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Periodisation of training

Endurance, efficiency, biomechanics of plyometrics, and immune considerations (Martin Krause 2012)

Endurance = "time to fatigue"

Training - "you need to stress, not strain the system to create change"

This section of the website deals with immune, physiological and biomechanical considerations of rehabilitation and training. Specifically, avoidance of 'staleness' and immune compromise from over-training is dealt with in consideration with the biomechanics of concentric and eccentric muscle exercise. The aim is to gain an oversight on how to train to recover from injury or prevent further injury. Ideally, this section should be read along with the sections, found elsewhere on this website, dealing with exercise and the immune system, exercise and muscle mass (Sarcopenia) and nutritional aspects of musculoskeletal health.

Altered biomechanical conditions as a result of misuse, disuse, overuse, abuse results in damage which can cause a viscious reciprocating cycle of muscle-tendon atrophy, degenerative changes, and immune-metabolic dysfunction that creates an environment of morbidity from chronic musculoskeletal dysfunction. At Back in Business Physiotherapy we use a combination of 'hands-on' therapy, exercise and nutritional supplementation to optimise the rehabilitative process. Importantly, development of a base training level of fitness through endurance exercise is considered essential for the development and maintenance of musculoskeletal health. Several reasons exist for this hypothesis, one of which is the fact that the deeper slow twitch postural muscles are the stabilisers of the body and these are more effectively trained through slow endurance training. In contrast the multi-joint superficial muscles are the mobilisers - ballistic muscles of the body and are important for speed and agility but must be trained on a good endurance base. Once an endurance base has been achieved, the more functional and difficult exercises of eccentric, muscle lengthening and loading regimes of plyometrics can be used, by building a graduated, progressive and periodised training regime. Finally, allostatic mechanisms of training for stress management can be employed which are immune enhancing, so long as good training involves cognitive goal setting through mental and physiological considerations that result in the avoidance of injuries and the minimisation of lost training days through ill-health from 'over-reaching' and lack of periodisation of training to recover and improve on 'over-training'

Symptoms of 'over-reaching' or over training include mood disturbances ("three bastards in a day"), non-restorative sleep and heart rate variability demonstrating a slow response from rest to activity and rest again. Physiological markers include raised cortisol levels.

Index

Immunological factors as a result of disuse

Immune Considerations and Nutritional Supplementation

Immune System and training

Oxidative Stress after Ultraendurance Exercise (overuse)

Overtraining

Musculoskeletal stress and the immune system

Sleep

Endurance training - "training the zones"

Endurance training - periodization

Power

Muscle Biomechanics

Plyometric Biomechanics

Plyometrics and eccentric muscle adaptation

Inverse Dynamics

Muscle Control

Motor control and oscillatory systems

Hip-back stability exercises

Back and diaphragmatic dynamic stability

Heart Rate Variability

Training Phases

Competitive Phase

Cooling Muscles

Good Reading

Conclusion

Immunological factors as a result of disuse

A biphasic stress response has been described in muscles during 'reloading' after a period of 'unloading'. Mechanical unloading as a result of disuse results in substantial muscle atrophy. This atrophy is a result of both increased protein degradation and reduced protein synthesis. Signaling pathways leading to this, include oxidative stress, proinflammatory signaling, reduced stress response, including heat shock proteins (HSP) and insulin-like growth factor (IGF-1). Insufficient HSP and antioxidant enzymes elicits oxidative damage of proteins and lipids (Lawler et al 2003, Free Radic Biol Med, 35, 9-16). Hence, unloading elevates oxidative stress. Paradoxically, loading also elevates oxidative stress. Nuclear Factor kB (NF-kB) has been implicated in both processes. Unloading is thought to induce numerous pro-inflammatory genes including nitric oxide synthase, cytokines, ubiquitin pathway ligases as a result of withdrawal of the stress - response including HSP25, HSP70, IGF1/Akt pathway (Lawler et al 2006, Muscle Nerve, 33, 200-207). The early portion of reloading, after a period of immobilisation is characterised by muscle damage and inflammation which requires a cognitive approach using a realistic time-frame for recovery to take place. Although, muscle recovery after 7-10 days of unloading is rapid (7 - 9 days), prolonged immobilisation greater than 17 days exhibits impaired recovery of muscle mass (Kasper 1995, J Appl Physiol, 79, 607-614). Reloading of muscles have been shown to result in a large up-regulation of NF-kB DNA-binding activity (Lawler et al 2012, Med Sci Sp Ex, 44, 4, 600-609). HSP25 phosphorylation decreased during prolonged unloading but returned to normal after 28 days of reloading. HSP70 and IGF-1 remained depressed during short term reloading but returned to normal levels as muscle mass improved, whereas in contrast Akt phosphorylation was greater in short term reloading but returned to normal by day 28 (Lawler et al 2012).

