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Some experts estimate that as much as 80% of the population will experience back pain in their lifetime (Rubin, 2007).  This estimation is bolstered by the fact that the American population spends at least 50 billion dollars each year on issues related to back pain (MEDTEP, 1994). Individuals should work towards prevention rather than treatment of back maladies. One of the best preventative measures is proper posture in the midst of exercise and activities of daily living to improve spinal health.

Most lumbar disc injuries occur when the spine is in flexion or extension (Callaghan & McGill, 2001). This is one of the reasons that coaches are adamant about cuing clients to find a neutral spine position before proceeding with activity (e.g. shoulders back, tucked hips, tightening glutes). In exercise, one never wants to compromise spine position for the ‘ability’ to load more weight in an exercise (Boyle, 2016). One should practice stability prior to incorporating movement or increasing one’s weight-load, while being mindful of avoiding excessive flexion or extension. The middle portion of the available range of motion has previously been described as the neutral range — this has been purported to be advantageous for preventing injury and enhancing athletic performance (Herring & Weinstein, 1995).

The next time you step foot into a gym, check your positioning. Don’t wait for a coach to correct your spinal position. Take responsibility for your postural and spinal health by learning the basic body weight movement with proper mechanics first and from that point forward, challenge yourself a little more. 

3 helpful tips for back pain prevention:

1. Warm up and stretch properly, paying special attention to the hamstrings and hip flexors.
   1. The hamstrings need to be stretched in order to relieve pressure off of one’s back and prevent anterior tilt of the pelvis. The same goes for stretching the hip flexors as tight hip flexors can produce a posterior pelvic tilt.
2. Maintain a healthy body weight through proper nutrition and an active lifestyle.
   1. A high fat and caloric diet in combination with an inactive lifestyle can lead to obesity, a condition that can put stress on the back. Proper nutrition to maintain a healthy body weight helps you avoid unnecessary stress and strain on your back. It is important to get enough calcium and vitamin D daily in order to keep your spine strong. These nutrients assist in the prevention of osteoporosis, the culprit to blame in many cases of bone fractures leading to back pain.
3. Find a neutral spine position and strengthen your core before applying any sort of load to a workout.
   1. It is very important to work in neutral spine position because the natural curves help to lessen the strain, providing spinal cushion and protection. This position helps the individual attain proper balance, utilizing mainly the back and the abdominals to find the perfect middle ground. The deep abdominals/postural muscles (more commonly known as the core) offer support to the spine in conjunction with the layered muscles of the back. The core is connected to the ribs, pelvis, and indirectly to the lumbar spine, allowing protection for the spin. Each layer of the muscle works to assist the spine in finding balance.  

References

Boyle, M. (2016). New Functional Training for Sports (2nd ed.). Champaign (IL):

Human Kinetics.

Callaghan, J.P., and S.M. McGill. Intervertebral disc herniation: Studies on a porcine model exposed to highly repetitive flexion/extension motion with compressive force. Clin. Biomech. (Bristol, Avon). 16(1) :28–37. 2001.

Herring, S.A., and S.M. Weinstein. Assessment and nonsurgical manage- ment of athletic low back injury. In: The Lower Extremity and Spine In Sports Medicine (2nd ed.). J.A. Nicholas and E.B. Hershman, eds. St. Louis: Mosby Year Book, Inc., 1995. p. 1189.

In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD.1994.

Lee, J., Y. Hoshino, K. Nakamura, and Y. Ooi. Trunk muscle imbalance as a risk factor of the incidence of low back pain. J. Neuromusculoskeletal Syst. 7:97–101. 1999.

Rubin Dl Epidemiology and Risk Factors for Spine Pain. Neural Clin. 2007; May; 25(2):353-71.

“Handout on Health: Back Pain.” National Institute of Arthritis and Musculoskeletal

and Skin Diseases. U.S. Department of Health and Human Services, n.d. Web. 28 June 2017.

The Issue: My biggest problem with creatine has been the barrage of supplements claiming to ‘boost exercise performance.’ It is hard for me to decide which products I should purchase and which I should avoid.  Of course, when going to your local Vitamin Shop/GNC, the employees will urge you to buy the latest and greatest; they want you to spend money. Before incorporating a new addition into one’s nutritional plan, one must explore both the positives and negatives of the suggested supplement. Does creatine really help? What harm can it do? Do I need it?

Research Perspectives: Allegations against creatine have been made with complaints of muscle cramps and gastrointestinal ailments. A problem with these complaints is a lack of evidence and the fact that the issues experienced are common symptoms that occur in the general population, not just with those who consume creatine. Studies show no change in functionality of the liver & kidneys in healthy subjects supplemented with creatine compared to those without supplementation (Kim et al. 2011).

