Mike Boyle's "ah-ha" Moments

By Mike Boyle

My good friend Alwyn Cosgrove wrote an article called Cosgrove's Five Ah-Ha! Moments: The Education of a Misguided Trainer. Alwyn inspires me in many ways. Most times his inspiration is based around his ability to beat cancer twice. This time it was around his writing.

Here are my Ah-ha moments, a smorgasbord of nutrition, rehab and training that might leave your head spinning. Before I start, I need to briefly introduce the smartest man you have never heard of. Although Bill Hartmann has previously held this tag, I think many now know how smart Bill is. My nominee for "smartest man you have never heard of" goes to Dr. Dan Dyrek DPT. In the area of physical therapy and the human body Dan is the smartest guy I have ever met. His skills in the care of the human body are unparalleled. I have the pleasure of meeting and brainstorming with Dan and his staff once a month and I look forward to it like a little kid. Most of my recent Ah-Ha's arrive at these meetings.

I think we should all remember that most of the smart people in this field are not writing books or posting in forums. Many are working their rear ends off getting people better.

Ah-Ha #1

Most people who think they have tendonitis actually have tendonosis. Is the difference just semantics? Absolutely not, it's an issue of understanding. You can't have "chronic tendonitis". If you do, you probably actually have a tendonosis. Does it matter? Absolutely. Those of you with chronic shoulder pain most likely have a tendonosis. In tendonosis the tendon undergoes a structural change in response to the chronic stress placed on it and the poor initial treatment. The condition is different and the treatment is different. Ice and anti-inflammatories do little for tendonosis as the condition is no longer an inflammatory one. In fact, my good friend Dr. Donnie Strack, another excellent PT, makes an great point. Continued use of anti-inflammatories actually can weaken a tendon and delay healing.

Ah-Ha #2

Number two relates closely to number one. Soft tissue work, whether for chronic muscle strains or for tendon issues, is like weight training. Treatment is actually a stimulus. In effect what the therapist is doing is irritating the tissue to produce a chemical response. The chemicals produced are what begin the healing process. This why soft tissue work is often painful and can leave you feeling similar to a workout the next day. According to Dr. Strack soft tissue mobilization ( think massage) stimulates the formation of fibroblasts which help take immature and randomly aligned Type 3 collagen (found in tendinosis) and changes it back to a stronger, more parallel mature Type 1 collagen.

Ah-Ha #2B

Soft tissue work goes by many names. The names don't matter, the treatment does. Physical therapists use the term soft tissue mobilization. Chiropractors usually use ART or Active Release

Technique. Massage therapists just called it deep tissue work. Just remember, the magic is in the hands, not the names. It's all pressure applied to tissue to deform it and cause a chemical reaction.

Ah-Ha #3 – Wolff's Law of Bone

Courtesy of Wikipedia:
"Wolff's law is a theory developed by the German Anatomist/Surgeon Julius Wolff (1836-1902) in the 19th century that states that bone in a healthy person or animal will adapt to the loads it is placed under. If loading on a particular bone increases, the bone will remodel itself over time to become stronger to resist that sort of loading. The external cortical portion of the bone becomes thicker as a result. The converse is true as well: if the loading on a bone decreases, the bone will become weaker due to turnover as it is less metabolically costly to maintain and there is no stimulus for continued remodeling that is required to maintain bone mass."

I know, you are all saying "I know". I think we don't really know. One of my clients is a world-renowned plastic surgeon. He told me that in some extreme cases the fibula ( a thin non-weightbearing bone) has been transplanted to replace a shattered tibia. Do you know what the result is? The transplanted fibula gradually takes on the shape of a tibia due to Wollf's Law. We must remember that everything in the body responds to stress, muscles, tendons, cartilage and bone. In fact studies have shown that athletes have thicker hyaline cartilage (lining bones) than non-athletes. This improves the body's protective mechanism in delaying osteoarthritis.

Ah-Ha #4 – Myers Locked Long/Locked Short Concept

If you don't have Thomas Myers book Anatomy Trains, get it. Myers is a Rolfer, an original student of Ida Rolf (yes Rolfing is named after a person, that was ah-ha 4B for me too). In Anatomy Trains Meyers again draws on the physical laws that govern the body and describes the concept of lengthened muscles being "locked long" and shortened muscles being "locked short". In some ways this challenges the Janda based NASM idea of simply stretching the short side and strengthening the weak/long side. It also explains why this doesn't seem to work well in older clients. Older clients have undergone structural change in both the bones and the muscles that will not simply be reversed with a foam roller, some stretching and a few strength exercises. Muscles in a chronically stretched position (think scapula retractors) become locked long. In effect they develop more collagen and less elastin in response to the constant tension. On the flip side the pecs on the other side become locked short. This is really important if you personal train. It's foolish to think you can undo years of soft tissue change with stretching. It is also tough to counter 8-10 hours of sitting with one hour of standing. Don't stop trying just realize that what took years to do will take years to undo.

Ah-Ha #5 – It May Be Ok to Do Painful Exercise

I have always said "if hurts don't do it" and "does it hurt" is a yes/no question. I still believe this in almost every case. However, my studies with Dan Dyrek have again shown me the error of my ways. In rehabilitating or reconditioning ( boy do the PT's get bent if they think I'm doing rehab) a client or an athlete with a tendonitis/ tedinosis condition it may be necessary to endure some tendon pain to produce the proper remodeling effect. In fact Dr. Strack points out that it may not just be necessary, but according to some studies is a must. If you are not sore with the program, research states that reps or external weight should increase.

Just remember this is the isolated exception to the rule. The painful stress to the tendon acts much like soft tissue work to initiate a healing response.

The key is the type of pain. Acceptable pain is localized to the target tissue, and the tissue is painful to touch. There should be no swelling and no motion restrictions. The pain should follow a DOMS like pattern and be gone in 2-3 days.

Ah-Ha#6 – Look for Weak Synergists

Everyone who knows me knows I'm a huge Shirley Sahrmann fan. I think in my lectures I'm elevating Shirley from the "smartest person no on has heard of" category to hopefully a household name in our industry. Sahrmann has said so many brilliant things but, the one that stands out is "any time you see an injured muscle, look for a weak synergist". Simple brilliance. Injured hamstring? Think weak glutes. Injured rectus femoris? Think weak ilio-psoas. The basic concept is that the injured muscle is simply a symptom of an underlying weakness. Talk about Ah-Ha's.

Bonus Nutrition Ah-Ha

Corn is not a vegetable! Corn is a grain. This may seem simple but I've always thought it was a vegetable. It tastes like a vegetable. It looks like a vegetable and it may be the worst thing you can eat. Avoid corn and more importantly avoid its ugly derivative, high fructose corn syrup.

My advice...Keep reading. Hopefully you will have these wonderful Ah-Ha moments just like me.