Doing videos is easier for me. So here’s two videos on wrist injuries, mostly as they relate to saber and broadsword fencing.
As always, questions and comments appreciated.
Doing videos is easier for me. So here’s two videos on wrist injuries, mostly as they relate to saber and broadsword fencing.
As always, questions and comments appreciated.
I recently came across this article on “9 Kettlebell Exercises for Everyone” and it is typical kettlebell ad copy (propaganda?).
It starts with:
Everyone can benefit from kettlebell exercises. Kettlebells have a unique shape which lets you blast your body in ways dumbbells can’t. You can pull, push, twist and swing kettlebells to get leaner, stronger and more powerful. Plus, kettlebells are easier on your wrists than dumbbells. Also, because of their offset weight, the gravitational pull of a kettlebell goes straight down, instead of from side-to-side with a dumbbell (which is shaped like a teeter-totter).
Let’s break this apart.
Not an auspicious start.
So, what are the exercises?
There is only one Kettlebell Exercise™©®, Bottoms-Up presses. It’s the only exercise where the unique characteristics of a kettlebell are both necessary and useful. An argument can be made also for the swing. But I don’t buy that argument.
Everything else is just exercises that can be done with kettlebells. All of these existed before kettlebells were getting hyped. All of them can be done well with dumbbells or barbells. These exercises, done with barbells and dumbbells, are used for athletic performance development and have demonstrated track records (literally) of being the best approach for athletic development.
In the linked article we see the following:
Seriously. The kettlebell gets pretty cult like. They have certifications and instructors and competitions and great ad copy. They charge a lot of money for a cheap lump of iron.
I love barbells. I own four, and lots of weight to go on them. I do a lot of barbell exercises. And I acknowledge their limitations. Anyone that says something is good for everything is wrong. And they are probably selling something.
On this blog I’ll talk about strength training or cardiovascular training and similar terms. Where we focus on the fitness objective in defining the exercise, instead of focusing on the tool. And that’s one of the big differences between a sensible training program and exercise fads.
Also, I’ve talked about kettlebells before on my old blog: Fight with All Your Strength.
* Also, the idea that a one paragraph description of how to do a KB snatch is sufficient is just irresponsible and dangerous. The author wrote more on the push press than the snatch.
** I’ve been worried for a while now that this term is racist, just because of human history. But I can’t find anything on that. And what I can find about just it’s origin is inconclusive.
About a month ago I broke a finger. My right index finger, proximal phalanx. Yes, I’m right-handed.
I broke it sword-fighting. (For those who don’t know I do Historical Fencing at Athena School of Arms.) My opponent’s sword hit a gap in my protective gear. The hit split my skin all the way down to the tendon. There was a visible, longitudinal defect in the tendon – that I got to see in the ER. And there is a diagonal fracture along the length the bone. Minor as far as fractures go – not displaced or open.
And so I was put into a heavy duty splint. It immobilized me from the tip of the index finger down to the carpal bones. With the middle finger included in the finger splint, almost like buddy taping the fingers. And it wrapped around the base of my thumb. I could barely get my thumb and pinky finger to grip.
I’m not convinced the OT who created my splint would have really approved of my exercise routine, but . . .
There was no chance I was going to stop unless it was impossible.
Squats, and variants thereof, were alright, it was just harder to grip the bar solidly to stabilize it. I’ve just been concerned with the fail state – if I had to ditch the weight I can’t move my hand out of the way as easily as usual.
Deadlifts are right out because I can’t generate the grip strength necessary. So I replaced them with barbell hip thrusts. It’s possible to move a surprising amount of weight with this. I’m up to almost 300 pounds with this. Single-leg deadlifts were still doable because the weight was light enough to grip.
This is where it got interesting. I couldn’t do any pushing exercises because the splint came down across the heel of my palm by the thumb. And of course I had trouble gripping for pulling exercises!