A superfluous amount of creatine (i.e. over the recommended amount) may cause those who have pre-existing renal disease or those at risk for renal dysfunction to be at a higher risk of experiencing related issues (Kim et al. 2011). Controlled creatine intake is imperative along with proper knowledge of potential high-risk factors to one’s health and well-being. Vandenberghe et al (1997) states that long-term creatine intake is beneficial to performance during resistance training. Young women (n=19) were tested for 10 weeks and performed resistance training for 3hrs a week.  The women were divided into two groups, a placebo group and creatine group.  After 10 weeks of training an intake of 20g/day increased phosphocreatine concentration by 6%.  Furthermore, Muscle PCr (Phosphocreatine) and strength, intermittent exercise capacity, and fat-free mass subsequently remained at a higher level in the creatine group. This study was able to conclude that long-term creatine supplementation enhances the progress of muscle strength during resistance training in sedentary females. (Vandenberghe et al, 1997). 

My Personal Experience: Just as doctors recommend we need more vitamin C or higher calcium intake, it can be suggested that if you want to become stronger, an increase in creatine consumption will help you reach your goals. As a collegiate baseball player, I want to be the best athlete I can become. As such, I lift 4-5 days a week. Each day I strive to exceed my performance from the prior one, paying attention to proper form and avoiding unnecessary training gaps. Although progress begins and grows in the gym, proper supplementation is also essential to improving athletic performance. I have been using creatine before & after each workout and I personally have noticed improvements in my performance. I have shown improvement in my bench press, back & front squat, and RDL since taking creatine versus before. I have seen significant improvement in my bench press, where I was stuck at 205lbs for a long while; I have now reached 220lbs two months after I began incorporating creatine.

Conclusion on Creatine: Despite my positive experience with creatine, I still hesitate to quickly agree with the famous claim of “boosting exercise performance.” It may contribute, but its contribution is towards the progress of muscle strength. Upon looking at research, I have concluded that I am not an individual at-risk from creatine intake; however, I am glad that I am educated and aware of which individuals should refrain from this supplement. As my plans included a CSCS certification, I find it more important than ever to be aware of, not only what I put into my own body, but also what I recommend that others put into theirs. Incorporating supplements into one’s training can help improve performance, but only with proper product knowledge and adherence to a training program that offers both safety and growth opportunity. I will continue to include creatine in my training. Should I choose to venture out and consider new additions into my plan, I will be sure to know the science behind the product and its potential effects on my health and well-being.

References

Kim, Hyo Jeong, Chang Keun Kim, A. Carpentier, and Jacques R. Poortmans. “Studies on the Safety of Creatine Supplementation.” Amino Acids 40.5 (2011): 1409-418. Web.

Vandenberghe, K et al. “Long-term creatine intake is beneficial to muscle performance during resistance training”. Journal of Applied Physiology Vol. 83. 1997.

http://jap.physiology.org/content/83/6/2055.short

Justin was born in Huntington Beach, California and moved to Long Valley, New Jersey when he was eight years old.  Justin will graduate with a B.S in Kinesiology in May 2018.  Justin currently plays baseball Westmont College under head Coach Robert Ruiz. 

Justin became interested in Kinesiology because of his involvement in baseball.  He loves the idea of working with athletes and helping them to become faster and stronger and reach their full potential.

Justin plans to get his CSCS and attend graduate school after Westmont.

The supplement industry grows rapidly as new and advanced products repeatedly claim to boost your exercise performance. One product that is widely advertised by supplement shops is creatine monohydrate. 

Creatine is a highly researched supplement, however the science behind creatine is not widely advertised. Creatine itself is a naturally occurring amino acid that can be found in natural foods such as meat (especially beef) and fish (especially salmon and tuna) and is also made by the human body in the liver, kidneys, and pancreas; It is then converted into phosphocreatine which is then converted into ATP, a major source of where our body gets energy other than glucose (Ehrlich, 2014).

The Question: If creatine is a naturally occurring amino acid in our body, why do we need to take it as a supplement?

The Process: The article International Society of Sports Nutrition position stand: creatine supplementation and exercise states that when we perform high intensity exercises, our phosphocreatine stores become depleted due to our body converting it into ATP, which is then used by our muscles.  When a creatine supplement is taken, the liver, pancreas, and kidney have more creatine to break down into phosphocreatine; this results in an increase in the amount of phosphocreatine molecules to convert into energy (Buford et al. 2007). 

