In this installment of Random Thoughts on Sports Performance Training, I want to hone in on shoulder stuff because, well, that's what I talk about a lot!
Let's get to the new content:
1. The neck is the easiest place to start with cleaning up shoulder movement.
I've written a lot in the past about how our arm care programs work proximal to distal, meaning that we focus on the center of the body before the extremities. Usually, the right proximal changes yield immediate distal improvements both via reducing protective tension and reducing stiffness in the muscles we're trying to "overpower" to create good movement. Usually, though, when it comes to proximal changes, folks look at the thoracic spine and rib cage only. In reality, the cervical spine ought to take precedence over both of them - particularly because all the nerve of the upper extremity originate from the brachial plexus, which ranges from C5 to T1.
Fortunately, while it might be anatomically correct, coaching optimal positioning in the neck is actually very simple in the context of weight training and arm care drills: get it to neutral and keep it there. In 99% of cases, that means getting people out of upper cervical extension, which fires up the levator scapulae (which competes against all the scapular upward rotation we want). Here's a video that walks you through what you need to know:
The thoracic spine and rib cage are sexy right now, but the cervical spine is an older, reliable option for cleaning up movement quickly in just about everyone.
2. Whenever possible, get core control integrated in your arm care drills.
I often come across arm care protocols that literally have athletes laying on a table for 30 minutes worth of "exercise." This not only leads to a disengaged athlete, but also overlooks the fact that the entire kinetic chain needs to be synced up to keep a shoulder healthy. We'll often use predominantly table-based exercises in month 1 to make sure athletes are picking up the technique in a controlled environment, but in almost all scenarios, these table drills are actually "fillers" between sets of strength training exercises that have the athletes up and around in the gym.
More importantly, after that first month, I try to make sure that at least half of our arm care exercises are done separate from the table. Maybe we do our horizontal abductions in a side bridge position, or integrate more bottoms-up carries or bear crawls for serratus activation. Perhaps the prone trap raises take place on a stability ball, or we shift to a TRX Y instead. Or, we could move the athlete to half-kneeling, split-stance, or in a rear-foot elevated position for their 90/90 external rotation holds.
Regardless of what we choose, the buy-in from athletes is definitely better - and just as importantly, the resulting training effect has a more specific carryover to sporting success.
3. Yet another study reminds us that GIRD is a measurement and not an actual pathology.
Glenohumeral internal rotation deficit (GIRD) was all the rage in the baseball sports medicine community for decades. Unfortunately, what many practitioners fail to appreciate is that GIRD can be a completely normal finding as long as an individual's total motion is symmetrical between throwing and non-throwing shoulders. We expect to see less internal rotation and more external rotation in a throwing shoulder because of retroverion in the throwing shoulder; the arc is just shifted. Here's a glimpse at what it looks like:
Anyway, we are now at a point in time where more and more research on GIRD is out there, and it's pretty resounding: it doesn't predict injury as well as we once thought. And, more importantly, the opposite seems to be true: a loss of external rotation (usually from a combination of less retroversion and soft tissue limitations) equates to a greater injury risk. We need to get more of the "GIRD? So What?" literature into the hands of doctors who aren't familiar with the latest research, as many are still making "GIRD" diagnoses when they really are just range-of-motion measurements. I delve into this in great detail in the Sturdy Shoulder Solutions product, but figured another study reiterating the point can't hurt. This one - Relationship Between Glenohumeral Internal Rotation Deficit and Medial Elbow Torque in High School Baseball Pitchers - just found that GIRD wasn't associated with medial elbow torque in high school pitchers.
It's time to move on from GIRD!
4. If you're about to have shoulder surgery (or any surgery), get your Vitamin D checked.
For years, we've known that having an adequate Vitamin D status was important for a myriad of biologic functions. Perhaps the most well known among observations on this front was a 2015 study of NFL players that demonstrated that players with inadequate preseason Vitamin D levels were more likely to have suffered a lower extremity or core muscle injury. In fact, the likelihood of a hamstrings injury was 3.61 higher in those with inadequate vitamin D levels! As such, it's become a big area of focus in the nutrition and supplementation world for athletes.
However, I've honesty never heard of an orthopedic surgeon looking at it for those who either have chronic pain or are about to undergo a surgical intervention to treat a structural defect. We need to change that, though. A recently published study, Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complications in Arthroscopic Rotator Cuff Repair, should help in that goal, though. Patients with pre-operative Vitamin D deficiency were 1.54 times more likely to require a revision surgery and 1.16 times more likely to require manipulation under anesthesia to overcome post-op stiffness.
