

Freed movement in the fascial planes leads to normal coordination of muscle activation. This can allow workout results to be more consistent with the targeted actions of exercise and desired goals. If you feel you are not getting the most out of your workout and you know you are doing the proper exercises with good form, consider a fascial evaluation.

Robert Inesta, DC, L.Ac, CCSP

The Importance of Being Flexible

Flexibility is underrated in both the fitness industry and in life, in general. A person’s flexibility refers to the ability of a joint to move through its full range of motion. It is important to attain a full range of motion to perform activities of daily living and to reduce the stress on muscles, which in turn decreases injury rates.

Flexibility is joint-specific, since each joint has a potential range of motion. Static flexibility refers to the range of motion that can be attained while not in motion; dynamic flexibility refers to the range of motion that can be attained during movement. Dynamic flexibility is important to athletes because range of motion is limited by the amount of time it takes for a muscle to lengthen, which affects athletic ability. The more a joint can flex, the better the athlete can improve sport-specific skills.

Greater flexibility of the muscle(s) around the joint translates into better posture, reduced risk of injury, and less muscle tension and soreness. We need to be flexible in order to perform every day activities, from sitting to standing, and from lifting items to turning the body in different directions. Joints become stiffer as people age. When our muscles are sedentary and inflexible, our bodies create poor posture habits and movements that reduce the mobility of joints and compromise body positions. Flexibility helps prevent this loss of mobility.

Stretching helps to reduce soreness after exercise and gradually elongates the muscle through its full range of motion, which improves muscular balance and resting posture. Additionally, stretching promotes muscular relaxation, which increases flexibility in the hamstrings, hip flexors, and quads. This decreases the likelihood of both sporadic and chronic back pain. Stretching also increases blood flow and nutrients to soft tissue, increasing joint synovial fluid, which lubricates the joints and improves greater range of motion and decreased joint pain and degeneration.

Stretching can be part of a workout or a workout all by itself. As a rule of thumb, before a workout, dynamic stretching should be done. Static stretching should be reserved for after a workout. When stretching, always be gentle and never jerk the muscle into position. Instead, smoothly move the muscle into position to safely lengthen the muscle tissue. Mild discomfort is normal during stretching, but there should never be any pain. Pain is an indication that the muscle is being overstretched or has been excessively stretched. Find 5-10 minutes per day to stretch to reduce stress and improve your health. Your body will thank you for it!

Breathe Easy

Breathing is the most basic movement pattern but it is often done incorrectly.  This causes tremendous consequences, in terms of our musculoskeletal health. If we think about how often we breathe, it is easy to see how incorrect patterns can lead to big problems. Faulty breathing patterns and the impact that they have are often overlooked. This is because it is such a subtle and involuntary movement that we typically do not think about it!

It is common to think of breathing only in terms of respiration, which is obviously essential to sustaining life. However, the effects go beyond the basic respiratory function. There has been much research demonstrating a link between breathing pattern disorders and low back pain, neck pain, shoulder imbalances, TMJ pain, poor motor control and posture.

Posture and breathing are directly related. One cannot be addressed without the other. Breathing pattern disorders usually develop as we begin to develop poor postural patterns very early in life. Watching an infant is a great way to see proper breathing, as they have not yet learned to do it the wrong way.

The diaphragm, which is the main muscle responsible for breathing, can be seen as an essential component of the core function. If we think of the trunk as a cylinder or column, with muscles and fascia wrapping around as a belt, the diaphragm acts a lid, while the pelvic floor muscles make up the floor. Often when working the core, we often focus on the abdominal muscles and do not consider the importance of the diaphragm. If breathing is not correct, one cannot have full core stability.

An easy way to assess your breathing is to stand in front of a mirror placing one hand on the upper part of the chest and one hand over the abdomen. Take a deep breath and notice the movement of the hands. If the hand on the chest elevates, this indicates incorrect breathing, or thoracic breathing.

The correct pattern is when inhaling, the abdomen expands, pushing the hand over the abdomen forward, or outward. The hand on the chest should not move much. This is known as diaphragmatic breathing, and properly engages the diaphragm.

Thoracic breathing engages muscles of the chest, upper back and neck as the primary breathing muscles. Over time, these muscles will develop tension from overloading and doing more work than they are designed to do. While these muscles are overworking, the diaphragm is under-working, contributing to core weakness and the long list of consequences that result.

Awareness of breathing pattern disorders through the simple test above is an important step. To begin working on correcting the pattern, try the following. Lay supine (on your back) and prop your legs up on a cushion, or support, so that the hips and knees are both at 90 degree angles. If you cannot do that, simply laying on the back with knees bent will also work. Place one hand on the abdomen and the other on the chest and breathe normally trying pull the breath into the abdomen. With each inhalation, the goal is expand the abdomen lifting the hand. The ribcage will also expand a bit laterally, but should not elevate. Try to stay as relaxed as possible while doing this and don’t worry about taking deep breaths. Breathe easily and normally. Do this for a few minutes three to four times a day.

This will start to groove the movement pattern and reprogram the system. Gradually, you will begin notice when breathing is being done incorrectly and will be able to easily switch to diaphragmatic breathing. It is more difficult to do this while upright, which is why the supine position is the best way to start the training process. It is very important to work on posture simultaneously in order to achieve the best, long lasting results. It is very difficult to breathe correctly with poor posture.

