Health in The News: June 19, 2012 - Americans Smoking Less, But Eating More

Hello folks,
No Smoking
I'm taking a break from the ACL series to bring you this news story. It's good and bad news. First, the good news. The amount of Americans that smoke is down by nearly 6% over the last 12 years and more americans report exercising is up as well. The bad news, 28.7% of Americans are obese and diabetes is on the rise. Click here to read the article:

Mixed bag of Health in America

So, we take the good with the bad right? Presumably, the obesity numbers will begin to creep down if the trend to exercise more comes up and people start making healthier decision. One step at a time.

What do you guys think?

ACL Injury Part 2: Prevention

Prevention is the best medicine. While there's no way to ensure that you will never have an ACL injury, there are some things you can do to lower your risk of getting injured. Below are three things identified in the literature that may help you avoid an ACL injury.

Appropriate Footwear

It should come as no surprise that good footwear can help you avoid a nasty ACL injury, not to mention other nagging injuries that athlete's suffer. This is especially athlete's who require cleated shoes. It's been shown that flat or pivot-disc style shoes have a reduced risk of injury because the lower the about of torsion at the knee.

Playing Surface

While this is mostly out of your control, it seems that playing on artificial turf puts you at higher risk of ACL injury than on natural surface. This, again, has to do with the about of torsion and the knee because of the great friction of the artificial turf compared to natural surfaces. 
The New Eyrie, Meadow Lane, home of Bedford Town FC - - 1720132

Neuromuscular Training

A major focus of research into preventing ACL injuries has been on neuromuscular control of the knee. This is done in an effort to reduce the amount of muscle imbalance between the hamstrings and quadriceps. Many programs have been developed, but one of the first and most ost significant was developed by Henning in the 80s. The basis of his program was to reduce the strain put on the ACL by the quadriceps by having athletes practicing landing, changing direction while running, and stopping with the hips and knees in slight flexion.

Another notable program is the PEP (Prevent Injury and Enhance Performance) Program - which consisted of sport specific training including warm-up, stretching, strengthening, plyometrics, and agility training.

The programs mentioned above along with the Sportsmetric Program developed by Hewett and Noyles, and proprioceptive training based off the work of Caraffa et al. (1996) have been shown to be largely effective in reducing the incidence of AClL injury rates by up to 90%.

ACL Injury Part 1: Mechanism, Function, and Risk Factors

When I was in high school my brother and I played on the varsity basketball team. He was amazing and we were from a small town; this meant that he played basically every minute of every game. When he was in his final year of school I remember we were playing in a tournament. It was the last quarter, my brother drove to the hoop, went for the easy lay up AND.... dropped like a ton of bricks. Later he told me he heard a pop and his knee gave way. That, my friends, was an complete ACL Rupture.

Mechanism of Injury

Up to 80% of all ACL injuries occur without contact - meaning that you don't have to get hit to get injured. Most injuries occur when landing  or quickly stopping with the knee fully extended (think after a lay-up or stoping after a 100m dash) or when quickly changing direction.

In injuries that are sustained because of contact to the knee is nearly always due to valgus stress - such as getting tackle or struck on the outside of the knee. Contact injuries like this are typically accompanied by damage to the medial collateral ligament (MCL) and the medial meniscus; collectively known as the unhappy traid.

Function of the ACL

The ACL is the most important ligament in the knee because it provides the most stability due to its orientation and thickness. The anterior cruciate ligament (ACL) is responsible for limiting anterior translation of the tibia on the femur, especially during knee extension. What this means is that it stops the shin from moving too far forward on the thigh. It also limits rotational movement at the knee joint along with the posterior cruciate ligament (PCL).

Who Is At Risk Of Injury

Well, anyone can get injured,but typically younger athletes in sports like soccer and basketball have the highest injury rate, in older people skiing has a large rate of injury. Here are common factors that may increase your risk of having an ACL injury.

  1. Athletes are at a much higher risk than the average person for an ACL injury due to the extreme forces about the knee in activities such as jumping, kicking, and quick changes in direction, with soccer having one of the highest ACL injury rates of any sport.