I solved this with a lifting hook. This is like the more common lifting straps, but I went for something more intense, these: Lifting Lab Weightlifting Hooks. These put almost all the pull into the strap around my wrist letting me do pulling exercises pretty close to normal. I even reached a point where I could do pullups!
The other workaround I used was to put an ankle strap around my wrist and use a cable column machine for flyes, reverse flyes and front raises. This allowed me to target both the pecs with the flyes and the deltoids with the raises. Thereby covering the same muscles I would work with typical pushing exercises. This preserves the muscle performance.
When I got back to bench press last week my plan had worked and I had maintained nearly 100% of what I was at when I broke my finger (5 pounds away from finally benching 2 plates!)
And the reverse flyes hit the mid-back muscles until I was able to return to doing rows instead.
. . . were right out. Boo. But I continued with box jumps to keep up my lower body explosive power.
At my follow-up appointment last week the splint got reduced to just a finger splint, freeing up most of my hand and allowing me to go back to doing regular pushing exercises. Hooray!
After a few weeks like that and now I can even take the splint off and type normally.
I didn’t let my injury stop me anymore than absolutely necessary. I kept up with every exercise I could and adapted those that were not doable in the usual manner. A big part of what I see physical therapy as being good for is this concept of maintaining function and adapting instead of stopping activity. We keep people moving. No matter what (almost).
After half a year of job hunting I’m finally employed as a full-time physical therapist. I am working at ProSports Therapy in Waltham. It is an outpatient clinic with a primarily orthopedic patient population. I appreciate working alongside a Boston Sports Club because it gives me access to the sort of equipment necessary for working at higher levels, especially with athletic patients.
It may seem odd but I’ll probably post more now that I’m working full-time. The job hunt was incredibly stressful and depressing for me. And left me feeling unmotivated.
Now that I’ve got patients to discuss I’m happy to be looking up research and thinking about physical therapy.
Recently I posted this article on my Facebook: Marijuana Beliefs Outstrip Evidence. I summarized a key point thus, “The only use for which marijuana has reasonably good evidence of effectiveness is for nausea.”
Note, I am all for removing marijuana from schedule 1 of FDA regulation and allowing for comprehensive research of the ways in which marijuana derived substances can be used medically. However I am firmly of the belief that they should go through the exact same FDA process as all other drugs.
The responses I got were predictable. One of the key points made by many was that if it helps people then what’s harm? I am going to set aside the point that it’s not helping most users and focus on the old “what’s the harm?” gambit. It is a standard part of the responses to criticism of alternative medicine.
If a treatment is just a placebo, and does not provide actual benefits then these are the harms that may result:
This list is not intended to be comprehensive. But does at least hit the highlights of the potential harms of medical marijuana.
An additional range of harms from the current approach to medical marijuana also includes the fact that it increases the danger to children for accidental ingestion and poisoning, especially with the prevalence of edibles and related products that are in similar packaging and have similar names to candy, as detailed here: More Marijuana More Problems for Young Children.
Ultimately, my position on this topic is that all medical treatments should be subject to a uniform study and approval process. The FDA is not perfect but they have a very good track record. The objective should be to lobby for marijuana to be removed from Schedule I, not to create a carve out from regulation where marijuana gets a free pass written by legislators.
One of the other blogs I follow is the Angry Chef. I aspire to be as entertaining as that blog. But also to be seen as serious – which I think are mutually exclusive goals.
Recently posted was a two-parter about “Ultra-Processed Foods” and the dietary guidelines of Brazil and the World Health Organization.
I encourage you to read them. But the short version is that the new nutrition guidelines of Brazil have a lot of positive characteristics about them. They encourage enjoying food, acknowledge the cultural and familial components of eating and meal times. These are good things. But they also go off on the concept of ultra-processed foods. Which is never defined. And the available evidence just doesn’t support the idea that UPF are inherently problematic
There exists this anti-chemical strain of though that modern processing of food is intrinsically bad. Because chemicals or something. That somehow the rise of lifestyle diseases like cardiovascular disease and diabetes are because of the chemicals and not calories and poverty.
