Tuesday, June 30, 2015

Book Review: Special Strength Development For All Sports by Louie Simmons

I just finished reading Louie Simmons’ new book, Special Strength Development For All Sports. I don’t know if there is a person that has influenced strength training in the United States more than Louie Simmons. He has created some of the strongest powerlifters of all time at his Westside Barbell gym, in Columbus, OH, and has worked with athletes in a variety of different sports along the way. His training system, which he refers to as Conjugate training, and methods have been heavily influenced by many of the Russian sports scientists and the work he did with the late Mel Siff. While Louie is quick to give these people credit for their concepts and ideas, which have shaped his methodology, his approach to training is truly unique and there probably isn’t a strength coach in the USA who, at one point in time, hasn’t tried “Westside Training”.

Certainly, this methodology of training is something that has influenced me when I first started reading about it back around 2002. If I had to describe the three methodologies that have influenced my training approach the most over the years I would say:

  1. Undulating Periodization – The work by Kraemer & Fleck as well as a lot of the research that has been published
  2. Charlie Francis – The concepts of High-Low and Vertical Integration
  3. Westside Barbell/Louie Simmons

These three approaches have been instrumental in how I think about training and how I set up a training program based on what things we look to focus on in each block/phase of training, which  then determines how we distribute the volume of work. These three approaches were the backbone of the training programs that Keith and I wrote when working with the athletes during my time at Nike.

Louie’s new book is a deviation from the books and DVDs he has previously put out, which are more focused on improving strength for the sport of powerlifting. While Louie has provided a vast amount of information on the web (for free, mind you) and has discussed using his methods for other sports, I think this may be the first time he has ever collected his thoughts on the topic in one single manual.

The manual begins by covering the concepts that shape the Westside Barbell approach to training. It goes over the methods of strength training, which Louie learned from Zatsiorsky’s work, and some of the approaches to strength development that most people have heard Louie talk about over the years.

The book then goes into a broad range of topics, discussing everything from the role of strength in sport to training methods for improving fitness qualities for different sports (Endurance sports, Olympic weightlifting, Team Sports, Combat sports, etc) to recovery and regeneration techniques.

One of the nice things about the book is that, while Louie is a powerlifting coach, he takes the time to discuss how these methods can be translated to other sports. I think a misconception that people have is that you have to train exactly as he advocates powerlifters to train. Louie discusses different methods of training and, particularly, incorporating plyometric activities into training, which could be thought of as a component of the “Dynamic Effort” method. Louie also explains strength-speed and speed-strength and makes recommendations of bar speed and intensities to appropriately develop these qualities. Additionally, Louie spends considerable amounts of time discussing the role and importance of General Physical Preparedness and provides a variety of training approaches to improve this quality.

Some key things Louie discussed were:

  • The importance of general fitness and how to develop it for athletes in different sports.
  • An approach to programming and periodization that encompasses training multiple qualities but having a key focus/emphasis in specific blocks. Team sport athletes need to have multiple qualities trained at a high level to have success and it can be difficult for some people to understand how to set up training phases without just trying to improve everything all at one time. Louie does a great job addressing this and talking about the various programming approaches using a three week wave.
  • The idea that you don’t need to max out each week. I am glad Louie touched on this, as I think it is something that people believe when they think about Westside Barbell training. The max effort day(s) within the Westside system are very important for increasing strength and motor unit recruitment; however, this doesn’t need to be forced each week. I believe this is important for team sport athletes, especially, as the rigors and intensity of training can be incredibly taxing on the body and trying to force a max effort lift each week could be detrimental to performance.
  • The volume of strength training. Strength coaches tend to prioritize the work they do in the gym to the detriment, oftentimes, of other things, such as fitness training, jumping/plyometrics, sprinting, etc. It was interesting to see Louie discuss the volume of strength training and share some of the volumes of strength training for athletes in different sport in countries like Russia. Louie is big on matching the appropriate training volume with the training intensity and draws heavily on A.S. Prilipen’s table for this. Louie mentions that, during a max effort session, you really only need to try and take 3 lifts above 90%. That is a very small amount of volume than what most strength coaches prescribe. As mentioned above, I think strength coaches tend to over prescribe a lot of their resistance training work and not pay attention to the actual volume that is being accrued over the training block. The idea that we want to do enough to force that adaptation we seek without going overboard is something to keep in mind. Finding the optimal amount of training is critical to allowing the athlete to continually train at a high level.
  • Supplemental and Accessory Exercises. Louie is big on using your accessory exercises and supplemental work to develop any weaknesses you may have. I think sometimes people think of this type of work as “optional”, as they put all their emphasis on the main/core lifts, but it serves a key purposes and Louie really drives this point home. Additionally, this type of work may be in a non-traditional form, for example, following your box squat, your main lift for the day, you may go and perform sled dragging in different directions as your accessory activity. This is very non-traditional compared to what most people would do, which would be just do a bunch of different exercises, but is highly useful for an athlete that has to run, cut, and change direction in their sport. A lot of your exercise selection here may also come down to the time of the season (offseason, pre-season, inseason) in terms of what exercises you select.

