Authors: T. Noakes

Journal: British Journal of Sports Medicine

Date: November 2011

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Summary:

• Here’s a recent article published in BJSM and shared to me by my graduate co-supervisor, Joe Baker. Rather than being a randomized control trial, this is a highly opinionated and perhaps controversial paper expressing his feelings towards the American College of Sports Medicine outlining the significance of the omission of his previous findings on exercise-associated hyponatremia (EAH) during prolonged exercise. Specifically, based on research that does not include his previous studies in 1985 and 1991, it was promoted by the ACSM that athletes should consume, during exercise, as much fluid as tolerable. On the contrary, it was proposed by Noakes and colleagues that exercise-associated hyponatremia “appears to be (related to) voluntary hyperhydration with hypotonic solutions combined with moderate sweat sodium chloride losses“. As an aside, it is not uncommon to witness typical EAH symptoms of vomiting, nausea, dizziness, altered mental status in less skilled (aka “slower”) endurance athletes. While the principle argument for this paper was to suggest that very low levels of postexercisue serum sodium concentrations in athletes suffereing from EAH result from body weight gain secondary to fluid retention irrespective of volitional electrolyte (i.e. sodium) consumption, the main “takeaway” from this paper was that his research may be largely ignored due to commercial influence. What Noakes does suggest however, is that increasing sodium ingestion with increasing duration of exercise may not provide any biologically significant effect to countering EAH. So should we really still be drinking our Gatosauce or should we be paying more specific attention to our water consumption levels if we’re less gifted and toward the “back of the pack”.

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Noakes, T. (2011) Changes in body mass alone explain almost all of the variance in the serum sodium concentrations during prolonged exercise. Has commercial influence impeded scientific endeavour? British Journal of Sports Medicine.

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For those of you interested in another summary of this paper, please take a look at Alex Hutchinson’s blog.

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Recently, I had the pleasure today of attending Movement U and subjecting myself under the watchful eye of Jessi Stensland.

This was a valuable experience for myself, not only as a professional, but also as an athlete who, like everyone else, spends countless pushing my own physical limits. And while I always strive for ideal form and proper mechanics, I may not always be doing what I think I am doing. As such, it was nice to have the eyes of another professional picking apart my leaky valves…aka, my flaws. Take a look above, my right knee is in slight valgus and my tibia is externally rotated…something I have not noticed since I don’t like training in front of a mirror.

Last year I raced Ironman Canada hiding all sorts of injuries. It pays as a sports doc and strength coach to know what to do to be able to make it to the start line. I never felt pain, but deep down I knew I had the potential to blow up. This year, on the other hand, the goal is to think like a doctor, train like a coach, and perform like an athlete!

So whether or not you are an expert or intern, independent of “talking shop” with another colleague or taking notes at a national conference, every now and then I suggest everyone “working” in the industry to take part in an interactive learning session and physically fall back into the “student” role.

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Professional triathlete, Jessi Stensland recently tweeted the following:

“Injury free running is not about the right shoe it’s about the right U!”

This immediately reminded me of Ironman, Mirinda Carfrae, who last August the Ironman Calgary 70.3 triathlon. I was there spectating that race (as my wife participated) and was fortunate enough to catch a glimpse of Mirinda’s beautiful running form. Here’s a shot I took of her after she swam 1.2 miles, biked 56 miles, and ran 11 miles.  Notice her form with  2 miles left to go!

Posture… check!

Now for those of you who want to see her running form in real time, then here’s an excellent breakdown I stumbled upon on youtube.

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Core Performance Endurance
Mark Verstegen and Pete Williams
New York, USA
Rodale Inc, 2007
238 pages

Core Performance Endurance, co-authored by one of the pioneers of “functional training”, Mark Verstegen, is a book written primarily for the endurance demographic with an objective of improving performance and avoiding injuries. The foundation of this text lies in Verstegen’s first book, Core Performance, but expands further based on the consideration of the typical high-volume and -intensity training programs of endurance athletes.

Core Performance Endurance is divided into four parts; 1) The Core Endurance Mindset; 2) Core Endurance Movement; 3) Core Endurance Nutrition; and 4) The Core Endurance Workout.

The Core Endurance Mindset lays the foundation for this book through a brief explanation of the importance of elasticity and tissue tolerance within the body and an interactive, reader-engaging biomechanical self-assessment. Core Endurance Movement builds upon this new “mindset” through an explanation of Pillar Strength, an introduction of “power endurance” (which I essentially interpret as “efficiency”), a look into TRUE energetics, and the importance of regenerating the body. While I respect the content of this text in its entirety, the heart and soul of Core Performance Endurance lies in this section (part 2)  through its potential to stimulate thought in the “experienced” athlete and pull him or her out of his/her comfort zone and into a new, more effective training mentality.

While the majority of Verstegen and Williams’ nutritional advice can be found in their book Core Performance Essentials, part 3 of this book, Core Endurance Nutrition addresses strategies that endurance athletes can utilize in their quests for performance. Specifically, Verstegen and Williams address the high importance of carbohydrates and protein, as well as the role of specific fats and nutritional supplements in athletes, but perhaps more importantly, they address meal timing as it pertains to improved performance. Examples of specific meals and food sources are included here.