There is already an enormous body of evidence that calories consumed are the primary driver of increased lifestyle diseases. And that the biggest confounder in this type of research is the known effect of poverty on health outcomes as well as on food choices/availability.
All of the various safety studies of chemicals used in processing food fail to show any evidence of harm.
Why then should we consider the idea that the “real” problem is processed foods? Well, as The Angry Chef points out, at least one researcher is actually performing a study to address this question. As opposed to just blaming the chemicals. It’s a randomized controlled study comparing matched diets of processed and not processed foods. Here’s the study at ClinicalTrials.gov.
I await the results of this study. And will update my understanding of the topic based on the results if they show that I’ve been wrong so far.
I asked a colleague if she had any suggestions for topics. She suggested protein powders.
I said, “ugh, no. I prefer food.”
So she suggested I explain why. And fine, I will.
The basic concept behind protein powder and supplements is that they “help” or are even necessary for strength training. Because you need sooo much protein (I resisted the urge to insert an eyeroll emoji). I saw some pretty big numbers for protein requirements for strength training, as big as 400g per day! And if you really believed those numbers then sure, protein powder would help you hit that number.
How much protein do people need? The USDA gives a value of 0.8 g/kg/day. This number is set to be sufficient for 97.5% of the population. Let’s assume that people who are serious about strength training make-up the 2.5% who need more (not actually a reasonable assumption, but let’s pretend). But remember that plenty of folks actually need less than the RDA.
The American College of Sports Medicine (ASCM) recommends (PDF) 1.2-1.7 g/kg/day for strength training. With a floor of 1.5 for novice lifters recommended by the National Strength & Conditioning Association (NSCA).
Published research from the National Health and Nutrition Examination Survey (NHANES) shows that most people are getting enough protein. The average American is actually already getting enough protein to be engaged in serious strength training without having to change their diet or add protein powder/supplements.
The exceptions found in the NHANES study were that a small but significant number of adolescent and elderly women who were not getting enough protein. That’s it.
If most people are getting enough without doing anything extra then why is there such a business in protein powder sales?
If you’re worried that you’re not getting the gains you want then protein powder provides an easy route to thinking you’ve solved the problem. Just buy something and you’re all set! You don’t have to actually analyze your diet, activity, form or program. Just buy something.
But protein consumption doesn’t trigger muscle building. If I deliver a bunch of construction materials to a local builder they aren’t going to just build a building because I provided the supplies. And you won’t build muscle just from eating protein. You need to do the strength training. You need to have a sensible program, with proper rest periods and enough work etc.
From looking around the gym it seems like a lot of the folks who are consuming the protein powder are already doing a reasonable program and are probably doing just fine with building muscle. In which case the powder is just a placebo. It does nothing but helps them feel like their approach is great. That feeling that they are doing all the right things probably helps with motivation and effort – which improves the outcomes. But the powder still isn’t actually helping.
Because it’s false.
Because it’s a waste of time.
Because it’s a waste of money.
Because it causes some people digestive problems. And telling those people they “need” to do it is a problem.
Because facts matter.
Then use MyFitnessPal and check. The app is free, unlike the powder. Or any other fitness and nutrition app – I can personally vouch for liking this app and finding it useful and having heard almost universally positive reviews.
Odds are you are getting enough protein, though.
Don’t use the target number the app generates. Use the math above.
Folks with these types of diets are more likely to be not getting enough protein. For meat eaters it’s pretty easy to get enough protein. For non-meat eaters is frequently takes a bit more effort and planning. But it’s still perfectly possible to do so just using food. And they need to make sure they’re protein sources are complete, which most vegetarians and vegans seem to already be aware of. Vegetables and fruits do have protein and a quick Google search brings up plenty of lists of high protein plant foods.
Protein powder is unnecessary and if you really are having trouble getting enough with the foods you are eating then I encourage you to first try upping your intake of protein rich foods to hit the goal. In particular vegetables and fruits. The real reason for preferring food though is the benefits of the micronutrients and fiber contained in the food. Both of which are good for health.
