Monday, October 13, 2008

Weighing in on Rapid Weight Loss

Q: I was watching Ms. and Mr. Olympia last night on a webcast. I heard that Jay Cutler lost 15 lbs in one!!! I know water pills can do some, but really? How healthy could that be? - Y.R.

A: Hey Y.R., thanks for the interesting question. Although rapid weight loss such as Cutler's isn't a good idea, the fact is that it's a fairly common practice in a number of sports. The rapid drop in weight is known as "making weight," and athletes such as wrestlers, boxers, mixed martial artists and Olympic Weightlifters, among others, will normally lose weight quickly and then gain it back almost as quickly before their events as a tool to gain a competitive edge.

Making weight stems from the use of weight classes, such as those used in boxing, which separates fighters into 17 different classes and weight divisions. In contrast, the UFC, which is the premiere Mixed Martial Arts promotion, uses five distinct weight divisions, although there are nine official divisions according to the state athletic commissions where MMA is sanctioned. In order to compete, an athlete must weigh no more than the pre-determined upper limit (normally within a pound) of the given weight class that the competition is set to occur.

In theory, this improves the competition and safety of sports where a larger athlete would have a distinct advantage over a smaller athlete. However, there is a loophole: by qualifying for a lower weight class through rapid water loss and dehydration techniques and then regaining some or all of that weight by the time of the competition, the athlete can enjoy an exceptional advantage over his/her opponent.

The recent EliteXC: Heat MMA weigh-ins. Noted female fighter
Gina Carano had difficulty making weight

While this certainly presents itself as a potentially dangerous practice for an athlete about to compete in a vigorous and demanding sport, when done under the supervision of a knowledgeable coach and doctor, the risks to the athlete's health can be minimized (but not eliminated). Obviously, the more weight that must be dropped, the more dangerous cutting weight can be. As you might expect, there have been a number of attempts to curb this practice, especially with younger athletes.

However, Jay Cutler certainly didn't drop his weight in order to make a weight limit. Although bodybuilding also has weight classes, Jay's reasons were more directly related to his performance on the stage: by dropping as much water weight as possible, a bodybuilder will appear to be leaner with more visible definition, helping his/her chances in the contest.
Quick: somebody get this man a Gatorade!

There's something else to consider about Jay's single-day 15 pound water loss, too: when you weigh about 300 pounds in an off-season, 250 in-season, 15 pounds is still around 5 - 6% of your weight, so it's not as startling of a drop as it may seem. Drops of 5-6% still would not qualify as being "healthy,' of course, but it's not the same as a 185 pound mixed martial artist attempting to make the 170 pound Welterweight class (although between the option of facing either Middleweight Champion Anderson Silva or Welterweight Champion Georges St.-Pierre, I'm not sure that either is a very good option for your long-term health!)

However, this still raises a good point, and one that I think that a lot of people miss out on: Bodybuilding is about attaining a certain look, nothing else. Not health, not performance at a sport, and not even strength...just large, proportionate muscles at a low body-fat level. Which means that, just like any athlete in any sport, some things that bodybuilders do will be healthy while other things will be anything but healthy.

Unfortunately, I think this point escapes many of the people that not only enter the sport of bodybuilding, but for those that try to "look like a bodybuilder" without understanding just what goes into that process or in turn what the process might do to his/her body. Especially for women, attaining such low levels of body-fat is impossible to maintain for long periods of time without serious health consequences including detrimental effects on a female's hormonal/menstrual cycles. The pictures that you see in magazines and from the stage are quite literally "snapshots" of that individual at the peak of their weight loss and physical appearance. Unfortunately, many of the fans of the sport who aspire to look like their favorite fitness model(s) year-round don't understand how difficult this can actually be without causing serious health issues.

I have worked with and consulted a number of individuals who have competed in the sport of bodybuilding/fitness, as well as individuals that have simply wanted to look like they did. I have always been careful to try and make them aware of the difficulties that may be ahead of them and the reality of what they think that they are seeing when they thumb through their favorite magazines.
It's pretty amazing what extreme dieting, good lighting, hair and makeup,
tanning, plastic surgery, and steroids can do for your physique!

