Are Your Tendons Weak?

blog shoulder painMuscles get all the attention.

But it’s the dense, fibrous tissue of your tendons that allow muscles to produce the powerful movements that transform your body.

The tendons must be strong enough to endure plenty of abuse because their role is to connect muscle to bone. If your tendons are weak you’ll suffer from strength loss, pain and worst of all you’ll be predisposed to a debilitating injury. It’s time to give tendons the attention they deserve.

In order to understand what can go wrong with tendons it’s important to know the key materials that form them. For the sake of this simple discussion, collagen is the essential protein that can make or potentially break your tendons. There are three primary types of collagen in the human body: type I, type II and type III.

Collagen type I and III are the key players at work in your tendons, but one of them doesn’t belong. You see, type I is the form that makes your tendons stronger and more resistant to tears. However, during the times when a tendon is chronically overstressed with excessive training the body responds by adding more type III collagen within the tendon.

What’s the problem with adding type III collagen to your tendons? It’s an elastic and weak protein that only belongs in your skin and blood vessels. Indeed, your tendons need the super strong proteins found in type I collagen to support explosive contractions.

When you overtrain a muscle it’s not clear to scientists why the body adds type III collagen where the type I form is desperately needed. But one thing is clear: when a tendon is chronically overworked the adaptive process is compromised. The end result is tendinosis caused by an excess of water, misaligned fibers and too much type III collagen.

Tendinosis and tendinitis both describe dysfunctional tendons, but the mechanism of injury differs between the two. Tendinitis is caused by an excess of inflammation.

Tendinosis, on the other hand, is degeneration of the tendon. It didn’t receive much attention until recent years because less was known about it. In fact, this might be the first time you’ve even read about tendinosis.  But trust me, it’s now getting plenty of well-deserved attention in the research world!

Here’s the kicker – if you’ve been suffering from pain in any tendon is highly likely that you’ve assumed it’s tendinitis. It could be, and this should be confirmed by your doctor. However, in many cases the problem is tendinosis and research shows the typical “rest, ice, ibuprofen” treatment won’t work.

How do you know which dysfunction you have? With regard to the notorious Achilles tendon, it’s pretty easy to figure out. Is one tendon substantially thicker than the other as shown in the pic below? If so, that’s tendinosis and it took years to develop. Yep, that thicker tendon you see is actually weaker and more susceptible to tearing than the smaller one!

Mosby Arnheim 88435625653_18-20LC 7/29/96rev: dlh 9/9/96

Unfortunately, it’s more difficult to identify tendinosis in other typically problematic joints such as the elbow and shoulder. In fact, tendinosis in the supraspinatus actually causes it to get thinner (the exact opposite of the Achilles tendon). Orthopedic surgeons that specialize in the shoulder are often shocked to see a paper thin tendon on that important rotator cuff muscle when they cut open the shoulder.

How do you know if the problem isn’t tendinosis, but tendinitis? If the pain is less than two weeks old it could be tendinitis because after that time the inflammation process typically subsides. Beyond that, you’re often dealing with another pathology.

If the pain is in the Achilles check if one tendon is thicker than the other. A thicker tendon means the pathology is tendinosis, not tendinitis. In any case, here’s how you treat either:

Tendinitis treatment: rest, ice and ibuprofen. If the pain hasn’t subsided after 2 weeks, consider tendinosis and check with your doctor.

Tendinosis treatment: as mentioned, this dysfunction won’t respond to the tendinitis treatment protocol (although, a few days of extra rest is never a bad idea). Research demonstrates that tendinosis responds well to eccentric training of the affected muscle. The eccentric contractions help stiffen the tendon and increase type I collagen synthesis (Ohberg et al, Br J Sports Med, 2004).

Eccentric Training Parameters for Tendinosis
Sets x Reps: 3 x 15, every other day.
Loading: moderate, don’t go for maximal loading.