Over the years, Louie has been incredibly generous sharing his ideas and concepts with the strength and conditioning community. The blog on his current website even contains videos of training sessions that take place each week at Westside Barbell, posted to his youtube channel. Louie’s commitment to give back to the strength and conditioning profession has been second to none and his new book Special Strength Development For All Sports, is a wonderful resource for strength coaches looking to understand how his approach to training the strongest powerlifters in the world can be applied to developing athletes in other sports.

from Optimum Sports Performance LLC http://optimumsportsperformance.com/blog/book-review-special-strength-development-for-all-sports-by-louie-simmons/

Scottsdale Sports Medicine

Do Rear Foot Elevated Split Squats Cause Back Pain?

I just got back from speaking at the Perform Better Summit in Chicago. In between my talks I took in Stuart McGill’s talk ( he is always one of my favorites and has greatly influenced me).

Recently Dr McGill has been vocal about Rear Foot Elevated Split Squats potentially causing back pain, particularly SI joint pain and as he calls it “pelvic ring” disruption.

We probably use the rear foot elevated split squat as much as anyone and, have not had any increase in SI joint pain or back pain in general. In fact, we switched to the split squat variations in response to back pain from heavy back and front squats.

My theory on why we don’t have back pain from the rear foot elevated split squat is three fold.

1- We use a relatively short stance. A lot of the videos I’ve seen have the rear leg quite extended.

2-  We rarely do more than 30 reps per week per leg. A big volume week for us would be three sets of 10.

3- We never put the bar in a back or front squat position. Positioning the bar this way causes a great deal of lumbar extension which could increase back stress and anterior hip stress. We always use dumbbells of kettle bells.

I think this “idea” is just that and has very little basis in fact. As much I’m reluctant to disagree with Dr McGill I have to one this one.

Early in the week I polled StrengthCoach.com members and couldn’t find one who thought that rear foot elevated split squats had resulted in either them or their athletes having an increase in back pain. Coincidence? I think not.


from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/30/do-rear-foot-elevated-split-squats-cause-back-pain/
Visit Us At:


Scottsdale Sports Medicine


Monday, June 29, 2015

Senior Tech: A Tablet for Aging Hands Fall Short

The AARP RealPad promises “no confusion and no frustration” for older adults. Starting with the on button, it delivers the opposite.

from Well http://well.blogs.nytimes.com/2015/06/30/senior-tech-a-tablet-for-aging-hands-fall-short/


Think Like a Doctor

Documents that are part of this week's Think Like a Doctor were accidentally published ahead of schedule.

from Well http://well.blogs.nytimes.com/2015/06/29/think-like-a-doctor/


Symptom-Free Carriers May Be Spreading Whooping Cough

A new study traces a rapid increase in the illness also known as pertussis to asymptomatic transmission, driven by a change in vaccines.

from Well http://well.blogs.nytimes.com/2015/06/29/symptom-free-carriers-may-be-spreading-whooping-cough/


Guinea Pigs Are Autistic Child’s Best Friend

Studies show that interactions at school make the student calmer and more willing to be there.

from Well http://well.blogs.nytimes.com/2015/06/29/guinea-pigs-are-autistic-childs-best-friend/


With Summer Sun Come Signs of Danger

The latest findings on the damage caused by ultraviolet radiation are enough to send one running past the sunscreen to get indoors.

from Well http://well.blogs.nytimes.com/2015/06/29/with-summer-sun-come-signs-of-danger/


Who Should You Take Advice From?

Brian Carrol wrote an interesting piece called Five Reasons Your Not Getting Stronger. It was pretty good and to the point.

I thought I’d analyze this part though?

Qualify the person you’re taking advice from using these 5 questions I learned from Dave Tate of Elite FTS:

1. What is his/her education and background?
2. How is/was this coach’s performance in the particular sport they’re coaching?
3. Who have they trained?
4. Have they been able to make athletes better than they were before training with them?
5. Do they practice what they preach?

If I score myself, I do pretty good on number 1, education and background.

Number 2, performance in the particular sport they are coaching? I was not very good at anything. In fact, my best sport was swimming. I played and liked lots of other stuff ( powerlifting, basketball, football) but, performance? Not so much. Surprisingly, I have a baseball worlds series ring ( played from 8 years old to 12 and stunk) and two ice hockey national championship rings ( never played). By the way, my dad one a few state championships as a basketball coach and never played organized basketball. Also, in most team sports, great players don’t make great coaches. In strength and conditioning most of the best coaches I know either weren’t very good, had a career shortened by injury or both.

3, who have they trained? I make a big comeback here. That part of my resume is better than average.

4, have they been able to make people better athletes than before they trained them? Another positive. At MBSC we have professional athletes who started with us a middle schoolers. I think this one is huge. I hate the coaches who suck up to some All Star and then take credit for him. This is sadly very common and something we go through every day.