Immune considerations and nutritional supplementation

Finally, recent investigations into the immune system of endurance athletes suggests that inflammation and immune sensitivity may be inversely proportional.  For example, upper respiratory tract infections are common amongst runners.  This may be due to irritation of the airways by air.  Alternatively, it may be due to the irritation set up by the mechanical loading of the musculoskeletal system during training.  Periodisation of training allows the body to recuperate, it provides a learning experience for the athlete of what they can tolerate and how to peak at the required time (see below).  Some of the recent investigations have highlighted the lack of salivary immunoglobulins in the period up to 2 hours after the cessation of training.  These investigators have suggested the use of carbohydrate nutritional supplementation immediately after exercise.  During my time in Switzerland, leading up to the Barcelona Olympic Games, there was an emphasis placed on carbohydrate supplementation (multodextrene), as well as magnesium for tired muscles in addition to regular blood checks of ferratin levels for women. These days, the supermarket and gym shelves are full of nutritional supplements.  With such a wide variety of choices available, it would seem appropriate to seek a consultation with a sports nutritionist.  Some information regarding carbohydrate supplementation can be found elsewhere on this website. Additionally, aging and vitality have been related to the capacity to enhance the immune system through exercise elsewhere on this website

Immune system and training

Title Overtraining effects on immunity and performance in athletes.

Author MACKINNON, LAUREL T

Institution School of Human Movement Studies, The University of Queensland, Brisbane, Queensland, Australia

Source Immunology & Cell Biology. 78(5):502-509, October 2000.

Abstract Summary:

Over-training is a process of excessive exercise training in high-performance athletes that may lead to over-training syndrome. Over-training syndrome is a neuroendocrine disorder characterized by poor performance in competition, inability to maintain training loads, persistent fatigue, reduced catecholamine excretion, frequent illness, disturbed sleep and alterations in mood state. Although high-performance athletes are generally not clinically immune deficient, there is evidence that several immune parameters are suppressed during prolonged periods of intense exercise training. These include decreases in neutrophil function, serum and salivary immunoglobulin concentrations and natural killer cell number and possibly cytotoxic activity in peripheral blood. Moreover, the incidence of symptoms of upper respiratory tract infection increases during periods of endurance training. However, all of these changes appear to result from prolonged periods of intense exercise training, rather than from the effects of over-training syndrome itself. At present, there is no single objective marker to identify over-training syndrome. It is best identified by a combination of markers, such as decreases in urinary norepinephrine output, maximal heart rate and blood lactate levels, impaired sport performance and work output at 110% of individual anaerobic threshold, and daily self-analysis by the athlete (e.g. high fatigue and stress ratings). The mechanisms underlying over-training syndrome have not been clearly identified, but are likely to involve autonomic dysfunction and possibly increased cytokine production resulting from the physical stress of intense daily training with inadequate recovery.

Endurance trainingExercise, Immune System, Cytokines, Heat Shock Proteins, Glutamine and muscle mass

allostasisExercise and fine-tuning the immune system through the development of sympathetic nervous system control over allostasis - implications for over-training, stress, pain management and cognitive behavioral therapy

Oxidative stress after Ultraendurance exercise (overuse)

Ultraendurance events have been shown to be associated with prolonged depletion of anti-oxidant capacity up to one month post event (Turner etal 2011, Med Sc Ex Sp, 43, 9, 1770-1776). Specifically, glutathione (GSH) remained depleted to approximately 1/3 of pre-race values, for up to 28 days after the race.

Quality of movement, and hence performance breaks down as fatigue sets in.

Fatigue is the stressor which affects change, however excessive fatigue from one bout of exercise or from successive repeated bouts of exercise without adequate recovery can cause strain. A failure to plan is a plan waiting to fail.

Training - "you need to stress not strain the system to create performance enhancing change"

Overtraining

A common symptom of over-training is non-restorative sleep, immune compromise and stress fractures. Approximately, 1/3 of young athletes have experienced 'non functional over-reaching (NFOR) or over-training (OT) at least once in their sporting life (Matos et al 2011, Med Sc & Sp Ex, 43, 7, 1287-1294). The rate was higher in individual sports (37%) when compared with team sports (17%). Individual sporting endeavors tended to consume more than 2 hours per day, 6-7 days per week, which was significantly greater than the training volume reported in team sports. Females were more prevalent in the OT cohort (36% vs 26%). Moreover, even in low physical intensity sports such as golf individuals may suffer from NFOR/OT. Training load and volume alone wasn't the sole contributor to OT, as sporting individuals appeared to devote more time to their sport and less time to socialising and other school activities.  Thus, they are at risk of developing a uni-dimensional personality which seems to place them at risk for NFOR/OT. Self esteem, identity and self-worth become intertwined which is fine whilst they are gaining sporting success, however sporting failure may result in stress and anxiety. Hence, young athletes should be encouraged to form multi-dimensional personalites through encouragment of a range of hobbies and interests. 

Over training in female athletes can be particularly severe as O-T leads to alterations in the luteal phase of the menstrual cycle which results in dysmenohrea and potential reductions in bone mineral density and metabolic dysfunction due to reduced estrogen levels.

Alterations in Mood

The 3 B's Rule - if you meet one bastard in a day that is just unfortunate, if you meet 2 then it is very unfortunate, however if you meet three bastards in a day then you are in over-training!!