I expected to find that most of the links I clicked would overestimate protein needs. And perhaps my results are associated with my search history and particular search terms, but I was pleasantly surprised to not find that. In fact WebMD even low-balled the protein estimate (and didn’t even say I had cancer!). Many of the sources I found just quoted the USDA and/or ACSM recommended numbers, which is encouraging.
But the hits weren’t all good. Strength training oriented sites (like BodyBuilding.com) tended to recommend higher amounts than actually needed. With the International Sport Sciences Association (ISSA) recommending 2-3 g/kg per day. Which is almost double the actual need. The reason I highlight this is the fact that ISSA does personal trainer certifications. Which shows that the cert isn’t necessarily a reliable indicator of knowledge. (I’ll also point out that they provide references for the rest of the info on that ‘myths’ page but have no reference for this recommendation.)
In general the hits I got were for sites emphasizing the need to get enough protein and generally taking the attitude that you need more or need to make sure you’re getting enough. But the reality is that most people already are. So the emphasis is all out of whack.
As I’ve brought up before, it’s important not to over-interpret preliminary evidence or attempt to extrapolate from basic science to clinical reality. So while I’ve long suspected that strength training would have a benefit when it comes to diabetes development, I’ve avoided actually saying that.
And so it’s always nice when the clinical studies back up what I suspected. Hooray!
One of the things I learned from my exercise physiology education was that strength training upregulates GLUT4 on muscle cells. GLUT4 is an insulin triggered transporter for glucose. This means that strength training increases the ability and sensitivity of the of the muscle cell to take glucose out of the bloodstream and put it in the muscle cell.
Theoretically, this should reduce the likelihood of diabetes. But does it?
To the research!
I recently came across this study from JAMA: A Prospective Study of Weight Training and Risk of Type 2 Diabetes Mellitus in Men. The large Health Professionals Follow-up Study was used to track physical activity in 32,002 men for 18 years. Any physical activity reduced the risk of developing or dying from diabetes. Strength training was more effective than cardiovascular training. Both was better than just one.
Things to note about why this research is notable for this conversation:
The best results were seen at 150+ minutes per week of weight training, cardiovascular exercise and for both. This may seem like a lot, but it’s hitting the gym 3 times a week and going for a 30 minute brisk walk most days.
There are limitations to the study, of course. It’s not randomized, but the best studies of this type of question can’t be because it’s hard to control behavior for that long in free-living humans. It’s only in men. Weight training is not necessarily defined the same as strength training.
As I’ll keep saying, the best outcomes result from a complete approach to physical activity which includes strength training, cardiovascular exercise, flexibility/range-of-motion and neuromotor (balance/agility) training.
(Updated for clarity based on Facebook feedback)
There is a lot of hullabaloo about carbs in nutrition circles, especially in clean eating types of diets. Especially if those carbs are from sugar. And extra especially if that sugar is high-fructose corn syrup. But the reality is that for weight loss and general health goals* carbs are not, in and of themselves, a big deal.
The science is clear that low carb and low fat diets produce the same long term outcomes when measuring weight loss. These two links do a good job of addressing this:
So, rather than repeat that content, I want to address why this is the more reliable research. Because, of course, there will be replies about research showing that low carb works better.
To analyze diet science we need to look at a couple of factors:
How long was the study? Any study of just a few months can show weight loss. The reality is that if you can’t show weight loss in a 12-16 week study then you are just bad at your job. Any possible diet strategy can show weight loss in this time frame. Such results are meaningless to this conversation.
The health outcomes that are important for this kind of research are ones that evolve over the course of decades. Some of the landmark studies in this field have been running longer than most of my readers have been alive.
So let’s be clear. 6 months or less is short. Too short for me to care about. Too short to inform human interventions. 1 year is the bare minimum to matter.
But why are studies like this even done if they are not meaningful? Well, they are preliminary research. Preliminary research plays an important role in the process of science but they are clearly not the end point. News stories about them are usually counterproductive and they shouldn’t be used to guide interventions in humans.
