Squatting is a fundamental human movement pattern that involves nearly every muscle in the body.

It’s handy for picking stuff off the floor, going to the bathroom, and just hanging out on a traffic cone.

And thanks to exercise science, data show that squats are excellent for building strength, power and mobility.  Full squats can help counteract many of the chronic musculo-skeletal problems we face today, such as weak glutes, hunched back, weak torso, etc.

If a person can perform a full depth squat with their own bodyweight, they’re probably a fairly fit person.

How to squat properly

1. Balance stability and mobility

The prime movers in the squat are the muscles around the hips and knees, but all joints below the belly button (hip, knee, ankle, foot) and most of the spine need both stability and mobility to squat properly.

If any of these areas are unstable or immobile, this can cause squat problems. The table below shows both optimal and faulty patterns for each body part involved.

Source: Kritz M, Cronin J, Hume P. The bodyweight squat: A movement screen for the squat pattern. Strength Cond J 2009;31:76-85.

2. Keep hips mobile

Muscles around the hips help stabilize the pelvis and knees during squats.

If someone lacks hip mobility, they will often lean forward too much when squatting (stressing the spine). Or they will initiate the squat by “popping the butt” up too quickly.

3. Knees follow toes

When squatting, keep knees stable, in line with the hips and feet.

When the knees flare out or cave in (beyond a couple degrees), tendons and ligaments become vulnerable and work extra hard to resist awkward forces.  This is probably why young athletes can “get away” with ugly squats (but this catches up with them as they age).

What your knees should NOT be doing during a squat. Source: Kritz M, Cronin J, Hume P. The bodyweight squat: A movement screen for the squat pattern. Strength Cond J 2009;31:76-85.

Make sure knees follow the direction of the toes. If your toes point out while squatting (which is a normal variation, especially for women with wider pelvises), so should your knees.

Don’t panic if the knees go slightly over the toes, as this can help to ease the movement for the lower back. What’s most important is that your hips are back, behind your heels.

The “squats hurt knees” myth

Many trainers used to recommend against full-depth squats, claiming that it caused knee injury. While forces on connective tissues of the knee increase during a squat, this does not lead to injury.

Squatting to full depth — where hamstrings touch calves, or slightly above — does not make knees looser or strain ligaments. In fact, full-depth squatting probably increases knee joint ligament stability.

There are low rates of knee injuries in competitive weightlifters who often perform deep squats for countless reps each week.

Shear versus compressive forces (or, why leg extensions aren’t a good substitute for squatting)

One key reason that full squats do not hurt knees has to do with the difference between compressive and shear forces.

• Shear force is sideways force. In the case of the knee, shear force would be loads that go crosswise to the shinbone — such as leg extensions (in which the machine’s pad sits on the shins and presses perpendicular to them).
• Compressive force is downwards force. In the case of the knee, compressive force would be loading along the length of the bone — such as in a squat.

Here’s the important point: Joints are better able to withstand compressive forces than shear forces.

In addition, with squats, many muscles fire at once, which also helps to protect the knee joint.

During leg extensions there is only quad contraction and with leg curls there is only hamstring contraction.  This can displace the tibia and stress the anterior & posterior cruciate ligaments (ACL & PCL).

However, during squats, both the quads and hamstrings contract. This helps to balance out the tibia in relation to the femur.  This keeps the ACL and PCL happy and healthy, and can also help rehab damaged ligaments.

Along with loading, shear and compressive forces increase with:

• fatigue;
• poor technique;
• faster rep speed; and
• more resistance.

What does this all mean?

1. Full depth squats, done properly and carefully, at an appropriate speed, are safe.
2. But you might want to quit doing those heavy leg extensions.

4. Keep ankles mobile and feet planted firmly

Ankles help with support and power generation during squats.  Limited ankle mobility can lead to the heels coming off the floor, foot pronation (outside of the foot elevating) and the knees caving in.

Remember to choose footwear that allows you to push through the mid-foot/heel. In general, running shoes are not good squatting footwear — they’re too squishy and don’t provide enough support.

Instead, wear thin-soled shoes (such as Chuck Taylors) or hard-soled shoes (such as Olympic weightlifting shoes). Or, go barefoot (or wear Vibrams).

Pronation from weak/immobile ankles	Arnold and Co. model squatting footwear

5. Keep spine neutral and chest “proud”

Remember the mobility-stability balance? For a good squat, you need lower back stability and upper back mobility.

The angle of the torso should remain relatively constant during a squat (as upright as possible, limiting forward lean). This doesn’t mean straight up-and-down, but rather keeping a natural arch in the spine, folding from the hips (rather than rounding or hunching), and keeping the chest “proud”. As hips go back during the descent, torso will naturally lean forward slightly to compensate.

With an unweighted squat, it’s all right if the lower back slightly rounds in the bottom position.  When you add resistance, especially with a barbell (which pushes the thoracic spine more into extension), you’ll naturally straighten out a little bit. Simply focus on keeping the spine neutral (i.e. a natural S-curve) with minimal rounding.

The lower back is often the weak link for weighted squats, especially in someone with longer legs and a shorter torso.  If you are tall and/or have long legs (in relation to your torso), you may have trouble staying upright with standard barbell back squats. Try a wider stance and/or front squats.

Biomechanics geeks, check out: How Leg Length Affects Squatting

The erector spinae muscles are critical during squats, as they help resist vertebral shear forces.  They can be strengthened (along with other torso muscles) by doing more squats.

Forces on the spine while squatting with heavy weights can be quite high, beyond what most biomechanics equations predict we’re able to support.  But the spine adapts over time to increased loads.

In the image below, you can see:

a) lumbar flexion
b) thoracic extension
c) neutral spine.

Ideally, you’re looking for (c).

Kritz M, Cronin J, Hume P. The bodyweight squat: A movement screen for the squat pattern. Strength Cond J 2009;31:76-85.

Learning to squat

If you have stiff ankles, immobile hips, a weak torso, discomfort, and strange noises in your joints with squatting, then you likely have a faulty movement pattern that needs adjustment.

If squatting results in acute pain, or you lack the mobility/strength to do one properly, swallow your ego and modify the movement (see squat progressions below).

