Strengthening the Rotator Cuff

First and foremost, proper technique is more important than weight. Starting out, use very little to no weight. I find that 3-5 lb wrist weights or dumbbells are enough.   These muscles are small; therefore, the goal is not to make them bulky by lifting heavy weight, but instead to concentrate on proper form to strengthen them.  Use your best judgment when choosing how much weight to utilize.

Depending on the condition of the patient, it is recommended that they perform these for 3 sets of 10, and build up to 3 sets of 25, then add resistance.  Results will vary depending on the severity of the condition and daily physical activity.

External Rotation:

This can be performed standing using thera-band or side lying with dumbbells.  Start by flexing the forearm to 90° with the elbow firmly on your side, then rotate your hand away from your body.

Start                                Finish

Internal Rotation:

Can be performed standing using thera-band, or side lying with dumbbells.  Same starting position as the external rotation, but rotate your hand towards your body.

Start                               Finish

Scapular Raise (Ceiling Punch):

Start by lying on your back, making sure that the scapula is flat. Raise your hand toward the ceiling while keeping your back, especially your thoracic spine, flat.  This movement can be performed bilaterally at the same time.

Start                                            Finish

Side Lying Lateral Raise (Abduction):  for the purpose of strengthening the supraspinatus, only raise the arm to be parallel to the ground.

Start                                                                      Finish

Field Goal or The “Y”:

Start by lying face down, making sure that your arms are straight and resting comfortably on a perpendicular position to the ground.

Raise your arms to look like a “Y”, while trying to squeeze the scapula together. Hold for 3-5 seconds. Do not reach over the level of your head.  Relax your neck and avoid shrugging your shoulders or arching your spine.

This movement can also be performed on an inclined bench or a swiss ball.

Start                                                          Finish

The “T”:

Same starting position as the “Y”, lift your arms to the sides to your body, squeezing the scapula together.  This can also be performed on an inclined bench or a swiss ball.

Start                                                     Finish

The “W”:

Starting position looks exactly like the Field Goal / “Y” finish position. Bring the elbows to your sides. You should feel an increase in posterior muscle contractions with this movement.  Because of the similarities in the positions, I’ll have patients transition from end position of “Y” straight into “W”.

Start                                               Finish

Results may be different for each individual.  Various factors can contribute to the shoulder pain, so make sure to see your health care specialist to get a proper assessment if your condition is not progressing.

Bio:

Dr. Chiang, DC, CCSP received his Doctorate of Chiropractic degree from Palmer College of Chiropractic Florida.  While at school, he was an active member of the Sports Chiropractic Council.  He also participated in Clinic Aboard where he and a group of future chiropractors went to Morocco and provided chiropractic care to the underprivileged and the underserved.

Dr. Chiang has a strong interest and knowledge base in athletic and overuse injuries, and enjoys taking on challenging cases. He believes in a well-rounded, evidence-base, patient-centered approach to care and utilizes an array of techniques, including: chiropractic adjustments, soft-tissue/myofascial mobilization, exercise, education, nutritional, and lifestyle modifications. Some of the soft tissue therapies include Active Release Techniques, Gua Sha, Kinesio-Tape, and Graston Technique. Furthermore, he constantly strives to better serve his patients by increasing his knowledge base through continuing education courses, workshops and conferences.  Dr. Peter is a Certified Chiropractic Sports Physician (CCSP), which focuses on working with athletes and sports rehabilitation.

Dr. Chiang enjoys treating patients of all ages for various neuro-musculoskeletal conditions ranging from acute injuries, to repetitive strain injuries, to supportive and wellness care. He owns and runs North Eastern Chiropractic in Framingham MA with his wife. He can be contact via his web site: North Eastern Chiropractic

Shoulder Impingement Part II: Strengthening is a post from: The Final Frontier In Bodybuilding , Fat Loss, Health & Fitness

Most of the time when someone comes into my office with shoulder pain, it is caused by impingement syndrome.  Impingement syndrome occurs when the tendons of the rotator cuff muscles become irritated and inflame as they pass through the subacromial space. This results in pain, weakness, and loss of movement at the shoulder joint1.  Some of the causes are2:

•    Keeping the arm in the same position for a long period of time.
•    Sleeping on the same arm each night.
•    Overhead sports like tennis, baseball (especially pitching), swimming, and weight lifting.
•    Overhead jobs like painters.
•    Poor control or instability of the shoulder muscles.