Musculoskeletal stress and the immune system

Recovery may involve analysis of technique, examination of training load (duration, frequency, intensity), adequate rest and nutrition, as well as a sound state of mind (mental strength). Over-training has been shown, within 4 weeks, after the onset of training, to be associated with increased oxidative stress both at rest and during submaximal exericise in a group of men after they underwent 7 weeks of  intense military training (Tanskanen et al 2011, Med Sc Sp Ex, 43, 8, 1552-1560)

This principle applies equally to endurance athletes such as road cyclists and mountain bikers who need to avoid 'staleness' or stress from the monotomy or boredom in training and/or chronic fatigue from the high volume of training.  In fact, when I was working with elite and professional cyclists in Europe, we commonly had road cyclists go running in the forest during the winter months to obtain greater strength and agility.  Equally, we frequently asked skiers to mountain bike during the summer, or go hiking with very heavy backpacks up mountain sides. In one female downhill skier, she had been performing well early in the season, then began to perform poorly, to which she responded by training more. Our coaching team decided to send her to the beach for a holiday just weeks before the world championships. She became world champion!!! In some cases, reductions of stress consisted of cross training whereby road cyclists got on the track (in the former East Germany) and track cyclists got out on the road (Australian team in Mexico), as well as flat riders doing hills. Although specificity of training is of paramount importance, such cross training can reduce the risk of 'staleness' and excessive fatigue from doing too much of the same thing.  Importantly, these strategies were most commonly employed during the off-season and/or in athletes who were still in their developmental phase of learning.

Cryostimulation

Whole body cryostimulation has been demonstrated to limit over-reaching in elite synchronized swimming, where variables such as reduced sleep quantity, increased fatigue and impaired exercise capacity are mitigated (Schaal K, et al 2015, Med Sc Sp Ex, 47, 7, 1416-1425). This is presumably as a result of heat shock proteins (Krause 2002) which are discussed elsewhere on this site. 

Sleep

Sleep plays a critical role not only in recovery but also in the restoration of function of the immune system. Immune system can be discussed in terms of cellular (T helper cell Type I) and hormonal (T helper cell Type II) components. Each part has a counter-balancing regulating effect on the other. Th1 has an active role in fighting pathogens such as viruses and some bacteria (common in travelling teams and sports where open wounds can occur) as well as a role in fighting inflammation. Whereas, Th2 cells play a role in fighting against most bacteria as well as parasitic worms (Clow & Hucklebridge 2001 Ex Immun Review 7; 5-17, and Miyazaki et al 2005, Biol Psychol, 70, 1, 30-37). Cortisol, Prolactin, Melatonin and Growth Hormone have all been implicated in have a balancing affect on Th2 cells. During the early phases of sleep the immune system is pushed towards the Th1 profile which is associated with inflammatory processes. During the early phase (30-45minutes) of waking cortisol levels rise between 50 -150% creating a Th2 bias (Cutalo et al 2005, Autoimmunity Reviews 4, 8, 497-502) and hence a bias away from a pro-inflammatory profile. This may be why people may feel stiffer in the morning as a result of injury or over-training..

Frequently, when a team or an athlete is underperforming the tendency is to train harder, more frequently and stress mentally about the underperformance. During my time as a physiotherapist to Swiss professional and elite athletes we demonstrated time and time again that good preparation, support and analysis of underperformance usually resulted in a quick return to optimum results. However, sometimes it was difficult to convince a Swiss National downhill skiing champion that she needed to spend a couple of weeks on the beach, just before their world championships!

At a competitive level, an endurance event is all about the conservation of energy, maximisation of efficiency, predictability, and maintaining some redundancy in the system for those unexpected moments in a race. Ultimately, it is about knowing yourself and learning to know your strengths and weaknesses as well as those of your competitors. The more multifactorial the training approach, the more experience which is gained and the greater the feedback for improvement. However, the immediate goals need to be attainable and be in synchrony with the long term goals (SMARTA - specific, measurable, achievable, relevant, timely, aligned).

Endurance training - "training the zones"

Zone One (<70% HR max): very low level light exercise, too low in itself to induce physiological adaptations. Minimal sensation of effort or fatigue. Easy to hold a conversation. Used as a recovery strategy between bouts of exercise (intervals) or as a recovery strategy after a hard training session or long race.

Zone Two: (endurance 71-80% HR max): classic long slow all day long distance training. Good for gaining and endurance base. However, if too much time is spent training slow, you become slow. Recovery from 2 hour sessions should be quite rapid, whereas longer sessions with some moderately fatiguing climbs may take 1-2 days to recover

Zone Three (tempo 81-85% HR max): intensity as a result of speed. Frequent sensation of fatigue, concentration required, conversation becoming difficult. Daily sessions possible so long as adequate energy requirements are met. HR recovery may be a good test to indicate how well you have recovered.

Zone Four (lactic threshold 86-94% HR max): efforts similar to time trialing on a bike. Continuous conversation very difficult. Continuous sensation of effort or fatigue in muscles being exercised. Mentally very taxing and generally performed in blocks or repeats of exercise with some recovery between bouts but not too long e.g. running 1-3 minute blocks with 1-3 minute rest in between; cycling 10-30 minutes with 10-30 minute recovery between blocks of exercise. Consecutive days of training possible, but check HR recovery every morning and also maintain an immune enhancing diet. Not wise to do just before a big race. Also unwise to do if there is a lot of other stress in your life. Recovery is super important.

Zone Five (95-120% HR max): short intense bouts of activity. Running 10-30 seconds, Cycling 3-8 minutes. Strong to severe sensation of fatigue. Laboured breathing. Repeated consecutive days of training not recommended and considered undesirable.

Endurance training - periodization

Periodisation of training allows the athlete to gradually build up their training volume and/or intensity, whilst allowing time for regeneration. Gradual increments of loading can occur, whilst reducing the risk of excessive over-loading and hence injury.  Additionally, training of various intensities allows the metabolic systems to develop in parallel.  Thereby the anaerobic and aerobic metabolic systems can be used to drive endurance.