Exercise Examples
Achilles tendon: negative single leg calf raise (eccentric phase only)
Triceps tendon: dumbbell lying triceps extension (eccentric phase only)
Supraspinatus tendon: dumbbell lateral raise (eccentric phase only)

Importantly, the eccentric (negative) exercise you choose should not cause pain. The real problems often occur at the extreme ends of motion. For example, some people have pain in the supraspinatus if they start the negative rep with their arms elevated to parallel since this is where the muscle has to fire most intensely. Use your own judgment and avoid the areas of motion – whether it’s at peak contraction or a maximal stretch – that cause the most pain.

Stay Focused,

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How to Know if Research is Garbage or Gold

blog research stack I’ll bet you’ve read an article that quoted intriguing research. Maybe that research was exactly what you wanted to hear: “Group X lost 320% more belly fat than those that didn’t take the pill!”

Sure, you assumed it was too good to be true. But it was a published study, so that must count for something legit, right?

Learning how to identify whether a study is reputable or garbage is an essential part of the information-building process. If you assume any study that’s published is credible, you’ll surely be suckered into believing a product, exercise or workout is reputable when it’s really not.

Today I’m going to cover 8 different categories of research. So the next time you read a story or article where the author bases his position – or sales pitch – on published research, you’ll know whether or not it’s legit.

I’ll start from the least credible category of research – the dreaded and overly-quoted animal studies – and work my way up the pyramid until we achieve research awesomeness.

Ranking Research From the Bottom Up

Foundational basic science: these studies are performed with animals or cadavers and rank at the bottom of the credibility pyramid. Don’t get me wrong: animal studies aren’t useless because it’s where virtually all medical research starts. But let’s be real, when it comes to building muscle we all know those animal results rarely carry over to human physiology (see the myostatin bull below).

blog myostatin bull

Narrative reviews, expert opinions, textbooks: the next step up in credibility is an expert’s opinion or textbook. On the surface, this type of research appears pretty solid – and it certainly can be – but the author’s bias and no “results section” to explain can heavily shape the content. That’s why it’s important to know the reputation of the author before you put credence into what he or she says. In my book, anything Dr. Eric Kandel says is as credible as the most reputable piece of research on the planet.

Case report: now we’re dealing with actual human subjects. However, the problem with a case report is that it tells the story of only one person (n=1). Therefore, it can be unwise to assume that same info will hold true for a group of people.

Case series: in this type of research, several case reports are put together to explain a specific point. A case series takes more than one person into account, but usually less than 20. Since the strength of research is in numbers (i.e., more subjects = stronger argument), you should take a conservative approach when hanging your argument on case studies.

Case-control studies: for this type of study, the medical history of people are compared to the history of people without the disease. The scientists can look at data from the past (retrospective) or assume what might happen in the future (prospective). An example of a case-control study would make a hypothesis such as: there is a relationship between autism and childhood vaccines.

The last three types of research – cohort studies, randomized clinical trials, systematic reviews – hold the most credibility. Collectively, they are known as Evidence-Based Clinical Practice Guidelines. So whenever you see one of the following three types of research quoted, you can be confident that it’s the most legit science out there.

Cohort study: for this study a group of people are monitored forward in time (prospective) or backward in time to assess the development of disease or some other outcome. An example hypothesis of a cohort study is: adults that exercise for 3 hours/week are less likely to develop diabetes than those who exercise 1 hour/week. Then a specific time period of the data (e.g., 5 years) is examined to determine if the research matches the hypothesis.

Randomized controlled clinical trial (RCT): a group of people are randomly assigned to different treatment groups. This is considered the gold standard in lab research for studying treatments or protocols, especially when there’s a large group of test subjects. A possible RCT hypothesis could be: 15 minutes of high intensity cardio will result in greater fat loss compared to 40 minutes of low intensity cardio.

So the researchers might take 400 people, assign them to either high intensity or low intensity exercise for 12 weeks, then analysis the difference in fat loss between the two groups.

Systematic review: this final type of research is the highest echelon of quality because it’s comprised of the largest amount of available data. A systematic review combines many past studies into one big study. An example hypothesis of a systematic review might be: physical therapy treatment reduces symptoms of low back pain.