Early on the pain usually only happens with overhead activities and lifting the arm. Over time, the pain may start happening at night, especially when laying on the involved side.  Pain is usually located in the front of the shoulder and may radiate to the side of the arm.  If the pain radiates past the elbow, it might be due to a pinched nerve. The best way to diagnose impingement is through history and orthopedic testing.  Some of the details that should be made available to your doctor when evaluating possible shoulder impingement include any history of previous trauma, positions that aggravate the pain, and what makes it better or worse. Another important factor to consider is how it affects your daily activities and workouts. What exercises are the worst to perform? Do you train your other muscles of the shoulder? If so, how often? Answering these questions will help your doctor to provide the correct diagnosis and the best course of action.

If you are suffering from impingement of the shoulder, the best thing to do is to rest, and stop all activities that will aggravate the shoulder. The pain and inflammation can be reduced through the use of therapeutic modalities like ice, ultrasound, and electrical stimulation, and through the use of nonsterodial anti-inflammatory drugs (NSAIDS)3.  Manual therapies such as Active Release Technique, FAKTR-ISTM, and/or Gratson Technique also help in reducing inflammation.  For severe cases, a corticosteroid injection may be necessary to relieve discomfort.  A stretching program should also be implemented to increase flexibility.  Stretching should include the posterior shoulder, the pectoralis minor, triceps, and biceps3.  The Sleeper Stretch is an excellent stretch for impingement.

Sleeper Stretch

When performing a sleeper stretch, make sure that you are not laying flat on your scapula, you want to lay mostly on your rib cage and the outside border of your scapula. Your arm should be 90 degrees from your torso with the palm of your hand facing the ground.  Then you want to gently push down at your wrist until you feel a mild stretch on your posterior shoulder and hold for 30 seconds. Do this for about 3 reps.  You should not feel anything in the front of your shoulder, and be careful to not push too hard. With this stretch your hand is not supposed to touch the ground.  The goal is to feel a mild stretch in the back of the shoulder and hold the position4.

Rest and avoid overhead workouts are the best way to treat impingement syndrome, along with regular stretching, and myofascial release techniques the symptoms should alleviate sooner.  Remember, if you are experiencing pain, seek the help of a health care specialist; it won’t just “go away”.

In the next article I will talk about some exercises to mix into the shoulder routine to prevent impingement from happening.

1.   Fongemie AE, Buss DD, Rolnick SJ. (1998). Management of Shoulder Impingement Syndrome and Rotator Cuff Tears”. American Family Physician 57: 667–74, 680–2.
2.     http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001474/
3.     Kirchhoff, Choldwig., Imhoff, Andreas B. (2010) Posteriosuperior and anterosuperior impingment of the shoulder in overhead athletes – evolving concepts”. International Orthopaedics. 34(7): 1049-1058.
4.    Laudner, Kevin G PhD, ATC., Sipes, Robert C, ATC, CSCS., Wilson, James T, ATC, CSCS. (2008). The Acute Effects of Sleeper Stretches on Shoulder Range of Motion. Journal of Athletic Training. 43(3): 359-363.

Bio:

Dr. Chiang, DC, CCSP received his Doctorate of Chiropractic degree from Palmer College of Chiropractic Florida.  While at school, he was an active member of the Sports Chiropractic Council.  He also participated in Clinic Aboard where he and a group of future chiropractors went to Morocco and provided chiropractic care to the underprivileged and the underserved.

Dr. Chiang has a strong interest and knowledge base in athletic and overuse injuries, and enjoys taking on challenging cases. He believes in a well-rounded, evidence-base, patient-centered approach to care and utilizes an array of techniques, including: chiropractic adjustments, soft-tissue/myofascial mobilization, exercise, education, nutritional, and lifestyle modifications. Some of the soft tissue therapies include Active Release Techniques, Gua Sha, Kinesio-Tape, and Graston Technique. Furthermore, he constantly strives to better serve his patients by increasing his knowledge base through continuing education courses, workshops and conferences.  Dr. Peter is a Certified Chiropractic Sports Physician (CCSP), which focuses on working with athletes and sports rehabilitation.