Clearly, Vitamin D has a huge link to soft tissue health, so don't overlook it!
Wrap-up
I'm a shoulder nerd and could ramble on all day on this stuff, but instead, I'll direct you to check out Sturdy Shoulder Solutions if you'd like to dig in deeper. You can learn more at www.SturdyShoulders.com.
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Buddy Morris: The Next Chapter - This is a great podcast at EliteFTS with Buddy Morris, head strength and conditioning coach at the University at Buffalo. I've long been a fan of Buddy's not only because he's a bright guy, but also because he's an example of everything that's right about strength and conditioning. He's humble, super approachable, and always looking to get better - regardless of how long he's been in the field. This is a "must listen" for up-and-coming coaches.
Cressey Performance on Social Media - You might not know it, but Cressey Performance is well represented on social media. If you aren't following us already, you're missing out on daily tips, exclusive articles, and the ever popular "quote of the day." Here's where you can find them all:
There's one question that I get almost daily, and in spite of the fact that it drives me bonkers, I still do my best to answer it:
What supplements should I take?
The problem isn't that there aren't some supplements out there that can really help. Anyone who's done even a cursory review of the research can speak to the value of supplements like Vitamin D and fish oil. And, anyone who has ever reviewed the typical teenage athlete's diet can appreciate that a greens supplement would go a long way.
The bigger issue is that this question is an example of the carriage getting put in front of the horse. In other words, the people asking the question are usually getting way ahead of themselves and need to focus on proper diet first.
If you don't know what a healthy diet actually includes, how can you know what you need to supplement (dictionary.com: "to complete") with to get to where you want to be?
It goes beyond that, as the supplement question opens a big can of worms for several reasons:
1. The margins in the supplement industry are absolutely absurd - As a result, there are a lot of unethical people who flock to this industry in hopes of making some serious cash, playing on people's ignorance and insecurities. This is why you see bold advertising claims, doctored-up before/after photos, and - shamefully - products that don't actually make their ingredients list. Some companies may use cheap fillers to keep their costs down, or include banned substances unbeknownst to the consumer in order to improve efficacy. As a result of all this, you can't just recommend a supplement anymore; you also have to take the reputation of the brand into account.
2. It's a dynamic industry - With big money and potentially world-changing discoveries to be made, the game is constantly changing. New research is published daily, and new products enter the market just as frequently to complement the daily influx of brands. Plus, new uses for old supplements are always being introduced. As an example, we once thought creatine was just a supplement for athletic performance, and now it's being looked at as a valuable supplement in treating many chronic disease states. Unless you're reading journal articles full-time and asking around in the industry, it's hard to stay on top of all the new information.
3. Dosing matters - Using the creatine example again, we were once all taught that we needed to load creatine for the initial period - and most of us who did it spent the first 7-10 days on the supplement with gurgly stomachs and diarrhea. Now, we know that's not really necessary. And, contrary to what we were told back in the 1990s, you don't need to crush a load of simple sugars to get the muscles to "suck it up." How much you take, when you take it, and what it's taken with all impact a supplement's efficacy.
4. Supplements mean different things to different people - If a person is financially comfortable, he or she can likely afford a new-age and potentially marginaly effective supplement in hopes of some return-on-investment. For someone else, that $40 might be a huge deal. What works for one athlete won't matter nearly as much for another, too; the baseball players with whom I've spoken haven't really benefited at all from beta-alanine supplement, but the competitive cyclists and soccer players have thrived on it; the metabolic demands of the sport are entirely different.
Additionally, everyone has a different social perspective on what supplements mean. I once had a mother ask me about creatine for her son, and she commented that she viewed creatine as a "gateway drug" like marijuana. This backlash is only getting worse and worse because of the unethical actions of a few professional athletes (blaming supplements for positive tests) and supplement companies (not living up to label claims).
For all these reasons, I really outsource my supplement questions to people who stay much more up-to-date on the topics than I can. At our facility, I'm fortunate to have a great nutrition folks who stay as up-to-date on the research as possible - and also has a great mindset from which to discuss things with athletes, coaches, and parents.
Fortunately for us, though, we also have the good folks at Examine.com and their expertise at our fingertips on this front, too. They're a 100% transparent, independent organization that scrutinizing supplement efficacy - and a whole lot more in the health and human performance industries. In other words, everything they publish comes from peer-reviewed journals and is without influence from supplement companies - so you don't have to worry about "bro science" infiltrating their findings.