If the investigators did their job, they started with a search of all studies about physical therapy and low back pain that meet a pre-set criteria for quality. Then they take the studies that meet the criteria and summarize the cumulative results. Finally, the researchers combine data from all studies and complete a new statistical analysis that’s known as a meta analysis.

If you’re fortunate enough to find a systematic review published in a reputable journal, you can put a lot of faith in the results.

I hope this brief overview of the different types of studies will improve your critical thinking skills and keep you from being bamboozled by research that isn’t reputable.

Stay focused,

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The Testosterone and Exercise Connection

blog dr schroeder Testosterone is the king of all muscle-building hormones. No other performance hormone has received more press.

So it’s no surprise that athletes will do everything possible to maximize it – even if that means breaking laws or rules.

You’ve probably wondered if there’s anything that can be changed within your training program to produce a significant, natural boost of testosterone?

Last August I started the revered Doctor of Physical Therapy program at the University of Southern California (USC) to further my education and knowledge base. One of the many advantages of being enrolled in the nation’s #1 ranked DPT program is the access I have to some of the smartest doctors and scientists on the planet.

E. Todd Schroeder, Ph.D., associate professor at USC is one of those guys. Dr. Schroeder heads much of USC’s research on muscle and exercise physiology, and one of his specialties is the effects that resistance training has on the almighty testosterone.

I sat down with Dr. Schroeder to discuss the connection between exercise and testosterone. Enjoy!

CW: Dr. Schroeder, thanks for talking with me today. First off, can resistance training increase testosterone levels?

Dr. Schroeder: Yes, Chad, it certainly can. If the intensity and load are high enough, you can significantly increase testosterone above baseline levels.

CW: Explain the time frame we’re talking about here. Does the testosterone increase occur immediately, and how long does it stay elevated?

Dr. Schroeder: Up to 30 minutes post-exercise is where we see the peak in testosterone. By the 45-60 minute mark the elevated level returns to baseline.

CW: What type of training parameters have you found to have the most significant effect for increasing testosterone?

Dr. Schroeder: Generally speaking, 6 sets of 7-8 reps with the heaviest load a person can handle with compound exercises works well. Importantly, the rest periods must be relatively short, somewhere around 45-60 seconds between straight sets.

CW: That sounds pretty intense!

Dr. Schroeder: It is. You see, it’s the stress we create in the lab with resistance training protocols that induce the anabolic response. Testosterone, cytokines and other mediators all play a role to create that effect.

CW: You mentioned that testosterone peaks around 30 minutes post-exercise and then returns to baseline 15-30 minutes later. Is that enough time to trigger an anabolic response that will significantly improve muscle mass?

Dr. Schroeder: Probably not. At this point it’s difficult to say what effect, if any, that temporary boost in testosterone will have, but it certainly won’t hurt your efforts.

CW: That makes sense. After all, many guys out there consistently train with plenty of intensity, but they still struggle to pack on new muscle. Can you talk a little more about what role you’ve seen testosterone play in the lab?

Dr. Schroeder: We’ve been studying the effects of resistance exercise and testosterone on the aging process. Testosterone is helpful in tissue repair and it decreases inflammation. Therefore, older individuals could benefit from protocols that keep it as high as physiologically possible.

CW: Is there anything you found during your research that surprised you?

Dr. Schroeder: Yes, a few years ago we compared the testosterone levels of male DPT students with master’s level male athletes in their 50s. We were surprised to find that the male DPT students with an average age of 24 years had lower testosterone than those older men.

CW: Wow, that just goes to show what negative effects the stress of graduate school can have on your T levels! I can relate considering I’m going through the program now. Indeed, whenever a guy asks me how he can naturally boost his testosterone, I tell him to start meditating 10-15 minutes per day.

Dr. Schroeder: I think that’s good advice and it might help. With regard to the relationship between testosterone and exercise, I recommend your readers check out the debate paper I contributed to for the Medicine and Science in Sports and Exercise journal. You can find that paper here.

CW: Thanks, Dr. Schroeder!

So where do Dr. Schroeders’ statements leave us? For starters, it’s clear that the scientific world still doesn’t understand, or hasn’t discovered, the physiological processes that lead to hypertrophy.