Full depth squats are often safer than shallow squats because it takes less external resistance (and less stress on the joints) to create the same stress on the muscles (thanks to lever arms).  This makes full depth squats ideal for most people.

Exceptions include:

• knee rehab (which should progress to full squats, in most cases);
• extremely long legs in relation to torso; and
• folks who have specific partial-squat-related goals, such as athletes training jump squats.

Full squat	Partial squat

Squat progressions

However, most adults in Western cultures (where people sit instead of squat) don’t squat well when they start. They’ve often lost their natural childhood ability to drop down easily on their haunches.

Thus, many folks have to re-learn how to squat properly.

Here’s a basic overview of the movement.

Start standing, with good posture. Feet can be anywhere from close together, with toes pointed forwards, to wide, with toes pointed out. Experiment and find which foot placement works best for you.

1. Take a deep breath, lifting the ribcage.
2. Keeping this “proud chest”, push the butt back first and then sit down. (Imagine sitting down in a chair that’s not there, or sitting down on the toilet.)
3. Let the torso tip forward naturally from the hips as the butt shifts back.
4. Keep heels down.
5. Go down until your hamstrings touch your calves. (Or as far down as you can go, for starters.)
6. Drive through the heels, and keeping chest “proud” and head up, ascend.

Here is a helpful step-by-step progression for learning the squat: Lurn To Squat Good — E-Zy!

Squat variations

The squat isn’t a single exercise — it’s an exercise concept. By mixing up the loading (overhead, front, back, dumbbells held at the sides, etc.), form (1 or 2 legs), speed, foot placement, etc. you can have a hundred (or more) variations on the basic idea.

Plate squats

Plate squats encourage upright posture and appropriate load distribution.  Hold the plate parallel to the ground. If the plate tilts downwards, you’re probably rounding your back.

To be a real hardass, try balancing a ball on top of the plate, as shown in the photo below.

Use a light plate. You aren’t doing this movement to show off for gym peeps.

Source: Chiu LZ & Burkhardt E. A teaching progression for squatting exercises. Strength Cond J 2011;33:46-54.

Goblet squats

An option for those who have trouble with standard squats, as well as a great warmup or beginner squat variation.

Back squats

In the classic back squat, the barbell sits on the traps/upper back, not on the neck.

Jump squats

If you want a powerful leg contraction, jump.

Adding resistance to jumps can increase power output and jump height.  When it comes to optimal jump squat form, thighs usually don’t go below parallel.

To load the jump, weighted vests are ideal. You can also hold dumbbells, though it’s somewhat more awkward. Barbell and Smith machine jump squats tend to be the most dangerous, because of the loading on the spine.

Zercher squats

An option for those who have trouble with standard squats. Also handy as sport-specific training for wrestlers, especially if you use a sandbag instead of a bar.

Front squats

In the front squat, the weight sits at the top of the front of the shoulders, in the “groove” between deltoids and collarbone.

Because the torso stays more upright in front squats, this style of squatting minimizes compressive forces on the spine and knee joints.

If the barbell begins rolling forward from the shoulders, there is a lack of mobility and/or torso strength.  Many people think wrist range of motion is the limiting factor here, but it’s usually tight internal shoulder rotators (pec major, lats, teres major, subscapularis). Work on keeping elbows high throughout the movement.

See also the table below for front squat errors and corrections.

Source: Waller M & Townsend R. The front squat and its variations. Strength Cond J 2007;29:14-19.

Overhead squats

Great for developing full body mobility, balance, and strength. Plus it just looks cool.

1-leg squats

When you’ve mastered two legs, try one. Working one side at a time can increase demands from supporting hip muscles.

Shrimp squats

Pistol squats

Bulgarian split squat

Place one foot behind you on a bench or step. Use this nonworking leg for balance only — drive through the front leg.

With added range of motion:

Summary & recommendations

The squat is a basic human movement. Performing it makes you better at athletics, fitness, and life in general.

If you want to get better at the squat, practice.  Practice helps to coordinate movement, and builds the mobility you need to do the movement properly.

Start with a squat progression, such as squatting down to a step. Make it your goal to get as full a range of motion as possible — even though this may take time.

Every body type is different. Try a variety of squats, stances, and ranges of motion.

Focus on form and proper technique, not piling on weight to impress your gym buddies. Check your ego at the door.

Do your mobility drills.  A body with poor mobility is a body that will likely get injured with squats.

Full squats are often safer than shallow squats. The deeper you go when squatting, the more muscles recruited.

Control the descent and reverse the movement carefully. Don’t rely on your ligaments to bounce you out of a deep squat.

Think about how the squat helps your fitness and performance — don’t focus too much on how much you can lift. The squat technique that allows you to lift the most weight isn’t necessarily the best or most appropriate option.

Keep it simple. Even babies can squat. Don’t over-think it.

Troubleshooting the squat

When you’re working on learning the squat, try snapping photos or videotaping yourself. This can provide invaluable feedback.

Trouble getting a comfortable squat pattern?

• Try a wider stance, with toes pointed out a little (remember knees follow toes).
• Use natural foot positioning (similar to other athletic movements), with toes slightly out.
• Keep heels on the ground. If need be, put small plates under your heels until you develop better mobility in hip and ankle joints.
• Control squat speed, using a 2-3 second descent (unless your sport/activity demands another style).
• Maintain a neutral spine.
• Take breaks — fatigue can result in poor mechanics.
• Keep your hands close to your body.
• Look forward and keep your head up.
• Work on mobility drills for ankles, hips and the thoracic spine (All About Dynamic Joint Mobility).
• Use squatting progressions (see above).
• Get a coach who can help.

Trouble keeping the weight on your heels?

• Build hip mobility.
• Build core stability.
• Build ankle mobility.
• Build thoracic spine mobility (All About Spine Health).
• Take off your shoes or get a thin soled shoe.
• Keep your chest proud and core tight.

Trouble squatting deep?

• Get your body warmed up (All About Warming Up).
• Widen your stance and rotate your toes out.
• Think about squatting between your legs.
• Build ankle, thoracic spine, and hip mobility.
• Build core stability.
• Start the squat by sitting your hips back.
• Try box squat progressions (high to low box).
• Drop the amount of resistance you’re using.

Do your knees cave in during squats?

