Home Posts tagged "PCL"

Newsletter #5

We’re five newsletters in, and while the feedback on our interviews has been fantastic, I’ve actually received several emails from people wanting to hear more from me.  In my infinite wisdom, I guess I never realized that people would actually sign up for an EricCressey.com newsletter to hear from Eric Cressey.  With that said, I figured that since I receive hundreds of emails on a weekly basis, I might as well pick a few from the pile and respond for everyone.  There will be some information, some sarcasm, and the occasional rant; I guess that’s part of the beauty of having your own newsletter.  As always, if there is something you’d like to see in the newsletter, just say the word; I’m all ears.

    Q: From reading your stuff and that of John Berardi, I’ve really begun to reconsider the traditional bodybuilding-influenced “bulk-cut” approach to improving body composition.  With respect to getting people to below 10% body fat, Dr. Berardi wrote that “people usually OVERESTIMATE the difficulty and UNDERESTIMATE the duration,” and that it is possible as long as:

    “1) They're willing to work out in excess of 5hrs per week (sometimes up to 8 hours/week).

    “2) They're willing to commit to eating better with each meal. Not follow a fat loss or bulking diet. Simply, every time they sit down to eat, they do better. “3) They're willing to learn a new normal.  We all have habits that are ‘normal’ and if you're 15, 20, 30% fat, your ‘normal’ = good for fat gain.  A diet is abnormal. You'll always get back to 15%, 20%, 30% if you're always doing something abnormal.  However if you re-learn a new normal, you can have a new body.” Judging from your writings, you seem to favor a similar approach.  I was just wondering if you would care to elaborate on any of these things.  I’ve really been thinking about how traditional bulking and cutting might very well be outdated, and would appreciate your thoughts.

    A:

    Those are definitely some statements with which I agree wholeheartedly, and I think that the more people that check out JB’s Precision Nutrition products, the less often I’ll have to encounter questions like this!  Once people start to adopt these ideals, I really think that we’ll see a paradigm shift in the world of training-nutrition interaction for body composition improvement.

    I, too, get really sick and tired of the “bulk and cut” mentality to which so many people adhere.  And, as a competitive athlete myself who has to maintain reasonably strict control over my body weight – yet has still seen consistent improvements in body composition over time – I feel that I have a solid frame of reference from which to speak.  In fact, as I look to drop a few pounds prior to APF Senior Nationals (June 2), my overall training and nutrition strategies aren’t changing much at all.

    With that said, I've got several problems with what has seemingly become the “traditionalist” approach:

    1. People adopt programs, but never habits. Consistency is more important than you can possibly imagine, but when you're constantly shuffling back and forth between programs, you're never really "getting it."  If you had the good habits in the first place, chances are that you wouldn’t have ever had to come to consider the extreme cutting or bulking, right? 2. Progress can be very tough to monitor in experienced individuals. Experienced natural lifters might be lucky to add five pounds of lean body mass a year. How realistic is it to really micromanage such subtle changes over a three-month period (assuming two bulks and two cuts per year)?  Spread five new pounds out over an entire body and you'll see that it isn't readily apparent.  Work with some guys who are 7-feet tall like I have and you’ll see that it’s even more hard to notice – especially when you see them on a daily basis. 3. Bulk/Cut is no way to live.  Let's assume that a year consists of two bulks and two cuts. So, basically, you're spending one half of the year gorging yourself until you become a fat-ass, and the other half in misery until you get lean enough to feel crappier and look better. Toss in a few root canals, a colonoscopy, and a few Ben Affleck movies*, and you’ve got yourself a year to be forgotten.  Yeehaw. 4. Think of the long-term consequences of the bulk/cut scheme.  If you read the research on weight regain and body fat distributions in recovered anorexics, you’ll see that central adiposity is extremely common.  Are severe cutting diets really that much different than clinical cases of anorexia?  Taking someone’s thyroid out and stomping on it would actually be a quicker means to the same end. 5. Do we really want to adhere to guidelines that are predominantly geared toward professional bodybuilders who are so juiced to the gills that you can smell GH on their breath?  They’ve got extensive anabolic arsenals in place to maintain muscles mass and optimize nutrient partitioning as they diet down, and thyroid medications to keep their metabolic rates up in spite of the reductions in calories.  Indirectly, all these substances improve strength and stave off lethargy, making training sessions more productive in spite of caloric reductions.  In the bulking scenarios, the nutrient partitioning effects are still in place, as these individuals are less likely to add body fat when eating a caloric surplus.

