CB ATHLETIC CONSULTING TRAINING REPORT

ISSUE #67

INSIDE THIS ISSUE...
- "INTERNET links to Human Anatomy"
- "Fast- & slow-twitch muscles"
- "ACTIVE RELEASE TECHNIQUES: Have you tried it?"
- "ART TESTIMONIALS"
- "NOTE: New phone number at bottom!"

 

1 - SURFING THE WEB FOR ANATOMY & INFORMATION

www.cbathletics.com is not the only informative site on the Internet! Check out Men's Health magazine and their fitness message board: www.menshealth.com. This site is especially relevant to males that are seeking to GET LEAN! - www.cbathletics.com/whatsnew.htm. If you are a bodybuilder, athlete, student, health professional, or just curious, these sites have great pictures and descriptions of the muscles of the human body.

1. Human Anatomy Online

2. Virtual Anatomy: Basic Human Anatomy

3. The entire Gray's Anatomy Textbook

4. Three Dimensional Human Reconstruction

5. On-line Exploration of the Heart

6. Muscles Exercising and in other Action

7. Major Muscle List

8. Numerous Anatomy Resources and Links

 

2 - SLOW- & FAST-TWITCH MUSCLES: THERE ARE NONE!

The following chart details the percent of slow-twitch muscle fibers in several human muscles. This data is from muscle biopsies of athletes and untrained individuals. For an overview of muscle fibers and definitions, refer to ISSUES #52 & #55. Note the great range in the measurement of fiber type indicating a highly variable quality in humans. In fact, the range can determine athletic success because fast-twitch fibers help in strength and power sports while slow-twitch fibers help in endurance performance.

MUSCLE % Type I Fibers

Erector spinae 54 (Range 31 - 94!)

Biceps 48-50

Triceps 33-40

Deltoid 42-55

Vast. Lateralis 49-54

Gastroc 55-60 (Sprinters/Jumpers may be only 25-50% slow-twitch!)

Soleus 70-80

Abdominal muscle 50

The take-home message is that most human muscles are composed of approximately 50% slow-twitch and 50% fast-twitch fibers. There really are no muscles in the human body that can be considered "fast" or "slow", although many animal muscles contain only 1 fiber type. The triceps may be as high as 60% fast-twitch while the soleus may be as high as 80% slow-twitch, but that is as close as the human gets to a "fast" or "slow" muscle.

Research studies have shown time and time again that the fast-twitch fibers (type II) respond to weight training by growing significantly more than type I (slow-twitch). Therefore, if muscle growth is the goal, training programs should focus on developing hypertrophy in the fast-twitch fibers. Thus, it is still most effective to train the muscle with heavy weights because heavy weights will provide the greatest growth stimulus to these fibers. Give a person a solid program and sound nutritional advice and forget about fiber composition.

 

3 - ACTIVE RELEASE TECHNIQUES: POPULAR, BUT IS IT PERFECT?

Active Release Techniques(r) (also know as ART(r)) is a rehabilitation method that has been promoted on several training websites and by the Society of Weight-training Injury Specialists (SWIS). As time has passed, more and more "hardcore" weightlifters and strength and conditioning colleagues have given praise to this therapy.

The following information has been gleamed from the ART website and others. Dr. Michael Leahy is the originator of ART, but unfortunately Dr. Leahy did not respond to an email containing questions and concerns on ART. Therefore, the following information is a summary of available INTERNET information only.

Of note, a search of MEDLINE (an INTERNET resource for scientific research) produced no findings for "Active Release Techniques" or Dr. Michael Leahy. However, it is quite possible that the journals containing information on ART may not have been explored with this search function. If anyone does have peer-reviewed research on the ART technique and its effectiveness, please send them to cb@cbathletics.com.

ART has been described as a technique that uses motion and manual tension to fix soft tissue injuries. But do not mistake it for massage! ART is promoted as a type of therapeutic manipulation that breaks down scar tissue that has formed around your muscles. Therefore, ART is supposed to help increase the pain-free range of motion of the joint and may decrease muscular pain.

Dr. Leahy promises almost immediate improvement (within 1-2 sessions). According to Dr. Leahy, if improvement does not occur, then:

I) The problem source is still unknown.

II) The treatment has been ineffective.

III) The patient needs to have an increase in strength.

Dr. Leahy believes that by resolving the soft tissue problem at the source of the pain, this will eliminate all future problems because the source of the problem has now been adequately dealt with. After reading about ART on several websites, this therapy sounded like a miracle cure for injuries. Some claimed that only 5 minutes of therapy could eliminate the need for surgery, thus preventing months of rehab. One website went so far as to claim it was "a medical technique on par with the x-ray"!