• Place a light band around knees as a guide (video).
• Strengthen the hip abductors/glutes.
• Focus on keeping the knees out and “spreading the floor”.
• Drop the amount of resistance you’re using.

Further resources

From Dork to Diva: The Squat (fellas, you can benefit from this article too):

Dan John squatting seminar

Hours of biomechanics fun

Other PN articles on squats and knees:

• Big Squat, Fast Sprint?
• All About The Knee
• Research Review: Front or Back Squats?

For extra credit

The squat has been shown to be effective during the rehab process of cruciate ligaments and/or patellofemoral injuries, with the most effective range of motion between 0 and 50 degrees of knee flexion (see image at right).  The vastus medialus oblique (VMO) tends to be activated more during partial squats.

The ultimate tensile strength of the patellar tendon is about 10,000 to 15,000 N.  The highest recorded compressive forces were obtained in a study of powerlifters lifting 2.5 times their bodyweight – about 8,000 N at full squat depth.

The greatest risk of injury with full depth squats is probably to the menisci and articular surfaces of the knee rather than the ACL/PCL.

Strong hamstrings can help to increase knee stability during the squat.

Stress on the knee ligaments can be decreased by keeping the heels on the ground

Peak quad involvement during squats is from the upright position down to 90 degrees knee flexion.  Beyond that, the hamstrings and glutes contribute most.

Foot placement (toes in, out, straight) doesn’t seem to influence muscle activation. Only a very wide stance incorporates more of the adductors.

References

Schuna JM & Christensen BK.  The jump squat: Free weight barbell, Smith machine, or dumbbells? Strength Cond J 2010;32:38-41.

Chiu LZ & Burkhardt E.  A teaching progression for squatting exercises.  Strength Cond J 2011;33:46-54.

Learning the Squat 1: Debunking the myths.  Krista Scott-Dixon.

Why squat? Krista Scott-Dixon

Goblet squats 101.  Dan John.  http://www.t-nation.com/free_online_article/most_recent/goblet_squats_101

Squat like you mean it: Tips for a deeper squat.  Tony Gentilcore.  http://www.t-nation.com/free_online_article/most_recent/squat_like_you_mean_it_tips_for_a_deeper_squat

Salem GJ & Powers CM.  Patellofemoral joint kinetics during squatting in collegiate women athletes.  Clin Biomech (Bristol, Avon) 2001;16:424-430.

Leg training myths exposed.  Alwyn Cosgrove.  http://www.t-nation.com/free_online_article/sports_body_training_performance/leg_training_myths_exposed

Kritz M, Cronin J, Hume P.  The bodyweight squat: A movement screen for the squat pattern.  Strength Cond J 2009;31:76-85.

McBride JM, et al. Relationship between maximal squat strength and five, ten, and forty yard sprint times. J Strength Cond Res 2009;23:1633-1636.

Gullett JC, et al. A biomechanical comparison of back and front squats in healthy trained individuals. J Strength Cond Res 2009;23:284-292.

Escamilla RF. Knee biomechanics of the dynamic squat exercise.  Med Sci Sports Exerc 2001;33:127-141.

Comfort P & Kasim P.  Optimizing squat technique.  Strength Cond J 2007;29:10-13.

Escamilla RF, et al.  Effects of technique variations on knee biomechanics during the squat and leg press.  Med Sci Sports Exerc 2001;33:1552-1566.

Five habits of defective squatters.  Mike Robertson.  http://www.t-nation.com/free_online_article/sports_body_training_performance/five_habits_of_defective_squatters

The squat: Good exercise gone bad?  Nate Green.  http://www.t-nation.com/free_online_article/sports_body_training_performance/the_squat_good_exercise_gone_bad

Fleming BC, et al.  Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction?  Exerc Sport Sci Rev 2005;33:134-140.

Schoenfeld BJ.  Squatting kinematics and kinetics and their application to exercise performance.  J Strength Cond Res 2010;24:3497-3506.

Waller M & Townsend R.  The front squat and its variations.  Strength Cond J 2007;29:14-19.

10 tips for flawless squattin’.  Mike Robertson.  http://www.t-nation.com/free_online_article/sports_body_training_performance/10_tips_for_flawless_squattin

Deep squatting – part 1. Anders Hansson.  http://www.athleticdesign.se/athletics/squat_article_1_english.html

Click here to join the waiting list.

1. Mobile joints above and below the knee
2. A strong knee joint
3. Proper mechanics during physical movement

That about sums it up.

What is the knee?

The femur, tibia, and patella come together to form the knee joint. The width of the knee joint allows the structure to handle greater loads.

The patella is your “kneecap” and sits within the quadriceps tendon, providing an enhanced mechanical advantage when the quads are contracted. The back side of the patella is a smooth surface made up of hyaline cartilage. This is important during knee movements: flexion, extension, and rotation.

The knee ligaments, capsule and menisci help to keep your knee joint together.

The value of exercise

Our bodies respond to the stresses that we place on them. If you exercise regularly, you inspire turnover and growth of knee structures (muscles and connective tissue). This is a good thing. To keep the knee joint healthy, you need to balance exercise loading, frequency, activity type, and rest/recovery.

For instance, if you keep pounding out the hard miles doing only distance running every day, you’ll probably end up with tendonitis. On the other hand, if you sit around all day, you’ll also risk knee injury from weakened knee structures and the pressure of the kneecap on the thighbone in the seated position (aka “movie theatre knee”).

For healthy knees, get regular daily activity, keep the joint moving through a full range of motion, and do different things.

Knee ligament anatomy

Knee Ligament Anatomy Animation

Four main ligaments provide stability and prevent excessive movement of the knee.

1. Anterior cruciate ligament (ACL) – prevents the tibia from moving forward
2. Posterior cruciate ligament (PCL) – prevents the tibia from moving backward
3. Medial collateral ligament (MCL) – prevents excessive inward movement of the knee joint. This is the most commonly injured knee ligament, but it can usually heal without surgical intervention.
4. Lateral collateral ligament (LCL) – prevents excessive outward movement of the knee joint

Knee ligaments are tiny. The ACL and PCL are only 6-14 millimeters wide.

Two crescent- shaped rings of cartilage comprise the menisci. The menisci provide knee stability, distribute weight from the femur to the tibia, act as shock absorbers, and spread synovial fluid. Just like other types of cartilage, they can be torn.