Dr. Chiang enjoys treating patients of all ages for various neuro-musculoskeletal conditions ranging from acute injuries, to repetitive strain injuries, to supportive and wellness care. He owns and runs North Eastern Chiropractic in Framingham MA with his wife. He can be contact via his web site: North Eastern Chiropractic

The Shoulder Part 1: Impingement Syndrome is a post from: The Final Frontier In Bodybuilding , Fat Loss, Health & Fitness

Vibration Training Review! is a post from: The Final Frontier In Bodybuilding , Fat Loss, Health & Fitness

Like the knee, the elbow is encased within an extensive synovial membrane, which synthesizes synovial fluid for the purpose of lubricating the joint.The elbow is quite stable, owing to the numerous tendons and ligaments that contribute to it’s integrity. In fact, many people are amazed to learn that over a dozen muscles cross the elbow joint— not just the biceps and triceps!

Causes and Pre-conditions for Elbow Problems: A Closer Look at the Problem

Acute traumatic elbow injuries are thankfully rare. Those that do occur are almost always the result of extreme stress in power and explosion events such as Olympic weightlifting and throwing. Falls (such as in skating, football, rugby, and equestrian events) and impact (as in football, combat sports, and hockey) also sometimes result in sudden traumatic elbow injury. Traumatic injuries of any type must receive immediate medical attention by a qualified sports medicine physician.

Chronic injuries in the elbow are usually a result of overuse. Boxers often suffer from such conditions. Of great importance is the fact that most trainees fail to consider the cumulative impact of all stressful events on the elbow, limiting their attention to training-related stress only. On the job, mechanics (constant work with wrenches, screwdrivers, etc.), secretaries and office workers (constant typing, and writing), and health professionals (massage, physiotherapy, and other forms of physical manipulations) are at risk for repetitive overuse syndrome (R.O.S.) to the elbow, due to constant and excessive contracture of the gripping muscles— all of which cross the elbow joint.

Most R.O.S. of the elbow is seen in the dominant side, so “handedness” becomes an additional factor to consider in these types of injuries.

Among athletes, throwing, particularly in baseball and the javelin event are leading causes of R.O.S. of the elbow. Boxers are also susceptible (from the high volume of punches thrown in training and competition), as are tennis players and golfers. Bodybuilders, fitness enthusiasts, and recreational athletes are not by any means immune to R.O.S.

The biggest problem with the elbow is the tiny size of the tendinous attachment sites, of which there are many. These sites can become progressively weakened by both impact and the dynamic forces of leverage. This leverage means that 10 pounds in the hand equals approximately 45 pounds at the shoulder joint, for a person with average arm length.

Another way to view this phenomenon is to compare the force you get by turning a bolt with a long handled wrench, as opposed to a short handled wrench. Now consider that a tennis player, for instance, makes this already long lever even longer by putting a racquet in the hand! The impact of repetitively hitting the ball, compounded by the very long lever arm created by the racquet, results in cumulative microtrauma to the tendinous attachment sites at the elbow.

Over time, if not treated, these tendons actually begin to fray, much like a nylon rope would if stretched beyond it’s tensile strength. Eventually, the tendon can detach from it’s attachment site at the elbow, requiring surgical repair.