The fact is that bodybuilding can often be a very difficult and unhealthy lifestyle (certainly healthier, by most standards, than sitting on a coach eating donuts, of course, but still with its own risks nonetheless), and the majority of people with "real" jobs and "real" lives will find themselves having a very difficult time achieving these "unreal" physique goals. Just like facing a boxer that cut weight to make a fight and who now outweighs you by 15 pounds, you might find that you are at a distinct disadvantage when trying to step into this ring. That doesn't mean that you shouldn't aspire to look better and to be healthier, but always be aware of what that actually means...and looks like!

Thanks for the letter, Y.R., and for reminding us that seeing
isn't always believing!


Saturday, October 11, 2008

The FitCast Insider

I just wanted to let everyone know that Kevin decided to re-release The FitCast Insider for a limited time, at $30 off of the original price...sweet!

If you haven’t heard of The FitCast Insider, it is a set of 19 audio interviews as well as a high quality version of the tremendously popular Dan John Squat and Olympic Lift video. It's an awesome compilation of interviews and information ranging from weight loss tips, nutrition, rehab/performance enhancement and strength training.

You get 1 Gigabyte of fitness and nutrition information for less than the cost of a single personal training session with information that would make any typical personal trainer's head spin right out of his underarmour dry-fit t-shirt!


Wednesday, October 8, 2008

Bigger, Stronger, Blogger*

If you haven't listened to this week's episode of The FitCast (Bigger, Stronger, Faster*), you missed a fantastic interview with the Chris Bell, the writer and director of the documentary Bigger, Stronger, Faster*
Simply put, I was able to see the movie, and it was fantastic. Steroids are, of course, currently a hot-button topic and has seen an increase in media and cultural interest recently. Chris forces us to look at ourselves as a "culture on steroids" and challenges us to see that even as we damn the use of performance enhancing drugs in the media and in polite conversation, we applaud it and encourage its use in our society. This deleted scene, featuring among others current Mr. Olympia Jay Cutler, demonstrates this perfectly:

Have a listen to the interview and then do yourself a favor and get a hold of the dvd to watch it for yourself. The movie looks at more than just a drug or even a "drug-culture," but rather at America as a "culture on drugs." In fact, even as I write this, I am guilty of being part of the culture as well, have already used drugs today: two Tylenol Cold multi-symptom tablets to help me with a stuffed nose and sore throat that I woke up with this morning. I also used protein powder in my morning breakfast shake, took a handful of fish-oil tablets and of course a multi-vitamin, along with the caffeine in my tea.

So the question that Chris ultimately asks is an important one: if we are a culture and society where supplements and drugs are woven into the fabric of our existence, where do we draw the lines between acceptable and unacceptable substances? In fact, am I, in this sense, being hypocritical by using a powerful stimulant (caffeine), dietary supplements (whey, vitamins, fish oil) and even an assortment of drugs (Acetaminophen, Dextromethorphan and Phenylephrine, the active ingredients in Tylenol) while at the same time deciding that steroids are not only a "bad thing" but in the past being guilty of passing judgment on those that choose to use them?

While we may feel that there is a big difference between a Tylenol and a steroid, ultimately it's not the differences between the two drugs but the similarities that bind them that is so important in understanding the current issues with performance enhancing substances, whether they help us to compete in sport, stay awake for an early morning meeting, or help us to suppress the discomfort of the common cold. It is our society that produces these issues and not the other way around, and ultimately we as a society must take a hard look at who we are as a people and not just at the people themselves who use these substances.

I hope that you'll agree that it was an excellent interview! Tony, Leigh and I will be returning this weekend for the round-table discussion with all-new listener questions and discussions. We're working on some cool new segments for future episodes, so I hope that you'll continue to enjoy listening!


Saturday, October 4, 2008

Dysfunctional Definitions

Q: I just listened to the Fit Cast episode with you (and glad to know you will be a regular contributor, you were great) and was wondering how to find a therapist that can help with imbalances. I'm most certain I have more than your average bear (I've had ACL replacement on both knees - when I squat, my right foot turns out almost 45 degrees, but my knees and thighs are parallel. That's imbalance, right? ;)

Anyway, what are some good resources to find a good pro? My therapist for recovery was great, but she's not that kind of trainer.