It’s not just ligaments that keep our knee intact. The quadriceps, hamstrings and calves enhance stability too. When these muscles are strong, we are able to rely less on the passive structures, like ligaments, to resist unwanted movement.

What you should know about the knee

Most knee problems develop over time, not just on a random day in your basement during a dance-a-thon. This is repetitive trauma (think: wear and tear), and any mechanical device (including the knee) will fail with excessive strain. One in three sports-related injuries occurs at the knee.

Warming up and dynamic joint mobility

Warming up and dynamic joint mobility seem to be important for knee health. These practices help to control inflammation, distribute joint fluid, develop structures around the joint, and enhance range of motion.

Resistance training

Resistance training through a full (and mechanically correct) range of motion is essential for healthy knees. Weight-bearing exercises can help to promote joint stability and strength.

However, poor technique (including going too heavy in a partial range of motion) and too-heavy or too-frequent resistance training without adequate recovery can damage the knee joint. Don’t keep hammering away at those squat one-rep-maxes too often — mix up the movements and the loading.

And remember that your legs move in more than one plane! Try asymmetrical and one-legged movements such as:

• “star” lunges or jumps (stepping/jumping out to the side or on a diagonal)
• stagger-stance squats, wrestling shoots
• side/diagonal step-ups on to platforms
• zig-zag jumps and runs, etc.

Common knee problems

Patellar tendonitis

Get ready for this knowledge bomb: Tendonitis is the inflammation of a tendon. Who knew? This often takes place with repeated stress and loading (translation: overuse). Ice, adequate recovery between workouts, and developing mobility can help. You can reduce discomfort by limiting the range of motion during exercises, but ideally you want to work your way back to a full,  healthy range. You can also use static holds and eccentric training.

Chondromalacia patella/kneecap pain

You’ll often notice this with climbing stairs, walking down hills, or sitting. This is the progressive destruction of hyaline cartilage on the backside of the kneecap. You might hear snapping, popping and cracking noises when you bend your knee. Perfect technique on lower body exercises and reducing the range of motion (with the eventual aim of increasing that ROM) can help. Women tend to suffer from this condition more than men.

Torn meniscus/removal of meniscus

Meniscus problems often manifest as a catching or grinding sensation in the knee. Since a meniscal injury can cause pain, catching and swelling, many people opt for surgery to remove torn bits. Menisci lack blood supply except at their outer rim, so they often heal poorly when torn. Heavy vertical compressive loads (e.g. heavy squatting, jumping) can interfere with healing. Use a limited, gradually increasing range of motion and minimal resistance while recovering.

Ligament problems

ACL injuries are common in sports with running and jumping, such as basketball and soccer, or with twisting/lateral forces on the knee, such as downhill skiing. Women suffer ACL injuries more than men because their knee joints tend to be looser; however, learning and practicing proper running and jumping form can greatly reduce the risk.

ACL repair is a biggie, since it cannot simply be sewn together after it tears (try attaching two mop ends). Rather, ACLs are reconstructed with borrowed tendons.

It may be months before progressive resistance training can be re-introduced after an ACL repair. Rehab for ligament injuries often involves partial range of motion exercises and hip/hamstring strengthening. While open chain exercises might serve a purpose in limited rehab settings, use is reserved until post-operative knee function is assessed.

Mild sprains can occur when a ligament is overstretched or partially torn and recovery consists of rest and ice. Workouts resume when tolerated once the knee feels better.

Arthritis

While breakdown and inflammation of knee joint cartilage can take place with advancing age, it doesn’t mean pain and disability soon follow.

The elephant in the room with most arthritis is body weight. A higher body weight is strongly associated with knee arthritis. If your BMI is above 30, chances of developing arthritis go up nearly 4 times. More body mass requires more plantar flexion and a shorter stride. This leads to hamstring dominant knee stability. Not good. An abnormal positioning of the feet during walking and running is also common in those who carry extra pounds. The toes can rotate out (duck walk) or in (knock-knee, aka valgus), both of which can cause knee injury and diminished mobility.

What to do for knee health

Check your shoes and how you walk

A non-bouncy and relatively flat shoe sole can assist in balance and integrity around the foot and ankle. There is emerging interest in barefoot/minimally shod walking — the theory is that the more sensory input comes through the soles of the feet, the more the body can perceive and correct deviations in position.

Messed up shoes, feet and ankles can lead to messed up knees. In fact, too much cushioning in a shoe could be a problem; it’s harder to stabilize feet in squishy shoes.

“Duck feet” or the opposite, “knock knees” and excessive heel strike when walking/running can cause knee problems.

Check your squat

Learn good squat technique and use it. Don’t sacrifice good technique for adding more weight, especially in a partial range of motion.

Keep your hips behind your heels — sit back into the squat. The farther forward the knees, the greater the force on the knee joint. The goal is to keep shins closer to vertical, although Olympic weightlifters tend to squat with a slightly greater shin angle.

Good squat form

Good squat form

Squatting with a serious forward shin lean (aka the “campfire squat”) can be safely done unweighted, but it puts a lot more stress on the knee joint — we don’t recommend you try it with heavy weight.

Free weight squatting seems to activate muscles around the knee more than machine squats.

The back squat results in higher compressive forces at the knee joint, compared to the front squat.

Squatting on a decline or with something under your heels maximizes load on the patellar tendon and minimizes glute recruitment.

Back squat	Front squat
Squat with heel elevation
Just plain awesome

A wide stance and greater range of motion when squatting can elicit more hip musculature. If you squat wide, you’ll probably find it most comfortable to turn the toes out slightly — be sure that your knees are following the direction of your toes, and don’t let the knees cave in.

Going down to where hamstrings contact the calves (rather than stopping and reversing direction at parallel) seems to be the safest position for knees during weighted squats. This will need to be adjusted based on length of femur, tibia, and torso. Once the lower back starts to lose its lordotic curve, you are likely going too deep.

Check your muscle balance

Many physios say that the knee is the “outlet valve” for the hip. Knee problems may actually be hip problems.

