PT on the Net Research

Balance in Training - Part 1


Most athletes are under the impression that the adaptations their bodies make to a training stimulus are good ones. Any cyclist receiving physical therapy for low back, neck or shoulder pain could convincingly argue against that point. When they train hard on their bikes, when they do the hill repeats, when they do the form sprints and threshold intervals they are imposing a demand on their bodies. Their bodies then, if all conditions are met (more on this later), positively adapt to this demand. They get stronger; they get more fit, they get faster. Unfortunately, we don’t live in a perfect world and often our bodies don’t adapt the way we want them to. Our training and the stresses involved may actually take us out of balance.

Don’t think for an instant that this problem is exclusive to athletes; the average professional is dealing with the same issues. This person, your next client, thinks that by working out in the gym, he is helping relieve stress and he doesn’t understand why he has more pain than he did before he started working out. That’s the purpose of this article: to discuss the imbalances and stressors that plague us and our clients. The following articles will explore the internal and emotional impact of stress and imbalance; and finally what to do to help yourself and your clients.

Balance and stress can be very subjectively defined. The ways our clients are imbalanced and stressed are in their musculo-skeletal system (muscles and bones), in their visceral system (internal organs) or their limbic (emotional/mood) system or more likely a combination of all of these. Let’s look at the musculo-skeletal system.

Think of the way an athlete performs his sport or your client performs his job. Is it in a posturally dysfunctional position? Many sports require this; again refer to cyclists. They are flexed at the trunk, internally rotated at the shoulders and hyper extended in the cervical spine. Think of the way a cyclist sits on a bicycle. I like to use the analogy of software engineers who do their computer work while sitting in a chair with their keyboard on the floor and their monitor at desk level. Ouch. This is not too exaggerated from any other professional who spends long hours on a computer. Understanding the demands of your client’s profession is essential.

Once the working position of your athlete/client has been established, consider the duration of that position. Is he/she in poor posture for prolonged periods? More importantly, is he/she in any position for prolonged periods? The human body does not particularly like to be still for too long. In fact, I would say anyone who spends more than an hour or two (consecutively) a day in a certain position (and who does no corrective exercises) has significant musculo-skeletal imbalances.

For example, if we spend too much time bent forward, our body often forgets that it can bend backward. If left unchecked, this can lead to a myriad of consequences such as: posterior migration (when a disc moves in a posterior direction, compressing a spinal nerve root) of a lumbar disc; posterior migration of a cervical disc; anterior laxity (the anterior aspect of the joint becomes weak and dysfunctional) in the shoulder capsule; and Brachial Plexus nerve entrapment (when the nerves that supply the energy to the arms become impinged-like putting a kink or stepping on a water hose) JUST TO NAME A FEW!!

By not moving enough or performing virtually the same motion repeatedly for long durations, the body reacts by un-integrating itself. Regardless of the task, if the movement does not involve balanced total body, multi-planar movements, then it un-integrates the body. The human body strives to be as efficient as possible and is very task oriented. The nervous system drives the body to accomplish the goal by any means necessary, even if it creates movement patterns that are dysfunctional and will likely lead to pain.

The problem of isolated movements is exacerbated by how long we do them. Again, consider the person who sits at a computer all day. Frankly, our bodies were never designed for this. Even if one’s position at work is technically and ergonomically perfect, one is still likely to experience some sort of pain from overuse and imbalance. When working at a desk, because it is such an isolated activity, the structural/muscular adaptation that happens as a result is skewed. For example, sitting in a flexed-hip position for an extended period will result in a shortening adaptation of the Ilio-Tibial tendon (IT band) which is directly related to IT band tendonitis. How many of your clients out there have experienced IT band issues?

Tendonitis, or any “-itis” for that matter, is a rampant inflammation. Did you know that our bodies have a built in anti-inflammatory mechanism? We do, and its primary agent is called cortisol.