The Effects: Studies show that creatine monohydrate is the most effective nutritional supplement in terms of providing lean body mass and anaerobic capacity (more ATP/more energy).  In one study, Creatine supplementation enhances muscular performance during high-intensity resistance exercise, fourteen active men were divided into two groups: a creatine group and a placebo group. Both groups performed a heavy load to failure bench press; 5 sets to failure based on each subject’s predetermined 10 repetition maximum.  Subjects also performed a jump squat exercise, which consisted of 5 sets of 10 repetitions using 30% of each subject’s 1-repetition maximum squat.  The creatine group ingested 25g of creatine monohydrate per day & the placebo group ingested an equivalent amount of placebo (Buford et al. 2007).

The Results: The subjects were assessed by diet, body mass, skinfold thickness, pre-exercise and 5-minute post-exercise lactate concentrations, and peak power output for the bench press and jump squat. Creatine supplementation resulted in a significant improvement in peak power output during all 5 sets of jump squats and a significant improvement in repetitions during all bench presses and jump squats.  Furthermore, a significant increase in body mass of 1.4kg was observed after creatine ingestion. In this study, one week of creatine supplementation (25g/day) enhanced muscular performance during repeated sets to a heavy load to failure bench press and jump squat exercise (Volek et al. 1997).

While this is just one study’s conclusion, the article International Society of Sports Nutrition position stand: creatine supplementation states that “nearly 70% of these studies (creatine’s effect on performance) have reported a significant improvement in exercise capacity, while the others have generally reported non-significant gains in performance” (Buford et al. 2007).

Stay tuned for my next post where I will dive into further studies of creatine monohydrate. 

Works Cited:

Buford, Thomas W et al. “International Society of Sports Nutrition Position Stand: Creatine Supplementation and Exercise.” Journal of the International Society of Sports Nutrition 4 (2007): 6. PMC. Web. 19 June 2017.

“Creatine.” University of Maryland Medical Center. Ed. Steven D. Ehrlich. A.D.A.M, 26 June 2014. Web

               http://www.umm.edu/health/medical/altmed/supplement/creatine

Justin was born in Huntington Beach, California and moved to Long Valley, New Jersey when he was eight years old.  Justin will graduate with a B.S in Kinesiology in May 2018.  Justin currently plays baseball Westmont College under head Coach Robert Ruiz. 

Justin became interested in Kinesiology because of his involvement in baseball.  He loves the idea of working with athletes and helping them to become faster and stronger and reach their full potential.

Justin plans to get his CSCS and attend graduate school after Westmont.

by Chris Ecklund, MA, CSCS, USAW, PES, TPI

Current trends in Fitness and Health (e.g. CVD risk factors, increases in BMI, Blood Pressure, Diabetes, Orthopedic injury in knees and backs, etc.) are not exactly following an upward trajectory, though some of them are beginning to taper off. Perhaps this is a turn towards the positive?

Present methods to combat these negative trends are, in my opinion, generally erroneous and may lead to poor outcomes, such as the following:

• Doing Long Slow Distance Cardio as the main source of Energy System Development.
• Jumping on the Gluten Free (or Dairy Free, or Vegan, or Juicing) bandwagon.
• Going all in on High Intensity, Orthopedically Risky Training protocols as the Gold Standard (i.e. Tabatas, Crossfit, Bootcamps).
• Taking on the P90X “Muscle Confusion” and “Do a Different Workout Everyday” Mantras as your own.
• Doing Nothing.

While none of these are inherently negative, we often have the wonderful response to these ‘new’ trends to embrace the novel and jump in without thought. Taking on the mantra of “more is better” as one’s own without proper evaluation on whether or not the chosen method is the right one results in improper care and recovery.

Case in point: Not everyone needs Steady State Cardio training (as was heavily promoted in the 1970’s). It’s not necessary for everyone nor even advisable for many.  It is important to choose a training method that fits you and works for you.

The Journal of the American College of Cardiology’s explored the idea of dosage as related to health benefit in the study “Leisure-Time Running Reduces All-Cause and Cardiovascular Mortality Risk.”  Specifically, it looked at the associations of running with all-cause and cardiovascular mortality risks in 55,137 adults, 18 to 100 years of age (mean age 44 years)” to explore the “long-term effects of running on mortality.”

The conclusion?

…5-10 minutes a day is great and will improve most health measures.

For those wondering, “Is more actually better?” take a look at the study by the American College of Cardiology, titled “1197-358 / 358 – Are Cardiovascular Risk Factors Responsible for the U-Shaped Relationship between Running and Longevity? The MASTERS Athletic Study”.