Their offering has expanded dramatically since the site was founded over a decade ago, and with that in mind, I’m going to encourage you to check out Examine 2.0, the newly launched update to their flagship offering. Examine distills thousands of studies into actionable insights. They also include monthly updates of the latest research, helping you to stay on top of what’s new in the industry (and get CEUs in the process). Through 8/25, you can get a big discount as one of my readers at http://examine.news/cressey.
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Here's this week's list of recommended strength and conditioning reading:
Who Are "They," Anyway? - This was an outstanding post by Mariana Bichette, who - as a MLB wife and the mother of a minor leaguer and 15-year-old ballplayer - has a tremendous perspective on everything from player development to scouting, not to mention how parents can best handle the teenage baseball years. I hear about parents talking about "well they ranked this kid as #4 in his class in Kentucky" (or whatever other number/state) on random blogs or showcase websites. If you liked my recent article, 20 Ways to Prepare Young Athletes for Success, you'll love everything Mariana writes. Look around her website and you'll see what I mean.
Roman's Road Rules - This article from my buddy, John Romaniello, is a great resource to anyone who travels regularly but still wants to eat clean and train regularly.
Vitamin D Deficiency Rampant in Patients Undergoing Orthopedic Surgery, Damaging Patient Recovery - Vitamin D has gotten a lot of attention in recent years, and with good reason; it clearly has some serious implications in terms of our health on the musculoskeletal and endocrine fronts (just to name a few example). This article at Science Daily certainly verifies that, and serves as a good follow-up the study a few years back that demonstrated players with deficient pre-season Vitamin D levels were more likely to get hurt over the course of an NFL season.
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Here's a little of recommended reading for the week:
Deloading on 5x5 Weight Training Programs- The 5x5 sets and reps approach is a very popular one, but most people ignore a very crucial factor that influences how successful this approach is: deloading. Learn more from this older post of mine.
Vitamin D, Calcium, and Dairy Intakes and Stress Fractures Among Female Adolescents - It always seems like calcium gets a lot more love than vitamin D when it comes to bone health, but here's a recently published prospective cohort study that shows that vitamin D is most likely the bigger player in preventing stress fractures. Just one more reason to supplement!
The Myth of In-Season "Maintenance" Training - I thought Ben Bruno did a good job relaying an important message about the value of in-season training, particularly among youth athletes. The overwhelming majority of kids can continue to get strong with good training in-season, so they need to view in-season strength and conditioning as developmental. Otherwise, it becomes one step forward (off-season), one step backward (in-season) for an entire high school career.
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My "random thoughts" pieces are some of my favorite writings that I've ever published, and today seemed like a good day to throw out some quick and easy ideas on how you can feel better, move better, lose fat, gain muscle, get strong, and - if you're super-motivated - take over the world. Here goes...
1. Get a good training partner.
There are random dudes you meet at the gym who provide a mediocre lift-off on the bench press here and there, and then there are dedicated training partners. There is a big difference. A good training partner will tell you to get your act together and train hard when you're slacking off, or even hold you back when your body is banged up, but you're stupidly trying to push through it. It's guaranteed accountability, motivation, expertise, safety, competition, and all-around awesomeness. To be honest, I often wonder if most people get the best results working with a trainer/strength coach for these factors more than the actual expertise the fitness professional provides!
2. Make your bedroom a cave.
One of the best investments my wife and I made when we bought our new house were reinforced window shades for our bedroom so that very little light could get through when they were down. They make a dramatic difference in terms of how dark you can make your room at night (especially if you have street lights near your residence) and were 100% worth the extra cost, as compared to regular shades.
Even if you don't want to spend the extra few bucks on souped-up shades, though, you can still get some of the benefits of "cave sleeping" by blocking out light from cell phones, alarm clocks, and - if you're a frat boy - bright green neon signs of your favorite beer in your dorm room. Also, do your best to shut the TV and computer off at least thirty minutes before you hit the sack as well, as it'll give your brain time to wind down and transition to some deep, restful sleep.
3. Take Athletic Greens.
I've always been a non-responder to supplements. As an example, I never gained an ounce when I started taking creatine in 2001, and never noticed a huge difference in sleep quality when I started taking ZMA. Still, I pretty much trust in research and go with these supplements, plus mainstays like fish oil and Vitamin D and assume that they're doing their job. It's interesting how some of the most essential supplements we take are the ones where we might notice the most subtle difference, isn't it?
Anyway, in 2011, I added Athletic Greens to this mix. I look at it as whole food based "nutritional insurance" use it in place of my multivitamin. I think it's solid not only as a greens supplement (which, incidentally, doesn't taste like dog crap), but also because it directly improves gut health to improve absorption of micronutrients. With loads of superfoods, herbal extracts, trace elements, antioxidants, and pre- and probiotics, I could tell that it would be something that would decrease inflammation and improve immunity (something I've viewed as increasingly important with each passing year as life has gotten more stressful with the growth of Cressey Performance).