Power

The development of endurance may take months and up to 10 years.  Strength is required to develop power, as power is equal to the product of force times velocity.  Power is important for speed.  Frequently, endurance athletes train slow and stay slow.They also need power which in German is called "Steigungsvermoegen".

Maximising strength also enables the body to enhance the firing of impulses to the muscles by the central nervous systems.

Since power = force x velocity then strength training to attain power requires velocity.  However, an inverse relationship exists between force and velocity.  As velocity increases, the force of contraction decreases.  Soft sand running or running in knee deep water may be a good compromise in the quest to attain power. Additionally, these forms of training help reduce over-striding and high impacts of foot strike as speed increases.

In this example from cycling research, performance power can improve by 22% through improved technique of hip extension. Biomechanics can influence the immuno-physiology and vice versa.

Biomotor abilities specific to running ability may be attained using for examples eccentric (muscle lengthening) quadriceps, calf and hip muscle loading in lunging.

Muscle biomechanics

Understanding muscle biomechanics and length-tension relationships (Hill model) allows for more specific training stimuli. Ultimately, the optimisation of power requires a balance between velocity and force since P=Fv. Similarly, efficiency may be improved by considering Power as Work over time P=W/t

Plyometric biomechanics

Plyometric exerices designed to improve power use the concepts of elastic and kinetic potential energy to improve energy absorption and movement execution. The following equations are taken from Wikipedia (7May2008)

This allows better utilisation of the stretch-shortening cycle of the lower limb muscles, in addition to reducing excessive muscle hypertrophy.

Plyometrics and eccentric muscle adaptations (Martin Krause 2003)

The eccentric component to this exercise cause more profound changes to the connective tissue of the muscle (broadening and streaming of Z bands) than concetric exercise.  Investigations into eccentric exercise revealed pain 8 hours after initial exercise which was maximal 48 hours later (DOMS = delayed onset muscle soreness) (Newham, Mills, Quigley, Edwards 1983).   These investigators found low frequency fatigue 10 minutes after a 20 minute period of stepping (Newham et al 1983).  Additionally, they demonstrated progressive increases in IEMG during the exercise in the rectus femoris (160% increase) and vastus medialis (140% increase) in the eccentric contracting leg (Newham et al 1983).  Mechanical damage to the sarcoplasmic reticulum resulting in less calcium release for each excitatory action potential was suggested as the cause of the low frequency fatigue (Newham et al 1983).

However, a number of sites in the myofibrillar complex such as reduce binding sensitivity and capacity of Troponin C for calcium, altered troponin-tropomysosin interaction to impaired binding and force generation by actin and myosin have been implicated in impaired force generation (Green 1990).  Indeed, in the absence of any association between relaxation rates and Calcium kinetics raises support for the notion of a rate-limiting process controlling the relaxation of fatigued muscles being located in the contractile proteins (Hill et al 2001).  During fatigue the relaxation times can be prolonged as much as 50% (Bigland-Ritchie et al 1986) thus resulting in increased force generation during submaximal stimulation due to tetanic fusion despite a substantial fall in the maximum tetanic force (Bigland-Ritchie et al 1986).

The initial overall loss of force production seen may be due to Desmin and Titan damage (Lieber & Friden 2002).  Desmin acts as an extra-sarcomeric mechanical stabilizer between adjacent Z discs and the attachment to the costomere at the sarcolemma (Lieber, Shah & Fridén 2002).  The costomere complex contains Talin, Vinculin & Dystrophin which attach to the trans-sarcolemmal proteins Integrin and Dystrophin associated proteins.  These proteins allow the lateral transmission of force from actin to the basal lamina containing type IV collagen which is contiguous with the endomysium (Kovanen 2002).  Desmin loss after eccentric exercise can occur within 5 minutes, possibly as a result of increased intracellular Calcium leading to Calpain activation and selective hydrolysis of intermediate filament network (Lieber & Fridén 2002).  This may result in the ‘popping of sarcomeres' of different length thereby potentially loosing their myofilament overlap of actin and myosin (Lieber & Fridén 2002).  Hence, reduced force production would be expected.  Additionally, the release of matrix metalloproteinase (MMP) which may degrade the extramyocellular type IV collagen (Korskinen, Kovanen, Komulainen et al 1996).  However, this effect occurs many days after exercise (Korskinen et al 1996) and could even effect torque production 28 days after exercise (Lieber & Fridén 2002).  This has significant implications in exercise training prescription.

flash file created by Martin Krause 2003

Titan molecules span the gap between the ends of the thick filaments and Z-bands. At the 2007 MPA conference in Cairns, Rob Herbert, provided the AJP oration whereby he explained the significance of Titan as a major determinant of extensibility in muscle fibres. Additionally, he stated that Titan is differentially expressed in human skeletal muscle as short stiff fibres and long compliant fibres

