Functional Circle II

The Functional Circle Class last semester was a blast. As I explained in my blog post “New Directions“ I had some challenges to overcome, but everything went quite fine and the participants were satisfied. What I learned from teaching this class was that even with very limited equippment it is possible to challenge 10-15 people in one session. My focus was to achieve high movement quality, before letting people lift heavy weights. That's why I put a focus on mobility and controlled mobility, further on in a second part on core and joint stability. Within a few sessions, movement quality improved very quickly. This was quite impressive and surprised me a lot.

As the weather got better and temperatures became warmer, the wish of training outside got stronger. I was open for this idea, even though there were some challenges to overcome. It was not possible to use the equipment the way I wanted to: there were limited possibilities to hang or set things properly and someof the stuff available couldn't be used outdoors at all. After easter break I came up with a new concept. Still, I oriented myself on the Human Movements, so Push, Pull and Core Training built a stable part of the plan. After squats, I wanted to do lunges, because I needed some more time to figure out how to get the people to hip hinge perfectly with the equipment and time I had available.

So the final plan was:

Mobility:

Pull Over

Spiderman Walkout
T-Spine Rotation
Squat to Stand
Lunge Matrix
Cook Hip Lift

Stability:
Halo
Theraband Hip Hinge and Row
Seratus Push Up
Monster Walks
Alternating Arm Leg Raise
Superband Bycicles

Strength:

1) Triset
Inch Worm
Lunge
Band resisted Mountain Climber

2) Triset
Theraband Push
TYI Rows
Side Plank

To train coordination we did a series of different throwing, catching and running exercises with a ball, to also get the cardiovascular system started.

The participants of the class stayed the same throughout the whole time. What they achieved in movement quality in the first sessions benefited them a lot later on. They learned new exercises even more quickly which allowed them to train more intensively. Also, their focus became totally different. In the beginning everyone wanted to be exhausted as much and as quickly as possible. So they went through the strength part very sloppy to be able to do more and more reps. But soon the participants realized that the more effort they put into the strength part, the more benefit they got out of the whole class. Still, everyone was exhausted after class, even more than before.

Now the next year of Functional Circle starts and a new plan is being designed. This time focusing on the hip hinge. The hip hinge is a complex movement pattern and I find it difficult to teach. But building a lot of regressions into the two warm up circles is the perfect way to make the hip hinge clearer to the people. But that's another story to tell in a different post following soon.

The Cruciate Ligaments

After two long semesters at the University in Krems I was glad that summer break had begun. One thing was clear: I wanted to take one month to concentrate only on training. The plan was to focus on Kickboxing, but I totally fell in love with Luta Livre and spent most of my time learning about positions, escapes, passes and submissions. Soon I stumbled upon a technique called „Heel Hook“, a submission which attacks the anterior cruciate ligament (ACL). Pretty complicated stuff, so while at class I was trying to understand how to actually do and defend against this submission, after class I was part of some interesting discussions about the cruciate ligaments. Eventually I realized that I may not know as much about them as I thought I would. Therefore, I wanted to do a blog post about the knee joint, focusing on the cruciate ligaments, because I had found some interesting things during my research I didn't know before.

click to zoom

So let's start with some basic anatomy of the knee: this joint is made up of three bones, the femur, the tibia and the patella. Between the tibia and the femur there are two „shockabsorbers“: the medial and lateral meniscus. They transfer the load from the upper leg to the lower leg and stabilize the knee. As you can see on the picture, the femur and the tibia have different forms. The mensicii build a link between those two bones so that they can fit together.

On each side (medially and laterally) there is a ligament called collateral ligament. The medial meniscus is grown together with the medial collateral ligament, which makes injuries in this region more complicated. The collateral ligaments give side way stability to the joint. Between the two condyles of the femur and attaching to the tibia, two ligaments cross each other – the anterior and posterior cruciate ligament. Their function is not that simple, so later on I will talk about them more detailed. But first let's talk about the movement directions, because they are pretty simple. The knee can be flexed and extended but can be rotated only very little.