A: Hey AT, thanks for the question. It was a busy couple of weeks (funny how that keeps happening in your last semester of grad school...go figure!), but I definitely wanted to respond to your excellent question!

Unfortunately, most often a physical therapist is chosen by a patient not because of his/her qualifications or experience but whether or not that therapist accepts the patient's insurance and how close the office is to the patient. Finding a qualified and expert physical therapist (just like finding a great trainer, physician, massage therapist, etc) can be difficult depending on your location and/or your particular needs, but there are definitely some things that you can look for to help.

There are unfortunately very few resources on the internet which actually rate physical therapists, such as Angie's List. However, Angie's List is also a pay site, requiring either a monthly or annual fee for access. If you're willing to pay for it, you might find this service helpful.

Other than that, it's pretty similar to finding any good health-care professional: look at their credentials and experience!

Although it's not a requirement of practice, it's not a bad idea to seek out a physical therapist that chooses to enrich his/her knowledge by earning additional credentials beyond their degree. Of course, a good place to start would be looking for the Certified Strength & Conditioning Specialist credential, the CSCS. Other credentials include the Sports Certified Specialist (SCS) and the Orthopedic Certified Specialist (OCS), which indicate a therapist that has achieved advanced clinical knowledge and skills, being recognized by the American Physical Therapy Association as a board certified expert.
Of course, Certified Athletic Trainers (ATC) can also be a great option, and a number of physical therapists have their ATC as well. Other credentials following a PT's name that indicate expertise in manual therapy, such as CMPT or MPT (Certified Manual Physical Therapist) or the prestigious FAAOMPT (a Fellow of the American Academy of Orthopedic Manual Physical Therapists) are also good indicators of a highly experienced and expert practitioner.
Finally, I would be remiss if I didn't also mention Active Release Techniques (ART) here as well. Although I would not consider ART to be a complete system of treatment by itself, it is a very effective complimentary skillset when used properly as an adjunct treatment. An experienced therapist that has this credential is often very good at properly diagnosing and treating dysfunctions.

After narrowing your search, take a look at who the therapist has worked with (athletic populations in performance enhancement would be my first choice) and how long he/she has been practicing in orthopedics/sports rehabilitation. Experience goes a long way, of course, but make sure that you're getting a therapist with the the right kind of experience.

Finally, a word on education: at this point in PT training, there are a number of different degrees that a PT might have earned. You may find therapists that practice with an undergraduate degree in physical therapy, a Master's degree (MS or MSPT), or the Entry-Level Doctorate (DPT). In addition, there are a number of Terminal Degrees that a therapist may have earned as well, including the EdD., ScD., and of course the PhD. While it might be tempting to simply assume that a PT with the most educational letters behind his/her name is also going to be the best therapist, this might not always be the case. The terminal degrees are research-related and therefore do not necessarily translate into better clinical skills, and the difference between a DPT and a therapist with his/her Masters or even Bachelor's degree isn't as great as you might expect, either. The major difference between these entry-level degrees is primarily the amount of time in school, with the DPT student taking an expanded curriculum when compared to the other degrees. However, this doesn't mean that the DPT is a better clinician, which is even
acknowledged by the American Physical Therapy Association itself.

In this case, I would recommend experience and additional qualifications over simply the type of education when looking at a PT's abilities. As an aside, the DPT is now the standard entry-level degree of all new physical therapists, and most programs have already switched over from the MSPT to the DPT, so as the profession of physical therapy continues to move forwards, there will be fewer therapists that are practicing without the DPT (at this point, bachelors programs no longer exist by themselves, although there are some programs that offer undergrads the option of entering an accelerated 4+2 year bachelor/doctorate degree).

Now that you (hopefully) understand physical therapy a little better, let's take a look at what you're describing as your problem: a turned-out foot when squatting. This isn't actually an imbalance. It's a potential dysfunction or movement impairment. That means that there is a departure from what would be considered the standard, or normal, position or motion of part of the body during an activity. This is not, however, an imbalance by itself.

