ACSM Wrap Up- Part I by Eric Cressey

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"Looking for the Overlap: Where Science Meets Application in Resistance Training" Tony Caterisano, PhD, FACSM

Dr. Caterisano was a great way to start off the day. He's not only an accomplished researcher, author and faculty member at Furman University, but also a head coach of a top junior college wrestling team and a consultant to Virginia Tech's strength and conditioning program. Oh yeah, did I mention that he's a world champion Master's division powerlifter?

If you're looking for someone to bridge the gap between the laboratory and the trenches, Dr. Caterisano is your man. His lecture was based on six key points that all coaches should consider:

1. Teach movements before you teach lifts.

Young athletes can more easily adopt simple movements, so start with the basics and then piece them together in more complex movement patterns (e.g. clean-grip deadlift + shrug + jump shrug + upright row + high pull + power pull = power clean). In doing so, you'll foster basic strength and fulfill a fundamental prerequisite to ingraining kinesthetic memory in the motor neurons that will ultimately allow the lifters to execute complex lifts more rapidly.

So, the next time Mike Robertson and I yell at you about activating your glutes before you deadlift, think of Caterisano and give us the benefit of the doubt regardless of how easy these exercises may seem.

2. Prioritize training based on the time of the season.

If you're going to deviate from specificity, the off-season is the time to do so. It's important to remember that you can't maximize everything at once. Rather than abandon certain aspects of your training altogether, you just need to put them in perspective.

It was here that Dr. Caterisano presented the pyramid of athletic demands. I've seen it hundreds of times, but I'll never get tired of seeing it, as too many people completely miss out on this important concept in their quests to become good coaches. Here it is:




________Strength and Hypertrophy________

Strength is the foundation of all movement. You can train power, speed/acceleration, and agility until you're blue in the face, but these efforts won't do much good unless your strength improves. A certain amount of hypertrophy is necessary to support strength and, in turn, the other qualities. The type of hypertrophy — sarcoplasmic or myofibrillar — and the relative contribution of each to overall muscle mass, depends on the type of training and sport demands.

There's considerable evidence verifying that power training eventually comes to a standstill when maximal strength doesn't improve. A good analogy I often use is that strength is the glass, and power is the liquid within the glass. Unless you make the glass bigger, you can only add so much liquid before topping off your potential.

Conversely, if you only hammer away at maximal strength and never improve your rate of force development, you'll be dealing with a large glass and no liquid. Speed and acceleration are simply power applied to sporting contexts, and agility is the next step; it involves a combination of both speed and acceleration/deceleration.

3. Peak condition year-round isn't feasible. Plan for the peak!

In Dr. Caterisano's experience, most sports should plan on peaking twice per season. This assumes that the sport in question has a relatively short competitive season (as with basketball, wrestling or football). Sports like tennis and baseball are more challenging scenarios that may respond better to pseudo-undulating forms of periodization. (I’m partial to conjugated.)

Dr. Caterisano actually spoke of teams attempting to arrange their schedules around this "peak twice" concept. It's ideal to play your toughest regular season opponents when you're in mid-season form, and then save your second peak for the postseason. In other words, if you can dictate your own schedule, put your weakest opponents early and late in the regular season.

4. Avoid overtraining. Know when to rest.

Put as much "effort" into restoration as you do into training; it's the payoff period! Your opponents don't spot you three touchdowns because you trained harder or longer than they did! Dr. Caterisano earned a gold star (from me, at least) when he cited Zatsiorsky on the "delayed transformation" phenomenon whereby you utilize rest weeks to reap the benefits of the demanding training that preceded them.

5. Eat based on the level of activity.

This one logically follows #3 and #4. When you're not training as frequently, intensely or lengthily, you won't need as many calories. You should, however, make sure that you still get sufficient calories to promote restoration and general health.

6. Know the role of supplements.

Young athletes don't need to worry about supplements until other lifestyle factors are in order. Caterisano used the example of water being the best supplement when one isn't consuming enough fluids. He recommends (likely based on working with wrestlers) that athletes be weighed daily. A 1-2% body weight drop in 24 hours is usually indicative of inadequate fluid intake.

I was really glad to hear Dr. Caterisano talk at length about the benefits of meal-replacement powders, too. Many presenters want to avoid the supplement questions at all costs, but he came right out and said that they're a must for the vast majority of his athletes from both convenience and digestibility standpoints.

At this point he opened things up questions. Some crazy massage therapist asked about where flexibility and bodywork like rolfing fit into his pyramid. Wrong pyramid, lady. I don't recall anyone ever overtraining on stretching or massage.