5, do they practice what they preach? Oops, abject failure. I have not lifted a heavy weight since the 80’s and probably do far too many 12 ounce curls ( I will occasionally go heavy at 16 and 22).

Bottom line, be careful with guru’s, Dave and John are right however I would recommend that you really focus on 1, 3, and 4. Playing the sport and looking good doesn’t make you a good coach.

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/29/who-should-you-take-advice-from/
Visit Us At:


Scottsdale Sports Medicine


Sunday, June 28, 2015

Interval Training Secrets

There are two primary methods of performing interval training. The first is the conventional Work to Rest method. The Work to Rest method uses a set time for work and a set time for rest. Ratios are determined and, the athlete or client rests for generally one, two or three times the length of the work interval before repeating the next bout. The big drawback to the work to rest method is that time is arbitrary. We have no idea what is actually happening inside the body, we simply guess. In fact for many years we have always guessed, as we had no other “measuring stick”.

Heartrate Method

With the mass production of low cost heartrate monitors, we are no longer required to guess. The future of interval training lies with accurate, low cost heartrate monitors. With a heartrate monitor there is no more guessing. We are no longer looking at time as a measure of recovery, as we formerly did in our rest to work ratios, we are looking at physiology. What is important to understand is that heartrate and intensity are closely related. Although heartrate is not a direct and flawless measure of either intensity or recovery status, it is far better than simply choosing a time interval to rest. To use the heartarte method, simply choose an appropriate recovery heartrate. In our case we use sixty percent of theoretical max heartrate using the Karvonen method (see The Problem With Formulas box). After a work interval of a predetermined time is completed the recovery is simply set by the time it takes to return to the recovery heartrate. When using HR response, the whole picture changes. Initial recovery in well-conditioned athletes and clients is often rapid and shorter. In fact rest to work ratios may be less than 1-1 in the initial few intervals. An example of a typical workout for a well-conditioned athlete or client is show below.

to read the rest, click here

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/28/interval-training-secrets/
Visit Us At:


Scottsdale Sports Medicine


Saturday, June 27, 2015

Cherries Add a Dash of Sweetness

Martha Rose Shulman, the Recipes for Health columnist, adds cherries to grains and more.

from Well http://well.blogs.nytimes.com/2015/06/27/cherry-recipes-for-health-cherries-add-a-dash-of-sweetness/


Friday, June 26, 2015

The Weekly Health Quiz: Sex, Pot and Fidgeting

Test your knowledge of this week's health news.

from Well http://well.blogs.nytimes.com/2015/06/26/the-weekly-health-quiz-sex-pot-and-fidgeting/


Ask Well: Assessing Knee Supports

The evidence on the effectiveness of knee braces isn’t clear. First, though, it is important to recognize the differences in what they do.

from Well http://well.blogs.nytimes.com/2015/06/26/ask-well-assessing-knee-supports/


The Truth About Target Heart Rate Training

We just got the MYZone system so I thought I’d hit this topic again.

Every time I have this conversation with a group I always get the question “ If this stuff about target heart rates isn’t true, why is it plastered on the front of every treadmill”. I can’t really answer except to say that it probably came out of the legal department.

The truth is that target heartrate zone training is a highly flawed concept that could result in us drastically overtraining or undertraining ourselves or a client. Why is it a flawed concept? Because the physiologists know that only a small percentage of the population actually fits the formula. Did you know that seventy percent of the population is plus or minus ten to twelve beats from the theoretical 220- age formula. Yes seven out of ten people don’t fit the mold. Even worse, thirty percent of the population deviates nearly twice that much.

In mathematical terms for seventy percent of the population maximal heartrate actually equals:

220 – age plus or minus 10-12 beats per minute

For thirty percent of the population maximal heartrate actually equals:

220- age plus or minus 20-24 beats per minute

Why is this such a big deal? To realize why, we need to first state that those whose heartrates are on the high end are at little to no risk. All that happens with those folks is that we don’t push them hard enough. The problem is with the folks who have an unusually low maximum heartrate. If we were to push a person in the thirty percent group that is minus twenty-four beats per minute to eighty percent of their theoretical maximal heartrate, we would actually be pushing them to ninety percent. This would be a major error that could have significant ramifications.

The lesson here is that, as with so many of the so-called truths of fitness, there is actually significant variability in what we seem to think is an accurate and time-honored formula. Be careful with yourself and with you clients. Buy a heartrate monitor and learn how both you and your clients really respond to exercise.

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/26/the-truth-about-target-heart-rate-training/
Visit Us At:


Scottsdale Sports Medicine


Thursday, June 25, 2015

Sharing My Story With Patients

For many doctors, facts, figures and data are king. For me, feeling truly vulnerable for the first time has transformed my life and practice.

from Well http://well.blogs.nytimes.com/2015/06/25/sharing-my-story-with-patients/


Run Uphill Easier & Faster: Example Session & Coaching Cues


I always maintain that hill running is one of the biggest ban g for your buck forms of training for runners. It helps athletes build strength-endurance and speed brilliantly.