Interestingly, one of our long-time athletes who is now playing baseball at a highly ranked D1 university, started taking Athletic Greens after we chatted about it this summer, and he sent me this note:
Hey Eric, thanks for the recommendation on Athletic Greens. I love the product! I have not gotten sick once since I started taking it 4 months ago, and my body feels better than ever. This is the first semester I haven't gotten sick. Hope all is well!
I guess I'm not the only one who likes it! Check it out for yourself here.
As an aside, they do a pretty cool combination where you can get greens, fish oil, and vitamin D all at once at a great price, and the fish oil is excellent quality. We have several athletes who get everything in this one place for convenience.
4. Go split-stance.
Last week, in my popular post, Are Pull-ups THAT Essential?, I included the following video of forearm wall slides at 135 degrees, a great drill we like to use to train upward rotation, as the arms are directly in the line of pull in the lower traps. With this exercise, we always cue folks "glutes tight, core braced" so that they don't just substitute lumbar extension in place of the scapulae moving into retraction/depression on the rib cage.
Unfortunately, these cues don't work for everyone - particularly those who are super lordotic (huge arch in their lower back). A great "substitute cue" for these folks is to simply go into a split stance, putting one foot out in front of the other (even if it's just slightly). As you have probably observed in performing single-leg exercises like lunges and split-squats, it is much harder to substitute lumbar extension for hip extension than it is with bilateral exercises like squats and deadlifts. Fortunately, the same is true of substituting lumbar extension for scapular movement on the rib cage. So, if you're struggling with the exercise above, simply move one foot out in front of the other and you should be golden.
5. Get some assessments done.
Imagine you were about to embark on a cross country trip with a great vacation in mind in, say, San Diego. However, I didn't tell you where you were starting the journey. While you might get to where you want to be (or at least close to it), it'd make the trip a lot more difficult. You'd probably blow a bunch of money on gas, sleep in some nasty motels in the middle of nowhere, pick up an awkward hitchhiked who smells like cabbage, and maybe even spend a night in a Tijuana jail along the way. Not exactly optimal planning.
A strength and conditioning program isn't much different than this cross-country trip. If you don't know how your body works - both internally and externally - you need to learn before you subject it to serious stress. Get some bloodwork done to see if you have any deficiencies (e.g., Vitamin D, iron, essential fatty acids) that could interfere with your energy levels, ability to recover, or endocrine response to exercise. Likewise, consult someone who understands movement to determine whether you have faulty movement patterns that could predispose you to injury. I think this is one reason why Assess and Correct has been our most popular product ever; it gives folks some guidance on where to start and where to go. Otherwise, the strength and conditioning program in front of you is really just a roadmap, and you don't know where the starting point is.
These are just a few quick thoughts that came to mind today, but I'll surely have many more in the follow-ups to this first installment. Feel free to post some of your own ideas in the comments section below, too!
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Here are a few recommended reads for the week:
Shoulder Pain vs. Neck Pain - This old post highlights a simple, but very accurate observation from Mark Comerford.
28 Synergistic Factors for Success - I wrote this article at T-Nation back in 2005, but it still holds water and will make you appreciate how many differen factors are impacting your progress.
Too Much Vitamin D? - This great Q&A from Brian St. Pierre addresses this new question that seems to be popping up quite a bit.
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Yesterday, I featured Part 1 of this interview with Rick Cohen, MD, the president and founder of Bioletics. Today, we pick up where we left off.
EC: Please tell us about the tests you use to determine mineral levels. For what specific minerals are you testing, and what are some of the common findings you're seeing that can make a big difference in how someone feels and performs?
RC: Our daily diet must contain adequate amount of macro minerals, which are necessary for all biochemical processes in the human body. These minerals include calcium, chloride, magnesium, phosphorus, potassium, sulfur and sodium. Among these, the most important are calcium and magnesium. Calcium helps to neutralize acidity, clear toxins and build bones; it also increases alkalinity and muscular flexibility. And while calcium receives a lot of media attention, the true king of all minerals is magnesium.
Magnesium is not only the single most important mineral in sports nutrition, but it is also one of the most critical elements in our body. About 350 enzymatic functions depend on magnesium, including ATP, the key factor that creates energy for every cell. Optimal magnesium levels enhance athletic endurance and strength by increasing metabolic efficiency. Magnesium promotes muscular contractility, decreases oxygen consumption, and improves cardiovascular efficiency.