Next, some out-of-place bodybuilder in funny pants asked about "body part training frequency." Someday, these poor lost souls will grasp that the reason athletes are athletic while bodybuilders have overuse injuries and are essentially useless in performing everyday tasks is because athletes train movements, not muscles.

"Hypertrophic Obstructive Cardiomyopathy" Stacy Martin, MD

Each year, hypertrophic obstructive cardiomyopathy (HOCM) accounts for 36 to 48% of 10 to 25 cases of sudden cardiac death in athletes under age 30. While 50% of HOCM cases occur spontaneously, 50% appear to be congenital, as mutations in cardiac sarcomere structure can negatively impact the ability of the heart to contract.

With this problem, there's a marked increase in the release of certain growth factors, leading to cardiac hypertrophy, scarring and fibrosis. The problem only gets worse with exercise, as ischemia and arrhythmia lead to further elevated left ventricle pressures and more hypertrophy. Unfortunately, the first symptom may be sudden death, especially since the condition is difficult to detect in patients under age 13. Otherwise, shortness of breath, chest pain, fatigue and fainting are warning signs related to HOCM. If someone (especially an adolescent athlete) has these symptoms, a doctor should consider his or her family history, perform a physical exam, and order one or more laboratory tests (i.e. EKG, echocardiogram).

No cure exists for HOCM, so the doctors typically recommend abstaining from the vast majority of activities — essentially anything that causes transient rises in blood pressure. Surgery has been performed in the most serious cases, but it's not typically recommended due to a 3-5% mortality rate. As a general rule of thumb, if an athlete is in his 30's by the time HOCM is discovered, he's probably going to be okay, and can continue with his normal activity level provided that he doesn't become symptomatic.

No jokes on this one. HOCM is scary stuff. Keep an eye out for these symptoms, especially if you're a young athlete, coach or parent.

"Runner's Diarrhea" Mike Pleacher, MD

Yes, they really devoted a full 45 minutes to this. It's hard to believe that people really give a shit (pun!), huh? Apparently, this is a bigger pain in the ass (pun!) than we could even imagine.

About 20-33% of endurance runners complain of lower abdominal cramping and/or a feeling of urgency and frequency during and after long duration races. Moreover, one study found that 20% of runners had occult blood in their stool after they completed a marathon. That kind of data collection must have been a crappy (pun!) job.

Butt (pun!) anyway, it's important to differentiate between upper and lower gastrointestinal symptoms. Upper GI problems relate to gastro-esophageal reflux disorder, nausea/vomiting and belching. They generally occur because of low esophageal sphincter pressure, increased gastric acid secretion, and reduced gastric emptying during exercise.

Conversely, lower GI problems "hit you much lower," and may be due to a number of factors:

All in all, the important point to take away from this presentation is that "aerobic training = diarrhea." Consider yourselves forewarned, cardio bunnies.

"Dynamic Movement and Core Development in Preparation for Athletic Performance" Paul Goodman, MS, CSCS, USAW

Goodman, head of Strength and Conditioning at the University of Vermont, offered a good blend of scientific and anecdotal information regarding how to integrate dynamic warm-ups and core training into an athlete's programming. This discussion was preceded by the rationale for warm-ups in general:

You can get each of the first five from any ol' warm-up, but it takes a dynamic protocol to get the final two kicking. Pre-training neural activation is valuable, as it increases the likelihood that you're using the right musculature — and not compensatory activation patterns that could potentially lead to tissue overload and injury — to complete a movement. These activation patterns are best "grooved" with more reps and less resistance. What better way to get after them than a dynamic warm-up?

Goodman prefers that these warm-ups last a minimum of 10 to 20 minutes, and preferably longer. Doesn't it kind of make you wonder when his athletes actually find time to lift weights, do conditioning work for their specific energy systems, and actually play their sport?

This duration has a lot to do with the fact that he insists on doing all his core training before weight-training. I have no problem with doing some core work prior to lifting, but I have a hard time believing that doing 10 to 15 sets of high rep core work pre-training is going to instantly improve my squat. I'm all for warming-up and activating the core just as I would the limbs of the body, but I'd prefer to save the heavier loading on core training to the end of the training session.

Anyway, a typical Goodman warm-up will progress as follows:

Many of the self-proclaimed functional training gurus (who, incidentally, have still not figured out what the term "functional" really meant when rehabilitation specialists first introduced it) would just stop at #6, have a wobble-board orgy and call it an intense training session. Goodman, on the other hand, gets his athletes in the gym for the money exercises. Good call.