    Now, put a natural lifter in the same scenario, and you’ll see right away that he’s immediately at a disadvantage.  Drop calories too fast, and your endogenous testosterone and thyroid levels fall.  You get tired and weak, and your body has to find energy wherever it can – even if it means breaking down muscle tissue.

    I’m not trying to get on a soapbox here; I’m just trying to make people realize that they’re comparing apples and oranges.  You need to do what’s right for you.

    And what does that entail?  Adopt admirable dietary, training, and lifestyle habits, and you’ll build a strong body that moves efficiently and just so happens to look good.  Leave the quick-fix approaches for those with “assistance” and anyone silly enough to watch a fitness infomercial from beginning to end.

    *Note to readers: This reference was spurred on by my good friend, Tony Gentilcore, who was responsible for the quote of the week:

    “There are two kinds of people that irritate me: people who use the leg press, and Ben Affleck.”

    (For your information, Tony has a bit of a crush on Jennifer Garner, and it tends to make him a little biased when the time comes to review Affleck movies)

    Q:

    I was wondering what your thoughts on “finishers” to workouts are.  You know, tough stuff to test yourself at the end of a lift.

    A:

    Truthfully, I rarely add "finishers" to the end of sessions. In my opinion, this brings to light an amazing "phenomenon" that exists in the performance enhancement field. Those who make frequent use of finishers are the very same individuals who don't know a thing about volume manipulation for optimal supercompensation. If the finisher was such a valuable inclusion, then why wasn't it written into the program initially?

    Some people claim that these are an ideal means of enhancing mental toughness.  I can’t disagree, but I do think that your mental training stimuli should already exist in your programming.  If you need to search around for things to haphazardly incorporate at the end of a session, then you need to take a look at program design abilities.  I’d rather see a “finisher” just be considered an appropriately-planned “last exercise.”  Believe it or not, there should even be times when you leave the gym feeling fresh.

    There may be instances where I'll push an athlete (or myself) with increased volume and/or intensity based on the pre-training mood.  This is one basis for cybernetic periodization; effectively, you can roll with the punches as needed.

    I will say, however, that finishers have their place with younger athletes where you’re just trying to keep the session fun.  If you find something productive that they’re enthusiastic about doing, by all means, deviate from your plan a bit and build on that enthusiasm.  When they start getting more experienced, though, you’re going to have to know when to hold back the reins on them a bit.

    Q:

    In December of 2001, I was rear-ended going about 30mph; five cars were involved, and I was the first car hit from behind. My knee hit the dashboard when I was hit from behind and my head was jerked backwards when I hit the car in front of me.

    My knee started hurting soon after, although I never got it checked out.  It’s now become a sharp pain and a constant, dull ache as well with weakness on stairs and squatting-type positions especially.  In addition, there are tender areas, on the outside and top of the knee, that cause extreme pain when I am bending, squatting, lying down, or sitting down for too long. My hip has also been affected, also aching constantly. My right leg and knee also hurt and knot up easily.   The surrounding muscles are very weak with several knots in them, and I also have a very tight iliotibial band.  Any ideas what might be going on?

    A:

    I thought "PCL" (posterior cruciate ligament) the second I saw the word "dashboard;" it's the most common injury mechanism with this injury.  I’m really surprised that they didn’t check you out for this right after the accident; you might actually be a candidate for a surgery to clean things up.  Things to consider:

    1. They aren't as good at PCL surgeries as they are with ACL surgeries, as they're only 1/10 as common.  As such, they screw up a good 30%, as I recall – so make sure you find a good doctor who is experienced with this injury to assess you and, if necessary, do the procedure.

    2. It's believed that isolated PCL injuries never occur; they always take the LCL and a large "chunk" of the posterolateral complex along for the ride.  That would explain some of the lateral pain.

    3. The PCL works synergistically with the quads to prevent posterior tibial translation.  As such, quad strengthening is always a crucial part of PCL rehab (or in instances when they opt to not do surgery).  A good buddy of mine was a great hockey player back in the day, but he has no PCL in his right knee; he has to make up for it now with really strong quads.

    4. Chances are that a lot of the pain you’re experiencing now is related more to the compensation patterns you’ve developed over the years than it is to the actual knee injury.  For instance, the tightness in your IT band could be related to you doing more work at the hip to avoid loading that knee too much.  Pain in the front of the knee would be more indicative of a patellar tendonosis condition (“Jumper’s Knee”), which would result from over-reliance on your quads because of the lack of the PCL (something has to work overtime to prevent the portion of posterior tibial translation that the PCL normally resisted).