Treatment Options: from Conservative to Radical

• Rest: The most effective yet overlooked aspect of post-injury recovery is simply to become more aware of and markedly limit activities that cause pain and swelling to the affected area! In light of the elbows ubiquitous role in almost all human activity, this is no easy task!
• Forearm Strap: Used by tennis players, golfers, and other athletes with elbow problems. The strap acts like a “shunt,” absorbing impact and vibrational forces before they reach the tendinous attachment at the elbow. One of the best straps is the Interceptor, by Weider.
• Aspirin Therapy: Aspirin reduces edema (swelling). Recovery simply does not begin until edema has subsided. Experiment with dosages— in many cases, low dosages of aspirin work just as well as large doses, with less possibility of stomach irritation. To protect your stomach lining even further, try crushing the aspirin tablets between 2 spoons and mixing them into a glass of milk. Since the body eventually develops a tolerance to it., use aspirin judiciously— only when needed most. Always check with your physician before implementing a regular schedule of aspirin therapy, no matter how small the dose.
• Diathermy: A high frequency form of heat which can penetrate as deep as 2 1/2 inches into injured tissues. Administered by a chiropractor or physical therapist, diathermy promotes circulation to the injury site, accelerating the healing process. Diathermy should precede cryo-therapy treatments.
• Electro-stimulation: Moderate to intense amounts of intermittent electrostimulation are applied directly to the injured tendinous area for 10-15 minutes per session. This form of electrostimulation is most effective when it follows diathermy and is followed up with cryo-therapy.
• Cryo-therapy: After diathermy, construct an ice pack by placing crushed ice in a “zip-lock” bag. Cryo-therapy is very beneficial in reducing edema, reducing pain, and pumping muscular tissues free of accumulated training-induced waste products. Spend at least 15, but no longer than 20 minutes on the ice.
• Cortico-steroids: Administered by injection to the injury site, corticosteroids help to reduce inflammation and pain. The drawback, however, is that these agents cause a breakdown of collagenous and ligamentous tissue after repeated injections.
• Proliferent-injection Therapy: is injected directly into the injury site, causing an “artificial injury” which then provokes the collagenous cells to begin restructuring themselves more quickly.
• Surgery: In the most extreme cases, a torn or avulsed tendon or ligament may require surgical re-attachment. This is “the final straw” when it comes to solutions for joint problems! Many methods are used, including tendon grafts, and stapling.

 
Prevention is the Key

Fortunately, most serious elbow problems can be completely prevented with good training and work habits, and immediate intervention upon the onset of trouble. Never train through elbow pain— instead, seek the immediate guidance of a qualified sports medicine physician or chiropractor.

Elbow Problems and Conservative Solutions is a post from: The Final Frontier In Bodybuilding , Fat Loss, Health & Fitness

The prevalence of these cases can be attributed largely to the fact that the knee is an anatomical vortex of sorts, where the body’s largest and strongest muscle groups converge upon the tiny, yet in most cases hardy, kneecap. Add to this a lack of basic anatomical knowledge, improper exercise technique and/or selection, and unsuitable workout gear, and the prescription for disaster becomes compounded exponentially.

In this discussion we will examine several factors which collectively, have the potential of determining your predisposition for experiencing knee symptoms. Much of this information has received minimal exposure from industry magazines and trade journals in the past, and therefore should be of considerable interest to current and prospective fitness professionals and health care specialists.

Knee Anatomy and Biomechanics

Keeping your knees healthy and asymptomatic begins with developing a functional understanding of how this unique joint is constructed (anatomy) and how it does and doesn’t function (biomechanics). The knee is relatively simple to understand from a mechanical perspective, but please refer to the appropriate illustrations as you read this section— doing so will enhance your comprehension of the discussion.

The knee is an unarthroidal (meaning movement in one direction only) hingetype joint, roughly equivalent to a door hinge for practical purposes. Five different types of structures are involved in the knee’s functional anatomy— bones, ligaments, tendons, muscles, and articular cartilage. Here then, is a brief definition of these structures:

Bone: Purposeful human movement would not be possible without bones. The four bony structures which are involved in knee function are the femur, or thigh bone, the tibea and fibula (the shin bones), and of course, the patella, or kneecap.

Ligaments: Fibrous and very tough connective tissue which connects bone to bone, providing stability and integrity to the joint. Two sets of ligaments help to stabilize the knee joint— the anterior and posterior cruxiates, which are deeply located within the knee, and serve to limit rotation and hyper-extension, and the co-laterals, one on either side of the knee. The co-laterals protect the knee from being moved from side to side, and help to establish the integrity of the joint by keeping the tibea and femur attached to one another.