Unfortunately, magnesium deficiency is very common. Inadequate dietary intake, sweat loss, physical and psychological stress and acidic beverages-such as energy drinks and sodas-cause the body to extract both magnesium and calcium from the bones and tissues in an effort to maintain proper blood pH. This combination of mineral loss and acidity in the body will decrease athletic performance and prolong recovery. It will also increase bone turnover and the resulting risk of stress fractures. This is exactly what we were seeing in younger female athletes with accelerated bone loss.
Despite magnesium's pivotal role in energy production and muscular health, many athletes are completely unaware of its critical importance. Part of the problem is that there is not an easy or inexpensive test available for intracellular magnesium levels. While it may seem easy enough to assess levels of minerals - especially of magnesium and calcium in the blood - it's not.
We have overcome this problem by using a functional marker of mineral balance called NTx. Bones are living tissues that are constantly breaking down and rebuilding. When they break down faster than they can rebuild, the body excretes increased amounts of NTx. While NTx is not specific indicator of low magnesium, it tells us when an athlete has an intracellular calcium/magnesium imbalance as well as poor amino acid and/or vitamin D status.
EC: What's your take on the most effective way to combat a magnesium deficiency that's discovered?
RC: That's where the other issue with magnesium comes into play: oral supplements work slowly; it can take more than a year to adequately restore your levels. In the past, intravenous infusions were considered the most effective way to go. But this was expensive and impractical for most athletes. Based on our research at Bioletics, we have found that the use of a topical magnesium oil spray to be very effective at restoring low magnesium levels after only two to three months of use.
EC: What about the hormonal panel you guys run? What does it include?
RC: As athletes, we want our body to have a positive anabolic to catabolic ratio. In simple terms, anabolism is the process of growth and repair. Your anabolic state is at its highest in your teens. Testosterone is the key anabolic hormone. Catabolism is the process of breakdown and destruction. Your catabolic state is as its highest after injury and illness, and increases as we age. Cortisol is the key catabolic hormone. By measuring your saliva, it is possible to create a snapshot of both an athlete's testosterone and cortisol balance as well as their anabolic/catabolic status. Unfortunately, we frequently find low T/C ratios in athletes.
Testosterone is an important health and performance hormone-for both men and women. It plays a key role in directing muscle growth and repair; it is what enables the body to generate optimal power and recover fully after such a hard effort. Testosterone contributes to an athlete's ability to stay focused, motivated and positive. A premature decline in testosterone levels can be attributed to a number of different factors: poor diet, lack of sleep, excess body fat, nutritional deficiencies, environmental estrogens, and/or the use of medications, alcohol, and drugs.
Cortisol is a major steroid hormone produced in the adrenal glands. It allows the body to cope during times of stress. Without proper cortisol response, you will not be able to effectively meet the daily challenges of life. Cortisol levels exhibit a natural rise in the morning and fall at night. If this rhythm is disrupted, the body's mineral balance, immune response, blood sugar and stress responses will all be negatively affected.
While it is very difficult to reverse the natural age-related decline in testosterone, the effects of stress and training on testosterone can be minimized. Since even "positive" stress can deplete testosterone, those who participate in endurance-related sports are especially at risk for having lower than optimal levels.
Research shows that testosterone levels are temporarily decreased as a result of overtraining, while serum cortisol levels increase. These changes in testosterone to cortisol balance are sometimes disastrous for an athlete, as they lead to elevated resting heart rate, poor performance, slow recovery, sore muscles, poor appetite, lethargy, muscle loss, irritability and a low sex drive.
Periodic assessments of both testosterone and cortisol are important when it comes to uncovering a potential hormonal deficiency or to simply fine tuning your training program.
EC: I'm curious about the essential amino acid test. In particular, I'm wondering if you're seeing issues in this regard not only in people who don't consume enough protein, but also in folks who DO eat a lot of protein and for whatever reason don't utilize it properly.
RC: Of all the Bioletics assessments, the widespread deficiency in essential amino acids was the one that surprised me the most. Almost every athlete knows that they need to eat protein and most athletes supplement their diets with additional protein powders. Yet, 90% of the athletes whose plasma amino acids we've tested were essential amino acid deficient.
Essential amino acids are the building blocks of protein. They allow the body to build and maintain muscle, neurotransmitters, hormones and key digestive and metabolic enzymes. Research shows that the lack of just one essential amino acid can significantly interfere with these processes.
What I've come to realize is that athletes don't have a protein need; they have an essential amino acid need. And it's not how much protein we eat that is critical; it's the biological value of the protein we eat that counts.