    5. From an acute rehabilitation standpoint, I think you’d need to address both soft tissue length (with stretching and mobility work) and quality (with foam rolling).  These interventions would mostly treat the symptoms, so meanwhile, you’re going to need to look at the deficient muscles that aren't doing their job (i.e. the real reasons that ITB/TFL complex is so overactive).  I'll wager my car, entire 2006 salary, and first-born child that it’s one or more of the following:

    a) your glute medius and maximus are weak

    b) your adductor magnus is overactive

    c) your ITB/TFL is overactive (we already know this one)

    d) your biceps femoris (lateral hamstring) is overactive

    e) your rectus femoris is tighter than a camel's butt in a sandstorm

    f) you might have issues with weakness of the posterior fibers of the external oblique, but not the rectus abdominus (most exercisers I know do too many crunches anyway!)

    Again, your best bet is to get that PCL checked out and go from there.  If you’ve made it from December 2001 until now without being incapacitated, chances are that you’ll have a lot of wiggle room with testing that knee out so that you can go into the surgery (if there is one) strong.

    Good luck!

    That’s all for this week; I hope everyone enjoyed it!

    All the Best,

    EC

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    When Knee Met Dashboard

    In December of 2001, I was rear-ended going about 30mph; five cars were involved, and I was the first car hit from behind. My knee hit the dashboard when I was hit from behind and my head was jerked backwards when I hit the car in front of me.

    My knee started hurting soon after, although I never got it checked out. It’s now become a sharp pain and a constant, dull ache as well with weakness on stairs and squatting-type positions especially. In addition, there are tender areas, on the outside and top of the knee, that cause extreme pain when I am bending, squatting, lying down, or sitting down for too long. My hip has also been affected, also aching constantly. My right leg and knee also hurt and knot up easily. The surrounding muscles are very weak with several knots in them, and I also have a very tight iliotibial band. Any ideas what might be going on?


    I thought "PCL" (posterior cruciate ligament) the second I saw the word "dashboard;" it's the most common injury mechanism with this injury. I’m really surprised that they didn’t check you out for this right after the accident; you might actually be a candidate for a surgery to clean things up. Things to consider:

    1. They aren't as good at PCL surgeries as they are with ACL surgeries, as they're only 1/10 as common. As such, they screw up a good 30%, as I recall – so make sure you find a good doctor who is experienced with this injury to assess you and, if necessary, do the procedure.

    2. It's believed that isolated PCL injuries never occur; they always take the LCL and a large "chunk" of the posterolateral complex along for the ride. That would explain some of the lateral pain.

    3. The PCL works synergistically with the quads to prevent posterior tibial translation. As such, quad strengthening is always a crucial part of PCL rehab (or in instances when they opt to not do surgery). A good buddy of mine was a great hockey player back in the day, but he has no PCL in his right knee; he has to make up for it now with really strong quads.

    4. Chances are that a lot of the pain you’re experiencing now is related more to the compensation patterns you’ve developed over the years than it is to the actual knee injury. For instance, the tightness in your IT band could be related to you doing more work at the hip to avoid loading that knee too much. Pain in the front of the knee would be more indicative of a patellar tendonosis condition (“Jumper’s Knee”), which would result from over-reliance on your quads because of the lack of the PCL (something has to work overtime to prevent the portion of posterior tibial translation that the PCL normally resisted).

    5. From an acute rehabilitation standpoint, I think you’d need to address both soft tissue length (with stretching and mobility work) and quality (with foam rolling). These interventions would mostly treat the symptoms, so meanwhile, you’re going to need to look at the deficient muscles that aren't doing their job (i.e. the real reasons that ITB/TFL complex is so overactive). I'll wager my car, entire 2006 salary, and first-born child that it’s one or more of the following:

    a) your glute medius and maximus are weak
    b) your adductor magnus is overactive
    c) your ITB/TFL is overactive (we already know this one)
    d) your biceps femoris (lateral hamstring) is overactive
    e) your rectus femoris is tighter than a camel's butt in a sandstorm
    f) you might have issues with weakness of the posterior fibers of the external oblique, but not the rectus abdominus (most exercisers I know do too many crunches anyway!)

    Again, your best bet is to get that PCL checked out and go from there. If you’ve made it from December 2001 until now without being incapacitated, chances are that you’ll have a lot of wiggle room with testing that knee out so that you can go into the surgery (if there is one) strong.

    Eric Cressey
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