Here are two helpful videos, where you can get a visual impression of this joint and it's characteristics:

click to zoom

The ACL resists anterior tibial translation and rotational loads. The PCL is much broader and stronger than the ACL and helps to stabilize the knee. Usually people say, that the cruciate ligaments are taut in flexion and relaxed in extension. But unfortunately it's not that simple. The ACL is built up on one hand of a smaller anteromedial bundle which is tight in flexion and is the primary restraint against anterior tibial translation in flexion. On the other hand the ACL consists of a larger posterolateral bundle which is tight in extension and stabilizes the knee near full extension.

Although at approximately 30 degrees of flexion neither of the bundles are taught. This leads to the most translation available and is the position where injuries in twisting movement most likely occur. Generally speaking the problem with ligaments is, that they do not stretch like tendons do. Imagine ligaments as ropes and tendons as rubber bands for example. Stretching a tendon is part of everyday life. But if a ligament gets stretched too much it tears apart.

click to zoom

Let's keep it simple and focus only on the ACL. Injuries of the ACL are very common in the field of sports and much more likely than PCL injuries. In sports cutting or sidestep maneuvers have a lot of impact on the ACL. These movements can be found a lot in soccer games or american football for example. The typical injury occurs with the knee externally rotated, in 10-30 degree flexion with the knee placed in a valgus position. ACL tears also occur, if there is an anterior tibia translation with the knee in shallow flexion.

Up to 80% of the ACL injuries occur in non-contact situations, for example if the athlete takes off with the aim of changing direction, or in landing situations, with the knee close to full extension. Especially landing situations require eccentric muscle action. If the hamstrings and the quadriceps are weak, the tibia translates anteriorly and the ACL might get injured. 

The Heel Hook on the other hand is a little bit different, because it is a contact and not a non contact situation. During this submission internal rotation on the tibia is applied via the heel. Also in flexion the tibia acts as long lever arm that generates increased forces to the joint. As we have heard before flexion combined with internal rotational forces are very dangerous for the ACL. So if a fighter finishes this submission and the opponent doesn't tap in time, or the fighter is not cautious enough, the ACL of the attacked fighter will be torn apart. Therefore, the Heel Hook is known to be a very dangerous submission and is even forbidden in some competitions. During training sessions I haven't had any troubles with the Heel Hook, because if you know about its dangers and are cautious in training sessions then injuries shouldn't happen at all.

There are ways to prevent ACL injuries. A lot of exercises in the field of prevention are focusing on balance training, plyometrics, movement education and agility training. Next semester at University I will attend to a lecture about sport specific injury rehabilitation. Hopefully I will learn about this pathology and its rehabilitation a lot more, so I can tell you about it in another blog post.

References:

• https://www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)
• https://www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)_Injury
• https://www.physio-pedia.com/Anterior_Cruciate_Ligament_(ACL)_-_Structure_and_Biomechanical_Properties#cite_note-Matsumoto-1

New Directions

Lucky me: I got some new opportunities to work in the field of sports and fitness. Since January I have the chance to teach two Martial Arts classes, Shinergy, on a regular basis. One for children and one for adults. At the end of February the University of Krems offered me a chance to take over a Functional Circle class, once a week. In addition I was asked to give Personal Training to a client with the goal of losing some weight, so there are new challenges waiting for me.

Mostly the challenges are new responsibilities that I have to deal with: making decisions for people who are trusting me to make them better, stronger fitter and leaner. Until now I usually followed orders, what to do in classes, which exercises to teach, how many reps, sets in a specific time the people have to do. It was perfect in the beginning because I could focus on my didactic skills and had a safe place to grow confident. Sometimes when I had the chance I changed, or optimized the program a little, but never have I had the chance to develop my own concept for a class until now.

I want to write one specific post about each class: Shinergy, Krems and Personal Training, because I have a lot to go through and a lot to sort out. Today I will start with the Functional Circle Class in Krems.

At the beginning I was a little afraid of the Functional Circle class. I was told to teach for 90 minutes, about 12 people with very little sports experience, with very limited equipment. I was used to train around 8-10 people mostly with a lot of experience, a but load of equipment and a strict guideline of what to do. My first thought was: how am I going to challenge everyone for 90 minutes? I was told that before I took over, the class usually ended after 60 minutes. Everyone was too exhausted to go on, so there was some stretching at the end and then the class ended early. So I needed to focus on getting the people to workout for 90 minutes. Even if it's with low intensity. They pay good money for this class, that's why I really want them to get the most of it.

