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After lower back pain, shoulder issues might just be the most common form of injury and aches and pains experienced in the gym and on the field. When you consider the anatomy and physiology of this complex joint, it's no surprise. The shoulder is a somewhat delicate ball-and-socket joint, loosely slung by a capsule of ligaments, tendons, cartilage and muscle. Yet it's delicate nature allows for tremendous range of motion, one of the largest ranges in the human body, and allows us to take advantage of our dextrous hands.

Shoulder aches and pains are just a reality of human existence. Injuries, however, are not. And if we want to build strong, healthy, injury-free shoulders, we need a basic understanding of the anatomy of the shoulder joint. Coach D breaks down the basic components of the shoulder, how they function, and why this important when it comes to shoulder training and health.

In Part 2, we will discuss common injuries of the shoulder, and in Part 3, strategies for managing pain, rehabbing injuries, and training considerations for long-term shoulder health.

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In episode #5 we discussed one of the ten general physical skills: flexibility, and it's analog mobility. Most people believe that they are not flexible enough, that they need more mobility, and the path to acquiring it lies in a gauntlet of contortionism. Or yoga. How much flexibility and mobility do we really need though? Is it possible to be too flexible? How much time should we allocate to mobility work? Coach D takes us through the research and his decades of coaching experience to answer these questions.

To recap, flexibility is defined as the range of motion (ROM) in a joint or body segment. All joints in the human body have a normal degree of ROM established in the medical literature, plus or minus a few degrees depending on individual anthropometry, amount of body mass around the joint, tissue elasticity, and other factors. Mobility is a function of flexibility, the combination of a joint's passive ROM and your ability to utilize that ROM by producing force (strength). Skill also plays a role in mobility. Your ability to move a joint through it's passive ROM in a skilled motor pattern is an expression of mobility.

How much do you need? Well, it depends. One way to think about it is you only need as much as your daily activity, training, and sport (if any) demands. Excess mobility is not necessarily a good thing. A gymnast needs to be able to do the splits, of course, but a sprinter does not. More importantly, the sprinter doesn't want to be able to do the splits, because the work necessary to do it would likely detract from their speed on the track. Two different levels of mobility, each specific to the purpose. Likewise, if you just barbell train and perhaps do a little conditioning and outdoor activity, you probably don't need to stretch like a gymnast.

For many masters trainees, however, mobility is an issue. It gets in the way of productive training, because it prevents utilization of the greatest effective range of motion -- for instance, squatting so that the hip crease is below the top of the patella in a low bar back squat. If this is you, you need to work on your mobility. The good news is, the barbell is actually one of best stretching modalities there is, since it is a loaded stretch that involves both shortening and lengthening the muscles over a long range of motion and with a complex motor pattern that requires lots of neural input to reproduce.

Mobility work can be broken into four types, in order from least effective to most effective. We use all types in the PT clinic and in the gym, depending on how much mobility the trainee needs and where their fitness is at:

1. Passive or static stretching (least effective): a bodyweight stretch held for a period of time, such as touching your toes and holding the position, or a hurdler's or runner's stretch, holding a lunge position. The literature suggests that 30 seconds is the appropriate hold length for passive stretching, with 3-5 stretches per muscle group. People with ligamentous injuries or contractures may require longer holds.
2. Active or dynamic stretching: unloaded stretch performed by actively moving the joint through a range of motion, such as leg swings or hip openers.
3. Isometric stretching: a static stretch performed against an immovable resistance, such as a rack, bar, or box. You should stretch to the point of tension; a slight amount of discomfort is ok, as long as there is no pain. Again, 30s holds tend to work best here.
4. Loaded stretching with movement (most effective): an active stretch performed against a resistance. Barbell movements like the squat are some of the best examples. If a trainee cannot perform the barbell lifts safely, then they may need to use a combination of the other modalities until they are mobile enough to safely perform the barbell lifts.

Whatever method you use, you need to do it daily. Twice a day is even better than. Thomas Kurz in his book Stretching Scientifically argues for stretching multiple times per day, with an emphasis on building strength in the range of motion being trained.

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It's an innocent question... when is strong, strong enough? For most people, the answer is never. They will never be strong enough. Because most people aren't actually training, and if they are training they are not training for strength. Those of us in the 40fit Nation aren't most people though. So back to the question: how strong is strong enough?