Most people have stronger quads than hams and glutes, making knee stability unbalanced. Counteract this with strong hips. Strengthening the hips two times per week for six weeks reduced patellofemoral pain for one group of athletes. The following exercises can strengthen the hips:

Hip Bridge

Dumbbell Step-Up, Alternating

Single-Leg Stiff-Leg Deadlift, Weighted

X-band walks

Band stomp

But don’t completely neglect the quads. Weak quads can lead to an unstable knee joint. And an unstable knee joint can lead to weak quads. It’s a vicious cycle. The vastus medialis obliquus (VMO) is a key knee stabilizer.

Activating the VMO can be tricky. Try terminal knee extensions (TKEs) and backwards walking (even better on an incline) to start.

After you master TKEs and backwards walking, full range of motion squats and single leg exercises can help develop the VMO (well, when proper form is used).

Activating the muscles surrounding the knee can be tough with a wider Q-angle. The Q-angle is the relative angle between the hip and knee, and problems can arise when it’s larger (i.e. the femur has more of a tilt). This is one of the reasons why female athletes — who have wider pelvises than male athletes — are more likely to suffer an ACL injury.

Check your flexibility/mobility

We need mobile joints and soft tissues around the knee to accommodate enough movement.

In your life you’ll have a personal standard for knee flexibility depending on what you do (professional chess player vs. collegiate pole vaulter). But if you can’t do a full squat, you probably have limited mobility.

Joint mobility can be good, but we don’t want excessive joint mobility at the knee joint itself. However, limited mobility can affect proper range of motion, which alters knee mechanics. Thus, we want a balance between mobility/movement and stabilization.

We can improve the knee’s range of motion with flexibility exercises and building mobility at surrounding joints. (See All About Dynamic Joint Mobility.) Conversely, we reduce the knee’s range of motion by being inactive — especially if we sit all day, which shortens the front of the hips and “turns off” the muscular contribution from hips. This alters hip mobility and the knees pick up the slack.

Improving hip mobility is one of the most crucial things you can do to improve knee health. Stretches for the hip flexors:

Lunge with knee on pad

Mermaid/one legged king pigeon (advanced)

Anterior/posterior leg swings

Warrior lunge with reach

Side to side leg swings

Bow pose

Back dome (starts at 2:00 in video – no resistance)

Don’t neglect ankle mobility either. Like the hips, the feet/ankles can affect the kinetic chain. Flexibility exercises for the ankle:

Wall knee taps

Elevated ankle stretch

Foam rolling for the tibialis anterior (about ¾ down the page)

Summary and recommendations

Healthy knees require…

…mobile joints above and below the knee.

• Work on hip and ankle mobility exercises.

…a strong knee joint.

• Do full range squatting movements.
• Train the quads, making sure to activate the VMO.

…a strong posterior chain.

• Train your hips, hamstrings, and glutes.
• Include single-leg work.

Don't forget that posterior chain!

…proper mechanics during physical movement.

• If it hurts your knee, avoid it (but work on your underlying biomechanics and solving the fundamental problems).
• Check your gait and shoes.
• Learn and practice proper running, jumping, and exercise form.

In general, if your knees are already in pain, the rules of exercise modification include decreasing the resistance, adjusting the range of motion, controlling the speed, reducing the volume of work, and/or changing exercises.

For healthy knees, get regular daily activity, keep the joint moving through a full range of motion, and do different things.

Extra credit

Closed chain exercises can reduce the anterior directed forces acting on the tibia in relation to the femur, increase compressive forces between the tibia and femur, increase co-contraction of the hamstrings and quads, mimic daily functional activities more closely, and reduce the incidence of patellofemoral complications. (Translation: training real-world movements like squatting and walking uphill puts the correct forces on the knee, recruit the right muscles, and keep your knees happy.)

Proprioception helps to protect the knee from injury and joint damage. Develop proprioception by doing single-leg lower body exercises, wearing a knee sleeve (for additional sensory input) or standing on one leg while you brush your teeth and floss.

Forces on the knee can range from about twice your body weight during normal walking, to more than four times your body weight during running and jumping activities.

Knee wraps and sleeves can help to promote warmth and blood flow at the joint, as well as provide proprioceptive cues. However, taping and loosely wrapping the knees will not provide much stability, so don’t rely on this.

Heat applied to the knees pre-workout can help make tissues more elastic.

Be careful with plyometrics if you’re overweight or your knee is injured.

Further resources

Nick Tumminello’s Joint Friendly Strength Training DVD

Big legs with bad knees

Mike Robertson’s Knee Basics Part 1 |  Part 2 |  Part 3

References

Schwanbeck S, Chilibeck PD, Binsted G. A comparison of free weight squat to Smith machine squat using electromyography. J Strength Cond Res. 2009;23:2588-2591.

Gullett JC, et al. A biomechanical comparison of back and front squats in healthy trained individuals. J Strength Cond Res. 2009;23:284-292.

Paoli A, Marcolin G, Petrone N. The effect of stance width on the electromyographical activity of eight superficial thigh muscles during back squat with different bar loads. J Strength Cond Res. 2009;23:246-250.

Caterisano A, et al. The effect of back squat depth on the EMG activity of 4 superficial hip and thigh muscles. J Strength Cond Res. 2002;16:428-432.

Escamilla RF. Knee biomechanics of the dynamic squat. Med Sci Spots Exerc. 2001;33:127-141.

Senter C, Hame SL. Biomechanical analysis of tibial torque and knee flexion angle: implications for understanding knee injury. Sports Med. 2006;36:635-641.

Robertson M. Bulletproof Knees. 2007.

Shankman G. Training guidelines for strengthening the injured knee: Basic concepts for the strength coach. NSCA Journal 1989:11:32-42.

Johnson J. Treat your own knees. Hunter House Publishers. 2003.

Messier SP. Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Rheum Dis Clin North Am 2008;34:713-729.

O’Neill DF. Knee Surgery: The essential guide to total knee recovery. St. Martin’s Press. 2008.

Garrett J & Reznik B. Knee pain: The self-help guide. New Harbinger Publications. 2000.

Fleming BC, Oksendahl H, Beynnon BD. Open- or closed-kinetic chain exercises after anterior cruciate ligament reconstruction? Exerc Sport Sci Rev 2005;33:134-140.

Visnes H & Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper’s knee): a critical review of exercise programmes. Br J Sports Med 2007;41:217-223.

Dierks T. Presentation – American College of Sports Medicine Annual Meeting, 2010.