So I sat down and thought about what to do. I double checked and got a little help from a good friend and finally came up with the following concept:

- 15 Minutes Mobility with 6 exercises 2 Minutes each, 1 Minute per side

- 15 Minutes Stability with 6 exercises, 2 Minutes each, 1 Minute per side

- Agility Training 10 Minutes with the Agility Ladder

- Strength Circle 25-30 Minutes, 2 Groups with 3 exercises each, 8-12 reps, 3 sets

- Lactic Capacity Endurance: 3 exercises, 25 seconds on, 35 seconds off, 3 sets

After I decided on how to do the class I had to think about what to do. I knew, that I wanted to focus on the Human Movements: Push, Pull, Squat, Hinge. Also I wanted to focus on Core Training, because what I experienced in earlier classes was that usually the weakest link when it came to training was core strength. So especially with the students participating in the Functional Circle, who were sitting all day almost all week, using almost none of their core muscles, I wanted to give the opportunity to get a stronger and eventually prevent pain.

So I went to see the place and noted that there is only limited equipment to use:

- one barbell

- some dumbbells bars

- barbell weights, all in all maybe 80 kilos

- a couple of stability balls

- 1 sling trainers

and a couple of things I am bringing myself:

- 2 slide pads

- 2 superbands

- 2 minibands

- 1 slingtrainer

- agility ladder

- 2 elastic therabands

The next challenge was to choose specific exercises. I have no chance to screen the people before the training, so the exercises have to be suitable for everyone. I can't do overhead presses, because I don't know if everyone has the shouldermobility to do so. Same thing applies for hip mobility, knee stability and so on. So I prepared for the most common injuries, limitations and restrictions. Also I tried to find exercises which were correctives too, to maybe be able to make the mentioned problems better. The result was the following:

1) Mobility:

- Cook Hip Lift

- Hip Flexor Stretch

- Side Lying T-Spine Rotation

- Spiderman Walkout

- Squat to Stand

- Wall sliding miniband shoulder Mobilisation

2) Stability:

- Ball Leg Curl

- Deadbug

- Fire Hydrants

- Pallof Press

- WTYL Rows

- Sumo Walks

3) Strength:

- Inclined/BW/Weighted Push Up

- Inverted Row

- Body Saw

- Heart Beat Squat/Prying Squat

- Glute Bridge

- Bear Crawl

4) Endurance

- Mountain Climber

- Burpees

- BW Squats/Jump Squat

I couldn't figure out a solution how to get the group to lift heavy. Even if two people are lifting at the same time there is only 40 kg left for one person. For bilateral lifts that's almost nothing. The solution is to include unilateral lifts which I want to do in the future. But if I do unilateral lifts there has to be technical coaching from my side. Unfortunately the equipment is to small to get everyone to do the same exercise at the same time. So me standing in front of a class explaining the most important aspects step by step is not an option. I have to continue thinking about this problem and most importantly I have to come up with a solution.

All in all I had 6 weeks until now and I have to say that the class runs just fine. I even got new people to join and from what I hear the feedback is very positive. But there is one thing left which is bugging me. There is one trainee with rheumatism in my class and there are weeks where the limitations take over and I don't know what to do anymore. So for the next 6 weeks I need to find more alternative exercises to do, even if more than one joint is limited.

What I really enjoyed during class was to see how movement quality improved each session. When we started everything was really hard for the group, but they listened carefully and transferred most of my explanations to their movement carefully. Also they want to go outside after easter break, which means that I have to adapt the program and work with even less equipment. There will be a follow up post when I decided what to do next, so I will keep you updated on this topic.

The Thoracic Outlet Syndrome

Most of my time I am either at school learning, or at the gym and on the mats, training and teaching. I watch people training hard, some of them thinking about what they are doing, some of them fooling around making more damage to their bodies than actually doing some good. Lucky me, I always found myself in good hands when it came to training. Everything I did was thoroughly screened and individualized. I trained focused and was able to stay mostly injury and pain free during my time of intensive training. Some previous problems even got much better. Being focused on many different things, I forgot to take proper care of my shoulders. There were no severe problems in movement, but I was always in a lot of pain after hard training sessions, especially in boxing. In addition, I felt my arms getting numb and cold at night, but I didn't know where all of this was coming from. I treated my hurting shoulder with some mobility work, which eventually made things better, but it was no solution in the long hall.

