Tuesday, January 17, 2012

workout

Tuesday, January 17, 2012

Health

January 16, 2012, 4:31 PM

Personal Best: Workouts Have Their Limits, Recognized or Not

Krzysztof Ryder/Getty Images
At the gym last week I saw a guy lifting weights, working out his shoulders while two friends urged him on. He alternated two similar exercises with heavy weights, repeating one exercise 10 times and then the other one 10 times, never resting between sets.
“We want to burn out his shoulders,” one of the man’s friends explained to me.
Exercise researchers would be appalled.
While public health officials bemoan the tendency of most people to do little exercise, if any, physiologists are fretting over the opposite trend: an increasing focus on extreme exercise among some recreational athletes. Weight lifting with no rest between sets and with no days off. Endurance training with no easy days or days off. Competitions that encourage excess.
To enter a recent race, my friend Joel Wilbur had to sign a waiver acknowledging he could die. Still, Joel was disappointed to find the race wasn’t all that dangerous. After signing a death waiver, he said, he expects some serious risks.
My workout partner Jen Davis once signed a race consent form that said: “There are sections of the trail that travel along cliffs. If you’re not careful you could fall to your death. Very few runners go the distance without taking one painful spill. Most runners take lots of them.”
She found the trail so arduous and dangerous that she never did it again.
And there is no shortage of commercial fitness programs promising to push people beyond their limits.
“People think a good workout is, ‘I am in a pile of sweat and puking,’ ” said William Kraemer, a professor of kinesiology at the University of Connecticut. But if that happens, he said, “it means you went much too quickly, and your body just can’t meet its demands.”
It’s not so easy to strike the right balance between exertion and rest, researchers say. Do too little, and the results may be disappointing.
That may be what happened to my colleague Jason Stallman. He wanted to avoid the usual consequences of marathon training: injuries from overuse. So he invented his own training program.
He exercised on weekdays but did not run. He ran just once a week, on the weekend, when he would do a long run.
Jason felt great, and the long runs went well. But when it came time to race, he said, his legs just didn’t have it. His time was slower than for most of his previous marathons.
Experienced athletes know that the only way to improve is to push yourself. Lift weights that are heavier than those you’ve tried before. Run or cycle at a fast pace on some days, but focus on increasing your distance on others. Work out enough that you may not fully recover between sessions.
You should feel tired, said John Raglin, a sports psychologist at Indiana University. But if you do too much with too little rest, your performance gets worse, not better.
“Serious athletes recognize these issues — whether they respond to them or not is another matter,” Dr. Raglin said. “A lot of recreational athletes really have no idea.”
When they train harder yet stop improving, even backslide, “they become alarmed and try to increase their training,” Dr. Raglin said.
He sees it over and over: An athlete will get into a training schedule and become very dogmatic, never taking a day off.
“The importance of recovery is a big topic in exercise science,” Dr. Raglin said. “It hasn’t filtered down to the serious recreational athlete.”
Muscles need to recover after they are stressed with heavy weights, Dr. Kraemer noted. Researchers have long known that the way to build strength is what they call periodization: Rest days and easier days and weeks are interspersed with periods when the weights are increased.
In endurance sports, muscles experience a different kind of stress, said Dr. Bengt Saltin, director of the Copenhagen Muscle Research Center at the University of Copenhagen. But the problem with intense exertion day after day is very similar.
Intense endurance exercise depletes muscles of their energy supply, glycogen. Muscles store enough glycogen only for an hour and a half to two hours of activity, Dr. Saltin said.
It takes a day for trained endurance athletes to replenish glycogen. Athletes with less training have less of the enzyme that restores glycogen — glycogen synthetase. It can take up to two days for them to restore this muscle fuel.
In addition, connective tissue in muscles can be damaged and needs time to recover. In a study of runners in an annual local race that is a bit longer than two marathons, Dr. Saltin and his colleagues found that the athletes’ muscles lost their elasticity as their connective tissues weakened.
Running got harder and harder, so much so that the energy required for a set pace at the end of the race was 50 percent higher than it had been at the start.
So how to avoid a self-defeating training program? There are no hard and fast rules, because individual athletes vary so much. A training program that one person thrives on will break another, equally talented athlete.
Dr. Raglin said even the experts, researchers like himself who study overtraining, had trouble defining the symptoms. Psychological changes are the most consistent signs of a problem, he said.
In the early stages of overtraining, athletes constantly feel tired; by the end stage, they may be nagged by depression.
Recreational athletes must be attuned to their fatigue, Dr. Raglin said. If it persists for several days, they should take a day off or simply do a lot less during workouts. A diary or notes on how they feel can help.
And that does not mean that difficult regimens are out of the question, Dr. Raglin said. He should know — he’s training for a contest in March, the Arnold 5K Pump and Run, in which competitors must bench press their body weight up to 30 times and then run a five-kilometer race.
“I don’t think it is very extreme,” Dr. Raglin said.
At least there is no death waiver.

