Ankle Braces and Ankle Health

This is an article written by my good friend, and former co-worker Carson Boddicker. He is the founder of Boddicker Performance, a Flagstaff, AZ based athletic performance company. In the article Carson talks about ankle health and possible danger involved with ankle bracing. If this article sparks your curiosity check out his blog at boddickerperformance.com
-Enjoy, Will Hawkins

"I recently was asked what was the “best” ankle brace to use. Below are my thoughts, which are in line with that of ACE Bandages and Kinesiotape. Enjoy!
Weeding through the ankle brace market can certainly be trying for even the professional. While they are a great short term “band-aid; to be entirely honest, an ankle brace will only make your problems worse in the long run by weakening the tissues around the joint even more and contributing more to the instability.

Your best bet in my mind, without question, is to address the root of the cause of the ankle instability instead of just treating the symptom itself.

With an ankle injury, many things can go wrong. Often, the bones of the foot and lower leg begin to not play together nicely, with the talus migrating superiorly and anteriorly, thus losing range of motion in the toes to your shin range of motion–dorsiflexion–which is critical in the health of the foot, ankle, and knee. Here, we’d be certain to try and improve dorsiflexion range of motion with both active and passive techniques. It’s also important to address calcaneal inversion with active mobilizations.

Furthermore, the most lateral muscles of the lower leg, the peroneals (as a group), are put on an extremely fast stretch, and become scarred up and inhibited. Research shows that in cases of chronic ankle instability, these muscles respond slower to a stability challenge than a healthy tissue does due to muscle spindle activity. One of the best ways to handle this is through a combination of soft-tissue therapy, proprioceptive training, and nerve flossing techniques."

Best regards,
Carson Boddicker
http://www.boddickerperformance.com/

Ice Ice Baby

Anyone who knows anything about acute injuries has heard of the RICE acronym, that is, rest, ice, compress and elevate. Ladies and gentleman I am here to tell you there is a reason you’ve had RICE crammed down your throat (pun intended). RICE works. This is why.

Rest- Rest is arguably the most important factor in the RICE acronym. Rest allows the body time for inflammation cycles to carry out healing. There is however a misconception that rest means immobilization. This is incorrect. Rest means avoiding serious trauma while trying to maintain/improve soft tissue quality and not losing range of motion in any affected joints. Take an ankle sprain for example, if the ankle is completely immobilized for long periods of time not only will the body’s natural compensatory responses be choked out, atrophy will being to take place in the uninjured connective tissue. This of course leads to an even weaker joint, and a longer recovery time.

Ice- Many athletes have terrible memories of being forced to sit in 30 degree ice tubs after football practice, but I can assure you, ice used properly is your friend. It’s not exactly immerging science that ice helps swelling go down. Ice acts as a local vasoconstrictor which limits blood flow (inflammation) to the site of application.

Compress- Compression is another method used to reduce swelling, and it’s not very complicated. Any 4th grader who watched Bill Nye The Science Guy understands that fluid takes the path of least resistance. Compression on the injured site resists your body’s acute injury response to send gratuitous amounts of blood to the injury site.

Elevation- Whether it’s on the basketball court or in the Physics lecture hall, I have always hated gravity. What’s to like about an invisible force that limits you from doing just about every cool thing there is to do on this planet. In the case of acute injuries however, gravity it your friend. When you raise your injured limb above your heart gravity will cause less blood flow to enter the injured area. Pretty cool right? Gravity, I guess you’re not that bad…

While this isn’t anything ground breaking information I hope this post will serve as a clear and concise explanation of how to treat acute injuries. The best way to avoid inflammation is to not get injured but if you simply must sprain your ankle RICE is the way to go.

-Will Hawkins

UFC Periodization

This is something I typed up for my Clinical Exercise Prescriptions class. It goes into the basics of periodization, in a humorous way, and points out that periodization should be applied to more than just an athletes workout, but there lifestyle in general. The premise of the essay is I am writing a training program for my self to fight BJ Penn for the UFC Welterweight title.

When developing a periodized program for me to fight in the UFC for the Welterweight title, I first looked at my specific needs (other than an act of God), and what energy systems my greatest needs fit into. In order to uncover my specific needs I subjected myself to a barrage of tests. First test was V02 Max. I have had six V02 Max tests run on me in the last six months (one would be sufficient) and I recorded the average result. Additionally I performed a Functional Movement Screen (FMS) on myself and recorded my score. I also performed a five repetition max test on bench press, squat, and dead lift. From these tests I have come to the conclusion that my biggest need for improvement is in my VO2 max but this must be accomplished without losing any anaerobic power (2).