The synopsis of the study is this: those who ran more than 20 miles/week actually decreased life longevity compared to those who ran less that 20 miles.

Ask yourself:  

“What is my goal? Why do I train? How much do I actually need?  What is the minimum effective dose?”

Assess your needs, research your options, and make an educated decision.

To many, the focus of healthy aging is to live as long as possible. We have seen the life expectancy in the United States increased from 47 years to 79 years over the last 150 years, but the maximum lifespan (oldest age people are capable of living to) has only increased marginally during the same period. There appears to be an age, between 70 and 100 years old, where our bodies are naturally no longer able to keep up with the challenges of everyday life and as a result, shut down (Fries, 2005). Therefore, the primary goal of healthy aging is to live through our physiologically set lifespan with the highest quality of life.

The compression of morbidity hypothesis was developed by James F. Fries of Stanford University School of Medicine and proposes that living an active lifestyle with good nutrition and practicing abstinence from dangerous habits such as smoking delays the onset of disability until the last years of life (Fries, 2005). For example, a sedentary and active senior may both live to 85 years old, but the sedentary senior may become disabled at age 75, while the active senior may not reach the same level of disability until age 84. The active senior will be able to maintain their lifestyle of choice for an additional 9 years.

A 21 year-long study following a group of runners with an average starting age of 58 years old found that the runners developed a disability corresponding to challenges performing one activity of daily living, such as walking, 8.6 years later than the control group (Chakravarty et al. 2008). The differences between groups diverged increasingly at higher levels of disability.

Additionally, the runners did not experience more osteoarthritis and had fewer knee and hip replacements than controls (Chakravarty et al. 2008; Chakravarty et al. 2008).

Habits like exercise, healthy nutrition, and not smoking are important because the occurrence of a significant medical event late in life often leads to disability. Seniors should exercise as protection against injuries that could threaten their self-sufficiency. It is never too early or too late for anyone to start.

Seniors can benefit from the cardiovascular components of aerobic exercises (e.g. hiking) and the improvements in strength and stability that come from intelligently programmed weight training. In the runner study, the investigators note that the runners should be viewed as multidisciplinary athletes because many of them gave up running for other training modalities during the study (Chakravarty et al. 2008). Fries suggests that the most important thing is to find an activity you like and stay as active as possible (Fell, 2015).

Understanding the concepts behind the compression of morbidity can lengthen the time seniors can live full, independent lives.

Further Reading:

Chicago Tribune Article

Overview of Compression of Morbidity

Review of research

Tyler was born and raised in Santa Barbara, California and began training at Prevail in 2016. He attended Westmont College and will be attending medical school this fall. While at Westmont he graduated Summa Cum Laude, led a student-run homeless outreach program, and volunteered with medical clinics in Mexico and Bolivia.

After Tyler’s mother was diagnosed with rheumatoid arthritis (RA), he became interested in the cellular mechanisms behind the disease. He conducted his Major Honors project at Westmont on the role of the microbiome in inflammatory arthritis and conducted summers of research at Harvard Medical School studying the role of macrophages in RA. Including his critical care clinical research at Cottage Hospital, his research has resulted in seven presentations, three at national medical conferences.

These days, high school athletes are constantly finding themselves “in-season.” This could be the combination of school and club seasons for one sport athletes, the year-round rotating seasons of multiple sport athletes, or even rotating school sports alongside club seasons. So what strategies can we utilize to minimize burn-out, prevent injuries, and keep athletes at peak performance year-round? In addition to a proper strength and conditioning base, we can implement proper soft tissue care, nutrition, and proper rest.

So let’s focus on quality of sleep instead. If they can only get 7 hours, let’s make sure they get a good quality 7 hours. There are multiple proven strategies to increase quality of sleep without major sacrifice. The hardest strategy for high school athletes? Putting down their phones before bed. A 2009 study by the Surrey Sleep Research Centre confirmed that the blue light emitted by electronics such as phones, televisions, and computers decreases the feeling of sleepiness and improves cognitive performance. That’s all great, unless you want to go to sleep. Through inhibition of the production of a retinal protein, exposure to blue light before bed decreases sleep duration as well as quality of sleep.

If reducing blue light exposure seems out of reach to the athlete (and often, sadly, it may), there are other strategies. As the body prepares for and enters sleep, internal body temperature drops. To prevent interference with this natural change, it is best to keep the room cool (somewhere around 65 F).

Lastly, and perhaps the most intuitive strategy: complete darkness. Again with the light – the darker the room is, the less possibility there is for interference with optimal sleep patterns. 

So let’s let our athletes not only sleep, but also sleep well. And who knows, you might sleep better too!