An imbalance refers to the interaction between either opposing muscle groups (such as the quadriceps on the front of your leg and the hamstrings on the back of your leg) or muscles that work together as synergists, such as the actual muscles that make up the hamstrings: the
semitendinosus, semimembranosus and biceps femoris muscles. When the natural relationships between muscles are changed and one or more muscles become weaker or shorter than the other(s), this is called an imbalance. For example, the normal and healthy strength ratio between the quadriceps and the hamstrings has been examined quite a number of times in the literature, such as in this study from the journal Physical Therapy. Most of these studies find a natural strength ratio somewhere around 2:1 quadriceps:hamstrings, depending on the study and the methods.
As you might expect, these two concepts are, of course, related. Our current model for the cause of chronic injury/pain is based on muscle dysfunctions and imbalances. If we take the example of the 2:1 strength ratio and change it to make the quadriceps much stronger than the hamstrings, for instance (perhaps 2.5:1 or 3:1), this will change the forces occurring at the knee and the way that we move, which can lead to chronic issues. However, the terms imbalance and dysfunction do not describe the same concept, but rather two aspects possibly having an effect on the same overall issue.

The truth is, the reason that your foot turns out even if your legs and knees appear to be lined properly could be happening for a number of reasons, some of which would be structural (meaning that the actual alignment of the bones and joints are to blame) while others could be functional (meaning that there are adaptations to your muscle lengths, strength and movement that causes this to occur). To make it a little more complicated, there is very rarely any single cause for a problem, and it is far more likely that you are dealing with both issues to some degree: there may be muscle strength and length issues that have resulted in structural changes (imbalance leading to dysfunction), or you may have structural issues that have contributed to changes in your muscles that are contributing further to the problem (dysfunction leading to specific imbalances).

Usually, dysfunctional movements such as the kind that you're describing can be improved if not entirely corrected, but understanding what is actually contributing to the problem is just as important as being able to identify the problem in the first place. For example, I would take a guess and suggest that what is actually occurring when you are squatting is probably a relatively common issue such as an over-pronation of your right foot. This can be caused by a number of issues including structural changes in the foot itself due to muscle weakness and/or shortness in the hip extensors, leading to changes in the kinetic chain from the ankle up to the low back and even beyond.

In this example, muscle weakness and subsequent poor dynamic control of the knee leads to compensatory strategies in the lower leg, foot and ankle. Normally, the biceps femoris muscle acts as a strong lateral stabilizer of the knee, preventing your leg from falling inwards (adducting) during a squatting motion. In your case, there are a number of reasons that would lead me to suspect that this might not actually be happening. Although I don't know how you actually injured both of your ACLs, muscle weakness in the hip extensors such as the biceps femoris can be one of the causes for such injuries, especially in non-contact ACL injuries. I'm also assuming that your ACL injuries were in fact non-contact (meaning no direct trauma to the knee itself) since bilateral ACL ruptures would be a pretty rare thing...even for a football player! Non-contact ACL tears occur 2-4x more in female athletes than they do in males, based on the sport and activity, which also leads to my assumption concerning the mechanism of your injuries.

If there is a weakness of your lateral (outside) hamstrings, the biceps femoris specifically, we would normally expect to see a dynamic valgus where the knees fall inwards towards one another. However, in order to prevent this, your particular strategy may be to laterally rotate your tibia (turn the shin/lower leg outwards), resulting in an improvement in the biomechanical ability of the biceps femoris muscle to exert force and maintain the position of your knee, disguising the actual weakness that exists. Because of this, there would be an increased pressure on the outside of the foot (the little toe and the "fifth ray"). This is not how we would normally walk or place pressure on our feet, so in order to balance out the contact forces of the foot your body has responded by pronating your right foot, allowing contact to once again be placed closer towards the inside of the foot (big toe and "first ray").
Of course, I could be completely wrong, too! But by putting the details together like my attempt above, coupled with a complete physical examination and evaluation of movement, a good therapist will be able to "read" the signs of your body and correct the issue.

Thanks for the great question, and thanks for listening to me ramble on the FitCast! I'm glad that you like it.