Like many things, the answer is "it depends." Mainly, it depends on your goals and interests, and how much priority you place on them in life. For the competitor, the athlete, she may never be strong enough. Every athlete needs a high level of strength, and athletes in strength sports, naturally, need as much as they can attain. For those with no competitive aspirations, it may not be worth the time, effort, and pain to pursue the highest level of strength.

Everyone would benefit from at least running through the entire novice phase of their linear progression. Coach D recommends, for men, working toward a 2x bodyweight deadlift, a 1.75x squat, 1.5x bench, and bodyweight press, for men. Women should scale these multipliers down: 1.5x deadlift, 1.25x squat, 1x bench, 0.75x press. This puts an average sized, 200lbs man at a squat in the mid-300's, a 400lbs deadlift, 300lbs bench, and 200lbs press. A man who has attained these strength levels could be considered strong, certainly strong enough for just about any situation life could throw at him.

As the loads continue to climb, it is common for trainees to experience some aches and pains at some point as their connective tissue fails to adapt as quickly as their muscle tissue. This is the point where a competitor would continue to push through, and accept that aches and pains come with the territory. For the person just looking for general health, this is the time to back off the strength training a bit, slow down the rate of adaptation, and allow the connective tissue more time to adapt.

As you can see, there is no answer to the question: strong enough? If you have to ask it, you're probably not strong enough. But to those dedicated trainees who have made an honest run at a novice linear progression and achieved the strength levels above, it's OK to back off the strength training for a while to focus on other aspects of fitness.

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Last episode we posed the question: why do our workouts have to be so hard? The scientific answer to this question lies in the concept of the stress-recovery-adaptation cycle, or SRA cycle, derived from Hans Selye's work in the first half of the twentieth century. Simply put, in order to generate an adaptation, which we would recognize as an increase in one or more of the ten general physical skills (strength, endurance, mobility, etc), then you must progressively increase the amount of stress applied during the training program. That is the nature of training: it must become "harder" over time to continue driving progress.

In the 1950's Austro-Hungarian endocrinologist Hans Selye developed a theory known as the general adaptation syndrome which describes the effect of acute stress, generated by a stimulus (real or imagined), on an individual. Selye observed that the effect of stress on an organism was to disrupt homeostasis and, if continued unchecked, eventually kill the organism. If the stress was removed and the organism was given sufficient time and resources to recover from the stress, then it adapted to the stress in a manner specific to the type of stress imposed.

From this work, strength and conditioning coaches have gleaned the concept of the stress-recovery-adaptation (SRA) cycle, which guides the programming decisions behind our training model. Put simply, an athlete wishing to get stronger, faster, or more cardiovascularly fit must be subjected to a workout which stresses her, then recover from that workout by eating and sleeping. When this process is repeated over a period of time, she begins to see results and -- voila! -- she has performed what we call training, or a systematic, planned series of workouts toward a goal.

This is a key observation that we first covered in episodes #1-10 but we must restate now: in order to get stronger (or faster, or more fit, etc.), you must perform exercises which stress your muscles enough to disrupt homeostasis. This is why our workouts inevitably become hard -- they must generate enough stress to drive an adaptation. And this should be obvious; if you keep lifting the same weight every workout, you cannot get stronger. You are already adapted to that weight, thus there is not sufficient stress to disrupt homeostasis. One of the programming variables has to change -- you must do more reps, use more weight, or otherwise increase the volume or intensity of the exercise to drive adaptation. Yet, we see this time after time in the gym. People perform the same exercises, with the same number of sets and reps, with the same weight, over and over again, expecting results but not getting them. In short, these people are merely exercising when they should be training.

At first, just about anything constitutes a stress. For the completely sedentary person, a walk around the block is probably stressful enough to make them both stronger and more fit. This is known as the novice effect, and explains why people get results in the short-term for nearly anything. As Mark Rippetoe, the author of Starting Strength: Basic Barbell Training, is fond of saying, for rank novices "riding a bike will make their bench press go up." Beyond this point, however, a good training program that incrementally increases stress to drive adaptation over a long period of time is needed. Fortunately, novices can make progress nearly every workout for the first few months of their training. In this case the SRA cycle is very short, about 48-72 hours long.