Wednesday, January 4, 2012

ice may be bad for sore muscles

Wednesday, January 4, 2012

Health

January 4, 2012, 12:01 AM

Why Ice May Be Bad for Sore Muscles

Should you ice a sore back?Patrik Giardino/Getty ImagesIs ice the best remedy for an aching muscle?
Phys Ed
Already, the benches in gym locker rooms and beside basketball courts are filling with 2012’s early casualties, those of us who, goaded by New Year’s resolutions, are exercising a bit too enthusiastically and developing sore muscles. Many of us will then drape ice packs over our aching muscles. But a new review article published this month in the journal Sports Medicine suggests that for sore muscles, ice is not always the panacea that most of us believe it to be and that, in some instances, it can be counterproductive.
For the study, researchers at the University of Ulster and University of Limerick in Ireland reviewed almost three dozen earlier studies of the effects of using ice to combat sore muscles, a practice that many who exercise often employ. Ice is, after all, the “I” in the acronym RICE (rest, ice, compression, elevation), which remains the standard first-aid protocol for dealing with a sports-related injury. Icing is also widely used to deal with muscles that twinge but aren’t formally injured. Watch almost any football, basketball or soccer game, at any level, and you’ll likely see many of the players icing body parts during halftime, preparing to return to play.
But there has been surprisingly little science to support the practice. A 2004 review of icing-related studies published to that point concluded that while cold packs did seem to reduce pain in injured tissues, icing’s overall effects on sore muscles had “not been fully elucidated” and far more study was needed.
Last year, a small-scale randomized trial found no discernible benefits from icing leg muscle tears. The cooled muscles did not heal faster or feel less painful than the untreated tissues. But, as the researchers point out, it is difficult to scientifically study icing, since you can’t blind people to whether they are receiving the therapy or a placebo. People generally can tell if their muscles are getting cold or not.
Which leaves the findings of the new review about icing by athletes as the best overview we may have for now. And the findings are not altogether comforting.
The authors write that, in a majority of the studies they looked at, icing was quite effective at numbing soreness. But it also significantly reduced muscle strength and power for up to 15 minutes after the icing had ended. It also tended to lessen fine motor coordination. Some of the reviewed studies found that people experienced impaired limb proprioception, or their sense of where their limb was in space after it had been iced.
The result was frequently, at least in the short term, poorer athletic performance. Volunteers were not able to jump as high, sprint as fast, or throw or strike a ball as well after 20 minutes of icing.
“The current evidence base suggests that the performance of athletes will probably be adversely affected should they return to activity immediately after cooling,” the authors conclude.
Why an ice pack before exercise should depress performance isn’t fully understood, though there are several theories. “The most likely reason is that ice reduces nerve conduction velocity,” said Chris M. Bleakley, a research associate at the University of Ulster who led the study. “Nerve impulses in the muscle slow down.” Cooling, he said, also probably “affects the mechanical properties of the muscle tendon unit,” meaning that the muscles and tendons, which should work together seamlessly, do not.
There’s also the possibility that icing sore muscles may increase the risk of injury, though the studies did not examine this issue directly. If your iced shoulder or legs feel sluggish during a tennis match or run, the authors suggest, you presumably will push harder, even as the iced muscle, being numb, doesn’t alert you to the beginnings of a more severe injury. The risk really applies “to situations where athletes are returning to competition immediately after icing,” like when you apply a cold pack before a run or “ice on the sidelines or at halftime to treat pain and discomfort,” Dr. Bleakley said. That means for most of us, there may be times when it’s fine to ice sore muscles – like after a hard workout or when we experience serious injury — provided we do not jump back into the field.
Most earlier studies have found little benefit from icing after exercise, but also few negative side effects. And if we must resume activity, the negative effects of icing are thankfully short-lived, usually disappearing within about 15 minutes. They also were less severe if the icing time was shortened, Dr. Bleakley says. “Application times of three to five minutes had much less of an adverse effect on performance” than keeping the ice pack in place for 20 minutes or more, he said.
The fundamental lesson of the review is clear.
“Ice has many benefits,” Dr. Bleakley says. “It is cheap and remains an excellent method of numbing pain.”
But relying on ice to get you back into that senior-league basketball game or onto the running track when you’re already sore is inadvisable. “Athletes should consider that pain is usually a sign that something is wrong with your body,” Dr. Bleakley says. Listen, and stay out of the second half of the senior-league basketball game or skip a day’s run. You have the rest of 2012 to fulfill your resolution.