Test Results

V02 Max 56 ml*kg*min

FMS 16/21

Bench 5-rep max 225 lbs.

Squat 5-rep max 300 lbs.

Dead lift 5-rep max 275 lbs.

While a of 56 is decent it’s not good enough to maintain peak performance for three, five minute long rounds .The best way to increase my VO2 is to integrate aerobic conditioning into every facet of my training. I would structure my grappling, and striking sessions to have an aerobic capacity building emphasis. While this is pretty effective for most, why stop there. If I’m going to have a chance at beating B.J Penn in a fight, I would need to employ some “experimental tactics” as well as an act of God. For this I turn to Hypoxia training.
Hypoxia training is essentially training in an oxygen depleted environment to attempt to cause cardio respiratory adaptation. This can be legally accomplished one of three ways. One can either train at high altitude, train in a hypobaric chamber/room, or wear some type of devise that inhibits oxygen intake. Some fighters train with their noses plugged while wearing a modified scuba snorkel in their mouth to accomplish this. According to the February, 2007 Journal of Aviation, Space and Environmental Medicine, this type of training can lead to, “significant increase in the ventilatory anaerobic threshold (p<0.05). Significant increases (p<0.05) in pulmonary ventilation, tidal volume, respiratory frequency, O2 uptake, CO2 output and ventilatory equivalents to oxygen (VE/Vo2) and carbon dioxide (VE/C02) were observed at the ventilatory threshold and within the transitional zone of the curves.” All these results can be coupled with gains in anaerobic strength if properly integrated into a free weight circuit. In training to fight in the UFC this would be the only type of weight lifting I would do (1).
Because my specialty is grappling there are a host of needs that come with that. The greatest needs of a grappler are a good strong core, excellent hip and T-Spine mobility and full body strength. The full body strength requirement would be met by the free weight circuit training, but some other specific workouts would be necessary to attain core strength and hip/T-spine mobility. For increasing T-spine mobility I would do a plethora of rotational exercises with a fixed pelvis causing the mobility to come from my T-Spine rather than L-Spine. For increasing hip mobility I would focus primarily on the abductors and the glute complex. These are huge muscles that are underdeveloped in most athletes. The awesome part about that is you can accomplish increasing hip mobility while you are teaching your CNS to fire these huge muscles more effectively.
In addition to knowing what fighters need to train, one must also know when they need to train. The most important thing is that you are in your peak conditioning during the fight. When it comes to periodization there are two basic models; linear and daily undulating. Linear models (like the one required for this project) are great if the fighter didn’t have a strength coach he could consult daily, but the linear model isn’t as good as the daily undulating model. The daily undulating model takes into account lots of different factors and is better suited for change in the case of injuries or any other type of unexpected stressor. Both models do agree on one thing however; the need to taper off the week leading up to the fight. The week leading up to the fight is supposed to be skill’s work only.
In addition to periodizing a workout regamine; nutrition, hydration levels and amount of sleep are extremely important. These topics are worthy of papers of their own but I will try to sum up there importance in one paragraph each.
When it comes to Nutrition I believe the Paleo Diet is best for fighters. The paleo diet is derived from the word “Paleolithic” which refers to the Stone Age. The diet was made popular by Dr. Lauren Cordain's book entitled "The Paleo Diet." The paleo diet is essentially the diet of a Stone Age caveman. "The Paleo Diet" book sites that because the genetic makeup of the human body has changed only .02% over the last 40,000 years why should our diet change? The diet preaches that all the food you consume should be in its most natural form (fish from the ocean not from a farm) and non processed fruits, vegetables, nuts and legumes. The Paleo diet is very high in protein, due to proteins believed ability to increase insulin sensitivity which helps keep you feeling full. All of the science behind the paleo diet is pretty heavy into evolutionary biology. Dr. Cordain even says in his book that. "I didn't design the diet, nature did." This diet has recently received a lot of attention through the rise of crossfit, which many UFC fighters use as their training regimen (5).
Another thing that must be accomplished to achieve greater fitness as well as general health is maintaining proper hydration levels. The need for proper hydration in UFC fighters is magnified by the fact that most fighters train in extremely hot rooms. The Journal of Biochemistry and Physiology published an article entitled, “Nutritional Needs for Exercise in Heat”, that explains how this problem is fixed. This article sites that athletes should hydrate well prior to the workout, drink as much as they comfortably can during the workout, then drink as much as they can after the workout and make sure they intake sufficient quantities of all four electrolytes. If athletes don’t rehydrate after workouts there body will stay in a catabolic state, and can experience cell damage due to increased free radical production (3).
Sleep is by far the most important part of recovery, and possibly also the most abused. Athletes tend to turn that all around once they find out that human growth hormone (HGH) the same hormone many athletes illegally inject themselves with is naturally let off in your body while you sleep (5). This HGH is essential for proper musculoskeletal recovery. Sleep is also necessary to maintain a healthy immune system, and this will go a long way to help a fighter (4).
While periodization is very important it obviously can’t make up for the talent discrepancy between BJ Penn and I. Most athletes are however surprised when they receive their first periodized program and see what they’ve been missing out on. Science doesn’t lie. Sometimes your body needs to work in overdrive and sometimes your body needs rest. Often only the knowledge of a trained professional can differentiate between these times to that’s why proper periodization is so important. It truly can set apart a winner from a loser.
-Will Hawkins