Costomeres are 15 different proteins

  • Low oxidative muscles have a tendency to tear during eccentric exercise
  • Loss of desmin proceeds loss of fibronectin membrane
  • Fibre strain results in increased intracellular and extracellular calcium which ?may lead to desmin hydrolysis through calpaine?
  • Sarcomere shortening occurs to the detriment of tendon lengthening
  • Excitation-contractile coupling may be the area disrupted rather than pure sarcomere disruption
  • Structural changes of the disruption of the cytoskeleton include dystrophin (sublaminal membrane protein), sometimes desmin and titin, whereas alpha actin is always OK ?suggesting that calpaine is not the enzyme responsible for protein dysruption?
  • Creatine Kinase has no correlation with these cytoskeletal changes
  • Inflammatory process important for tissue cleaning and remodelling
  • Mechanism for muscle adaptation may be myosin gene regulation - heavy chain myosin isoform upregulation
  • Oxygen into the Mitochondria and through the electron transfer chain (ETC) results in ATP use of 20% for power and 80% for heat, therefore people producing less heat may be producing more power?
  • Slow twitch muscle fibre concentration varies with the years of training
  • Cycling cadence velocity at peak efficiency for slow twitch muscle fibres is 80rpm

 

Vibration fatigue is probably reduced through enhanced transverse forces by wearing pressure garments such as SKINS. Additionally, venous return is probably also improved through the pressure gradient which these garments provide.

Also check out the 'tensegrity model' as it applies to microbiomechanical and macrobiomechanical structure, flexibility and integrity - the new way of the future

http://fig.cox.miami.edu/~cmallery/255/255chem/tensegritymodel.htm

http://reality.sculptors.com/~salsbury/Synergy/largest-synergy-ball.html

tensegrity model

Inverse Dynamics

Inverse dynamics dictates that in an accelerating system, the forces are directed along the muscles which span more than one joint to provide a mechanism for the transfer of energy from one limb segment to the next. Clinically, this has important implications in training, as the entire limb must be functioning optimally to be able to attain efficiency of movement.

Muscle control

Peripheral muscle contractile efficiency may be enhanced if the muscles origin at the pelvis is stabilised by core stability muscles such as transverse abdominis, pelvic floor, diaphragm and internal oblique. Certain one joint muscles such as, for example, the obturator internus are biomechanically continuous with the pelvic floor and hence provide an important stabilising function as well as act as a conduit for the obturator nerve. The iliacus stabilises the hip whilst the Psoas membrane is continuous with the diaphragm and hence has an important lumbo-pelvic-costal stabilising function as well as acting as a hip flexor. Moreover, the 2 joint muscles acting as 'energy straps' between body segments eg knee - pelvis will require stabilising actions in the trunk based on Newtons third law of action-reaction. Importantly, these forces only occur in the same plane of motion. Therefore, muscles which act in multiple planes of motion are inherently better stabilisers of multidimensional joint motion than muscle which act solely in single planes of motion. Naturally, in a functionally unstable spine, it would be better that the reaction force is anticipated by the appropriate bracing beforehand. This would require 'feedforward' motor control of movement. Additionally lack of pelvic control would result in reduced lumbopelvic rhythm making leg movements not only inefficient but also potentially injury producing through 'misuse'. Therefore, the hamstring, quadriceps, gluteal, ITB-Tfl muscles would need to act synergistically with the trunk muscles. Regardless of how strong the core muscles are, 'the tail ends up wagging the dog' if the correct co-ordination and timing between muscle groups isn't present. Similarly, based on the 'energy strap' hypothesis even calf muscle tightness can produce increased anterior tilting and rotation of the pelvis making a person appear to be walking with their 'tail wagging in the air'. It is therefore important to provide verbal and visual feedback to the person so that they become cognisant with reasons for their ongoing problems of pain and/or reduced sporting performance.

Gym workouts using large muscle mass usually requires 48-72 hours rest between bouts of training. However, large amounts of concentric exercise with emphasis on 1 rep max will result in adverse weight to power ratios due to excessive hypertrophy of the muscle group. Therefore, when considering endurance type of sporting activity, 3 sets of 7-15 repetitions may be more beneficial, especially when eccentric contractions are used.

Motor control and oscillatory systems

Motor learning theory devised by Bernstein suggests that the body will use the momentum of the limbs to optimize the degrees of freedom in the system.  Similar to a mass-spring analogy where the perturbations of the mass will be dependent on the damping characteristics of the spring,  the brain will introduce muscle tone to dampen the angular velocity and hence acceleration of the system.  Therefore, instead of the muscles of the leg lifting the limb, the antagonistic muscles are decelerating the limb towards the end of trajectory.  Moreover, by using eccentric (muscle lengthening and contracting) muscle contractions the system becomes efficient through these decelerating movements through enhanced visco-elastic rebound as well as the conservation of momentum.

Changing speed of training, not only allows the use of various metabolic energy systems, but it also trains mechanical efficiency and therefore should reduce the rate of energy expenditure.  The more efficient the system the greater the time to fatigue may be.  Importantly, acceleration places an emphases on the changing velocity.  Sprint training, Fartlek training (progressive increases and decreases in speed), counterjumps (plyometrics), eccentric-concentric leg pressing, eccentric-concentric lunging, undulating hills, running-jumping are all exercises which may improve angular momentum and therefore efficiency.

Besides training implications, there are also clinical considerations when for example a component of the kinetic chain isn't functioning in it's stretch-shortening cycle and energy dissipation function as it is supposed.

Hip-back stability exercises

(right click on graphic to replay)

Stair and hill work should further tune the biomotor abilities. Core stability exercises for the abdominal region using a Swiss Ball or Body Blade may be another example of specific strength training, which should enhance efficiency through improved lumbo-pelvic rhythm. Poor technique can lead to inefficiency and injury (eg hip-low back pain). 