It's a common belief that one protein is just as effective as another when it comes to rebuilding tissue. But dietary proteins all contain a different mix of the eight essential amino acids we need. Therefore their biological value-their ability to be utilized anabolically by the body-differs.
Research indicates that approximately 40% of the protein in high biological foods such as whole eggs, meat, fish, poultry is used by the body for anabolic purposes. Only about 20% of that found in low biological food such as whey, soy, egg whites, beans and nuts is used for growth and repair. So, vegetarians and those who consume much of their daily protein as a bar or powder should know that these proteins are not well utilized by the body.
And the problem gets even more complicated. Even if you are careful to consume only high quality proteins, you still may not be utilizing them effectively. Stress, age, the use of medications, and/or certain cooking methods can reduce your body's ability to fully digest the protein you're eating.
Athletes need to be aware that competition, training, and injury all damage structural proteins. As a result, the athlete's body naturally requires greater amounts of essential amino acids for repair, recovery, and growth. An amino acid deficiency will prompt the body to break down body tissue-primarily muscle-in an attempt to access the missing essential amino acid(s) it needs.
Because of all these issues, we strongly recommend that all athletes use an essential amino acid supplement formula. These formulas do not require digestion and are almost 100% utilized for anabolic purposes. While many of us have come to rely or believe protein powders will cover our protein needs-and I was one of them-we now understand that protein supplements are just not as effective as we once thought.
EC: Lastly, you've just added an essential fatty acid (EFA) panel. What are you looking for on this?
RC: Yes, I'm very excited about this new assessment, as the benefits of optimal essential fatty acid status are numerous and it brings us closer to our goal of being able to conveniently and inexpensively assess EVERY key, biological process in the athletic body.
Essential fatty acids perform many physical functions. No cell, tissue, gland, or organ can function normally without them. Optimal EFA levels are critical to reducing overall inflammation in the body. They help you work harder and recover faster; they protect your joints, improve your mood and promote deeper sleep.
Our EFA status becomes stronger when we eat foods that are similar to those eaten by our primitive ancestors - lean meats, antioxidant-rich fruits and vegetables, and fats with a high omega-3 to omega-6 EFA ratio.
Over the past 50 years, we've developed an unfounded fear of healthful fats. And we've started over-consuming processed fats. Most Americans consume very little natural omega-3 fats, which can be found in fish, grass-fed meats, seeds and nuts. Instead, we eat processed omega-6 fats: corn, soy, canola, and safflower oil. As a result, we've created a very unhealthy omega-3 to omega-6 fat ratio in our bodies. Recent research has shown that this low omega-3 to omega-6 ratio (Omega-3 index) is not only the most powerful marker of inflammation, but the strongest predictor of sudden, cardiac death.
Last year, when Bend suffered the loss of a 39 year-old world class athlete and the cause of his death was attributed to unknown cardiac cause, I became very motivated to find an affordable, at-home EFA assessment for athletes. I am excited to say that we now offer athletes the opportunity to assess inflammatory status and their critical Omega 3 index with just a single drop of blood.
EC: Very cool. Nothing like some cutting-edge stuff to wrap this great interview up! Thanks for taking the time today, Dr. Cohen.
For more information on Dr. Rick Cohen and Bioletics, head over to their website. And, don't forget that they've arranged a sweet discount for all EricCressey.com readers. Enter the coupon code ECCPP25 at checkout, and you'll receive $25 off the cost of your initial basic or complete panel.
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Last September, I was put in touch with Dr. Rick Cohen, and we hit it off right away. In addition to being a knowledgeable and super-qualified physician, Rick is also a baseball fan and performance geek just like me (I knew he was legit when I met him for the first time and he was rocking some Vibram Five Fingers shoes!). Rick's enthusiasm and forward-thinking mindset is absolutely contagious and has gotten his company, Bioletics, off to a great start.
Just to get a feel for what he does (and while remaining unbiased), I had my fiancee go through a series of performance testing they do (outlined below) and the entire process was fantastic. One of the glaring issues discovered was low vitamin D, which has since been addressed. Just two months prior to our work with Rick, I'd encouraged her to ask her primary care physician to check her vitamin D levels at a routine physical. The physician's response was "No. You're not post-menopausal." The take-home message from this quick story is that not all physicians have all the information (or even a small fraction of the information, as Vitamin D plays countless roles in the body other than bone metabolism).
Since forward-thinking physicians are few and far between, it's sometimes a challenge to find someone good in your area - and that's where a guy like Rick and his company can come in to help out. I highly recommend Bioletics - to the point that I wanted to get Rick on-board for an interview to share some of his great information. So, without further ado, Dr. Rick Cohen.