neck pain

Wednesday, January 4, 2012

Health

January 3, 2012, 11:00 AM

For Neck Pain, Chiropractic and Exercise Are Better Than Drugs

What's the best treatment for neck pain?Tony Cenicola/The New York TimesWhat’s the best treatment for neck pain?
Seeing a chiropractor or engaging in light exercise relieves neck pain more effectively than relying on pain medication, new research shows.
The new study is one of the few head-to-head comparisons of various treatments for neck pain, a problem that affects three quarters of Americans at some point in their lives but has no proven, first-line treatment. While many people seek out spinal manipulation by chiropractors, the evidence supporting its usefulness has been limited at best.
But the new research, published in The Annals of Internal Medicine, found that chiropractic care or simple exercises done at home were better at reducing pain than taking medications like aspirin, ibuprofen or narcotics.
“These changes were diminished over time, but they were still present,” said Dr. Gert Bronfort, an author of the study and research professor at Northwestern Health Sciences University in Minnesota. “Even a year later, there were differences between the spinal manipulation and medication groups.”
Moderate and acute neck pain is one of the most frequent reasons for trips to primary care doctors, prompting millions of visits every year. For patients, it can be a difficult problem to navigate. In some cases the pain and stiffness crop up without explanation, and treatment options are varied. Physical therapy, pain medication and spinal manipulation are popular options, but Dr. Bronfort was inspired to carry out an analysis because so little research exists.
“There was a void in the scientific literature in terms of what the most helpful treatments are,” he said.
To find out, Dr. Bronfort and his colleagues recruited a large group of adults with neck pain that had no known specific cause. The subjects, 272 in all, were mostly recruited from a large HMO and through advertisements. The researchers then split them into three groups and followed them for about three months.
One group was assigned to visit a chiropractor for roughly 20-minute sessions throughout the course of the study, making an average of 15 visits. A second group was assigned to take common pain relievers like acetaminophen and — in some cases, at the discretion of a doctor — stronger drugs like narcotics and muscle relaxants. The third group met on two occasions with physical therapists who gave them instructions on simple, gentle exercises for the neck that they could do at home. They were encouraged to do 5 to 10 repetitions of each exercise up to eight times a day. (A demonstration of the exercises can be found at www.annals.org).
After 12 weeks, the people in the non-medication groups did significantly better than those taking the drugs. About 57 percent of those who met with chiropractors and 48 percent who did the exercises reported at least a 75 percent reduction in pain, compared to 33 percent of the people in the medication group.
A year later, when the researchers checked back in, 53 percent of the subjects who had received spinal manipulation still reported at least a 75 percent reduction in pain, similar to the exercise group. That compared to just a 38 percent pain reduction among those who had been taking medication.
Dr. Bronfort said it was a “big surprise” to see that the home exercises were about as effective as the chiropractic sessions. “We hadn’t expected that they would be that close,” he said. “But I guess that’s good news for patients.”
In addition to their limited pain relief, the medications had at least one other downside: people kept taking them. “The people in the medication group kept on using a higher amount of medication more frequently throughout the follow-up period, up to a year later,” Dr. Bronfort said. “If you’re taking medication over a long time, then we’re running into more systemic side effects like gastrointestinal problems.”
He also expressed concern that those on medications were not as empowered or active in their own care as those in the other groups. “We think it’s important that patients are enabled to deal with as much control over their own condition as possible,” he said. “This study shows that they can play a large role in their own care.”