Back and diaphragmatic dynamic stability

Improved thoracic function through lateral diaphragmatic breathing for enhanced blood flow, improved eccentric iliopsoas and superficial abdominal oblique muscles efficiency, as well as enhanced scapula positioning and improved pelvic floor function.

 

Heart rate variability

More precise monitoring of the rate of recovery can be achieved by examining 'Heart Rate Variability'whereby the response of the heart from 3 minutes prone to 2 minutes of upright posture is measured. High variability dictates a fresh response - low variability indicates a 'stale response' or high stress related fatigue. This allows the athlete to more objectively determine which days should be recovery days and which ones are days where they can train a little harder. Importantly, chronically reduced HRV is suggested to be a 'red flag' for sudden cardiac arrest in otherwise fit and healthy individuals. Such individuals should have further testing by a cardiologist before recommencing their training regime.

Training phases

 

Training phases may be separated into various stages depending upon the age of the athlete and whether the athlete is a novice or an experienced athlete. General physical abilities may include multilateral development of endurance eg using cycling and swimming or even a team sport like soccer as an adjunct to running training.  Specific physical suggests more time devoted to the particular run eg 5000m vs 10000m vs marathon vs orienteering and less time devoted to other sports.

However, during the regeneration phase of periodisation or during an injury the other sporting abilities may play a greater role.

Specific biomotor abilities relates to those aspects of the sport which relate to specific training regimes to enhance co-ordination, strength and agility.  Plyometrics using depth jumps and rebound is an example of such a specific training regime and should only be used in the already well trained athlete. Sports such as Orienteering require endurance, power and agility in terrain and therefore utilises speed work on various ground, in various vegetation and on different slopes.

 

Don't increase your training volume by more than 10% in a week

Remember the 3B's (Bastards in a day) Rule

Competitive phase

As training proceeds into the competitive phase some athletes place a higher proportion of their loading on intensity whilst reducing the total volume of training.  Cycles such as this one may be biannual or biennial.  Importantly, periodisation and cyclic loading is not restricted to any particular time frame. Although,  it does place  emphasis on incremental loading moreover it places emphasis on optimal regeneration and recovery. Additionally, such a methodology provides a 'base' for the next cycle of training activities. Each macrocycle may be made up from microcycles which can last days, weeks, months or years. Remember, each time you train to change your bodies abilities you are stressing the system and therefore recuperation is important.

Cooling muscles

Cooling muscles will also profoundly affect the rate of contractile responses to neural input. Through cooling, the muscles resting tension increases.

 Good Reading

Conclusion

Altered biomechanical conditions as a result of misuse, disuse, overuse, abuse results in damage which can cause a viscious reciprocating cycle of muscle-tendon atrophy, degenerative changes, and immune-metabolic dysfunction that creates an environment of morbidity from chronic musculoskeletal dysfunction. Allostatic mechanisms of training for stress management can be employed which are immune enhancing, so long as good training techniques involve cognitive goal setting through mental and physiological considerations that result in the avoidance of injuries and the minimisation of lost training days through ill-health. Periodisation of training and correct technique reduce the risk of over-training, 'staleness', immune compromise and injury by considering the importance of rest, nutrition and correct biomechanical and physiological loading. Please look at Link to Training and Rehabilitation for further details

REFERENCES:

Bigland-Ritchie B, Bellemare F, Woods JJ (1986) Excitation frequencies and sites of fatigue.  In : Jones NL, McCartney N, McComas AJ (Eds) Human Muscle Power . Human Kinetics Publisher, Champaign Ill , pp197-213.

Green HJ (1990) Manifestations and sites of neuromuscular fatigue.  In:  Taylor AW, Green HJ, Ianuzzo D, Sutton J (Eds). Biochemistry of Exercise Human Kinetics Publisher,  Champaign,  Ill., pp 13-25

Hill CA, Thompson MW, Ruell PA, Thom JM, White MJ (2001).  Sarcoplasmic reticulum function and muscle contractile character following fatiguing exercise in humans.  Journal of Physiology , 531.3 , 871-878.

Koskinen S, Kovanen V, Komulainen J, Hesselink H, Kuipers H, Vihko V, Takala T (1996).  Type IV collagen, MMP-2, and TIMP-2 mRNA levels in skeletal muscle subjected to forced eccentric contractions.  Medicine & Science in Sports & Exercise , 28 , 153

Kovanen V (2002).  Intramuscular Extracellular matrix: complex environment of muscle cells.  Exercise Sports Science Reviews , 30 , 20-25

Krishnathasan D, Vandervoort, AA (2000).  Eccentric strength training prescription in older adults.  Topics in Geriatric Rehabilitation , 15 , 3, 29-40.

Lieber RL, Fridén J (2002).  Mechanisms of muscle injury gleaned from animal models.  American Journal of Physical Medicine and Rehabilitation , 81 , 11, S70-S79

Lieber RL, Shah S, Fridén J (2002).  Cytoskeletal disruption after eccentric contraction-induced muscle injury.  Clinical orthopaedics and related research , 403S , S90-S99.