However, as with everything, your results depend specifically on your execution.

If you perform hill reps with great form, the hills themselves will help you develop strength through range of motion in your glutes and hamstrings more than running the same pace on the flat.

Conversely, if you heave your way up hill with poor form, this is one of the fastest ways to exacerbate muscular imbalances and place more strain on the knees and low back, to name just two areas.

Check out the coaching cues in the video above, and try example session described…

Let me know how you get on :)

The post Run Uphill Easier & Faster: Example Session & Coaching Cues appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

from Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution http://feedproxy.google.com/~r/KineticRev/~3/kJVKVeR5p_Y/

Scottsdale Sports Medicine

Living With Cancer: Being Mortal

Too few cancer patients know how useful the book "Being Mortal" can be for those dealing with the difficult decisions presented by incurable disease.

from Well http://well.blogs.nytimes.com/2015/06/25/living-with-cancer-being-mortal/


Did Jarome Iginla Specialize?

From Sports Illustrated March 5, 2007 Page 18

Jarome Iginla on playing baseball in addition to hockey as a child:

“I was mostly a catcher and a pitcher, and I played a little shortstop { on a travel team }.

I dreamed of being like Bo Jackson and one day playing hockey and baseball. I loved them equally, and I stayed with baseball until I was about 17.”

Jarome played baseball in season, in the spring and did not play in any spring hockey leagues or tournaments.

He did not “specialize” in hockey like many are mislead to do. He took time off from skating and playing hockey.

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/25/did-jarome-iginla-specialize/
Visit Us At:


Scottsdale Sports Medicine


The Joy of (Just the Right Amount of) Sex

Sex makes people happy, but more isn’t always better.

from Well http://well.blogs.nytimes.com/2015/06/25/the-joy-of-just-the-right-amount-of-sex/


Wednesday, June 24, 2015

Bad Neighborhoods May Be Bad for Your DNA

Researchers have found that living in unsafe neighborhoods is associated with shorter telomere length, a marker of aging cells.

from Well http://well.blogs.nytimes.com/2015/06/24/bad-neighborhoods-may-be-bad-for-your-dna/


Ugly Fruits (and Vegetables) Get a Makeover

An ad campaign is changing the way French consumers view unattractive produce.

from Well http://well.blogs.nytimes.com/2015/06/24/ugly-fruits-and-vegetables-get-a-makeover/


Fidgeting May Benefit Children With A.D.H.D.

Instead of telling children with hyperactivity and attention problems to sit still, perhaps we should encourage them to wriggle at will.

from Well http://well.blogs.nytimes.com/2015/06/24/fidgeting-may-benefit-children-with-a-d-h-d/


Runner’s Knee or Something Else?

When it comes to running injuries, Runner’s Knee (aka PFS or Patellofemoral Syndrome) is easily one of the most common.

It’s also one of the most commonly overused diagnoses as anything in the front of the knee gets lumped into that PFS group. That’s why in this video I go through the three most common overuse injuries in the knee and talk about what they have in common, and what they do not.

For those of you battling knee symptoms, here are three self treatment plans to get you started:

Remember… the knee is the middle man. Take a step back to look at the entire leg chain to make sure knee symptoms don’t stick around!

The post Runner’s Knee or Something Else? appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

from Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution http://feedproxy.google.com/~r/KineticRev/~3/LyO11z-DvAQ/

Scottsdale Sports Medicine

Tuesday, June 23, 2015

Another Workout on the Green at Market St in Lynnfield

Join us @ Lululemon Athletica for” Thirsty Thursday” in Lynnfield. On the green at Market St this Thursday June 25th at 6:30pm for a free workout with a few of our MBSC trainers.

Thirsty Thursday || Mike Boyle Strength & Conditioning
Thursday at 6:30pm
lululemon athletica MarketStreet in Lynnfield, Massachusetts

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/23/another-workout-on-the-green-at-market-st-in-lynnfield/
Visit Us At:


Scottsdale Sports Medicine


Monday, June 22, 2015

The Silence of Stillbirth

One in 160 pregnancies in the United States ends in stillbirth. Dr. Eleni Michailidis, 38, gave birth to a stillborn son, Alexander, in February. This is her story.

from Well http://well.blogs.nytimes.com/2015/06/22/the-silence-of-stillbirth/


Piriformis Syndrome: What Runners Need to Know


Quite some time ago now I posted one of my favourite stretches for runners to ease the often painful symptoms of Piriformis Syndrome.

In the new video above, I discuss some of the common causes of Piriformis Syndrome in runners, as well as the importance of addressing the root of the problem, not just the symptoms!