Tendons: Fibrous bands that that connect muscles to their bony attachments. In the knee, the patellar tendon connects the quadriceps muscles to the patella, and then in turn to the upper shin.
Muscle: We all have a clear idea as to what muscles are, but let’s examine the ones that cross (via their tendinous attachments) the knee joint. First are the quadriceps, the powerful muscles of the anterior (front) thigh. Next are the hamstrings, or the leg biceps, located on the posterior thigh. Finally, the gastrocnemious, the most superficial calf muscle, crosses behind the knee joint, where it contributes as a knee flexor.

Articular Cartilage: You’ve heard of “torn cartilage” in knee injuries before. cartilage is the connective tissue which provides for a smooth articulation between bones at the joint. Cartilage also acts as a shock absorber. The meniscus is the knee’s only cartilage. Located on the tibeal plateau, it cradles the femoral condyle, or the rounded knobs of the lower femur. Since the tibeal plateau is flat, and the femoral condyle is rounded, the meniscus provides a better “fit” between these two structures.

Training Gear For Healthy Knees

For most, training attire is primarily a matter of vanity— looking good while you’re training. But two pieces of standard training gear— your shoes and knee wraps— should be carefully selected and applied, not only to maximize comfort and short term safety, but more importantly, to ensure the long term health of your knees.

Your shoes are literally where the rubber hits the road. We urge you to think of your shoes as the foundation of your leg training sessions. Wearing old or broken down fitness shoes for heavy squatting or leg pressing is like putting old, worn-out tires on a race car! There are several reasons to avoid training in your “tennies:”

First, most general purpose fitness shoes simply lack adequate stability, and have little or no arch support for heavy lifting. As you squat, your feet may develop a tendency to pronate, or “cave in” toward the inner side. When this happens, the knees are also forced inward, leading to a constant strain on the medial collateral ligament, excessive shear force on the meniscus, and improper patellar tracking, which in turn can lead to chondromalacia (to be discussed shortly).

If your feet tend to pronate anyway, or if you’re prone to being “knock knee’d” (and these two conditions are very often associated with one another), it becomes even more important to select good training shoes. Another important reason for using specialized shoes for squatting or other heavy leg training movements is that they provide a deep and solid heel cup, which prevents the foot from rocking and rolling laterally (to the outside) when it is compressed under heavy loads.

Finally, there is a difference between a shoe being worn out and being broken down. Even if your shoes look fine, they still may offer no arch or heel support at all, either because they never had any to start with, or because after a handful of heavy leg sessions, the supports have compressed to the point to where they no longer function as they were intended. Think about it— a tennis shoe is meant to support a 160 pound tennis player, NOT a 600 pound leg press! Loads like these cause the shoe to break down without visual signs of wearing out.

We strongly recommend that you choose a heavy-duty training shoe (please see corresponding list of companies that offer these shoes) that you use for training, and training only. Use a stable running shoe or cross trainer for everything else.

Knee wraps have long been a mainstay for competitive powerlifters, and for good reason. When properly used, wraps can dramatically improve knee safety during heavy squatting and leg training sessions. Whenever you contract your quadriceps muscles, the patellar ligament “wants” to pull away from it’s attachment at the upper front aspect of the tibea. During squatting, for example, the heavier you go, the lower you go, and the faster you descend, the more this tendency is compounded. Please refer to the sidebar below on proper knee wrapping.

You’ll notice that the wrap is tightly wound in a cylindrical fashion around the upper shin (where the patellar ligament attaches), then more loosely wound over the kneecap itself (this is important to avoid grinding the patella into the femoral condyle, creating a case of chondromalacia for yourself), then tightly wound over the lower third of the thigh. The rationale for wrapping the knees prior to heavy squatting is that it reduced the pulling forces on the patellar ligament at it’s attachment to the shin. This translates to significantly reduced chances of avulsing (detaching) your patellar ligament during heavy leg movements.

According to Dr. Paul Ward, knee wraps also provide several other benefits beyond protection of the attachment site of the patellar ligament. These benefits include keeping the knees warm, which improves blood flow and tissue elasticity, reducing the possibility of muscle tears during high-intensity leg pressing or squatting. Additionally, knee wraps assist the patella in tracking normally over the femoral condyle, reducing the possibility of developing chondromalacia.