There’s a lot of hype about cortisol currently, but how many trainers really understand what it is? Cortisol is a glucocorticoid produced by the human adrenal gland. It comes from the synthesization of cholesterol, and its production is stimulated by the pituitary gland or more precisely pituitary adrenocorticotropic hormone (ACTH). Cortisol acts through specific intracellular receptors and affects numerous physiologic systems including immune function, glucose regulation, vascular tone and bone metabolism.

Cortisol production has a circadian rhythm with peak levels in the early morning and a nadir at night. All that controls cortisol and its rhythms is not yet understood and can be disrupted by a number of physical and psychological conditions. ACTH and cortisol are not completely dependent on circadian rhythm; they also act in response to physical and psychological stress.

Cortisol exists finitely within the human body. There is not an endless supply. Cortisol is allocated according to the hierarchy of control systems within the human body. At the top of the system (highest priority) is respiration. About middle priority is the visceral system and at the bottom is the musculo-skeletal system. For example, if there is a lot of visceral stress, then there is less resource for musculo-skeletal stress if the two stressors were experienced simultaneously. However, this system also works on a “first come-first serve” system. For instance, if the client is constantly stressing his musculo-skeletal system, then there is less resource for any other stressors that may be experienced subsequently.

When tissue within the body is stressed and then begins to swell or inflame, there is a message sent through the nervous system to the brain. The brain then tells the adrenal glands that the system has been stressed at (fill in the area/organ), and it needs some cortisol to control this inflammation. This is a good and normal response within the body. What would happen, though, if the said body was for some reason depleted in cortisol? Simple, the inflammation would progress and then become an “-itis.” The typical response to an “-itis” is to take Ibuprofen; this would be appropriate if the cause of the “-itis” was an Ibuprofen deficiency.

Any time the body is stressed it evokes this reaction from the adrenal glands. The ability of a person to cope, their energy, and their endurance depend on proper adrenal functioning. This is where the aforementioned types of stress really come into play. Stress is something that is not only blind, but also cumulative. The body cannot differentiate sources of stress. For example, if every time your client comes home from a workout (musculo-skeletal stress), his significant other gets upset with him (limbic stress). His brain interprets these stressors and calls on the adrenal glands to release cortisol. The problem now is that cortisol has been either used to handle his emotional stress rather than the musculo-skeletal stress from their workout or the cortisol has been allocated to two systems. So what follows is he doesn't get to recover properly from the workout, and he more than likely does not deal with the emotional stress effectively either. If he isn't keen to this going on, he may go out and train hard the next day, and the same situation happens again. The cycle can go on and on with the end result being OVER-TRAINING and/or overuse injuries combined with an increasingly dysfunctional relationship.

You see, nature always wins. If your body keeps getting stressed without ample time to recover, it gets drained. When your body gets too drained, you don’t have the sense to slow down, nature steps in and she puts you in pain. I mean what’s a better way to get you off of your workout routine so you can recover than to give you some debilitating knee pain? It’s time to re-look at the musculo-skeletal pain of your clients.

What are other ways we are stressing our bodies? Let me rattle off a few:

  1. Not being asleep by 10:00pm or not getting enough sleep. This upsets the body’s natural circadian rhythms and deprives the body of its time to replenish.
  2. Poor nutritional habits. Ignoring food intolerances and/or eating processed foods stresses the digestive (visceral) system.
  3. Poor communication skills/relationship issues. These are psychologically (limbic) damaging.
  4. Money issues. Again, psychologically stressful.
  5. Cooking in a microwave. Microwaves alter the molecular structure of food, turning it into something the body thinks tastes good perhaps but does not recognize and therefore treats as a toxin (stresses the liver-viscera).

The list goes on and on. The vastness of this issue is impossible to quantify. Don’t be alarmed, though. Stress is not necessarily always a harmful thing. What IS harmful is when your body no longer has the resources to combat the stress.

So what now? How do we learn to identify visceral and emotional stress? Fortunately there are many ways. Part 2 of this series will address limbic/emotional stress as well as visceral stress.