Eventually the novice can no longer add stress to the workout and make progress. This is easiest to observe in barbell training. The novice adds five pounds to the bar each workout, but cannot complete the prescribed number of sets and reps. At this point, he must start adding weight every other workout, and perhaps perform a lighter workout in between, in order to add weight to the bar. Eventually adding weight every other workout becomes every week, then every two weeks, then monthly, and for the advanced athlete nearing their genetic potential for strength, every few months. In these cases, the SRA cycle is stretched over a period of time rather than a single workout.

Though it's beyond the scope of this episode, recovery is equally important. It is, after all, half of the equation. When we recover from a stressful workout our brain makes new neural connections and becomes more efficient at recruiting motor units for the task, our muscles grow, our cells become more efficient at generating ATP and eliminating waste products. Food and sleep are the primary components of recovery. The important thing to keep in mind here is that as you add stress to a training program, the recovery must keep pace, or you risk overtraining and stalling progress, losing progress, and even injury.

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As the saying goes, it's a feature, not a bug. Hard, that is. Any training program worth its salt must be hard, at least part of the time.

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Robert Santana is back for part 2 of a deep conversation on nutrition, dieting for bodyfat loss, and fostering healthy eating habits for sustainable weight loss. In this episode, Santana breaks down the roles of the macronutrients in a weight loss situation, and explains why carbs are NOT evil (and in fact do not lead to body fat gain). He explains why it's the combination of high fat and carbohydrate -- especially in processed foods -- that leads to caloric surplus and, therefore, body fat gain.

He also offers some practical advice for very overweight or obese people who need to lose weight. Santana's approach favors a moderate reduction in calories to drive weight loss at approximately 1% of total bodyweight per week (so, for a 300lbs person, about 3lbs per week). This has proven to be a sustainable weight loss target in the short term, and ensures that the trainee will see results fairly quickly while, importantly, not keeping them in "diet mode" for too long. At this point, he will hold them steady at their new bodyweight for a month or two before entering a calorie deficit again. This approach serves two purposes: besides the satisfaction of quicker weight loss, it teaches the trainee how to alter their eating habits to effect a caloric deficit, and it teaches them how to sustain their bodyweight during the maintenance phase. During each phase of the diet, Santana focuses his clients' efforts on developing good habits, one at a time, rather than counting macros.

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Coach D sits down with dietician and Starting Strength Coach Robert Santana to talk about the million dollar question: how do you lose fat, and keep it off? First, it's important to understand why we get fat -- the body chemistry of fat and muscle gain -- and where we've missed the mark on the science of fat loss in our modern culture.

Santana discusses the phenomenon of the skinny fat body, sometimes referred to as "dad bod," and why we need to shift our ideas about "weight loss" toward "muscle gain." Many people who fall into the normal and overweight category, typically as measured by BMI, don't need to lose weight per se, but rather gain muscle and lose bodyfat. Thus, the scale is the wrong tool for measuring progress. Instead, these people should focus on tracking waist measurement, bodyfat (via a simple test like skinfold caliper test), and their progress under the bar. Yes, they should be weight training!

As he explains, metabolism is largely driven by the metabolic rate at rest. Physical activity only contributes a small amount of the total calories burned each day, less than 25%. Consequently, building muscle mass drives far more calorie burn than cardiovascular training. Muscle mass also improves nutrient partitioning, or the body's ability to route incoming calories toward productive processes like muscle protein synthesis (as the name implies, the production and renewal of muscle mass) instead of fat storage.

Santana will join us again next week to dispel more myths about dieting, nutrition, and fat loss, so stay tuned with 40fit Radio!

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Everyone's got one, and they all stink. We're not talking about opinions. We're talking about excuses. As the New Year approaches -- and along with it new resolutions and promises to change old habits -- it's easy to imagine yourself six months or a year later with exactly the body you want, performing exactly the skills you want to learn, achieving all your goals... but it doesn't work like that. Time and time again, people make resolutions and fail, often before the first quarter of the year has come and gone.

Why does this happen? It's simple, really. Consistency is where the rubber meets the road when it comes to training. Consistency is easy when the year is young, spirits are high, and motivation is plentiful. As soon as life gets busy again, as soon as a setback occurs -- travel, sickness, a minor injury -- people often miss sessions, and never get back to the consistency they began their training program with.