1. Miguel, Casas. "Intermittent hypobaric hypoxia induces altitude acclimation and improves the lactate threshold.." Journal of Aviation, Space and Environmental Medicine 71.2 (2000): 125-30. Print.
2. Sanders, Michael, and Jose Antonio. "Strength and Conditioning for Submission Fighting." Strength and Conditioning Journal 21.5 (1999): 42. Print.
3. Burk, Louise. "Nutritional needs for exercise in the heat." Comparative Biochemistry and Physiology 128.4 (2001): 735-48. Print.
4. Yutaka, Honda. "Growth Hormone Secretion During Nocturnal Sleep in Normal Subjects." Journal of Indocrinology and Metabolism 29.2 (1969): 20-29. Print.
5. Cordain, Loren. The Paleo Diet: Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat. New York, NY: Wiley, 2002. Print.

Thanksgiving: The Test for Disciplined Athlete's

Becoming a better athlete is a goal that many people have, but the discipline required to be elite is elusive. Time, physical/mental exertion, and a host of various other disciplines of restraint are often what set the weekend warrior apart from the elite athlete. One of the chief areas where athletes must use restraint is in what they consume. Unlike the average Joe who is only concerned with keeping there beer belly to under three square feet, the athlete in most cases must not only eat properly to remain lean, but eat to aid there body in performance and recovery. This raises the question, "What is the perfect diet for athletes?" My answer is there isn't one. Here is a brief synopsis of a relatively new movement in athletic nutrition.

The paleo diet is derived from the word “Paleolithic” which refers to the stone age. The diet was made popular by Dr. Lauren Cordain's book entitled "The Paleo Diet." The paleo diet is essentially the diet of a Stone Age caveman. "The Paleo Diet" book sites that because the genetic make up of the human body has changed only .02% over the last 40,000 years why should our diet change? The diet preaches that all the food you consume should be in its most natural form (fish from the ocean not from a farm) and non processed fruit's, vegetables, nuts and legumes. The Paleo diet is very high in protein, due to proteins believed ability to increase insulin sensitivity which helps keep you feeling full. All of the science behind the paleo diet is pretty heavy into evolutionary biology. Dr. Cordain even says in his book that. "I didn't design the diet, nature did." This diet has recently received a lot of attention through the rise of "crossfit." It is the official diet of crossfit.

While I think some of the phyletic gradualistic evolutionary theory entangled with the Paleo Diet is pretty self refuting, I think the paleo diet is generally a pretty good way to go. How can you go wrong with all natural fruits, grains, and vegetables, for complex carbs and fiber, and naturally raised "lean meats", nut's and legumes for protein sources. No matter what your view is on the creation/evolution of the human body most everyone can agree that our bodies were not designed to consume transfats, Red dye #40, and every form high fructose corn syrup Coke can throw at us. I think the Paleo Diet is pretty sensitive to this fact, and that's why it's a healthy diet in my book.

Have a Great Thanksgiving; take it easy on the eggnog (not paleo friendly).