Lange AK, Banvanseele B, Fiatarone Singh MA. Strength training for treatment of osteoarthritis of the knee: A systematic review. Arthritis Rheum 2008;59:1488-1494.

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Dynamic Joint Mobility (DJM) is when someone actively moves a joint through its range of motion (ROM), and where the goal is, with precise movement practice, to improve the joints’ mobility.

DJM is not:

• statically holding a joint in position
• moving a joint through partial ROM
• having the joint passively moved through its ROM by someone or something else

DJM: A brief history

DJM has a long history, mainly as an integral part of martial arts practices such as T’ai Chi, Qi Gong and Bagua zhang.

It’s even part of modern martial arts like Russian Systema, particularly the floor movements.

Beyond bodyweight movements, there has been a resurgence of interest in Indian clubs for upper body and shoulder rehab (see DVD in resource section below). Club practices move body joints in multiple planes and through a full ROM.

The late 19^th to early 20^th century physical culture of richer joint movement that included calisthenics, rope climbing and club swinging waned by the mid 20^th century. Exercising in gyms since then has largely become about training in limited planes and ROM.

In the 21^st century, specific joint mobility practice outside the martial arts context via programs such as Intu-flow, Super Joints, Spiralflow and Z-Health have been developed. These programs are designed to re-introduce joint mobility practice and overcome limitations of restricted gym movements and sedentary lifestyles.

Why is dynamic joint mobility important?

Our bodies are plastic: we constantly adapt to what we do. This adaptation shows up when we learn new physical skills and build new body tissues. The principle applies to our brains and nervous system, too. We are “use it or lose it” organisms.

Our design is so physically interconnected that what happens at one site cascades to others.

For instance, if the movement in our ankle joints is restricted from normal ROM, this can impact our gait. To make up for this restriction, our knees and/or hips may change movement to support the missed job of the ankles. We practice this compromised gait many times a day, causing our muscles and related tissues to adapt to support our “special” gait.

This adaptation may have painful consequences: our knees may hurt from a walk that moves those joints outside a normal ROM. Likewise, our hips may be pulled out of their normal pattern emerging as low back pain.

This cascade is often why movement specialists will say “the site of pain is not always the source of pain.” Compromised joint ROM is often seen with limited squat depth and poor running economy.

As use-it-or-lose-it organisms, we get the body we practice having.

On the plus side, this means that better practice = better body.

By practicing joint mobility with intent, we re-educate and rehabilitate our movement towards a healthier ROM.

Left: Demonstrating how to identify joint locations for a DJM movement (an outside toe pull here).	Right: Demonstrating one way to position the foot to hit the outside toe pull properly.

Source: From R-Phase DVD.

Benefits of DJM training

Proprioception/Sensory motor benefits

Beyond the physiological benefits of moving joints through their ROM, joint work helps us neurologically: joints are key triggers for sensory-motor perception. We experience the world in a sensory-motor hierarchy of visual (vision), vestibular (balance) and proprioceptive (where we are in space) systems. Joints have a very high number of proprioceptive nerves that tell the brain where we are in space and how fast each part of us is moving.

Reducing injury

Studies on ankle mobility have shown that athletes who practiced enhancing mobility/proprioception in their ankles reacted better to simulated stumbling than those who had not. Likewise, mobility work as part of balance and resistance training in elderly women at risk of hip fractures was found to have a profound effect on reducing the incidence of falls.

Micro DJM

To counterbalance high repetition typing/writing, someone can use “micro DJM”.

Typing is largely finger flexion without finger extension. Mobility drills designed for the wrists, hands and fingers help us get in repetitions that balance extension or flexion with up, down, side to side, and back and forth, movements that are all part of this joint’s capacity. These simple strategies can restore mobility around the joints and reduce the effects of associated conditions like repetitive strain injury.

Jammed joints and reduced strength

The nervous system is designed for survival first, not performance. If the nervous system detects a problem in its function – like a joint that is not able to move properly – it more or less cuts down power to the rest of the system (so the compromised component doesn’t put the system at risk).

This shutdown is global. A jammed joint in the foot can be seen in reduced quad muscle strength. Conversely, opening up the jammed joint can bring the power back on line. This phenomenon was first noted decades ago and labelled the “arthrokinetic reflex.”

Here, PN Moderator and Z-Health Master trainer Mike T Nelson demonstrates the effect of jammed and unjammed joints on any other muscle’s performance.

How does DJM compare to…

…stretching?

Stretching has emerged as a dominant form of warm-up and cool-down. If someone has restricted ROM when doing a lift, we hear about “tight muscles” needing to be “stretched out.” We know, however, that there are times (such as before a heavy lift) when elongating a muscle is not optimal. See more: All About Warming Up.

DJM can improve performance without the potential negatives of static stretching. A DJM movement such as the outside toe pull (described here, shown above) can have a direct effect on the hamstrings to increase ROM at the hip.

…foam rolling?

Foam rolling is an increasingly popular strategy to work what is presumed to be restricted fascia, trigger points and/or again “tight” muscles. These approaches often tend to focus on the site of the issue as the source of the issue, without necessarily exploring why this tightness has evolved in the first place.

By working on joint mobility across the body, areas previously seen to be persistently tight begin to open up and, importantly, stay open. Further, foam rolling, from the body’s perspective, is passive – it’s an act being done to part of the body by something else – thus, less of the nervous system is involved in the movement.

Active vs. passive body mechanics

DJM is an active model, rather than passive, meaning that the body is actively engaged in movement and therefore firing up more neurons to learn how to reproduce these movement patterns on its own. It’s the difference we experience between someone putting their hands on our wrists and guiding us through a tennis swing, for instance, and doing it ourselves.

Below: Eric Cobb demonstrates differences between active vs. passive therapy in Essentials of Elite Performance Mini Course

Proprioception & pain

Pain is part of neurological signalling triggered by another proprioceptive nerve, the nociceptor.

Typically, there are more mechanoreceptors (nerves that sense touch, movement, and position) around joints than nociceptors. Mechcanoreceptive nerves send their signals several hundred times faster than most nociceptors. This means that proper joint movement can send a far stronger signal, faster, to the body than a pain signal can.