Newham DJ, Mills KR, Quigley BM, Edwards RHT (1983).  Pain and fatigue after concentric and eccentric muscle contractions. Clinical Science , 64 , 55-62

Sun Tzu : The Art of War

mastery of energy, mastery of the heart, mastery of strength, and mastery of adaptation

they who know themselves and know their adversary will always win

Last update : 20 August 2015


 

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    Ehlers Danlos Syndrome

    Is your child suffering Ehlers Danlos Syndrome? Hypermobile joints, frequent bruising, recurrent sprains and pains? Although a difficult manifestation to treat, physiotherapy can help. Joint Hypermobility Syndrome (JHS) When joint hypermobility coexists with arthralgias in >4 joints or other signs of connective tissue disorder (CTD), it is termed Joint Hypermobility Syndrome (JHS). This includes conditions such as Marfan's Syndrome and Ehlers-Danlos Syndrome and Osteogenesis imperfecta. These people are thought to have a higher proportion of type III to type I collagen, where type I collagen exhibits highly organised fibres resulting in high tensile strength, whereas type III collagen fibres are much more extensible, disorganised and occurring primarily in organs such as the gut, skin and blood vessels. The predominant presenting complaint is widespread pain lasting from a day to decades. Additional symptoms associated with joints, such as stiffness, 'feeling like a 90 year old', clicking, clunking, popping, subluxations, dislocations, instability, feeling that the joints are vulnerable, as well as symptoms affecting other tissue such as paraesthesia, tiredness, faintness, feeling unwell and suffering flu-like symptoms. Autonomic nervous system dysfunction in the form of 'dysautonomia' frequently occur. Broad paper like scars appear in the skin where wounds have healed. Other extra-articular manifestations include ocular ptosis, varicose veins, Raynauds phenomenon, neuropathies, tarsal and carpal tunnel syndrome, alterations in neuromuscular reflex action, development motor co-ordination delay (DCD), fibromyalgia, low bone density, anxiety and panic states and depression. Age, sex and gender play a role in presentaton as it appears more common in African and Asian females with a prevalence rate of between 5% and 25% . Despite this relatively high prevalence, JHS continues to be under-recognised, poorly understood and inadequately managed (Simmonds & Kerr, Manual Therapy, 2007, 12, 298-309). In my clinical experience, these people tend to move fast, rely on inertia for stability, have long muscles creating large degrees of freedom and potential kinetic energy, resembling ballistic 'floppies', and are either highly co-ordinated or clumsy. Stabilisation strategies consist of fast movements using large muscle groups. They tend to activities such as swimming, yoga, gymnastics, sprinting, strikers at soccer. Treatment has consisted of soft tissue techniques similar to those used in fibromyalgia, including but not limited to, dry needling, myofascial release and trigger point massage, kinesiotape, strapping for stability in sporting endeavours, pressure garment use such as SKINS, BSc, 2XU, venous stockings. Effectiveness of massage has been shown to be usefull in people suffering from chronic fatigue syndrome (Njjs et al 2006, Man Ther, 11, 187-91), a condition displaying several clinical similarities to people suffering from EDS-HT. Specific exercise regimes more attuned to co-ordination and stability (proprioception) than to excessive non-stabilising stretching. A multi-modal approach including muscle energy techniques, dry needling, mobilisations with movement (Mulligans), thoracic ring relocations (especially good with autonomic symptoms), hydrotherapy, herbal supplementaion such as Devils Claw, Cats Claw, Curcumin and Green Tee can all be useful in the management of this condition. Additionally, Arnica cream can also be used for bruising. Encouragment of non-weight bearing endurance activities such as swimming, and cycling to stimulate the endurance red muscle fibres over the ballistic white muscles fibres, since the latter are preferably used in this movement population. End of range movements are either avoided or done with care where stability is emphasized over mobility. People frequently complain of subluxation and dislocating knee caps and shoulders whilst undertaking a spectrum of activities from sleeping to sporting endeavours. A good friend of mine, Brazilian Physiotherapist and Researcher, Dr Abrahao Baptista, has used muscle electrical stimulation on knees and shoulders to retrain the brain to enhance muscular cortical representation which reduce the incidence of subluxations and dislocations. Abrahao wrote : "my daughter has a mild EDS III and used to dislocate her shoulder many times during sleeping.  I tried many alternatives with her, including strenghtening exercises and education to prevent bad postures before sleeping (e.g. positioning her arm over her head).  What we found to really help her was electrostimulation of the supraspinatus and posterior deltoid.  I followed the ideas of some works from Michael Ridding and others (Clinical Neurophysiology, 112, 1461-1469, 2001; Exp Brain Research, 143, 342-349 ,2002), which show that 30Hz electrostim, provoking mild muscle contractions for 45' leads to increased excitability of the muscle representation in the brain (at the primary motor cortex).  Stimulation of the supraspinatus and deltoid is an old technique to hemiplegic painful shoulder, but used with a little different parameters.  Previous studies showed that this type of stimulation increases brain excitability for 3 days, and so we used two times a week, for two weeks.  After that, her discolcations improved a lot.  It is important to note that, during stimulation, you have to clearly see the humerus head going up to the glenoid fossa" Surgery : The effect of surgical intervention has been shown to be favourable in only a limited percentage of patients (33.9% Rombaut et al 2011, Arch Phys Med Rehab, 92, 1106-1112). Three basic problems arise. First, tissues are less robust; Second, blood vessel fragility can cause technical problems in wound closure; Third, healing is often delayed and may remain incomplete.  