A preliminary study might just be used to determine in an approach is feasible, or to determine dosing, safety and similar characteristics. But they don’t tell us if an intervention works.
There is, of course, another more cynical reason for short-term diet studies: using them to sell stuff. Since positive results are just about guaranteed in a short-term study they create an easy way to apply the “clinically proven” sticker to your diet and resist FTC objections.
A lot of the objection to sugar and carbs is the result of a belief that calories from those sources are particularly bad for human health compared to protein or (good) fats. However, this comes pretty much entirely from research in petri dishes or animal studies.
Again this is another example of over-interpreting preliminary research. The results of applying a substance directly to a cell in a petri dish cannot be generalized to the whole human body. There are so many other factors at play in understanding how a substance will affect clinical outcomes. How is it digested? How does it interact with other substances in the body? How do homeostatic mechanisms operate to limit any changes? Etc.
And while animal research is a useful step in health research for humans we are, forgive me for stating the obvious, not mice. Or rats. Or guinea pigs. Or regular pigs. Or even monkeys. The question of what animal are we most like, a mouse or a rat, suffers from the fact that it depends on what part of the human system you are studying. And even then, we cannot just blithely assume that any animal results will apply to humans.
An extension of the last point is research into biomarkers. In short biomarkers are substances found with chemistry tests that are thought to indicate a particular (disease) state. Some are well validated, like troponin for a heart attack, others are not, like telomere length for aging. It is important to understand that a biomarker is correlated to the state of the body and is not a direct measure of the state of interest. They can be suggestive, but they don’t always predict actual health outcomes.
One of the most commonly misused biomarkers are any markers for inflammation. The assumption being that such markers indicate that something Bad is happening. So if eating sugar boosts the levels of some inflammatory biomarkers it must be terrible for you! But the research into actual health outcomes – death, disability etc. – doesn’t bear this out. Sure, eating too many calories leads to problems but the source of those calories doesn’t actually predict outcomes.
Yes it’s calories. Clearly though, understanding that is not the hard part. Behavior change is the hard part. Establishing new eating patterns and habits is the hard part. Fad diets that focus on one, or a few, components like sugar or carbs attempt to create the impression that it’s what you eat, not how much, that really matters. And it’s just not true.
* General health goals = is the phrase I’m using to mean premature death and disability/loss of function due to lifestyle modifiable diseases and risk.
(We’ll see if this becomes a regular thing for this blog)
The Environmental Working Group released its annual Dirty Dozen list again. They are a non-scientific group of scaremongers. This list of theirs epitomizes this fact. They take the publicly available USDA data on pesticide residue and then report characteristics like the number of different residues found and the amount of those residues. Then they rank grocery store produce based on these numbers.
What they never do is compare those values to the actual amounts necessary to harm a person. Because if they did, they’d look silly. For instance you’d have to eat 10 kilograms a day of strawberries just to reach the low end of minimum appreciable risk (RfD). (I got the math from here.)
The techniques used to detect pesticide residue are incredibly sensitive. Far more sensitive than necessary for human health. The tiniest amounts can be detected. But those tiny amounts need to be compared to results from toxicology studies to have any meaning.
The Environmental Working Group also asserts, without evidence, that a wider variety of pesticides on a plant is somehow intrinsically more dangerous than just one pesticide. This statement might be true – different chemicals may interact to be more dangerous than toxicology research on a single chemical indicates. But no evidence suggests that it is. And human health is carefully tracked by the CDC.
And even if more chemicals on the plant is more dangerous they fail to take into account the fact that the plant already has thousands of different chemicals inside. At at much higher concentrations than the pesticides. And those plant chemicals include substances evolved to kill other life forms to protect the plant i.e. pesticides. There is more of those pesticides than the ones applied by farmers.
In short, their list has nothing to do with known toxicology information. It is just an attempt to scare people. And CNN and other media swallowed it whole.