It would be easy to single out testosterone as being the main hormone that triggers the cascade of events leading up to muscle growth. However, studies don’t support that notion. Indeed, a study of men with near castration levels of testosterone were able to experience significant gains in size and strength with resistance training (Hanson et al, J Gerontol A Biol Sci Med Sci, 2013).

What do we know? The resistance training workout itself is obviously the stimulus for muscle growth, even if the scientific world still hasn’t figured out the physiological processes it triggers.

So if you want to build muscle faster, the most logical strategy is to find ways to stimulate your stubborn muscle groups more often. I’ve spent the last 13 years tweaking and experimenting with short High Frequency Training workouts to help you build muscle faster than ever before.

Stay Focused,

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Bare Bones Physiology

blog skeleton

Your body is comprised of around 206 bones. Unless you broke one of them at some point in your life, you probably don’t give much thought to any of them.

But bone physiology is important for any trainer or hard-training athlete to understand, so I’m going to cover the basics of what you need to know.

First off, bone isn’t a passive tissue that just maintains your uprightness and holds your soft tissues in place. Nope, bone is a living, adaptable tissue that’s classified as an organ. It can grow, repair and remodel, much like muscle tissue.

Growth: bone starts off as hyaline cartilage and then ossifies to give it that hard structure adults carry around.

Repair: as you know, when a bone breaks it doesn’t stay broken. The bone can repair big damage (i.e., fracture) and it can also repair micro damage that occurs on a daily basis. You don’t feel micro damage but it occurs each time you lift heavy weights or land from a jump.

However, you will feel micro damage if it accumulates faster than the bone can repair itself, thus causing a stress fracture. The only treatment for a stress fracture is rest so you can let the skeleton system put the deposition/resorption ratio back in balance.

Remodel: cells in bones feel tension and respond by either laying down new bone (deposition) or removing bone (resorption) when the compressive forces halt for an extended timeframe.

Importantly, remodeling is not just growth. Patients with paralysis experience high levels of remodeling through resorption. Remodeling and resorption are constantly occurring throughout life. Whether that remodeling results in more or less bone depends on the ratio between the two.

Bare Bones Physiology

Your bones consist of spongy bone on the inside, and a hard covering of compact bone on the outside. As mentioned, bone is a living tissue that receives blood from arteries and vessels that supply nutrients to keep it strong or make it smaller through resorption (deloading) or repair damage.

There are three types of cells within bone: osteoblasts, osteoclasts and osteocytes.

Osteoblasts lay down new bone either after a fracture or when the bone is stressed through load bearing and weight training.

Osteoclasts do the opposite since they chew up bone either after a fracture to remove the damaged tissue, or when you unload the skeleton system. Astronauts have to deal with the ramifications of increased osteoclasts (resorption) activity when they’re in space.

Osteocytes help maintain the bone integrity and can deposit or reabsorb bone based on the demand you give the skeletal system. Osteoblasts eventually become osteocytes.

Now, I’ll address three important questions about bone that are frequently asked…

What makes bones weaker?

The most obvious answer is an extended period of time when your skeletal system isn’t receiving compressive forces. I’ve already mentioned astronauts since they’re the most extreme example, but you could also lose bone density by being bedridden for an extended period of time. You might also lose bone if you dropped weight training from your exercise plan and started swimming instead.

Nutritionally speaking, a diet low in protein, vitamin C, calcium or vitamin D can all weaken the bones so it’s important to get enough of each. Osteoporosis occurs when resorption outweighs deposition. Most older people experience some level of bone loss due to decreased load-bearing activity and a change in hormones (estrogen and parathyroid).

Will weight training stunt a child’s growth?

“There’s absolutely no research that shows weight training will stunt a child’s growth,” was the reply my bone professor at USC gave me when I asked him that question.

It’s easy to think that weight training or gymnastics might keep kids short since most of the great ones are anything but tall. However, the reason you see so many short athletes in those sports (at the Olympic level) is because being small helps them excel at their sport. In other words, the young athletes that grew tall didn’t make the cut.

How much can I increase the diameter of my bones?