Summary and recommendations

1. Dynamic joint mobility is important for overall wellness and function.

We have seen that one jammed joint anywhere reduces the strength of the body everywhere, but freeing this joint immediately improves performance. Our bodies are designed to move through a large ROM and various planes of movement.

Sedentary bodies rarely experience this full ROM in all joints. Since our bodies are designed to adapt to what we do, lack of movement can quickly develop into movement restrictions that have associated effects on well being, from tight muscles to arthritis.

2. This same plasticity, however, can quickly adapt to movement practice.

A deliberately designed DJM practice has tremendous and rapid benefits for well being, and re-educating our bodies about how our limbs are supposed to move. Such programs can be time efficient and move each body joint through its ROM in just 10 minutes.

A shoulder mobility sequence from Z-Health

3. Find a mobility coach.

Mobility practice, like any movement, requires skill development. While there are DJM programs available on DVD, for guidance and support, a coach can ensure quality of movement and accelerated progress (listings below).

Resources

Linked Listing for movement coaches (PN’s guidelines on how to pick a personal trainer apply here, too).

Cobb, E, Mauck, K, Mauck , Z-Health Neural Warm Up 1 and R-Phase Package (DVDs and manuals). Z-Heath Performance Solutions, Arizona USA, 2006.

Cobb, E, Mauck, K, Mauck, S. The Essentials of Elite Performance (DVD Mini-Course) Z-Heath Performance Solutions, Arizona USA, 2010.

Jones, Brett, Cook, Gray . Club Swinging Essentials (Featuring Ed Thomas) (DVD). Functional Movement, Virginia, USA, 2010

References

Anderson, Owen “Can proper proprioceptive training reduce your probability of injury?” Sports Injury Bulletin. (no date, but post 2001).

Blakeslee S & Blakeslee M. The Body Has a Mind of Its Own: How Body Maps in Your Brain Help You Do (Almost) Everything Better. Random House, NY, 2008.

Baszanowski, W., ed. 8 European Weightlifter Federations: a Brief History of Their Centenaries. Special Issue. European Weightlifter, EWF Secretariat. 2005 (pdf).

Butler D & Moseley LG. Explain Pain. Noigroup Publications, Australia, 2003.

Cobb, E, Pincus, R. The SPEAR System and Converting Flinch Response. Law and Order. 2003.

Colvin, What it takes to be great, Fortune Magazine, October 19 2006.

Doige, Norman. The Brain that Changes Itself. Penguin, Middlesex, UK, 2007.

Deliagina, T. Neural Bases of Postural Control. Physiology 2006;21(3):216-225.

Frost HM. From Wolff’s law to the Utah paradigm: insights about bone physiology and its clinical applications. Anat Rec 2001;262(4):398-419.

Karinkanta S, et al. A multi-component exercise regimen to prevent functional decline and bone fragility in home-dwelling elderly women: randomized, controlled trial. Osteoporos Int 2007;18(4):453-62.

Lederman, E. Neuromuscular Rehabilitation in Manual and Physical Therapies: Principles to Practice. Churchill Livingstone, London, 2010.

McIntosh, G., Hall, H. “Low Back Pain,” Clinical Evidence, BMJ Publishing Group Limited. Oct 2008.

Myers, T. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 2^nd Ed CHURCHILL LIVINGSTON London & New York, 2008.

Ostry DJ, et al. Somatosensory plasticity and motor learning. The Journal of neuroscience: the official journal of the Society for Neuroscience 2010;30(15): 5384-5393.

Riemann BL, & Lephart SM. (2002) The Sensorimotor System, Part II: The Role of Proprioception in Motor Control and Functional Joint Stability. Journal of Athletic Training 2002;37(1):80-84.

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Kettlebells are iron or steel balls with flattened butts on one end and a curved handle on the other.

Kettlebells are used both for general athletic training and competitive sport. They facilitate whole body dynamic movement for strength, endurance, and power training. They are used by sports teams, those who train at home, world class athletes, and folks who want to burn fat and build muscle.

Kettlebells: a brief history

Humans probably devised a kettlebell-type object — a weight with a handle — not long after they figured out how to use their opposable thumbs.

Kettlebells, or things that seem to look like them, have been found in excavations of ancient Greece. It’s thought that implements like them were used in Russia initially as grain measures, with the approximately 16 kg, or one “pood“, being the standard measure.

Modern kettlebell manufacturers generally respect these weight conventions; thus kettlebell sizes range in 4 kg increments around the 16 kg “1 pood” standard (e.g., 12 kg, 16 kg, 24 kg and 32 kg). However, manufacturers are increasingly producing sizes in between the standards – like 14 kg and 28 kg, and masses as great as 60 kg kettlebells.

From obscurity to mainstream

Kettlebells have a long history in Europe and Russia from the 1700s onward, and were a feature of European gyms and strongman performances in the late 19th and early 20th century. Now, they are perhaps best known for their association with late 1940s Russian physical culture.

Their popular introduction to North America in the 21^st century is largely credited to Pavel Tsatsouline, a Russian émigré, Special Forces trainer and coach. Along with his book The Russian Kettlebell Challenge (see references below), Tsatsouline concurrently began offering classes and a kettlebell trainer certification known as the RKC, now the oldest and most established kettlebell certification in North America.

Since their introduction in the West, kettlebells have slowly begun to emerge as a mainstream training tool with numerous trainer certifications being offered. Likewise, what is known as Girevoy Sport (GS) kettlebell competitions as formalized in Russia around the mid 1980s have started being held in North America. Valery Fedorenko is credited with the sport’s presentation in North America and is now mainly promoted through what has become the World Kettlebell Club.

Why are kettlebells important?

Because of their design, kettlebells enable many familiar movements from pushes like the shoulder press to pulls like Renegade Rows. Yet, they also support whole-body, dynamic weighted movements, once the specialized preserve of Olympic barbell lifters.

The kettlebell swing

For instance, the foundational kettlebell movement — the swing — starts with a posture and hip drive similar to the deadlift or Olympic clean, but the cannonball-with-handle kettlebell design means that this weight can be swung up from between the legs, driven by the hip thrust forward to about chest height, and then accelerated down again by the shoulders pulling the weight down, back through the legs, then driven back up again with the hips, back and forth for reps.