Also in this video, I’ve featured a handful of example exercises. Give them a go, and let me know how you get on in the comments below…

The post Piriformis Syndrome: What Runners Need to Know appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

from Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution http://feedproxy.google.com/~r/KineticRev/~3/L3BfJHFyLaY/

Scottsdale Sports Medicine

Surgery for Knee Pain May Not Provide Benefits

People in their 50s and older often get arthroscopic surgery for knee pain, but a new review of studies suggests that it has serious risks.

from Well http://well.blogs.nytimes.com/2015/06/22/surgery-for-knee-pain-may-not-provide-benefits/


Pollution May Age the Brain

Exposure to air pollution may hasten brain aging, a new study has found.

from Well http://well.blogs.nytimes.com/2015/06/22/pollution-may-age-the-brain/


Seeking Efficient Paths to Slimmer Children

Several popular strategies not only help children achieve and maintain a normal weight but also save a lot of health care dollars, researchers found.

from Well http://well.blogs.nytimes.com/2015/06/22/seeking-efficient-paths-to-slimmer-children/


Sunday, June 21, 2015

The Real Dad Bod

To celebrate Father's Day, we're sharing a selection of stories from dads and the people who love them about what having a dad bod really means.

from Well http://well.blogs.nytimes.com/2015/06/21/the-real-dad-bod/


Friday, June 19, 2015

Defending Champ Vanderbilt Beats TCU 7-1, Returns to Finals

By THE ASSOCIATED PRESS from NYT Sports http://www.nytimes.com/aponline/2015/06/19/sports/baseball/ap-bbc-cws-tcu-vanderbilt.html

Understanding Stress Fractures in Runners

Stress Fracture Lady

In this article, I’ll try to give you a good overview of stress fractures generally, as well as giving you a little insight into my mind (scary place to be I know!) when I’m reasoning through how to manage a stress fracture, as there are a number of variables to be aware of.

So if you’re sitting comfortably, we shall begin…

A stress fracture is essentially a crack or break in the bone. It differs from a standard fracture by way of mechanism.

Standard fractures are usually caused by a sudden, severe, high force trauma, like a fall from a great height, or a road traffic accident.

Stress fractures, on the other hand, are the result of an accumulation of sub-maximal loading over time. So the forces experienced are not great enough to break the bone outright, but the repeated application of that stress, without adequate recovery is enough for the bone to fail.

Now, I don’t want anyone reading this to worry about running and the health of your bones: Your bones are organic tissue and respond brilliantly to loading. So running is generally great for bone health.

When you load a bone, like in running, and give it sufficient recovery, it undergoes a process of re-absorption and bone formation that ultimately strengthens the bone.

If however, repeated load is placed on the bone, without sufficient recovery time in between, the bone doesn’t have the time to strengthen before the next bout of loading is applied. When this happens regularly, a stress fracture can result.

This is another great example of ignoring the law of adaptation and doing too much too soon. The cardinal sign of most running injuries!

The mechanism of stress fractures can be split into 4 camps:

Traction (muscles and connective tissue pulling on the bone repeatedly/excessively), impact, rotation or a combination of the above. Most running stress fractures are impact related, with the fractured bone having to absorb the the repetitive ground reaction force.

Fig 1. shows the progression of bone stress.

Stress Fracture Progression

Fig. 1: Stages of bone stress leading to stress fracture

Signs & Symptoms

You can have a stress fracture in any bone, but it tends to effect the weight bearing bones in runners.

Common areas include:

  • 2nd and 5th metatarsals
  • Tibia
  • Fibula
  • Navicular
  • Neck of femur

Diagnosing stress fractures

A big part of diagnosing stress factors, is in the subjective history, or the story the patient tells you.

In runners, there is traditionally a story that involves a change in training. This can be a sharp increase in mileage, or increase in intensity, such as adding in a new plyometric programme.

It could be as simple as a change in footwear but there is usually a change somewhere.

The location of pain, tends to be very local to the area of the fracture. There is often some swelling present too. In the early stages of the condition the pain is felt on weight bearing and is activity related, so pain is felt on running and worsens the more you do. As the condition progresses, the pain is there even at rest and often manifests at night.

Physical tests that can help diagnosis include palpation (touching in and around the painful area), as mentioned above, you would expect quite a local area of pain, not a widespread, diffuse pattern. Impact tests, although a bit cruel, can help with diagnosis. These include hopping, jumping and stamping and you’re basically looking for reproduction of the patients symptoms. These are often used as objective markers, a way to measure progress, so once they are pain free it’s a good sign that you’re ready to progress.

From an imaging perspective, MRI is the method of choice for diagnosing stress fractures.

Prevention / How to manage stress fractures

If I’ve reached the diagnosis of a stress fracture, the next question is: How are we going to manage it?

Not all stress fracture are made equal, so at this stage I have a few things going through my mind:

  1. Is it a high risk fracture?
  2. What are pain levels like? and how irritable is it?
  3. What is the quality of the bone like in the first place?
  4. Biomechanics

Is it a high risk stress fracture?

A high risk stress fracture, is a stress fracture with a high risk of non-union or delayed healing. Any area that has a poor blood supply, or risk of developing into a full fracture, can be classified as high risk.