During my studies in Krems I stumbled upon the „Thoracic Outlet Syndrome“. It described symptoms as numb arms, cold hands and hurting shoulders. I got myself tested and without a lot of surprise, the result was positive. Lucky me, everyone was eager to try out the test and the treatment on me, so after intensive treatment I got okay on the same day. I had the best night’s sleep, without waking up to numb arms.

During the next few weeks, I realized that I was able to do more work having less pain. I started testing people myself, realizing that there were many people with a positive result. That got me thinking and that’s why today I want to dig deep into the topic of the “Thoracic Outlet Syndrome”. For me as a physiotherapist-to-be and a trainer of Martial Arts this is a pathology I have to think about, need to take care of and try to avoid.

First, let's clarify which structures we are talking about: if you take a look at the picture of the skeleton to your right, you will find the clavicle painted green. The clavicle is part of the shoulder joint and is responsible for mobility while raising the arms. In addition, it gives muscles the chance to attach. I won't go into much more detail here, I could go on and talk hours about the shoulder joint, but let's focus on our original topic.

Directly under the clavicle, without leaving much space in between, the first rib attaches to the sternum. There are muscles called „scalene muscles“, which you can see on the picture at the left. They function as accessory respiratory muscles and they bend your neck sideward. The important thing for us is, that these muscles originate at the cervical vertebrae, and attach at the first rib. Therefore, they proceed through the space between the clavicle and the first rib forming two holes, the “Thoracic Outlet”.  

Through those holes, one specific nerve and vessels are breaking through: the nerve is called Brachial plexus, and is important for us, because it innervates all the way down into our arms and hands. The subclavian artery supplies our upper extremities and leads all the way down to our arms and hands too. 

To sum it up, the thoracic outlet is made out of the clavicle, the first rib, the anterior and medial scalene muscle, forming two little holes where the brachial plexus und the subclavian artery and vein break through.

Our lifestyle, injuries, or sports can influence these structures and eventually cause problems. For example, a lot of sitting puts the shoulders into a position where they point forward continuously, also called protraction. Because of permanent protraction, the first rib elevates and stays stuck there. It presses the nerve and vessels against the clavicle. This causes problems with blood circulation, numb arms and cold hands are the consequence.

Permanent shoulder protraction is also found in Martial Arts. The guard position in boxing forces the shoulder to point forward all the time. Without proper conditioning and training for shoulder health one of the breast muscles, the pectoralis minor (you can find the muscle at the picture to your right) will get tight and pressure the brachial plexus and the subclavian vessels. Again, numb arms, cold hands and other tense muscles can be the consequence.

I find myself in a field of sports, where we need to do many things encouraging exactly these mentioned positions. We have to stress body parts in a way they are not made for. What we are doing to stop making things worse, is compensating with conditioning and mobility. Still, there are many people with a positive test result. To be more specific: a positive test result for having a tight pec minor. Fixing this problem is very easy, so I thought about how to include a proper stretch into classes. I realized that it is pretty easy: what the pec minor does is to put the shoulder into depression and protraction, so to stretch it you need to retract your shoulder and elevate your arm above 90°. Either on the wall, or on the floor, it is easy to integrate the stretch into class, so I will start doing this on a regular basis.

Having realized all that I hope, that it will be possible to prevent the “Thoracic Oultet Syndrome” and maybe help some people who already have it. Since it is very easy to deal with the second type of the syndrome, it should be easy to accomplish this goal. I will keep you updated on this topic. When it comes to the first type (having an elevated first rib) unfortunately the only possibility to fix it I know, is to go to a therapist who mobilizes your first rib back into order. However, you can prevent both types by being aware of the fact that you need to compensate for burdens you put your body through. Speaking about shoulder health this should be a lot of mobility work and paying extra attention to the movement pattern “pull”, when it comes to your workout.