Stance Variables Affecting Knee Health

Whenever you squat, hack squat, or leg press, your foot position is an important variable in determining not only the results you’ll obtain from the exercise, but also the safety of your knee joints. Although each individual must determine their own best stance exercise per exercise (based on their own anatomical peculiarities such as height and leg length), the following variables must be taken into consideration:

1) The quadriceps muscles can contract more efficiently when the feet are pointing slightly (about 25 to 30 degrees) outward as opposed to straight ahead. If you squat with a very wide stance, your adductors tend to assist the quads. This can result in stress to the medial collateral ligament, abnormal cartilage loading, and improper patellar tracking.

2) During the decent phase of any type of squat, do not allow the knees to move more than 2-3 inches forward of their locked position. The further your knees travel over your feet, the greater the shearing forces on the patellar tendon and ligament. To avoid this, descend into the squat as if you were sitting back and down into a chair. Don’t worry if you lean forward a bit as long as you maintain a tight and arched back, and keep your bodyweight over the center of your feet. The ultimate objective is to keep the shins as vertical as possible throughout the entire movement.

3) In any leg training movement, make sure that your knees are tracking directly over your feet, not to the inside or outside. Many lifters turn their knees inward during the concentric phase of a heavy squat, and they usually aren’t aware of it. Give your clients immediate feedback, since after all, they shouldn’t be looking at their feet during the lift! If a client turns the knees inward, insist that they back off on weight until more correct movement patterns are mastered. Consider videotaping the squat session to provide unquestionable evidence when needed.

4) During the concentric portion of squatting or leg pressing of any kind, instruct your clients to “push from the heels.” This not only enforces a vertical plane of the shins, but also allows the quads to contract with maximum efficiency. Balance will improve as well, which adds an extra margin of safety.

5) Although many top bodybuilders advocate a very close stance for the purpose of “isolating the quads,” when squatting, remember the inherent tradeoffs in all ergogenic (work-enhancing) techniques. In this case, any leg training technique that isolates the quads also intensifies the shearing forces to the patellar tendon and ligament. A lucky few have knees that can take this type of punishment, but for most of us, a slightly wider stance, with toes pointing slightly outward and shins vertical, is a much safer and still very effective alternative.

6) Finally, teach your clients to be efficient in the exit out of the rack, and getting “set” in the squat stance. After lifting the weight off of the pins, the lifter should take just one step backward as immediately assume the squatting stance. This takes time to master, but eventually all the minute adjustments can be pared down substantially. Once set in the stance, cue your clients to keep their feet “nailed down” for the duration of the set. Many people “fidget” with their feet and toes between reps which can cause a variety of problems ranging from a break in concentration to a loss of balance.

How to Use the Knee Wraps

Knee wraps are only effective if used properly. So, if you’ve never used them before, take a moment to read this:

Sit on a chair or bench. Begin with the wrap completely rolled up (this makes the process much easier than fighting with a six foot tangle of cloth). With your leg straight, start applying the wrap on the upper portion of your shin. Wrapping from “in” to “out,” (counterclockwise for the left leg, clockwise for the right), anchor the wrap by applying 2-3 layers on the upper shin, then move upward, overlapping each previous layer by one-half the width of the wrap. When wrapping around the patella, make sure the wrap is a bit loose to avoid excessive pressure on the kneecap. Apply the wrap tightly again as you move past the knee, stopping somewhere on the lower third of the thigh. Tuck the end of the wrap under the previous layer to secure it. Repeat for the other leg.

Common Problems of the Knee

Chondromalacia: Degenerative changes (roughening) of the underside of the kneecap. Causes pain when rising out of a chair or when climbing stairs. Think about getting a grain of sand under your eyelid— the synovial fluid acts the same way! Tight quads are responsible for 80% of chondromalacia. Other causes include repetitive overuse, genu valgum (“knock-knees”), and a shallow lateral femoral condyle.

Healthy Knees for Life is a post from: The Final Frontier In Bodybuilding , Fat Loss, Health & Fitness

A fairly recent article in the Journal of Special Operations Medicine (JSOM)* examined the Musculoskeletal injuries from 5th group.