Finally, part 4 introduces The Core Endurance Workout, a regime built around power, strength, and regeneration. Unless the athlete is a coached professional or has experience in the field of contemporary strength and conditioning, it is unlikely he or she will be familiar with this approach to training. The workout contained within looks nothing like your conventional gym workout (bodybuilding OR team sport), nor does it resemble a program commonly seen in rehabilitation settings.  The exercises incorporated are detailed and geared toward improving both biomechanical efficiency AND performance. Progressions are included and transition the athlete from day one, straight through to race day.

While the world of sports performance and injury prevention continually evolve with contemporary research, Core Performance Endurance indeed provides a valuable educational resource to athletes of all levels and abilities. For the coach or sport medicine professional working with this demographic, this text also provides excellent insight into the role movement efficiency plays on various aspects of running, triathlon, and other similar sporting endeavors.

*Core Performance Endurance is available through my Amazon library

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Movement U is coming to Canada!

Attention all triathletes and runners:

What will YOU be doing on March 13th and 14th?

Professional triathlete Jessi Stensland will be making Edmonton (Spruce Grove), Alberta her one and only stop on her Winter/Spring schedule to teach her popular workshop series, Movement U.

This workshop will be held at the TransAlta Tri Leisure Centre and will teach you how to train more EFFECTIVELY and EFFICIENTLY so that you can perform more OPTIMALLY!

March 13: RUNNING: Movement Efficiency + Performance

March 14: SWIM BIKE RUN: Movement Efficiency + Performance

Click here to register.

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Gift Idea #1:

The Grid by Trigger Point Performance

The Grid is the younger sister of TP’s Quadballer (arguably the gold standard in self soft tissue release/rolling). I utilize both tools in my practice and while the Quadballer is excellent for precise, soft-tissue release in a clinical setting, the Grid seems to be a more versatile piece that allows athletes to release MANY specific areas of the body and simultaneously progress to a variety of body weight movements. In fact, outside of the clinical setting, I incorporate the Grid into my own training program both between and during specific exercises.

Here is a sample daily progression of BASIC “exercises” taking less than 10 minutes that EVERYONE can benefit from:

• Calf release
• Quadriceps / Hip Flexor release
• Thoracic spine release into Glute bridges (Hey Bret, do you approve?)
• Quadriped Lat roll outs (distal aspect of arms on Grid for thoraco-scapulo-humeral mobility)

For more advanced progressions, please visit the SMRT-CORE website

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Let me tell you why:

• POSTURE: In order to jump rope efficiently and for long periods of time, it is important that one maintain an ideal posture throughout the exercise. As such, improving ones posture will effectively facilitate a neutral spine position in each of the Cervical (neck), Thoracic (mid/upper back), and Lumbar (low back) regions, thereby promoting proper function of each of the active, passive, and neural components of spinal stability. Perfect posture promotes movement efficiency (see MovementU) and therefore, training to maintain ones posture may translate into increased efficiency during running.

• BILATERAL SHOULDER EXTERNAL ROTATION: In general, the glenohumeral joint is isometrically held in a bilateral external rotation position throughout the jump rope exercise. Reinold et al. recently demonstrated that the concentric bilateral external rotation exercise facilitated scapular control without the need for arm elevation, while simultaneously utilizing a good lower trapezius to upper trapezius activation ratio. While isometric contractions certainly differ from concentric contractions, one may hypothesize that isometrically maintaining the shoulder girdle complex in this position may facilitate optimal patterning of the thoraco-scapulo-humeral joints…especially  since isometric contraction of the glenohumeral external rotators play an important role in force coupling with the powerful pectoralis major during the early pull phase of swimming (this force coupling helps keep the head of the humerus centered within the glenoid fossa: aka dynamic stability). Similarly, bilateral external rotation may  also play a rehabilitative role in those athletes presenting with signs of Type 1 “SICK” scapulae (inferior prominence of the medial border) for the same reasons noted above.

• ECCENTRIC HIP ABDUCTION: During the stance phase of running, the hip plays a contributing role in absorbing ground reaction forces sustained by the body upon impact. This is so via eccentric contraction and control of the abductors of the hip (i.e. Gluteus Medius). Each “foot contact” of single and alternating leg rope jumping is not dissimilar to the stance phase of running as the hip abductors are called into action with every repetition. As such, incorporating rope jumping in the off season may result in preventing dynamic valgus (aka “buckling in”) of the knee, thereby minimizing energy leakage while running. The end result: A more efficient, powerful running gait.

• Low Intensity Stretch Shortening: Plyometric exercise has been scientifically demonstrated to be effective in improving performance and economy in certain distance runners. Since, jumping rope can be viewed as a lower intensity form of plyometric exercise, improving the stretch shortening capabilities of the deep flexors of the foot and ankle may translate into similar effects. At the very least, since mid- and forefoot runners tend to have a single and greater peak force upon impact (as opposed to the double peak seen in rearfoot strikers), performing low intensity stretch shortening exercise may strengthen the ability of the lower leg musculature to act as shock absorbers, subsequently minimizing chances of dynamic instability (i.e. overpronation) and/or tendinopathy (i.e. of the achilles).