EC: Thanks for taking the time for an interview, Dr. Cohen. Please fill us in a bit about your background, what you're doing at Bioletics, and where the idea for the business really emerged.
RC: My pleasure.
It actually all started in your neck of the woods in Massachusetts. I had a medical practice with a focus on nutrition, athletic performance and aging there for over ten years. At the time, I was very dissatisfied with the assessment options available in the medical field. So, I developed a few of my own that could be done at-home with either a saliva or urine sample or a finger stick blood spot.
After moving to Bend, Oregon last year, I became involved in screening some of the girls on my daughter's track team for iron deficiency and bone health. We also looked at vitamin D, which is a critical nutrient for both bone health and overall athletic performance.
When the results came in, it turned out that 95% of the runners low in iron. Additionally, 80% of the team was vitamin D deficient and more than 50% were mineral imbalanced. After adding amino acid and recovery hormone panels to the screen, I repeated it with several local elite athletes. Again, the results were shocking: not a single athlete was healthy from a biological standpoint.
At this point, it was pretty obvious that there was a need to turn the entire concept of human performance testing inside-out. For years we've been obsessed with peripheral performance measurements-heart rates, VO2 levels and power output. But the idea of looking inside an athlete's body has been completely overlooked.
Giving athletes the ability to assess their unique, physiological needs represents a paradigm shift in athletic performance. Despite all the marketing hype in the sports supplement industry, there's no such thing as a one-size-fits-all formula for improving your athletic performance.
As athletes, our basic, biological needs are all very different. We would never think of buying a bike, a baseball bat, or a pair of running shoes without trying them on or out for size. Why do we use nutritional supplements-protein powders, recovery drinks and vitamins-without knowing if they are a good fit for us?
EC: Now, let's talk about some of the specific things you guys can test. I've been a big vitamin D guy for years now, and I know that's one of your core tests. What are you seeing thus far?
RC: Optimizing your level of vitamin D3 is the single most important thing you can do for your health and well-being-and quite possibly your performance. Interestingly enough, vitamin D isn't really a vitamin at all. It's a hormone manufactured by your skin during critical periods of sun exposure.
Vitamin D is both a key building block and a cellular activator of almost every physical process. It regulates more than 2,000 of the 30,000 human genes. It's an essential part of the endocrine system, as it controls several of the adrenal hormones, growth of cells, and production of enzymes. It's a powerful immune booster that provides a front-line defense against colds and flu as well as cancer and autoimmune disease.
Vitamin D is essential for optimum athletic performance, as it contributes to muscular strength and recovery while controlling physical reaction time, balance and coordination.
So far, almost every athlete we have tested has had sub-optimal levels of vitamin D (less than 50 ng/ml) except for one professional triathlete who trains in the sun in Australia all year. Many athletes have been extremely low-under 25ng/ml.
Unless you can train outside year-round and/or make a conscious effort to get mid-day sun exposure; it is almost impossible to restore vitamin D to an optimal level-between 60 and 80 ng/ml-without supplementation. When supplementing, the best results have come from the use of a sublingual vitamin D3 spray. Gel caps, tablets and liquids are less effective.
The most important thing to remember is that your vitamin D level needs to be assessed and monitored. You can't just take a random dose of vitamin D3 and expect to get results. Bioletics offers an at-home finger stick assessment that is virtually pain-free; it takes only two minutes and two drops of blood to complete.
EC: Now, how about iron? It's traditionally been a huge issue for female endurance athletes, but are you seeing it as much in females who aren't on that level of training volume?
RC: Yes. We learned this is a huge issue, especially among teenage girls. In general, low iron is a problem among menstruating women because they lose blood every month. With teenage girls, the issue is compounded by the fact that their diets tend to be lower in calories, red meat and protein-all of which are critical for obtaining adequate iron.
Iron is critical for athletic performance, as it carries oxygen in the red blood cells from the lungs to the muscles. Severe iron loss results in a reduction of red blood cells (a condition known as anemia). What most athletes are not aware of is that you do not have to be anemic to be suffering from low iron. The most common signs of iron deficiency are fatigue, irritability, poor performance and slow recovery.
Another important point to stress is that while the assessment of red blood cell count, hemoglobin, hematocrit and serum iron are needed to diagnose anemia, these are not sensitive indicators when it comes to assessing deficiencies in iron stores-the supply of iron that's actually available for the body to use. The iron-binding protein, ferritin, is a much more reliable marker of functional iron stores. We like to see levels of ferritin in females between 40 and 70 ng/ml.