The authors decided to quantify the rates and types of these injuries in SF using the records from 5th group, “who treated numerous middle-aged team sergeants with shoulder, back, and knee overuse injuries”
The authors noted “Special Forces, and Ranger units are about 10 to 12 injuries per 100 Soldier-months, which is comparable to collegiate endurance athletes. Of all the types of units studied, Special Forces has the highest incidence of injury rate at 12.1 per 100 Soldier-months.”

This study revealed that physical training caused 50% of all injuries, and 30% were linked to running. Injuries resulted in 10-times the number of profile days (lost work days) as illnesses with the leading reason for outpatient visits in our Group was for musculoskeletal disorders.

The locations of affected musculoskeletal conditions in descending order include: back/neck (31%), ankle (10%), shoulder (10%), and knee (10%).

The authors found that “…over 40% of all clinical diagnoses in the 5th Group Clinic were for musculoskeletal problems.” This translated into injured members of 5th group being put on “light duty” an average of 20 to 30 days each which has “significant” operational impact on the unit.

It was interesting to note that in other army units studied, musculoskeletal injuries are more common in the lower extremities (e.g., knees and ankles) but in SF, upper extremity injuries (e.g., lower back, upper back, shoulders, etc) are more common. The authors theorized “This may be due to the slightly older average age of our Soldiers versus conventional units, in addition to the cumulative effect of repetitive micro trauma from airborne operations, combatives training, wearing heavy body armor, and carrying heavy loads.”

This article covered a bunch of additional info about injury rates and other details interested parties (trainers, docs, etc) can look up the full article for additional details there. Of most interest to me, was their comments on prevention:
“Finally to focus more on prevention, Special Forces Groups should modify unit physical training programs to incorporate the fitness and performance fundamentals used in today’s top athletic programs. Military researchers have shown that modified physical training programs can result in lower injury rates with improvements in physical fitness. Training regimens that emphasize core strength and cross-training would likely increase physical readiness while decreasing the incidence of spine and lower extremity injuries.”

I agree with all of the above. As mentioned, training hard and training smart, are not always the same thing. The latter leading to greater performance and reduced injury rates, with improved operational readiness and (potentially) greater operational longevity for the SF soldier. The top coaches involved in “today’s top athletic programs” follow similar guidelines I mentioned regarding programs that follow a wave form pattern vs. a linear pattern I had mentioned in other blog posts here.
I’m happy to see the medical and training community within the SOF community is starting to see the benefits in both performance -and reduced rates of injuries – following more modern concepts in training already being utilized by the top athletic programs and or coaches in the field. The authors finished their report by summing it up nicely:

“By making these changes to training and resourcing, Special Forces Groups will be investing in our most lethal weapon—the individual Special Forces Soldier.”

* Clinical Diagnoses in a Special Forces Group: The Musculoskeletal Burden
James H. Lynch, MD, MS and Mark P. Pallis, DO, FAAOS. Journal of Special Operations Medicine (JSOM): Volume 8, Edition 2 / Spring 2008, 76-79

Reducing Musculoskeletal injuries in SF soldiers is a post from: The Final Frontier In Bodybuilding , Fat Loss, Health & Fitness

A common issue for athletes and other active populations (e.g. SWAT, SOF, etc.) is joint and connective tissue pain with various causes and diagnosis such as tendonitis, bursitis, cartilage degeneration, to name a few.

The use of various anti-inflammatory drugs, as well as nutritional supplements (e.g., Glucosamine, fish oils, etc,), and other therapeutic modalities are of value, but are far from a cure at this point.

A topic I have been researching for some time is the use of GH and other growth factors as a possible treatment for joint/connective tissue degeneration.

The causes of joint pain are multi factorial, but in active populations are often training related: over training, lack of proper warm up, loading and exercise choices, and other variables.

That’s the first place people should look when having chronic joint issues, but not everyone has a choice in the matter as to how much exercise they do and or the types of exercise they perform; various athletes, special operations soldiers, SWAT operators, etc.