They come up with excuses to justify missing workouts. Or worse, they hide behind these excuse before ever starting a workout program. We've heard them all:

• I'm too busy to train
• I'm too tired to train
• I'm too sick to train
• I'm too old/injured to train
• I don't want to get bulky
• And so forth...

The problem is, out of the vast, overwhelming number of these excuses, there is no good reason NOT to train. The key to consistency is not motivation, or willpower, it's simply discipline. Discipline is simply the habit of training, no matter what, especially when you have an excuse. Eventually, the habit takes over and training becomes normal, and consequently, not training becomes abnormal.

Today, that may not be the case for you. That's ok. Let's get started right now. Don't wait until the New Year. Start today. Clear an hour on your schedule, and get started. Refer back to the first ten episodes for the basic overview of how to train if needed. It will be painful at first -- not the workout itself, but getting yourself to actually do it -- but string along enough workouts and it will simply become a new habit. You may even find you start to enjoy it.

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Coach D and Coach Trent discuss how routine and habits can impact your mindset and sometimes get in the way of good training. As the saying goes, humans are creatures of habit, and that holds true for training. Whether it's a pair of lucky underwear, a rocking tune, or doing the haka before a PR deadlift, we all develop habits and quirks which help us focus, clear our minds, and prepare to train. But what do you do when something's off? Maybe you left your gym bag at home and you're without a belt and shoes to squat in, or you have to run a new route with unknown surfaces and unfamiliar inclines. Is that workout a bust, or can you adapt on the fly and get some productive training?

Good coaches encourage productive habits and routines. Teaching a lifter to approach the bar the same way every time, for example -- right hand, left hand, then right foot, left foot, take a big breath, brace hard, etc. -- promotes the repeatability of a movement and gives the lifter's mind something to focus on while executing a complex movement pattern. Naturally, over time trainees develop their own personalized routines to mentally prepare for training and get into the right frame of mind to exert a high level of effort.

Sometimes these routines can shift our mental attention away from the body cues we can control -- things like "hips back" or "stay in the midfoot" -- toward ambient or circumstantial cues which we cannot directly control, such as what music is playing, what is going on in our peripheral vision, having clear sight lines outside the normal gaze of the movement. While these details are often what separate the good gyms from the bad, we cannot always choose where we train, and chances are we will encounter unideal environs.

Likewise, equipment can become a crutch, particularly for strength training. Again, a good coach will recommend you to buy and use basic tools which facilitate productive lifting: shoes, a belt, perhaps some wrist wraps for heavy pressing and benching, straps for the advanced deadlifter. However, form creep happens to everyone and equipment use can become a crutch masking poor technique. Using wrist wraps to maintain a moderately extended wrist in a heavy press, for instance, may be masking the fact that the grip is wrong, and needs to be corrected to carry the bar over the supportive bones of the forearm instead of the smaller, weaker bones in the hand and wrist. A lifter that has learned to push out against her belt rather than tighten her abs with a proper Valsalva may find herself unable to control her back position in a heavy squat, because she has compromised her ability to engage the abdominal wall in the lift.

All that said, don't try to fix what ain't broke! Habits and routines absolutely have their place in training. On the other hand, if you find yourself struggling with a lift, a movement, or a skill, examine your routine, and occasionally put yourself in totally new, unfamiliar environments to learn how to self-asses and adapt more readily. Some of us train for competition, where the field of play, the weather, and a host of other factors are unpredictable, and learning to thrive under pressure is a key skill. For the rest of us simply training to live a healthier life... well, life still throws curveballs, and the skills of adaptability and versatility is just as important in life.

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Trent and Coach D return for round 4 of the series on lower back pain, wrapping up the topic with a meaty discussion about exercise for treating chronic low back pain as well as acute pain from injury.

As mentioned in previous episodes, it's very important to first get an accurate diagnosis to understand what you're dealing with before getting back to training. Hard neuro symptoms such as loss of motor function, drop foot, etc. are more serious and may require a different approach to treatment than chronic sciatica, for instance. The diagnosis helps identify the source of the pain, and provides some idea of the likely healing time of the tissues affected (muscle, tendons, bone).

Once an accurate diagnosis has been made, treatment should -- in most cases -- begin immediately. Rarely is rest the right answer, unless the athlete is dealing with a severe injury. At this point, the coach or medical provider should begin educating the athlete about the nature of their injury and some of the things they may experience during the rehab process, being careful not to catastrophize the injury. Sometimes they are going to experience pain during their workouts, but using the exposure without danger principle discussed in Part 3 will help rewire their pain response while giving the tissue the best environment to heal.