-Will Hawkins

Cordain, Loren. The Paleo Diet: Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat. New York, NY: Wiley, 2002. Print.

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The Female Athlete's Epidemic

In 1998 the American Journal of Sports Medicine featured an article titled “The Association Between the Menstrual Cycle and Anterior Cruciate Ligament Injuries in Female Athletes.” This article confirmed the suspicion that many coaches already had, which is that hormonal, as well as anatomical, predispositions were to blame for the seeming epidemic of female athlete ACL tears. I have come to the conclusion that there are three major reasons that women are more than four times more likely then men to tear there ACL’s playing sports(1).

In order to make hypotheses about women’s increased susceptibility to ACL tears, one must first understand the basic anatomy of the knee, and the purpose of the ACL. First, the knee is a joint comprised of four bones; the femur, the tibia, the fibula and the patella. The knee joint is padded by sections of cartilage (menisci) on both the medial and lateral side. The ACL is one of four major ligaments responsible for stability in the knee. The ACL originates in the notch of the distal portion of the femur, and inserts into the tibia. Due to its origin and insertion, its primary purpose is to protect the knee from too much anterior translation of the tibia.

The first portion of the hypothesis we will discuss is the hormonal reason for women’s increased susceptibility to ACL tears. Dr. Kurt Spindle, an orthopedic surgeon in Nashville, has done some of the most relevant research on this portion of the female athlete’s epidemic. In his study, he discovered that women were three times more likely to tear the ACL when they were on their period. He explains this by stating that during a female’s period the hormones luteinizing and follicle stimulating hormone are allowed to enter the blood stream and these hormones comes into contact with the ACL’s recently discovered active hormone receptors. It is believed that this spike in hormonal levels can actually temporarily alter the composition of the ligament, therefore leaving the ACL more prone to tearing. Dr. Spindle also cited that women who had been taking oral contraceptives were less likely to tear their ACL’s. This is due to the fact that oral contraceptives skyrocket estrogen and progesterone levels, causing luteinizing and follicle stimulating hormones to not be released.

The second reason female athletes are at least four times as likely to tear their ACL is because of the difference in the anatomy of the hip. The term “Q-Angle” is defined as “a measurement of the angle between the Quadriceps (Rectus Femoris is usually used) and the patella tendon (3).” Q-Angles in women are generally at least five degrees larger than that in men, which causes an increased tension on almost all of the ligaments of the hip and knee. The hip structure most women have is great for giving birth, but not so great for playing sports that require lots of multidirectional movement.

The third reason for female ACL tears is an anatomical predisposition as well. The intercondyler notch is a portion of the knee, between the condyles, that the ACL glides through during extension and flexion of the knee. There are two rounded portions one on each side of the notch that are called condyles. These condyles provide a large source of stabilization for the knee. Think of the condyles as your knuckles when you put two fists (femur and tibia) together. One of the condyles main purposes is to give the ACL additional support in preventing to much anterior movement of the tibia. Women have smaller condyles (less knee stability) as well as a smaller intercondyler notch. The fact that women typically have smaller condyles is a distinct mechanical disadvantage that leaves women with less knee stability in general. Additionally, the smaller intercondyler notch, women have, can lead to the ACL being pinched or torn inside the joint. So there are a host of anatomical differences in the knee joint of women that leave them more susceptible to ACL tears.

So, what’s a girl to do? Should girls with wide hips avoid playing sports requiring multi directional movement? Should girls sit out from playing sports when they are on their period? Should collegiate athletic programs require their female athletes to be on oral contraceptives to lower their chances of season or career-ending ACL tears? There are obvious legal and moral issues involved with asking female athletes to take oral contraceptives but it’s an option I would not be surprised to see this option explored. However, my answer to this question is a resounding NO. A study done by the American Journal of Sports Medicine declared the women who undergo lower extremities injury prevention workouts are sixty-two percent less likely to suffer traumatic knee injuries (5). This tells us that corrective/preventative exercises are definitely the way to go.