  2. Women athletes are 2-4 times more likely to experience an ACL Injury in their career than their male counterparts.
  3. Tying in to the point above, ovulation has been proposed to put a woman at an increased risk of ACL injury because of the excess of estrogen and relaxin hormones, making ligaments less tensile, and therefore more susceptible to injury.

  4.  Increased knee laxity. This means that people with more flexible knees are at higher risk of sustaining and ACL injury.

  5. People with a narrow femoral notch

  6. A higher than average BMI has also been suggested, but only in women - a high BMI doesn't seem to affect a male's risk of ACL injury.

  7. Muscles imbalances. People who have much stronger quadriceps than hamstrings are at an increased risk because the hamstrings work as a protagonist to knee extension, prevent excessive tibial translation. Weak hamstrings mean that the ACL takes on more strain to keep the shin from moving too far forward on the thigh.

Health in the News: June 12, 2012 - Exercise Gadgets that work

Hello folks,

This article isn't so much news as it is just good information, I thought I'd share it with you anyway. Interestingly enough, a couple of the "gadgets" mentioned have to do with Instability training, which I posted about a little while ago.

Anyway, here's the article.

Exercise Gadgets That Work

What's your favourite Exercise "gadget"

I Can See Clearly Now

Hello interwebbers,

As any of you who are my regular readers know, I'm a master of physiotherapy student. I'm currently in a rotation in a stroke unit. Today I had a patient who had suffered a right TAC (Totally Anterior Circulation Stroke) a few months ago. Prior to the stroke he had been blind in his left eye for about six years. Today when he was in treatment with me he told me that on Saturday he woke up and was able to see out of his eye! Isn't that fascinating. He spontaneously regain sight. I was dumbstruck, I mean absolutely flabbergasted. I mean I can come up with a theory about why this happened perhaps fine evidence of this having happened before, but to me it's a miracle. Seriously folks, it was amazing.

Iris - left eye of a girl
Have any of you had similar experiences, where something completely unexpected happened that you couldn't really wrap your head around?

4 Common Mistakes Made at The Gym

Hi folks. As a personal trainer and kinesiologist I find going to the gym kind of frustrating - Not because I hate working out, but because I notice mistakes that people make and always want to correct them. I know how much some people hate when someone corrects them, so most of the time I just let it go, unless I think they'll get injured. Here are some of the more common mistakes I see.

1. Doing external shoulder rotations horizontally

Good on you for wanting to protect your shoulder. It's super important that you not forgot about those smaller stabilizing muscles. However, doing rotations horizontally isn't targeting the right muscles. Essentially all that you're doing here is resisting gravity with your biceps and trapezius.

To correct this you can do one of three things. First, if you must do the exercise horizontally, use exercise bands, they will provide resistance to the movement. Second, lie on your side and perform the movement as you did before. this will let gravity and the weight do what you want it to do. Third, laterally raise your arms and rotate up from there.

2. Using the lat pull-down machine as a rowing machine

Let's break this down. What are we trying to target when doing a correct lat pull-down? The correct answer is the lattismus dorsi What are you actually targeting doing the exercise like this:

Not only is performing the exercise in this way completely wrong, you're also setting yourself up for an injury.

To do the exercise correctly you need to sit up right and pull the bar straight down to about the height of your collar bone, as shown in the video below:

3. Putting too much weight on the curl bar

If you can't curl without using your back then you need to drop some weight. Seriously guys, learn mechanics and save your back.

4. Half bench press

I see this too often, some skinny kid (nothing against skinny kids, I am was one) loading two 45lbs weights on the bar coming down about half way. You're not targeting the pecs here friends, you're isolating your triceps (more or less). If that 's your goal, then may I suggest doing some dips, or close grip push-ups.

If you can't get the bar down to your chest then you need to reduce your weights and work on your form. Get yourself a spotter while you're at it.

What are some mistakes you commonly see at the gym?

Instability Training

Hello everyone,

digging through my archives I found this paper that I wrote during my undergrad. I thought I'd share it with you all. If you think it's absolute garbage let me know - I'm fine with that. I wrote this when I was but a wee lad of 20.