A high risk fracture is managed with either surgery or at the very aggressive end of conservative management (see fig.2).

High risk fractures include:

  • Neck of femur: Tension side (In certain fractures you get a tension side and a compressive side. In the compressive side, as the name suggests, the bones are being pushed together so actually favours union and healing, whereas the tension side is repeatedly being pulled apart, so it can be difficult for that area to heal and unite).
  • The patella
  • Medial malleolus
  • The base of the 5th metatarsal
  • Navicular
  • Sesamoid bones of the big toe

Pain levels & Irritability?

Having taken on board whether the stress fracture is high or low risk (most running stress fractures are low risk) you can then use pain levels, and how much activity it takes to bring on the pain, as guidance on how aggressively you need to offload.

Intuitively, we need the area to heal. Luckily, all that wisdom is already in your body. All you have to do is give it the right environment to heal in. This means taking the load off the injured area to give it a chance to do this.

In the lower risk stress fractures, you only need to back off activity, to pain free levels. It’s wise to maintain the strength and health of adjacent body parts, so there’s nothing wrong with training the other joints, other leg, or upper body, whilst waiting for the injured area to heal.

You may also cross train, as long as it’s pain free. Common examples are cycling and pool running. I’m a big fan of deep water pool running when you’re injured. You can maintain good running mechanics and still get all the physiological benefits of your run, just without the load!

So, if you work at the right intensity, you can still do a lactate threshold workout in the pool.

Bottom line is, if you understand stress fractures (which hopefully this article is going a long way to helping) and have been cleared of a high risk stress fracture, then there’s still loads you can do to maintain, and even further, your fitness.

Stress Fracture Management

Figure 2: A continuum of conservative offloading.
Conservative or Aggressive Conservative?

What’s the quality of the bone like in the first place?

Clearly, if you have a higher bone density i.e. stronger bones, that bone is less likely to develop a stress fracture and be better able to withstand the repetitive forces of running.

New runners, especially if there has been no other history of regular weight bearing exercises, tend to have less dense bone tissue, compared to runners who have been running and exercising regularly over years.

Poor nutrition and low vitamin D, have also been associated with poor bone health and therefore could put you at a higher risk of a stress fracture.

Women, with what known as the female athletic triad (eating disorders, amenorrhoea and osteoporosis) are also likely to have poorer bone health. It’s been reported that stress fractures in athletes with menstrual disturbances is 2 to 4 times that of eumenorrheic athletes.

A lack of oestrogen (or testosterone in men) has been related to poor bone health.

These issues are important to know, and with the help of a nutritionist or consultant, supplementation or medication can form part of the management plan.


The last thing whizzing around my brain at this point, is biomechanics. Biomechanics don’t necessarily cause a stress fracture, but they can give us the clues as to “why there?“.

I’m always fascinated why runners come in with pain that manifests in different areas. Why does runner ‘X’ have a stress fracture in his tibia and runner ‘Y’ have a stress fracture in his 5th metatarsal?

Likewise, why does runner ‘A’ have illiotibial band syndrome and runner ‘B’ have plantar fasciitis?

They’re all, likely, guilty of too much too soon, but biomechanical analysis (a posh word for just looking at how you move), gives us an insight into why that particular area has been overloaded.

It may be enough, just to offload the area until pain free, and then just be more graded with your mileage and intensity to prevent further problems. However, some people may benefit from a slight change in running technique to decrease load on that area.

Let me give you a couple of examples of how I change running technique and my reasoning behind each one:

Example 1: Tibial stress fracture

The cues I tend to use here, to offload the anterior medial tibia, are similar to that of medial tibial stress syndrome (MTSS) (some people believe tibial stress fractures and MTSS are on a continuum anyway, so it makes sense)