EC: How about men? Is too much iron a common finding?
RC: Good question.
In men, we are much more concerned with excessive iron than with low iron. This is because men do not bleed regularly and also tend to eat more red meat and calories than women.
The problem with too much iron is that it can create free radical damage in the body. Just as iron in metal rusts, it has a similar action in your body. Fortunately, your body has natural antioxidants to protect against the free radicals created by iron. But when levels get too high, it can become a problem. As we get older, excessive iron levels can play a role in the development of heart disease, cancer and immune disorders.
Excessive iron is linked to a genetic variation in iron absorption rates. Hemochromatosis is a genetic disorder where the body absorbs iron too readily and iron stores can get tens or even hundreds of times higher than normal and cause severe organ damage. While the full blown disorder is relatively rare, many people have lesser variants which cause gradual accumulation of iron over time. The second cause is dietary-we take in too much iron by eating iron-fortified foods like breakfast cereals and breads.
Just as with vitamin D, it is necessary to know your iron levels before you begin to take any kind of iron supplement. The restorative dose of iron is generally 36mg daily while the maintenance dose for those with a history of low iron is 18mg daily. Taking a restorative dose without knowing a benchmark can push iron levels too high. Playing it safe and taking a maintenance dose may not be enough.
Ideal levels of ferritin in men are between 70 and 100 ng/ml. If your levels are higher than that, it is important NOT to take any iron supplements or eat iron-fortified foods.
We have seen iron levels in the upper 100s and low 200s in younger male athletes. For these men, we recommended they monitor the levels every few years and to consider donating blood twice a year. This will not only keep their iron levels from climbing, but will greatly help those in need.
Part 2 of this interview with Rick will run tomorrow, but in the meantime, I've asked with Rick to arrange for a special discount for EricCressey.com readers only. If you head over to www.Bioletics.com and enter the coupon code ECCPP25 at checkout, you'll receive $25 off the cost of your initial basic or complete panel.
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1. Exciting week around here, as it's getting to be that time of the year when our high school ballplayers - both 2010 and 2011 - finalize some of their plans.
Last weekend, RHP Barrett O'Neill (2011) verbally committed to the University of Virginia on a baseball scholarship, and on Tuesday, RHP Travis Dean (2010) signed his letter of intent to pitch at Kennesaw St. University in Georgia. A few weeks earlier, RHP/3B Joe Napolitano (2011) had verbally committed to Boston College. These three comprise 3/8 of our current 90mph+ high school crew - and I suspect that the other five will be following soon!
Also this week, 2B Erik Watkins (2010) committed to Skidmore and CF Billy Bereszniewicz (2010) committed to Binghampton. Previously, catcher James Alfonso (2010) had accepted a scholarship to play at the University of Hartford. Plenty more to come soon, no doubt...
2. Speaking of Travis, here is something I love about him: he has INTENT on every single medicine ball throw he makes. It isn't just about "tossing" a ball to a wall and rotating your hips. It's about getting your entire body into the effort - to the point that you're trying to break the ball (or wall!) on every single drill.
Once we have taught our guys the technique for the drill, it's about getting after it. If you aren't training rotation aggressively, you might as well not do it at all.
3. I got a lot of great comments from readers on my A Few Days in Arizona on Monday; I'd encourage you to check it out.
4. One of the key points I made was that respiratory function was essential for ideal performance and posture, and I recognize that the concept might be completely foreign for a lot of my readers. To that end, I'd encourage you check out The Anatomy of Breathing.
It's a pretty quick read that gives you good insights into the anatomy of the respiratory system and common dysfunctions that occur. Once you start getting an appreciation for the muscles involved, you can start to see how poor diaphragmatic function can easily lead to overactivity of sternocleidomastoid, scalene, pec minor, intercostals - basically, a lot of muscles commonly implicated in upper extremity dysfunction. You can just stretch and massage those areas, but it's just like putting a bucket on the floor when the roof is leaking; it's better to just fix the roof (aberrant breathing patterns).
5. I also touched on breathing patterns a bit in my seminar this past weekend. Check out a few great reviews of the event:
6. Some interesting findings HERE that shows that there may be a strong link between childhood obesity and the development of multiple sclerosis later on in life. One hypothesis is that it may be linked to the low levels of Vitamin D that one sees in overweight kids, and another that it could be related to the fatty tissue itself. One more reason to take Vitamin D!
7. We're all headed to Providence tonight to watch CP client and pro boxer Danny O'Connor try to run his professional record to 10-0. I think we'll be setting a world record for the number of professional baseball players in attendance at a boxing match. Let's go, Danny!