Instability exercises as a means of training has become extremely popular in the media. Infomercials attesting the benefits of swiss balls, wobble boards, and other such equipment are common. One may be left to wonder how effective instability training actually is. Many studies show the effectiveness of using swiss balls or other such devices as a training modality, however can one achieve the same benefits from classic weight training? This paper will investigate the use of unstable platforms as a means of training and whether one actually needs to include it in their work out routine.

Personal trainer monitoring a client's movement during a fitball exercise
Behm, Hamlyn, and Young (2007) completed a study in which they compared trunk muscle activation during dynamic weight-training exercises to isometric instability exercises. Electromyograph (EMG) signals were recorded from the lower abdominals, external obliques, upper lumbar erector spinae, and the lower lumbar erector spinae. Subjects were to perform a squat and deadlift at 80% of 1 repetition maximum (RM), a squat and deadlift using lone body weight as resistance, and a side-bridge and superman exercise on a swiss ball. They found that the 80% 1 RM exercises elicited the greatest EMG activity in the lumbar-sacral erector spinae and upper lumbar erector spinae. They also found that no one exercise showed a significant difference in the external oblique and lower abdominal EMG activity. From their findings it was concluded that a moderately high intensity resistance, when performing dynamic exercises, can provide grater muscle activation than similar instability exercises and that it may be unnecessary to include instability exercises to a training program.

Supporting Behm et al. is Cavill et al. (2008). In this study the activation of trunk muscles during stability ball and free weight exercises were compared. Using the same stable exercises as Behm et al. (squat and deadlift) and comparing the muscle activation to three stability ball exercises (quadruped, pelvic thrust, and ball back extension) it was found that there was no significant difference in rectus abdominis and exertnal obliques between either type of exercise. It was also found that EMG activity of the back extensor muscles was greater during deadlifts and squats at all intensities when compared to stability ball exercises. They concluded that exercises performed on the stability ball were of too low an intensity to significantly increase core strength.

In 2005 a study by Marshall and Murphy was done on the difference between core stability exercises performed on and off a swiss ball. In their study eight subjects were to participate in four exercise protocols on a swiss ball and off a swiss ball – upper-body roll out, inclined press-up, contra-lateral single-leg hold, and a quadruped exercise. EMG activity was recorded from the rectus abdominis, exertnal obliques, the transversus abdominus and the internal obljques (TA-IO), and the erector spinae. Their results showed that EMG activity was significantly increased for the rectus abdominis and TA-IO at the top of the press-up when performed on a swiss ball instead of a stable bench. The rectus abdominis showed significantly higher activity when performing a single leg hold and at the top of the press-up on a swiss ball. Finally, the erector spinae showed increased activity with the left arm and right leg raised during the quadruped exercise.

This study somewhat contradicts the Behm and associates study in that it shows greater muscle activation when exercises are performed on a unstable platform. Also, these types of exercises may be more practical than moderately high intensity resistance training since they require a single piece of equipment (swiss ball) and a lowering intensity.

Grenier, McGill, and Vera-Garcia (2000) also found conflicting evidence to the 2007 Behm et al. study. They tested healthy men, with no history of low back pain, performing curl-ups using four different exercises – curl-up on stable bench, curl-up with upper body on swiss ball and feet on floor, curl up with upper body on swiss ball and feet on bench, and curl up with upper body on wobble board. EMG signals were recording from the upper and lower rectus abdominis as well as the external and internal oblique muscle on the left and right side of the body. It was found that curl-ups performed on a stable bench resulted in the lowest EMG activity whereas curl-ups performed with an instability device supporting the upper body resulted in nearly doubled the EMG activity. Results showed the greatest increase in the rectus abdominis muscle (upper and lower).

While the Gernier et al. and the Marshall studies do not compare the use of an instability device to resistance training they do show that muscle activity is greatly increased, especially in the rectus abdominis, and TA-IO when performing exercises with a unstable surface. This is significant because Behm et al. found that no one exercise increased muscle activity in the lower abdominals whereas these studies showed increased activity in the rectus abdominis and TA-IO, which extend into the lower abdominals.