  1. Increase cadence: One of my most used running re-education cues across the board. The best way to do this is via the use of a metronome. There are lots of free metronome apps if you have an iPhone, or you can by one pretty cheaply from places like Amazon. There’s no set stride rate you should aim for, so have a play around with it a bit. Generally, I go for 5%-10% more than your current cadence at a given pace and see what happens. You can always gradually increase it from there and re-assess the ‘experiment’. The theory behind increasing your cadence is to decreased an over stride, get you landing closer to your centre of mass (CoM) and with a straight tibia, as opposed to your tibia flicking out ahead of the knee. Think of it a bit like a pole vaulters pole. As they approach the jump, they plant the pole ahead of themselves so you see this big, anterior bowing of the pole, great for pole vaulting but not so good for tibias! If you can imagine the pole vaulter placing the pole down vertically, and not ahead of themselves, you will see a pretty crappy pole vaulter, but also less anterior bowing of the pole, that’s what we are looking for: less anterior bowing = less force through the painful area.
  2. Increase step width: Trying to move the load from the medial shin to achieve less varus (side bending) tibial bowing. I try and bring about this change using a variety of cues, and what works for one doesn’t always work for the next. Generally, asking people to have some daylight between their legs, imagine running on either side of a yellow parking line or, recently, i’ve been getting my runners to run with a resistance loop just above their knees, and instruct them to keep the pressure on the band.
  3. Stiffen the ankle: The idea here is to decrease the amount of dorsiflexion the ankle goes through. Lessening dorsiflexion, means less tibial bowing from the action of soleus as it tries to decelerate the tibia. Stiffening the ankle also helps to pretension the muscles so they can work reactively and elastically. Good for speed but also takes the load of the bone itself.
  4. Change the direction of the ground reaction force: Again, we are trying to decrease the anterior tibia bowing. If we go back to our rubbish pole vaulter, as we discussed, if he places the pole out in front of him with forward and downwards force it will create anterior bowing, however, if he plants the pole down with a backward and downwards force, it will not bow anteriorly, but posteriorly i.e the force will go more through the back of the tibia. Any change in the direction of the ground reaction force to a more backwards and downwards force will decrease the load in the anterior tibia and may be enough for us to keep running without pain. To cue this, I often video them and freeze the frame of them running when their swing leg is at its highest. From this position I instruct them to push their leg back and down, in a backwards tick type direction, using their glutes to perform the movement. Sometimes i’ll ask them to paw back on the ground (bit of a controversial cue from a performance perspective, but can just get them to direct the force more backward and down).
  5. Posture: Encourage the patient to run up tall. I often use the ‘helium balloon attached to the crown of the head’ cue. This cue helps decrease an anterior pelvic tilt or a forward lean from the waist. Both of these mechanics lead to the centre of mass shifting forwards. To compensate for this, you will have to over stride with the next step = more load on knee and shin area.

Example 2: 2nd metatarsal stress fracture

There could be a few reasons why the 2nd metatarsal is being overloaded. For simplicity, let’s say that gait analysis showed, generally good biomechanics higher up, but a pronounced forefoot strike. This would put a lot of stress through the metatarsals so would be a good idea to change.

You could work on the “oranges cue” (I have to give credit where it’s due, this cue was taken from the excellent Dr. Andy Franklyn-Miller and John Foster).

Basically, the idea of the “oranges cue” is to imagine that you have an orange taped to the bottom of your foot, around the mid arch area. Your goal is to squash the orange, without letting the orange squirt out the front (heel strike) or back (fore foot strike). As you’ve probably worked out, this will encourage a more mid-foot strike pattern.

Once you have all the above information, you should have enough data to make a decision as to how you’re going to manage this stress fracture, and, where on the management continuum you are going to begin (Conservative? Aggressive Conservative? Somewhere in between?).

Use your objective markers (hopping, jumping, stamping) along the way, to assess progress.

Stress fractures can take anywhere between 4 to 12 weeks to recover so, as always, I firmly believe that prevention is better than cure.

Stress fractures rarely surprise you out of the blue, there are warning signs along the way. Without going too deep in a running article, you’re body has great wisdom, if you listen to what it’s telling you, it will guide you to the right path.

The post Understanding Stress Fractures in Runners appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

from Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution http://feedproxy.google.com/~r/KineticRev/~3/i8kCzeuWZ2w/

Scottsdale Sports Medicine

The Weekly Health Quiz: High-Heels, Fats and Test-Tube Babies

Test your knowledge of this week's health news.

from Well http://well.blogs.nytimes.com/2015/06/19/the-weekly-health-quiz-high-heels-fats-and-test-tube-babies/


Alzheimer’s Supplements Targeted by U.S. Senator

Senator Claire McCaskill of Missouri this week raised concerns about dietary supplements that claim to protect against dementia and Alzheimer’s disease

from Well http://well.blogs.nytimes.com/2015/06/19/alzheimers-supplements-targeted-by-u-s-senator/


Free MBSC Workout This Saturday

Join our MBSC staff at the Eddie Bauer Grand Opening  Market Street, Lynnfield Ma. on Saturday June 20th.

First 100 purchases get a swag bag!
$25 gift card give aways all day long!
Raffle to win a $500 Eddie Bauer shopping spree!

Events on the green
10 am yoga
12 noon Zumba
2pm Free work out with MBSC

All are welcome to participate for free!
( free give aways while you work out!)
Mike Boyle Strength and Conditioning | 781-938-1330 | carrie@bodybyboyle.com|www.bodybyboyle.com

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/19/free-mbsc-workout-this-saturday/
Visit Us At:


Scottsdale Sports Medicine


Ask Well: Can You Drink Too Much Water?

Dehydration can be dangerous during exercise, but is it possible to drink too much water?

from Well http://well.blogs.nytimes.com/2015/06/19/ask-well-can-you-drink-too-much-water/


Running Warm Up Exercises: Five Minute Routine


I’ve posted previously about warming up before a run. It seems to be a topic most runners have a view on! We do all seem to differ to an extent in terms of how much of a warm up we each need for a given session.