From here, Coach D likes to break down the exercise progression into several steps, with pain and knowledge of the injury and the typical healing times for different types of tissue serving as the guide.

The Exercise Prescription

1. Bodyweight movements while laying on the back. At this point there should be little or no loading of the spine, just introducing light movement.
   • Bridges
   • Knees to chest
   • Trunk rotation
2. Bodyweight movement, progressing to sitting. The athlete should focus on keeping the spine neutral and using the back as a rigid lever during these movements. At this point we have still not introduced loading beyond bodyweight.
   • Sit to stands, from a high box to progressively lower box if necessary.
   • Hip hinges, using the back as a rigid lever
3. Compound movements, with light loading. This is a good time to break out the training bars, broomsticks, and PVC pipe. Adjust the grip, implement, or movement pattern as necessary to accommodate for pain tolerance. For instance, if the lifter is having a hard time holding a regular barbell, try a safety squat bar or buffalo bar. Loading should be conservative at this point; there will be plenty of time to progress to heavy later.
   • Squats using a light bar, kettlebell, or even bodyweight squats to a box, but using full range of motion.
   • Planks and side planks in short intervals, increasing duration over time, for athletes who still have trouble loading their spine in a horizontal position.
   • Sled pulls and drags
   • Weighted carries with dumbbells or kettlebells
4. Compound movements with progressive loading. At this point it's time to reintroduce the compound lifts -- the squat, press, and deadlift -- with some load.
   • The lifter needs to pay special attention to executing the lifts with perfect or nearly perfect form. At this point the athlete's pain should be low to moderate on the pain scale, and they can load the lifts using pain as the guide.
   • Use common sense with the progression: a 400lb squatter coming back from a minor adductor strain need not make 5lbs jumps every workout, but he probably should not make 50lbs jumps either. Likewise even a strong lifter coming back from a more severe injury such as a hamstring tear may need to make more conservative jumps while the tissue heals. In both cases the progression model will look the same, but the timelines will be different: the lifter with adductor strain may only need 2-3 weeks before he is back to squatting 90-95% of his previous loads, while the hamstring injury may require months, depending on the severity.

At first the athlete should be doing these movements every day. Once compound loading begins, as the loads climb they can start tapering their workouts from every day to every other day, eventually back to their original workout schedule, such as 3 times per week.

The key thing when dealing with pain is motion is lotion, and movement as soon as possible after an injury is the best way to promote healing in the damage tissues. For those suffering from chronic pain and not necessarily an injury, movement is still the answer! Progressing to compound movements with load:

• increases blood flow to the tissue, which brings nutrients, facilities cellular waste removal, and brings growth hormones to the tissue
• reduces scar tissue, as the muscle is encouraged to heal in the direction that it is used, as opposed to randomly scarring, which can increase the chance of injury in the future
• reduces muscle atrophy
• improves motor sequence firing and increases muscle stamina, which help make movement and everyday tasks easier

Further Reading on Back Pain, Pain Science, and Exercise Intervention for Pain

• In the Spine or In the Brain: Recent Advances in Pain Neuroscience by Nijs J, Clark J, Malfliet A, Ickmans K, Voogt L, Don S, den Bandt H, Goubert D, Kregel J, Coppieters I, Dankaerts W
• Effects of Functional Resistance Training on Fitness and Quality of Life in Females by Cortell-Tormo, Juan & Tercedor, Pablo & Chulvi-Medrano, Iván & Tortosa-Martínez, Juan & Manchado, Carmen & Belloch, Salvador & Perez-Soriano, Pedro
• Exercise in the Management of Chronic Back Pain by Dreisinger T
• The Effects of Strength Exercise and Walking on Lumbar Function, Pain Level, and Body Composition in Chronic Back Pain Patients by Lee JS, Kang SJ
• Individualized Low Load Motor Control Exercise and Education versus High-Load Lifting Exercises by Aasa B, Berglund L, Michaelson P, Aasa U
• Core Strength Training for Patients with Chronic Low Back Pain
• Which Patients With Low Back Pain Benefit From Deadlift Training? by Berglund L, Aasa B, Hellqvist J, Michaelson P, Aasa U

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