Voluntary Posterior Shoulder Subluxation : Clinical Presentation A 27 year old male presented with a history of posterior shoulder weakness, characterised by severe fatigue and heaviness when 'working out' at the gym. His usual routine was one which involved sets of 15 repetitions, hence endurance oriented rather than power oriented. He described major problems when trying to execute bench presses and Japanese style push ups.  https://youtu.be/4rj-4TWogFU In a comprehensive review of 300 articles on shoulder instability, Heller et al. (Heller, K. D., J. Forst, R. Forst, and B. Cohen. Posterior dislocation of the shoulder: recommendations for a classification. Arch. Orthop. Trauma Surg. 113:228-231, 1994) concluded that posterior dislocation constitutes only 2.1% of all shoulder dislocations. The differential diagnosis in patients with posterior instability of the shoulder includes traumatic posterior instability, atraumatic posterior instability, voluntary posterior instability, and posterior instability associated with multidirectional instability. Laxity testing was performed with a posterior draw sign. The laxity was graded with a modified Hawkins scale : grade I, humeral head displacement that locks out beyond the glenoid rim; grade II, humeral displacement that is over the glenoid rim but is easily reducable; and grade III, humeral head displacement that locks out beyond the glenoid rim. This client had grade III laxity in both shoulders. A sulcus sign test was performed on both shoulders and graded to commonly accepted grading scales: grade I, a depression <1cm: grade 2, between 1.5 and 2cm; and grade 3, a depression > 2cm. The client had a grade 3 sulcus sign bilaterally regardless if the arm was in neutral or external rotation. The client met the criteria of Carter and Wilkinson for generalized liagmentous laxity by exhibiting hyperextension of both elbows > 10o, genu recurvatum of both knees > 19o, and the ability to touch his thumbto his forearm Headaches Jacome (1999, Cephalagia, 19, 791-796) reported that migraine headaches occured in 11/18 patients with EDS. Hakim et al (2004, Rheumatology, 43, 1194-1195) found 40% of 170 patients with EDS-HT/JHS had previously been diagnosed with migraine compared with 20% of the control population. in addition, the frequency of migraine attacks was 1.7 times increased and the headache related disability was 3.0 times greater in migraineurs with EDS-HT/JHS as compared to controls with migraine (Bendick et al 2011, Cephalgia, 31, 603-613). People suffering from soft tissue hypermobility, connective tissue disorder, Marfans Syndrome, and Ehler Danlos syndrome may be predisposed to upper cervical spine instability. Dural laxity, vascular irregularities and ligamentous laxity with or without Arnold Chiari Malformations may be accompanied by symptoms of intracranial hypotension, POTS (postural orthostatic tachycardia syndrome), dysautonomia, suboccipital "Coat Hanger" headaches (Martin & Neilson 2014 Headaches, September, 1403-1411). Scoliosis and spondylolisthesis occurs in 63% and 6-15% of patients with Marfans syndrome repsectively (Sponseller et al 1995, JBJS Am, 77, 867-876). These manifestations need to be borne in mind as not all upper cervical spine instabilities are the result of trauma. Clinically, serious neurological complications can arise in the presence of upper cervical spine instability, including a stroke or even death. Additionally, vertebral artery and even carotid artery dissections have been reported during and after chiropractic manipulation. Added caution may be needed after Whiplash type injuries. The clinician needs to be aware of this possibility in the presence of these symptoms, assess upper cervical joint hypermobility with manual therapy techniques and treat appropriately, including exercises to improve the control of musculature around the cervical and thoracic spine. Atlantoaxial instability can be diagnosed by flexion/extension X-rays or MRI's, but is best evaluated by using rotational 3D CT scanning. Surgical intervention is sometimes necessary. Temperomandibular Joint (TMJ) Disorders The prevelence of TMJ disorders have been reported to be as high as 80% in people with JHD (Kavucu et al 2006, Rheum Int., 26, 257-260). Joint clicking of the TMJ was 1.7 times more likely in JHD than in controls (Hirsch et al 2008, Eur J Oral Sci, 116, 525-539). Headaches associated with TMJ disorders tend to be in the temporal/masseter (side of head) region. TMJ issues increase in prevelence in the presence of both migraine and chronic daily headache (Goncalves et al 2011, Clin J Pain, 27, 611-615). I've treated a colleague who spontaneously dislocated her jaw whilst yawning at work one morning. stressful for me and her! Generally, people with JHD have increased jaw opening (>40mm from upper to lower incisors). Updated 18 May 2017  Read More
  • Fri 09 Dec 2016

    Physiotherapy with Sharna Hinchliff

    Physiotherapy with Sharna Hinchliff    Martin is pleased to welcome the very experienced physiotherapist Sharna Hinchliff to Back in Business Physiotherapy for one on one physiotherapy sessions with clients in 2017.  Sharna is a passionate triathelete and mother and has had several years experience working locally and internationally (New York and London) in the field of physiotherapy. Originally from Western Australia, Sharna graduated from the world renowned Masters of Manipulative Physiotherapy at Curtin University. read more Read More
  • Mon 07 Nov 2016

    Pilates – with Brunna Cardoso

    Pilates – with Brunna Cardoso Martin is pleased to welcome the bubbly Brunna Cardoso to Back in Business Physiotherapy for Pilates Classes in February 2017.  Brunno is an experienced pilates instructor and has had several years experience training with pilates instructors in Brazil. Read more Read More

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Updated : 10 May 2014

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Copyright Martin Krause 1999 - material is presented as a free educational resource however all intellectual property rights should be acknowledged and respected