It’s important to keep in mind that this is a process. It will not change overnight. It takes a lot of work and consistency to retrain a system that has been in place for so long. Remember how often you breathe and for how long it has been done incorrectly! Do not get frustrated if you feel like you are getting nowhere. Keep working on it. If you feel you need more help, consider seeking the help of a professional who has experience with this. Many chiropractors, acupuncturists, trainers, physical therapists, massage therapists and other types of body workers can be very helpful.

There are many other health benefits to proper breathing, in addition to musculoskeletal health. One can write volumes on breathing in terms of musculoskeletal, biochemical, respiratory, mental/emotional, endocrine, neurological and spiritual health. Many types of meditation and relaxation exercise focus on the breath. It is synonymous with life. So contribute a few easy minutes a day to your breathing, and ultimately your health. It is a worthy cause.

Proprioception

Proprioception is defined as the body’s ability to sense stimuli with regard to position, motion and equilibrium. It is the sense of the orientation of one’s limbs in space; the ability to know where a body part is without looking at it.  Therefore, the body is able to sense the position of its parts, analyze it, and react with proper movement. Without proprioception, we would have to constantly watch our feet while we were walking.

Balance and proprioception are not the same things. The sense of balance originates from the fluids in the inner ear. Proprioception is provided by proprioceptors, which are sensory receptors. These nerves are located inside the body and transmit information from the muscles, joints, tendons and skin to the central nervous system.

Proprioceptors control balance, coordination and agility, and by training proprioception, we can improve balance, coordination and agility. Balance is a basic skill needed in practically every activity.  The key to efficiency is changing your center of gravity to match your moves. Agility is what allows us to move gracefully without wasting motion.  It allows our joints to move through the full range of motion smoothly and confidently. Proprioception also reduces the risk of injury. For example, ankle sprains are a fairly commonly injury for athletes.  These are often caused by a lack of balance or proprioception.  Even if a runner has strong lower limbs and good endurance and flexibility, slight deviations in the terrain during running require adjustments in balance. If the athlete has not trained the neuromuscular system to react appropriately when running on uneven ground or when they have a misstep, they may be injured.

Just like any other motor activity, proprioceptive ability can be trained. Any new motor skill that involves precise movement of our arms and legs– from baseball to painting to skiing – involves training our proprioceptive sense. And just like any new skill or exercise, it requires a progression during training. Start with simple exercises and make them more complex as the individual improves.

Proprioception can be tested by standing on one leg for 30 seconds with both eyes open and then standing on one leg with both eyes closed. Beginners should start with static balance activities and advance to agility and coordination activities. Balance exercises should start on the floor and progress to unstable surfaces, such as stability trainers or wobble boards. On the stability trainer, you can perform lunges, mini-squats, etc and progress to using a resistance band and then further progress to one leg. Wobble boards are good for static balance training and can be made more difficult by using a weighted ball. Be sure to exercise caution when using unstable surfaces.

After mastering balance, you can move on to more advanced proprioception for agility and coordination. Activities used to improve agility and coordination including pivoting, twisting, jumping and cutting. Progress jumping from two legs to one leg.

It is important to use correct technique when performing proprioceptive exercises. Reduce the intensity or level of activity if you cannot perform the exercise with proper technique. In order to reduce the risk of injury, perform these exercises before you are too fatigued. It is important to consider age and body weight when engaging in proprioceptive exercises. Performed correctly, this type of core stabilization or stability training is an invaluable tool to enhance overall fitness.

All Trainers Are NOT Created Equal

Many people who have personal trainers feel that theirs is the very best.  I have never met anyone who doesn’t rave about his or her trainer, especially if he/she has been working with them for a substantial period of time. Part of the training experience is the camaraderie and trust formed between the trainer and his client, and the majority of people are very loyal.

However, putting friendship and personality aside, only a handful of personal trainers are truly competent and knowledgeable. As a result, many people get injured and sometimes the client doesn’t even realize that their trainer is responsible. Many injuries are repetitive injuries, which are injuries that occur gradually over time due to frequent, repeated, unsafe movements.

The client may not even know that they are being injured! For example, one morning a person can wake up with his knee bothering him and he is unable to walk without pain. He may not remember doing anything the day before to cause the injury; in fact, this injury may have been happening gradually over a period of time. Therefore, a client may be ignorant to what is causing his ailment. Injuries may be caused by improper form, unsafe exercises, or lack of knowledge about anatomy and how the body works. Clients need to be able to evaluation their trainers objectively; you cannot assume that all gyms are hiring qualified, competent trainers.

Intensive training &/or education is not currently required to become a personal trainer. All that is required is a certification that is accredited that the National Commission of Certifying Agencies (NCAA); for example, the National Academy of Sports Medicine (NASM), NFPT (National Federation of Personal Trainers and the Aerobics and Fitness Association of America (AFAA). Most gyms require that their trainers are certified, but NOT all do! Make sure that your trainer is certified and that he attends seminars and takes continuing education courses to stay current.

The body is a complex machine and it is important that a trainer understands proper mechanics to avoid injury, especially if the client has pre-existing conditions. A trainer should perform an initial evaluation and obtain a health history so to target weak areas and avoid aggravating an injury or condition that is already present. The evaluation should include testing flexibility, balance, core strength, muscle strength and endurance, as well as proprioception. Your trainer should be able to explain why he is choosing certain exercises and how they benefit you. He or she should also be knowledgeable in functional training, which is training for daily activities or a specific goal. Additionally, your trainer should be able to use the initial assessment to design a tailor-made workout program for each individual. There is no one-size-fits-all in personal training.

There are many benefits to using a personal trainer rather than working out on your own. Choose wisely, because not all trainers are created equal. Do your due diligence and do your research to ensure you get the results that you want.