The research demonstrates that load-bearing exercise (think: heavy deadlift) can increase your bone mass 1% per year. Sure, that’s not much but the real factor is that you’re not losing bone: that’s what really matters. It’s important to add as much bone mass as possible before you turn 40 because it’s much more difficult to catch up later in life.

Although, it’s never too late to start laying down new bone with load-bearing exercises. Yep, you just might need to show grandpa how to deadlift!

Stay Focused,

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Squat Replacement and an Awesome Smoothie

In this week’s blog, I thought it was appropriate to answer a question from a reader since it covers two things that will probably interest you. – CW

Question: Mr. Waterbury, I bought your book, Huge in a Hurry. Holy shit, it works! But I have two questions. First, I can’t squat so what exercise should I do instead? Second, do you know a good smoothie I could drink before my workouts? Thanks, Patrick

CW: The barbell squat has been called “the king of all exercises” by many guys that are stronger than an ox on D-bol. For them, it’s a strength-builder that’s appropriate for their goals. But for many other people, the squat just doesn’t work.

Why? First of all, even though the “squat pattern” is a basic move that we all must master in order to sit on a chair or the bathroom throne, pulling off a perfect barbell back squat is another matter altogether. To perform a barbell back squat correctly, you must have sufficient mobility in the ankles, hips, T-spine and shoulders. Also, you must possess enough stability strength through your core to maintain the correct position.

blog bad squat

Those factors explain why the squat is a great exercise when you can do it correctly. However, most people lack in one or more of those areas and sometimes genetic factors such as long femurs and a short torso will always make the squat problematic.

If the squat isn’t ideal for your program due to structural, orthopedic or equipment limitations, there are two exercises you can do to replace it: hip thrust and stir the pot. The combination of those two exercises effectively challenge many of the same muscles as the squat, while also being user-friendly for almost everyone.

Hip thrust: perform with a barbell or a strong resistance band(s) as shown in the video below. Five sets of anywhere from 5-10 reps works well:

Pair the hip thrust with the Stir the Pot exercise that Prof. Stuart McGill made famous. Perform 5 sets of 6-10 alternating reps (3-5 in each direction):

Squat replacement
1A Hip thrust for 5-10 reps
Rest 30-45s
1B Stir the pot for 6-10 alternating reps
Rest 30-45s, and repeat 1A-1B for 5 rounds

Now, let’s get to everyone’s favorite blender concoction that doesn’t involve copious amounts of tequila: smoothies.

There’s definitely a plethora of smoothie recipes, books and blogs floating around the internet. Most of them consist of pretty straightforward ingredients such as fruit, protein powder and yogurt. That’s all fine, but there’s one simple smoothie I’ve used for years that might seem, well, odd on paper. But it’s packed with nutrients and it tastes awesome.

If you’re like 99% of my clients, you’ll eat up this unique combination of ingredients. Drink it 30-60 minutes before your workout to reduce inflammation and fuel your efforts. (Thanks to Dr. John Berardi since I initially learned a similar version of this smoothie from him):

Mix in a blender:
Around 20 ounces of water (more/less based on your taste preference)
2 fistfuls of fresh spinach
1 fistful of frozen raspberries
1 palmful of cashews
2 scoops of organic whey protein

Stay Focused,

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Add Strength to Your Program

blog franco deadlift Most of us want to get bigger and stronger at the same time. But most guys or gals that follow a bodybuilding-style program aren’t building much strength.

So today I’m going to outline a workout you can put in your current bodybuilding program that will fill in the much-needed gaps.

That’s important because if you increase your full-body strength you’ll be able to lift heavier loads in your bodybuilding workouts. This, in turn, will make it easier to build muscle in your other workouts.

Maximal Strength

There are many types of strength, so when I talk about strength-training I always make it clear to my audience what type of strength I’m talking about. In most cases, I’m referring to maximal strength: your ability to lift the heaviest load possible for 1-3 reps.

The master of maximal strength, Pavel Tsatsouline, and I have had many discussions on the best way to build it. Russian weightlifters – known as Olympic lifters to us in the states – spend most of their training cycle in the 80-85% of one-rep max (1RM) training zone. That fact will be surprising to many since it’s typically best to train with heavier loads than 85% of 1RM if you’re far from your maximal strength potential.