Individuals treated by ART insist that it can be a very painful procedure. However, practitioners suggest that aggressive treatment of most soft-tissue injuries with ART may eliminate the need for surgery. If ART really does help, it's likely that a few "uncomfortable" sessions with a competent ART specialist will still be much less painful than any surgery! Don't worry though, to become an ART provider practitioners must go through some extremely in-depth, hands-on seminars.

 

WEBSITE SUMMARY - www.activerelease.com

ART is promoted as a highly successful treatment for injuries of muscles, tendons, fascia, nerves, and the surrounding soft tissues. Examples of these injuries (referred to as cumulative trauma disorders -CTD- by ART practitioners) are carpal tunnel syndrome, rotator cuff problems, and chronic lower-back pain. The belief is that ART can help these CTD where other modalities such as traditional massage, movement therapies, and passive rest have failed.

ART is a novel approach, involving diagnosing and treating the underlying mechanism of the trauma disorder rather than just trying to relieve the pain. To become proficient in ART one does not attend a traditional school of medicine or therapy, but it is likely that most ART providers have post-graduate training in rehabilitation. In fact, more and more physical therapists and chiropractors are learning this technique.

Cumulative trauma disorders are due to cumulative injury cycles. The "cycles" are initiated by acute musculo-skeletal injury, repetitive injury, and constant tension/pressure and may lead to adhesions (adhesions are scar tissue). The injury is proportional to the volume and intensity of the "insult" and inversely proportional to the length of recovery between the "insults".

Injury = Insult

Insult = Number of reps x force of reps / amplitude of rep x relaxation between stress

Thus, if you continuously "insult" the tissue (by applying a high volume of stress to the tissue) you initiate an injury cycle. Continuous vibration and poor posture are 2 examples of increased insult due to high volume. Therefore, to decrease injury, you must decrease volume and intensity, or increase relaxation between "insults" (decrease the pressure and tension on the tissues).

To provide a clear example in less technical terms, imagine that you type for several hours a day, but you use a very poor keyboard and improper technique. This results in a high volume of stress and very little recovery between each period of stress. Therefore, you may enter a "cumulative injury cycle". Thus, a key in the prevention of any injury would be to use proper technique in whatever it is that you do, and also to take many rest intervals and breaks.

Often the end result of "insult" is the build-up of adhesions and fibrinogen formation. This can cause tightness and weakness in the tissue but is poorly understood. There are various textures and origins of scar tissue/adhesions and Dr. Leahy documents soft-tissue changes & nerve entrapment symptoms. Unfortunately, one of the problems with the theory behind ART is the wide variety of novel and vague terms used by Dr. Leahy in his ART material, including many just used in the preceding paragraphs!

Courses are offered to practitioners that work hands-on with soft-tissue injuries in order to provide an additional method of treatment. Through training, providers learn to diagnose the presence of abnormal inflammation and adhesion (scar tissue) by examining tissue texture, tension, and movement.

Dr. Leahy recommends that you get study materials several months in advance; otherwise, you may be overwhelmed by the amount of information covered in the course. Furthermore, it is not just 1 seminar. Instead, it is actually a number of seminars for the entire body (i.e. one seminar is devoted strictly to the upper extremities), thus a provider can become an accredited ART provider for a single body part or for the entire body.

Through the educational workshops, participants learn the ART diagnostic and treatment protocols for 105 upper-extremity structures and 75 spine structures. At the completion of seminar courses, instructors grade each participant on knowledge and protocol utilization. ART Soft-Tissue Workshops combine 25 percent classroom teaching with 75 percent hands-on skill training, presented in three eight-hour sessions.

The final testing protocol includes written examinations and practical evaluations. ART can also be learnt through a manual and an instructional video library (upper extremity and spine are separate). Prior to taking a workshop, participants should study the manual and videotapes that are provided in order to be on track during the workshop sessions.

At the workshops, ART instructors go over protocols, applicable anatomy, and demonstrate the required skill and treatment before having the students practice themselves. The seminars sound pretty intense and not something that anyone can breeze through. Fortunately, the ART website promises there will be one instructor for every ten students.

Not everyone is eligible to become certified in ART. This is a change from the past when everyone was eligible and it was just recommended that you have a lot of experience with anatomy and hands-on diagnosis and treatment of injuries. Regardless, the less experience you have with injuries, the more likely you are to have difficulty with the course.

Dr. Leahy states that it takes years to become successful and proficient at ART, but he also believes that students should be able to provide some benefits after their initial course. After hearing plenty of feedback from people having ART performed on their injuries, it is recommended that you seek out only a very experienced therapist or chiropractor. These people should know the difference between healthy and injured tissue.