As a rule of thumb, I usually suggest that the more intense the planned session, the more significant your warm up needs to be.

In this short video, I wanted to share a simple five minute routine of exercises that I often recommend to runners as a warm up to use after a long day behind a desk, in the car, or otherwise sitting for too long.

Let me know how you get on :)

The post Running Warm Up Exercises: Five Minute Routine appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

from Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution http://feedproxy.google.com/~r/KineticRev/~3/y5Jv01VUBMo/

Scottsdale Sports Medicine

Thursday, June 18, 2015

When Doctors Don’t Talk to Doctors

Poor communication between doctors and patients is discussed relatively frequently. But what about confusion between the teams of doctors who share patients in the hospital?

from Well http://well.blogs.nytimes.com/2015/06/18/when-doctors-dont-talk-to-doctors/


Adding People to Facebook Groups?

I just got another Facebook message saying ” ______ has added you to the group ____  _____ “.

Do us all a favor and don’t add us. It’s rude. You can ask if we want to join but, don’t just add people.

By the way, while I’m ranting please don’t use text messages for business correspondence, send an email. It’s so much more professional and far easier to keep track of.

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/18/adding-people-to-facebook-groups/
Visit Us At:


Scottsdale Sports Medicine


A Father and Son Embrace Meditation

Ethan Nichtern and his father, David, both teach meditation. The practice has shaped their bond through the years.

from Well http://well.blogs.nytimes.com/2015/06/18/a-father-and-son-embrace-meditation/


Wednesday, June 17, 2015

To Cut Teen Smoking, Raise Tobacco Sales Age

A new study has found a simple way to significantly reduce teenage smoking: raise the tobacco sales age to 21.

from Well http://well.blogs.nytimes.com/2015/06/17/to-cut-teen-smoking-raise-tobacco-sales-age/


Science Weighs in on High-Heels

The heroine of "Jurassic World" runs from rampaging beasts in high heels, without turning a hair or an ankle. But research on the biomechanics of wearing heels, including a new study of the effects on ankle strength and balance, says of her equipoise, ha.

from Well http://well.blogs.nytimes.com/2015/06/17/science-weighs-in-on-high-heels/


Monday, June 15, 2015

Wearable Devices to Prevent Sunburn

New devices monitor sun exposure and nudge users to apply sunscreen and take other steps to protect their skin from too much sun.

from Well http://well.blogs.nytimes.com/2015/06/16/wearable-devices-to-prevent-sunburn/


Tensor Fascia Lata (TFL) Stretch for Runners


As I find myself reiterating to athletes on almost a daily basis; you can’t stretch the Iliotibial Band (ITB)!

Two muscles, Gluteus Maximus and Tensor Fascia Lata (TFL) form the upper attachment of the ITB to the pelvis. When these muscles get tight, tension increases in the ITB, sometimes this can be a factor in why some individuals go to to develop ITB Syndrome.

In terms of Glute Max and TFL, rarely do I see athletes presenting with tight Glute Max muscles. Far more common is the athlete who exhibits tightness through TFL. These athletes usually greatly benefit from the stretch in the video above.

As I mention in the video, causes for TFL tightness is a topic for another day :)

Let me know how you get on with this stretch.

Leave a comment below…

The post Tensor Fascia Lata (TFL) Stretch for Runners appeared first on Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution.

from Run Coaching, Ironman and Triathlon Specialists - Kinetic Revolution http://feedproxy.google.com/~r/KineticRev/~3/2zeskp9gSZk/

Scottsdale Sports Medicine

The Y.M.C.A.’s Work Outside the Gym

The Y’s Healthier Communities Initiatives program has campaigned to make lifestyles healthier across the country.

from Well http://well.blogs.nytimes.com/2015/06/15/the-y-m-c-a-s-work-outside-the-gym/


Saturday, June 13, 2015

Take a Look at What’s New on StrengthCoach.com


Rower Lunges-

Standing Press-

Shoulder Upward & Downward Rotation Drill-

Summer Strength and Conditioning Guide for Parents: 3 Pitfalls to Avoid- Anthony Donskov
Is It Overtraining or Under Planning?- Mike Boyle http://www.strengthcoach.com/members/Is-It-Overtraining-or-Under-Planning.cfm

4 Day Summer Program PDF- Mike Boyle
These threads have been getting a lot of activity:

Advanced Forum
Is This a 3?

Beginner Forum
Teaching the Hip Hinge

The Strength Coach Podcast
In Episode 164, Anthony interviews Sue Falsone, with a lot of the conversation talking about concepts from her new DVD, “The Shoulder”.

In Episode 165, Anthony interviews Anaheim Ducks Strength Coach Sean Skahan about everything he is doing with the Ducks.

Listen Here

Thanks for logging in and thanks to all of our contributors.

from Michael Boyle's Strengthcoach.com Blog http://strengthcoachblog.com/2015/06/13/take-a-look-at-whats-new-on-strengthcoach-com/
Visit Us At:


Scottsdale Sports Medicine