For example, if you can’t deadlift twice your body weight without lifting gear you’re pretty far from what your body is capable of pulling. In other words, I would define a guy that can do a raw, double-body weight deadlift with an unmixed grip as a solid, intermediate lifter. For him, training in the Russian’s 80-85% of 1RM zone might be sufficient.

But I doubt it.

Why? Because those Russian weightlifters train with a very high frequency (they typically bench press six times per week – yikes)! Furthermore, lifting is their job. Indeed, they’ve spent decades building up to that training frequency, their nutrition and recovery modalities are spot on, and they have little else to worry about.

Most of us don’t have the time and energy to do what the Russian weightlifters do. Therefore, the other option that’s been battle-tested for eons is to cycle loads that around 90% of 1RM into your program.

The following protocol is for people that have been primarily training with sub maximal loads (85% of 1RM or less) and want to quickly boost their maximal strength while still maintaining their current training program.

How to Make it Work: do the following the workout one day per week in place of one of your bodybuilding-style workouts.

Duration: 12 weeks (you can go longer if you feel the need).

Workout Circuit: I favor full-body circuits for maximal strength training because they allow for more rest before repeating an exercise while still staying efficient with your time. There’s no need to sit around for 3-5 minutes between sets when you could be working another body part.

Here’s the structure of the workout you’ll do once per week (remove one full-body bodybuilding workout from your current program):

1A Upper body pull
Rest 1 minute
1B Upper body push
Rest 1 minute
1C Stir the pot for 6 alternating reps, or Swiss ball side plank for 20 seconds each side
Rest 30 seconds
1D Deadlift, squat or lunge variation
Rest 90 seconds, repeat 1A-1D for 3 rounds

Workout Explanation: there are hundreds of different exercises you can use to fill in the above circuit, and that’s a good thing because you must manage fatigue. Lifting 90% of 1RM for the same exercise – even if it’s only once per week – can beat you up pretty fast.

Therefore, every two weeks choose a new exercise for each category. For example, weeks 1-2 you might do a one-arm dumbbell row for your upper body pull; then weeks 3-4 you’ll do a pull-up. Or you might use the Romanian deadlift for your “lower” body exercise during weeks 1-2 and then switch to a reverse lunge for weeks 3-4. You get the idea.

Training Parameters: each workout will start the same way. First, you’ll go through the entire circuit 2-3 times with loads that rate as 5-6 on a scale of 1-10. This will turn on your nervous system and prepare your joints. Then you’ll perform three rounds (work sets) of either 3, 2 or 1 reps per set, based on the week, with the heaviest loads you can manage that day.

Don’t worry about getting the loads perfect for the work sets. It’ll probably take you one round of the work set after the warm-up sets to get a feel for your strength that day. Try to ramp up your training loads for the two rounds that follow.

Here are the set/rep guidelines for the 12-week phase:

Weeks 1-2: 3 sets of 3 reps (except side plank if you use it)
Weeks 3-4: 3 sets of 2 reps
Weeks 5-6: 3 sets of 1 rep
Weeks 7-8: 3 sets of 3 reps
Weeks 9-10: 3 sets of 2 reps
Weeks 11-12: 3 sets of 1 rep

Again, you’ll do this workout once per week in addition to your other sub maximal training workouts. The point is to develop full-body strength while still keeping your current bodybuilding-style program in place.

How to Boost Your Squat, Deadlift or Lunge

You’ll notice in the circuit listed earlier that before you do any squat, deadlift or lunge variation you’ll always do the stir the pot or side plank with a leg lift exercise. The reason is because those are two of the best core exercises to increase spinal stability: an important element for boosting your full-body strength while protecting your spine.

The following video shows the stir the pot exercise. You’ll do 6 slow reps, alternating the direction with each rep, making the biggest circles possible:

This video shows the Swiss Ball side plank. The instability from the ball makes this exercise more challenging and effective:

Now you have a simple way to add strength to any bodybuilding program!

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Stay Focused,