A study in which weight bearing activity, as opposed to callisthenic exercise, showed increased muscle activity during a swiss ball bench press (Marshall, P and Murphy, A., 2006). In this study EMG activity was recording from anterior deltoid, biceps brachii, triceps brachii, pectoralis major, rectus abdominis, and the TA-IO. A dumbbell bench-press was performed on both a stable base and with the upper body supported by a swiss ball. The results showed that muscle activation was greater for all muscles when the exercise was performed on the swiss ball and that activation was also higher during the eccentric phase of the press.

This study is very significant because it compares a weight bearing activity performed on both a stable and unstable supporting surface. Behm et al. compared weight-bearing activity to callisthenic exercise. Since these exercises are inherently different one would expect there to be greater EMG activity in an exercise in which the muscle must produce force to lift a weight. The 2006 Marshall and Murphy study proves that weight training in combination with a unstable supporting surface yield greater muscle activity and therefore will be more beneficial then weight-training or instability training alone.

In choosing a work out routine one must be cognizant of the available exercise modalities available to them and what will best suit their needs. While it is true that resistance training is effective in core strengthening (activation of muscles in the trunk) it is not the only way to target those muscles. It has also been shown that callisthenic exercises performed on an unstable surface can provide greater muscle activation then the same exercise performed on a stable surface (Grenier, McGill, and Vera-Garcia), but not to the same extent as deadlifts or squats performed at a moderately high intensity (Behm D.G., Hamlyn N., and Young W.B.). The most effective protocol appears to be the combination of a weight-bearing exercise and instability ((Marshall, P and Murphy, A.)


Behm, D., Hamlyn, N., & Young, W. (2007). Trunck muscle activation during dynamic weight-training exercises and isometric instability activities. Journal of Strength and Conditioning Research, 21 (4), 1108-1112.

Cavill, M. J., Cormie, P., McBride, J. M., McCaulley, G. O., & Nuzzo, J. L. (2008). Trunk muscle activity during stability ball and free weight exercises. Journal of Strength and Conditioning Research, 22 (1), 95-102.

Grenier, S. G., McGill, S. M., & Vera-Garcia, F. (2000). Abdominal muscle response during curl-ups on both stable and labile surfaces. Physical Therapy, 80 (6), 569.

Marshall, P., & Murphy, B. (2006). Changes in muscle activity and percieved exertion during exercises performed on a swiss ball. Applied Physiology, Nutrition & Metabolism, 32, 376-383.

Marshall, P., & Murphy, B. (2005). Core stability exercises on and off a swiss ball. Arch Physo Med Rehabil, 86, 242-249.

Health in the News - June 5, 2012: Too Much Exercise Can Be Harmful

Marathon Runners
This weeks news study worries me just a little bit, not because I overexercise, but because I can see it being used as an excuse to not exercise at all. The results of a recent study by Dr. James O'Keefe are all over the news today. To be fair, the results only indicate that the extremely fit (think Lance Armstrong, or Bruce Lee) are at an increased risk. Click this link to watch the video from Dr O'Keefe. . Here are just a few of the news stories written about the article. what are your thoughts?

Birthday Greetings

Hello blogland,

This post has absolutely nothing to do with health or fitness. It's my wife's birthday today and I wanted to wish her a very happy birthday here on my blog and invite all of you to head over to her blog and do the same. Tell her I sent you - it'll score me some points.

Ocean In Your Bedroom

Don't Make Yourself Look Like a Gorrila

Gorilla gorilla gorilla 01Hi folks,

I'd like to raise a small issue here about muscle imbalances. I won't go to far into depth about it right now, but here we go.

Why do so many people (read: men) do four or five exercises a day for their chest but do one, maybe two for their upper back?  You guys are going to end up looking like gorillas if you get doing that because you're going cause your scapula to protract (winged shoulder blande) and internal rotation of your arm.

Here's the deal, I have no problems if you want to do flat bench, incline bench, flys, and cable crossovers one day (actually I do, if you want to know them let me know in the comments) as long as the next day you balance those exercise out for your back! I know, I know, you want that shirt to fit nice and tight and have everyone comment about your pecs. That praise won't count for a whole lot when you have shoulder blades popping off your back, a subluxed shoulder and not be able to reach behind you to put on your seatbelt.