All three factors related to women’s relative knee instability are intertwined with the fact that women typically have roughly thirty percent less muscle mass then men. Muscle mass is one of the joints greatest stabilizers. There is a stigma in the exercise science field about training for large muscles, but this stigma is largely unfounded. There is a belief that flexibility and muscle mass are mutually exclusive qualities. This is not true. Gratuitous amounts of muscle mass and flexibility, however, are mutually exclusive.
Flexibility is defined as, “the ability of your joints to move throughout a full range of motion. (6)” Flexibility is talked about a whole lot in the athletic performance field, but sometimes we forget that being super flexible isn’t always good. Being too flexible can lead to joint instability due to the joints extremely large range of motion. This is why training for hypertrophy and balanced muscle ratios is so important. By training to achieve a proper quadriceps to hamstring strength ratio female athletes can drastically decrease likelihood of ACL tears (4). Most females, just like their male counterparts, are quadriceps dominant. Having strong quadriceps is great, but the hamstring complex by virtue of its origin and its insertion help to prevent too much anterior translation of the tibia from occurring. This anterior translations of the tibia is the reason most ACL’s tear.

Additional forms of corrective exercises should include multidirectional neural activation/enhancement drills. The quicker and stronger muscles can fire while an athlete is making a cut, the quicker the joint will be stabilized. Oftentimes ACL tears occur when an athlete plants a foot to cut and immediately the plant leg is compromised by a collision. It is not speculation to say that if surrounding musculature can fire quicker and stronger (more fibers), then these plant and twist tears would become less likely.

In conclusion, it is an undeniable fact that female athletes are up to four times more susceptible to ACL tears than their male counterparts. There are at least three scientifically proved reasons for this, and perhaps more that we have not discovered. There is, however, hope for the female athlete. There is a vaccine out there to help to aid in putting an end to the “female athlete’s epidemic.” Through the combination of preventative exercises aimed at producing neural adaptation and balanced hypertrophy, there can be more healthy knees out there on the field of play.

-Will Hawkins

1. Wojtys, EM, LJ Huston, TN Lindenfeld, TE Hewett, and ML Greenfield. "Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes.." The American Journal of Sports Medicine 26.5 (1998): 614-619. Print.


2. Spindler, Dr. Kurt. "The Effect of the Menstrual Cycle on Anterior Cruciate Ligament Injuries in Women as Determined by Hormone Levels." American Journal of Sports Medacine 30.2 (2002): 182-188. Print.

3. "The Q Angle." The Virtual Sports Injury Clinic - Sports Injuries. N.p., n.d. Web. 12 Nov. 2009. .

4. Pettineo, et. al. Female ACL Injury Prevention With a Functional Integration
Exercise Model. Strength and Conditioning Journal. Vol 26 No1, pp.28-33.

5. Joseph, M. Knee Valgus During Drop Jumps in National Collegiate Athletic
Association Division I Female Athletes : The Effect of a Medial Post. American
journal of sports medicine. 2008, vol. 36, no2, pp. 285-289

6. Marieb, Elaine N.. Essentials of Human Anatomy & Physiology (9th Edition) (Essentials of Human Anatomy & Physiology (Marieb)). San Fransisco: Benjamin Cummings, 2008. Print.

Awsome Quotes by Awsome Coaches

I'm currently working on writing a longer article, on female's predisposition for ACL tears, so here are some quotes to keep everyone entertained. I should be done with the article in the next day or two, then it's editing time. The final draft should be out in a week or so.

"Gold medals aren't really made of gold. They're made of sweat, determination, and a hard-to-find alloy called guts." - Dan Gable

“I don’t look at myself as a basketball coach. I look at myself as a leader who happens to coach basketball.” -Coach K

"The Six W's: Work will win when wishing won't." -Todd Blackledge

"When people ask me how to raise their level of performance, the first thing I ask is, How important is it to you?" -Dan Gable

"The harder you work, the harder it is to surrender." -Vince Lombardi

“I’m a big believer in starting with high standards and raising them. We make progress only when we push ourselves to the highest level. If we don’t progress, we backslide into bad habits, laziness and poor attitude." -Dan Gable

-Will Hawkins

Alleviating Ailing Ankles

This is an article written by my good friend Carson Boddicker, of Boddicker Performance, on alleviating ankle pain. The article not only describes how most ankle injuries occur, but it features videos demonstrating corrective exercises. It has been published online at Elite FTS and strengthcoach.com aswell as his company's website.

Here is the Link http://www.elitefts.com/documents/ankles.htm

Carson Boddicker is owner of Boddicker Performance, a Flagstaff, Arizona based company with a focus on improving athletic performance using an integrated training model to help each athlete reach an optimal level of competitive preparedness.

-Will Hawkins