"Tendinopathy: Tendonitis or Tendinosis? Implications for Therapy" Stu Steinman, MD, FACEP

Dr. Steinman came out swinging to destroy some faulty dogma. Since the suffix "itis" means "inflammation," using the term "tendonitis" to describe overuse-related pain at the insertion of tendons is a misnomer. There are no inflammatory cells present upon microscopic examination of the area, so strategies geared toward reducing inflammation aren't really the appropriate course of action.

In reality, tendinopathy is a degenerative process, so we're better off using the term "tendinosis." In this scenario, we actually want to rest the tendon, and then promote an inflammatory process in it to encourage the synthesis and deposition of healthy new collagen. True tendonitis is actually quite rare, and recovery is relatively rapid (one to six weeks) with anti-inflammatory modalities; 99% of patients make a full recovery.

Tendinosis, on the other hand, recovers over a longer period (two to six months) if it does at all (only 80% make a full recovery). Therapy is focused on promoting the deposition of strong, healthy collagen fibers. In serious cases, surgery is warranted to excise degenerative tissue.

Before one can treat tendinosis, the first couple of weeks should be used to control symptoms. With tendinosis, there may be inflammation of the paratenon (known as paratenonitis), the outer layer of the tendon. This explains why non-steroidal anti-inflammatory drugs (NSAIDs) may acutely reduce symptoms. Unfortunately, these NSAIDs actually inhibit the long-term healing process. As such, they should be used minimally, if at all. (So don't let your doctor load you up on them for extended periods!)

Once pain relief via NSAIDs and/or analgesics, protection (e.g. bracing), rest, ice and compression have been in place for a bit, one can move on to more aggressive therapeutic modalities aimed at promoting collagen synthesis and deposition. In this presentation, Dr. Steinman examined the background and efficacy of five such protocols:

1) Eccentric Exercise: We aren't talking about your 120% 1RM negatives here, so don't get your hopes up. Typically, eccentric exercise protocols are performed for three sets of 15 reps, twice per day, seven days per week, for twelve weeks. Loading should be to maximum pain tolerance, increasing the loading as symptoms improve.

The stress increases metabolic activity of tenocytes, improves collagen alignment, and stimulates collagen cross-linkage. One study that compared eccentric to concentric rehabilitation found that 81% of the eccentric group returned to baseline activity levels by the completion of the study, whereas only 38% of the concentric group was able to do so.

2) Deep Transverse Friction Massage (DTFM): This mode of therapy is purported to decrease adhesion build-up and increase fibroblast recruitment, both of which would theoretically improve collagen strength. Unfortunately, clinical trials have failed to definitively establish DTFM as a valuable part of a tendinosis rehabilitation program.

3) Extra Caporal Shock Wave Treatment (ECSWT): This modality aims to disrupt tissue on the microscopic level in order to stimulate the release of growth factors and the recruitment of fibroblasts. Its main benefit is that it's a short-term therapy; if it works, you don't need NSAIDs, steroid injections, PT, braces, surgery or even multiple office visits. Unfortunately, little standardization of protocols actually exists, and data in support of ECSWT is lacking, especially with respect to long-term effects.

4) Pro-Inflammatory Therapy (Prolotherapy): This treatment modality is based on the injection of growth factor substances such as hypertonic dextrose, talc and phenol. The underlying aim is to stimulate the release of growth factors, firm up abnormal blood vessels, and up-regulate fibroblast activity. Unfortunately, although prolotherapy has quite a following and has shown promise in a few clinical trials with osteoarthritis, more studies are warranted to determine the optimal methodology of delivery and its overall efficacy.

5) Surgery: This method reestablishes normal tissue structure by removing the degenerative tissue and allowing the natural inflammatory process to kick in and regenerate collagen. Rehabilitation is quite lengthy, and may even incorporate some of the aforementioned techniques. As such, this is definitely a last resort.

All in all, I can't help but think that it's just so much easier to train intelligently and avoid the tendinosis in the first place. If something is bugging you, back off the loading for a bit and get some ice on it. Your body will thank you in the long run.

"How to Teach the Olympic Lifts" Gary Valentine, MA, CSCS

Admittedly, I wasn't planning on attending this presentation, as I've been around the Olympic lifts for a few years now. Then I saw the name Gary Valentine as the presenter and changed my plans to catch an earful of what the 2003 World Masters Weightlifting Champion had to say.