Unless I am mistaken, the efficacy of jumping rope for triathlon performance has yet to undergo scientific investigation. Therefore, definitive conclusions from the above statements must certainly not be made. However, as with many currently performed exercises, the theoretical rationale for rope jumping as an off season exercise in triathletes may seem plausible and thus, may enable this exercise to be performed without much scrutiny.

So…JUMP AWAY!

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The authors of this review cited previously conducted research by Vleck, Laurse, Kreider, Delextrat, McCole, Bentley, Chatard, themselves, and several others. Based on this review, the current state of the literature can be summarized as follows:

• The best overall race performers were faster in the first few hundred meters (~ 200 to 500m) of the swim and slower swimmers generally expend more energy during the bike leg in order to “catch up” to those who exited first. These have correlated to overall performance and demonstrate the importance of being in the first pack of cyclists.
• Swim intensities of 80-85% and 90-95% have enabled athletes to cycle at greater power outputs than 100% swim intensities during sprint-distance triathlon. However, those who swim at 80-85% intensity also run 1% quicker than those who swim at 100% intensity.  Therefore, in consideration of the point noted above, an athlete’s swimming ability must enable them to swim with the front pack while simultaneously staying within 80-90% of maximum effort.
• Drafting during the swim (in order to minimize frontal resistance) certainly contributes to minimizing one’s intensity at a given speed as it has been shown to lower athletes’ heart rates and blood lactate concentrations. Further, with respect to the cycling leg, drafting during the swim has been shown to correlate with higher cycling efficiency as well as mean and peak power output. Thus, in order to minimize the physiological demands of swimming, one must swim 0-50 cm behind the toes or 500-100 cm lateral and behind the hands of the athlete he or she is drafting off of. This in turn, may allow one to maintain ideal positioning within the front pack with minimal effort.
• Wetsuits are intended to increase buoyancy and therefore decrease both hydrodynamic and passive resistance during the swim. These have been shown to improve swim time with relatively less energy cost (stroke rate, oxygen consumption and blood lactate accumulation), therefore saving energy that may be utilized in later portions of the race. It should be noted that wetsuits have also been found to increase body and skin temperature and therefore, may induce heat stress in an athlete.
• Speedsuits, on the other hand, decrease frictional resistance between the athlete’s skin and the water and do so with minimal effect on body temperature. These have been shown to improve swim time without affecting stroke rate, stroke length, and blood lactate accumulation. Therefore, speedsuits should be utilized at temperatures greater than 25 degrees (Celcius) or when wetsuits are not permitted.

It was no secret that the various strategies mentioned above are utilized during the swim leg of a triathlon in order to increase the likelihood of a optimal results. However, Peeling & Landers were perhaps the first to document all variables through this review in its entirety. It should be noted, however, that the majority of research has solely focused on the Sprint and Olympic distances and therefore, the recommendations pertaining to long course races (70.3 and Ironman) may differ.

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Study Methods

• 21 moderately trained men acted as participants. These men had a history of running for > 4 years (25-70 km/wk).
• A randomized crossover design was used that enabled the study participants to serve as their own controls (this is ideal in research to minimize the influence of external variables pertaining to the subject population)
• A stepwise speed-incremented treadmill test was performed to voluntary maximum termination. While most races are held in external environments (i.e. outside), this permitted maximum control of pacing.
• O2 uptake, CO2 production, pulmonary ventilation, lactate concentration, maximum heart rate, and anaerobic/aerobic thresholds were measured.
• Below the knee compression stockings that provided 24 mmHg of compression at the ankle and consistent 18-20 mmHg at the calf were utilized. This is different than the “graduated” compression traditionally used in medical settings.

Study Results

• Running performance demonstrated that time under load, total work, and maximum speed were significantly higher in the compression-wearing athletes. Running speeds at both anaerobic and aerobic thresholds were significantly faster in the intervention group as well.
• No difference was found pertaining to oxygen, lactate, heart rate, and pulmonary variables.

Although it is difficult to pinpoint with 100% accuracy the exact mechanism of operation (previous studies have looked at venous hemodynamics, arterial perfusion, tissue oxygenation, muscle oscillation, lactate clearance, and DOMS), the results of this study suggest that compression socks may actually play a role in improving various aspects of run performance through mechanical efficiency. Of course, many factors may have influenced this study’s results (psychological effects, lack of placebo, etc) and most certainly does one study not preclude theoretical confirmation, however, many other studies have shown statistical significance and I have yet to read a paper that has demonstrated negative impacts on sport performance. It is therefore within reason for athletes to utilize compression socks for purposes other than dressing up as a Larry Bird at Halloween. So for all the ballers, trigeeks, and Radcliffe-wannabes, you have my permission to emancipate yourself!

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