What Happened and What Changed

A lot has happened in the past few months. I quit my old life and stepped into the field of Sports (mostly Martial Arts) and Fitness. This was the best decision I possibly could make. As a newbie you can find thousands of options: courses to visit, certifications to make and instructor academies to participate in. It is almost impossible to decide where to begin with . I was (and still am) lucky to have council in these matters, because without I may not have ended up where I intended to go. There were many ups and downs, but now I am happy to say, that things are moving in the right direction: I did my certification in FMS and became a certified Kettlebell Trainer. During summer, I was able to teach many classes and get some teaching experience. That was good for me, because I could see how theoretical things work out in the real world. I really hope to be able to continue teaching during the new semester. I love working with people and I love to see how they manage to get stronger and move better. The next step is the final exam of the Shinergy Instructor Academy next weekend. Accomplishing that will make 2016 a very successful year with three educational trainings and a new field of study.

Another big step ahead was the fact that the University of Applied Science in Krems accepted me as a student for Physiotherapies. This is a huge thing, because there were tough admission procedures to go through and many candidates applying. Nevertheless, there is more to come. I am not even close to the point where I intend to be. Neither in my theoretical knowledge and my experience, nor in my skills. There is a long way to go, but it feels good to be on the right track.

Beginning my studies in Krems I realized something: What I learned in the past few months about science, anatomy, motion and social skills are not only fundamental basics in sports, but in physiotherapies too. Of course, studies in physiotherapies will go much, much deeper, but I am talking about the very basics here. I realized that the things I learned during my time being an assistant Trainer were on a very high level of knowledge and still have high value. Of course, I knew that before too. I got books to read, exercises to try out and many topics to think about. All of these things were connected and made a lot of sense. What really surprised me was the fact how far these theoretical aspects lead into the academic world. I knew that what I learned worked in the gym and made people healthy and strong. But, I was impressed by the fact that all of these aspects are so important and of high value, that even professors teach them at the university. Exactly this point made me realize one huge lack: People understanding the complexity of movement, motion, sports and training. With people, I mean not only Trainers, but also Trainees and common people. With understanding, I mean the fact that people simplify Fitness, Sports and even Movement to a very dilettantish and amateurish level and don’t know how far these things are based in science and research.  

There is one thing bugging me, since I started to put effort into training and teaching. People don’t understand what training and working as a Trainer means. To be clear: there is more to the term Fitness and the job of a Fitness Trainer than you might think. The problem is that there are no requirements, neither for the title nor for teaching. We live in a world where one can get certified in a specific field of Fitness by simply attending a weekend course, or even easier doing an online course at home. Actually, there is no need for a certification to work as a Fitness Trainer at all. There are many people teaching classes without fundamental knowledge. Putting everyone in the same bowl leads to the fact that people think of Fitness as a very simple way of doing some workout.

Training is not simple. People have to realize that the body is a complex composition of many different aspects. A lot of science is going on there while we don’t even realize it. It is impossible to learn the body’s way of working during a weekend course or online. You have to spend months or even years working out yourself, reading and understanding. That prepares you for teaching classes. If a Trainer is smart he realizes, that these certifications don’t prepare for training people in a healthy way. Best way is to think about where the lacks might be and fill them with books, articles or courses more detailed. Important is the awareness that a certification doesn’t equal being an expert and knowing everything about sports and the human body. 

I know one thing: that I know nothing

Socratic paradox

For me the term Fitness means a complex composition of many different things. People have to be strong and mobile enough to get through daily life easily and pain free. If they aren’t, then it’s my job to give them good basics in fundamental movement patterns and basic strength to get through daily life easily. But, it goes deeper than that. Fitness should also be able to prepare for competitions or challenges (notice, that I am still talking about sports as a hobby here). I have to know how to prepare someone for a marathon. Also, I have to know how to prepare someone for a Martial Arts contest. The most important thing is that I need to understand that both game plans need to be completely different.

Now you see that there is an urgent need for some standards in the world of Sports and Fitness. A trainer should know the fundamental basics of biomechanics, anatomy and science of sports. Firstly, to get people fit and strong, but mostly and more importantly they need to have knowledge basics not to get their people injured. Making people sweat is simple. Getting people strong staying healthy is much harder.