If his knowledge doesn't impress you, then a 347-pound clean and jerk and a 264-pound snatch at age 47 ought to get your attention. Plus, he had an attractive female understudy of his demonstrating the lifts, so that swayed me to some extent. Is there anything cooler than seeing a woman move some big weights and act like she loves it? If she'd been wearing a Red Sox hat and told me she liked beef jerky, I probably would've proposed to her right there.

Anyway, here are some key points I took away from Valentine's lecture:

Overall, it was a nice blend of new information and refresher material. Plus, it was very cool to hear Gary discuss the history of Olympic lifting and his decades of experience in the sport.

Free Communications of Note

Impact of Overfeeding and Exercise on Insulin Action

Researchers at UMASS-Amherst did a study on the effects of overfeeding. While exercise training acutely improves insulin sensitivity, short-term overfeeding of three to seven days markedly reduces it. This study sought to determine whether one endurance exercise session could offset the insulin sensitivity decrement imposed by three consecutive days of overfeeding. After establishing baselines insulin sensitivity index (C-ISI) and the area under the curve (AUC) for glucose and insulin with an oral glucose tolerance test (OGTT), subjects consumed about 835 calories more than maintenance intake for three days; the C-ISI and AUC tests were then repeated. Later, the same subjects repeated the protocol, but this time they consumed ~1625 calories over maintenance and exercised off the difference (~788 calories), so that the positive energy balance was similar to the third day in the first protocol.

There were no differences in blood glucose responses under any conditions on the OGTT, but both overfeeding conditions increased the insulin AUC, indicating reduced insulin sensitivity. The overfeeding alone group showed the largest insulin AUC, while overfeeding +Ex intervention decreased this AUC, but not to baseline levels.

Therefore, it appeared that short-term overfeeding significantly blunted the ability of exercise to acutely enhance insulin sensitivity (1). In other words, don't think that rubbing your arse raw on the bike for an hour is going to be enough to offset two months of holiday gluttony.

Role of Testosterone in Regulation of Substrate Use During Exercise

It's well established that men utilize more carbohydrate and less fat during submaximal exercise than women. While research has established a role for estrogen and progesterone in regulating substrate use under such conditions, the role of Testosterone in this regulation remains unclear.

Nine men cycled at 60% VO2max for 90 minutes on three separate occasions. These trials were performed under conditions of low T (a GnRH antagonist was used to suppress endogenous T), physiological T (no intervention), and high T (transdermal T supplementation). Researchers found no differences in carbohydrate or lipid oxidation, blood glucose uptake, or muscle glycogen utilization. As such, they concluded that circulating T doesn't factor in to the gender differences in substrate utilization during submaximal exercise (2).

I think we can go ahead and label this hormone as completely useless, don't you, folks? It's not like it builds muscle, gives us libido, and establishes secondary sex characteristics or anything…

The Effect of a Long Duration Continuous Static Stretch Versus a Short Duration Repeated Static Stretch on the Length of the Hamstring Muscle

In this four-week intervention, researchers found no difference in passive range of motion improvements among one 30-second stretch, two separate 15-second stretches, two separate 30-second stretches, and one 60-second stretch. They concluded that a 30-second stretch is sufficient, and that it doesn't really matter if that stretch is interrupted or continuous; both will improve your passive range of motion (3).

Keep in mind, though, that we're only talking about static flexibility here; you'll need more dynamic flexibility work to improve your active range of motion. Conveniently, this leads me to…

Acute Effects of Different Warm-Up Protocols on Jumping Performance in Female Athletes

Researchers compared three separate warm-ups on their effect on vertical and long jump performance. The first protocol involves traditional low-intensity cycling and static stretching; the second consisted of twelve moderate to high-intensity dynamic movements; and the third utilized the same twelve movements, but with a weighted vest (10% of body weight) added for the last four movements.

The dynamic movements were associated with improved performance on both jumps when compared to the cycling and stretching protocol. While this may seem like old news in light of the past few years' research, it was also interesting to note that performance following the weighted vest warm-up was enhanced over the dynamic movement alone protocol (4).

Without getting into the neuromuscular basis for why this works, I'll just say that a little resistance before power work will go a long way in improving performance.

This ought to hold you over for now. Check back tomorrow for Part II!

About the Author


1. Hagobian, TA, and Braun, B.

2. Gerson, LS, Hagobian, TA, Grow, DR, Chipkin, SR, and Braun, B.

3. Acebedo, D, Buckland, M, Avedisian, L.

4. Thompson, A, Kackley, T, Palumbo, M, and Faigenbaum, A.

Submitted by DMorgan on Sun, 09/09/2007 - 11:22am.

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