Here are some of the guidelines set forth by Leahy that are indicated as necessities for proper treatment:

* The practitioner must learn the techniques hands-on. While someone can save money and simply watch the videos for instruction, in all likelihood this will merely produce poor practitioners and unsuccessful treatment.

* The practitioner must work longitudinally on the tissue with a slow motion. It is pertinent that this specific technique is learnt hands-on.

* The practitioner can learn up to 13 different contact methods. The most basic is the thumb and the most advanced technique is "palmer" contact. There are also different pressures & tensions and variable movements that can be applied.

* The patient should be active in the rehabilitation and in control. By being in control, the patient can simulate movement (of soft tissue and neurally), and this enables the provider a free hand. When the patient is passive the practitioner must move the structure for the patient.

 

4 - ART TESTIMONIALS: MIXED VIEWS

Iain McGinnis, a student at McMaster University with lower back pain, says that, "Immediately after seeing ART specialists I feel noticeably better. My back does not feel as cramped and I move more freely. I feel much more relaxed although in a few hours I feel a little sore in the areas where the doctor was working, however after the therapy my muscles are much stronger."

Here's what Dr. Leahy said about ART's ability to help prevent or heal lower back injuries: "The major cause of back problems is a process called cumulative trauma disorder. When you work all day (standing or sitting), typically the deeper back muscles are weak and become tight, forming scar tissue in the muscle. Next, the scarring shrinks so it makes the muscle short and it blocks the circulation and hurts. Then you begin altering the mechanics of the spine resulting in disc degeneration. This is a chronic condition that builds up "silently" and is finally expressed in an "acute" injury. Now, instead of having to treat the back after the injury, ART has been designed to fix the soft-tissue and thus fix the root of the problem. "

Overall, ART sounds really great and may be just what is needed for some people, however this is what Greg Scott, a high school physical education teacher had to say. "Just a comment on ART for you, I had it done when I was having a nagging lower back pain looked at. The chiropractor I was seeing decided to do it on my hip flexors as a way to loosen up and realign my hips. He did so much damage that each subsequent visit was just to try and relive pain rather than work on the problem...therefore I stopped seeing him and went to the Canadian Back Institute instead to correct my back pain. I am sure that ART is effective given that you have a therapist or whoever who listens to the patient and goes easy at first, if not it can be really painful and set back your rehab."

Greg believes that chiropractors and massage therapists may take a different approach to ART (based on their formal training backgrounds) and therefore results may differ between professions. Something to think about and look into, says Greg. The more experience the ART provider has, the better your ART experience will likely be. The problem with any rehabilitation technique is that the practitioner improves with experience. Perhaps in the future this chiropractor may become an excellent ART provider, but it appears Greg did not benefit from an over-enthusiastic and inexperienced practitioner.

To find a successful ART provider you should ask around at your gym or at work. Perhaps someone else has had a positive ART experience and can suggest an experienced rehab specialist. Otherwise, do your homework and find someone that has the right credentials, and a lot of experience. In addition, make sure to communicate with the ART practitioner or the massage therapist or whatever specialist you are using. They can't tell how your body feels, you must convey that to them. Communication and knowledge will help you get back on track.

As with all therapy, ART should be focused on PRO-active rehabilitation and not just reactive. That means that you must do what you can to help the therapy, and you should not rely solely on others to solve your problems. Do the exercises that are recommended to you. ART should be applied on alternate days at most. This comes back to the magnitude of insult being proportional to intensity and volume. If the tissue is treated while inflamed from a previous session, then it will be detrimental.

According to Shawn Thistle who is studying to become a chiropractor, "I am planning on taking ONE of the three seminars (spine, upper, and lower extremities) - they are VERY expensive, so lots of people try to do it just by watching videos. I have had ART done to me by someone who has taken the course for that part of the body, and someone who hasn't - quite a difference." Shawn's comments indicate the disparity between practitioners at present and also highlight one possible flaw that some people may not have had hands-on teaching.

Mike Gough, CSCS, www.optperformance.com, "ART is a good addition if you are consistently treating athletes, but if you not doing it all the time, then what's the point. For example, some certified individuals that only practice ART sporadically might end up only giving you pain and no results."

Regardless of your injury, get it properly diagnosed so you can properly treat it! Furthermore, always be "PRO-active" in your rehabilitation and follow the exercises outlined by your therapist. There is no point in returning to the clinic with the same injury time and time again. It only becomes a waste of energy that could be spent better off trying to heal the injury in other manners. Of course, the best thing to do is to avoid injury in the first place. Remember that if you keep using bad form, you are going to keep getting bad injuries!"

 

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cb@cbathletics.com