I have written in prior articles that I think the use of GH and other growth factors (IGF-1, etc) was a promising way to treat connective tissue/joint problems, and studies are starting to support that conclusion.
There have been impressive developments recently in the use of growth factors for accelerated healing of sports related injuries, overuse syndromes, improved healing after some plastic surgery procedures, as well as studies finding success in the area of orthopedics.

More controversial, my hypothesis has also been that many people who suffer from chronic connective tissue problems and chronic back problems are often found to have low IGF-1, and reversing that state of low IGF-1 as a treatment for these pathologies is a viable treatment. It appears the former concept – using growth factors to treat joint pathology – is getting greater attention with the scientific/medical community. The latter concept – that a deficiency in these growth factors may be the cause of their joint related problems – a much more controversial idea.

But hey, I don’t mind being ahead of the curve and waiting for the scientific and medical community to catch up to me! Remember, Growth factors (e.g., IGF-1, bFGF, PDGF, EGF, and others) are the mediators that control the biological processes necessary for repair of soft tissues. After hitting the gym or the road with 60-80lbs of stuff on your back, and having muscles and joints in need of repair from micro trauma caused by those activities – or in the case of traumatic injury to muscles, tendons and ligaments – these growth factors are responsible for healing the injuries, with animal studies showing clear benefits in terms of accelerated healing and repair.

Regarding research on the issue of using growth factors to treat sports related injuries, a recent review in the British Journal of Sports Medicine entitled “Growth Factor Delivery Methods in the Management of Sports Injuries: The State of Play” examined the issue. The review covered a wide range of topics that examined the use of growth factors for treating various sports medicine related injuries. However, the report also noted,

“The use of growth factors in Sports Medicine is restricted under the terms of the WADA* anti-doping code, particularly because of concerns regarding the IGF-1 content of such preparations, and the potential for abuse as performance-enhancing agents.”

So, as hormones such as growth hormone (GH), IGF-1, as well as others may have performance benefits in athletes, they are banned by the International Olympic Committee (IOC) and are on the WADA list of agents.

It’s important to note that this review is talking mostly about directly delivering, via injection, the growth factor in question into the injured joint, which results in a much higher concentration to the injured area while reducing whole body/systemic exposure.

The IOC and WADA are concerned with athletes taking these hormones for performance enhancement vs. treating an injury. However, WADA has what they refer to as a “Therapeutic Use Exemption” which states:

“Athletes, like all others, may have illnesses or conditions that require them to take particular medications. If the medication an athlete is required to take to treat an illness or condition happens to fall under the Prohibited List, a Therapeutic Use Exemption may give that athlete the authorization to take the needed medicine.”

There are various ways of delivering higher doses of growth factors to injured tissue, but each has in a reliance on the release of the aforementioned growth factors which are released upon injection at the site of an injury. This means you get a high therapeutic dose at the site of the injury with a low whole body/systemic exposure of these growth factors.

So what about athletes and other active populations using GH who are not subject to IOC or WADA rules? Many athletes using low dose GH report improved joint function and less pain from GH therapy. Of course, not injecting it into the joint (and that should NEVER be attempted without medical supervision), which is how most athletes use GH, means a greater whole body effect and a lower concentration at the site of injury, which opens up additional areas of concern.

Regardless, it still appears to help with joint problems. I also recommend people who have chronic joint problems have their IGF-1 levels checked via blood tests. Healthy young people who have adequate diets and protein intakes don’t generally suffer from low IGF-1 levels, though I find it’s more common than some might realize, and not uncommon in older adults.

Finally, the use of GH for joint problems has to be done in the context of legality. I do not recommend people use illegally obtained GH for this use and need to find a medical doctor willing to work with them on their medical/joint related problems, but physicians using GH for this use is becoming more common as additional research and clinical feedback becomes available.

Creaney L, Hamilton B.
Growth Factor Delivery Methods in the Management of Sports Injuries:The State of Play. Br J Sports Med. 2007 Nov 5

* = The World Anti-Doping Agency

GH therapy for joint degeneration and back pain? is a post from: The Final Frontier In Bodybuilding , Fat Loss, Health & Fitness