Depending on the mass of the kettlebell used, sets of swings are either very low-rep (3-5) with adequate recovery breaks, or high-rep (anywhere from 10-100 or more for time), depending on the energy system/strength type being trained. This demonstrates the versatility of the kettlebell — the same movement can be used for everything from maximal strength, to strength-endurance, to “cardio” or metabolic conditioning.

Hanging onto the kettlebell during swings also works the grip and forearms. Kettlebell swings can also be performed with two hands on one bell, one hand/one bell, or one bell in each hand for two bells at a time (doubles).

The Beautiful Swing
More Beautiful Swings

Other dynamic kettlebell movements like the snatch and the clean and jerk also develop full body strength, power and endurance, and besides being used for general conditioning, are the core kettlebell competition moves.

Kettlebell advantages

The primary advantage of kettlebell training is its efficiency. While it’s helpful to have a few kettlebells of different weights, one bell alone can give you a darn good workout.

• They are a room efficient gym: if there is room to swing a cat, there’s room to swing a kettlebell.
• By varying weights used, you can use the same movement for cardio, strength-endurance, speed, or power.
• You can do presses, pulls, squatting-type movements, and dynamic work.
• Because dynamic kettlebell movements involve the whole body, you work upper and lower body strength concurrently and time effectively.
• Because these are compound moves, you must engage antagonist, agonist and support muscles.
• The hip drive focus is also particularly useful for working the core and “posterior chain” — the muscles of the spine, butt, and back of the legs.
• The focus on form for shoulder work helps strengthen and stabilize the shoulder joint.

Cautions

Some people immediately fear for a lifter’s back when they see any dynamic movement of a weight at high speeds. Kettlebells can evoke a similar response in those unfamiliar with proper form.

Yet Stuart McGill, a leading back expert, is a strong supporter of kettlebells (and deadlifts). Lifters maintain spinal stability and neutral spine throughout the movements (notice in the photos above that the lifter never rounds the back, but keeps a natural curve).

That said, as with any skill, doing it right can be safe; doing it wrong can lead to injury.

“Safety first” is such a mantra in the kettlebell community that the staple training manual since 2006, Enter the Kettlebell (review), includes a chapter on safety and back health, and concludes with the warning: “If you get hurt, it’s your fault.”

Applications for kettlebells

For fat burning

When combined with proper nutrition, training with kettlebells seems to offer the benefits of intense interval training on bikes but with the strength development of weights. There are increasing numbers of weight loss stories where kettlebells, along with good nutrition, contribute to success.

For field athletes

Strength and conditioning (S&C) coaches like Jeremy Layport and Chris Holder are using the kettlebell to improve overall endurance capacity of their athletes. Even Lance Armstrong has been seen swinging kettlebells (below).

A basic S&C template that many coaches use with infinite variety is to alternate between kettlebell swings and Turkish get ups. For example, one partner does a Turkish get up to the left and to the right, while the other swings non-stop.

Getting more from one kettlebell

The kettlebell design also means it can be used in a variety of ways to extend the life of a given kettlebell weight.

While the standard hold is with the handle across the palm with the bell resting against the forearm, a challenging alternative is to use the bottoms-up grip where the handle is squeezed, and the weight is held straight up, rather than resting against the wrist, as in the “bottoms up carry” as described by Stuart McGill (pdf).

Warning: Despite the great versatility of a single bell, kettlebells are also well-known to multiply. Partners of new kettlebell enthusiasts should be aware that claims of “I only need one, or maybe two — look, they take up no space” may still find kettlebells behaving like Tribbles.

Getting started: find a coach

The best start for any kettlebell user is to begin with a coach [see more at PN’s How to Find a Trainer].

A trained eye can evaluate key parts of foundational moves, such as:

• proper grip/wrist alignment with the bell
• foot to knee position
• shoulder action
• appropriate back alignment

Likewise, learning good technique will help preserve hands when doing high repetition kettlebell work.

Avoid this ouchy when doing high-rep kettlebell work by learning good form first

A few sessions with a coach is the best way to help learn and refine these elegant moves.

There are listings of RKC “Hard Style” coaches. The IKFF lists coaches who blend GS style with mainly bodyweight fitness training, or, one can go right to the Russian source with the IKSFA for a technique workshop.

A well-qualified coach will also be able to help anyone work up to a kettlebell swing and beyond, as some folks aren’t quite able to achieve that butt back swing position right away. So coaching is key: trying to swing kettlebells without proper form is about as safe as trying to deadlift with a rounded back.

Summary and recommendations

Kettlebells are a fabulous and often overlooked tool for strength and conditioning. The mileage one can get from a single kettlebell is hard to match with any other training tool.

• As the kettlebell’s signature movements are dynamic, they blend the benefits of compound strength lifts with power and endurance work.
• Kettlebell work also helps develop forearm, hand and finger strength because of numerous options for grip, and various loads dynamically challenging the grip repeatedly and at high speeds.
• A single kettlebell workout can include a great variety of pushes, pulls and ballistic movements. Because of the options of varying load and sets, kettlebells offer fat burning alternatives to bikes or treadmills.
• Kettlebells engage the whole body with a single tool that is small, portable, and affordable for home use.
• Kettlebells can help strengthen the spinal musculature, keeping your back happy; there is no significant lumbar flexion in kettlebell work.

Whether looking for conditioning, fat burning, raw strength or power, it’s worth any practitioner’s while to investigate kettlebell training.

For extra credit

Early research in support of kettlebells

Most of the formal research on kettlebell training for performance is in Russian. We know it mainly from Pavel Tsatsouline’s translations and summaries like these from Enter the Kettlebell.

In the 20th century, Soviet science validated what Russian hard men had known for centuries: kettlebell lifting is one of the best tools for all around physical development. Voropayev (1983) observed two groups of college students over a period of a few years. To gauge their performance, he used a standard battery of the armed forces physical training (PT) tests: pull-ups, a standing broad jump, a 100- meter sprint, and a 1K run. The control group followed the typical university PT program, which was military oriented and emphasized the above exercises. The experimental group just lifted kettlebells. In spite of the lack of practice on the tested drills, the kettlebell group showed better scores in every one of them! Vinogradov and Lukyanov (1986) found a very high correlation between the results posted in a kettlebell lifting competition and in a great range of dissimilar tests: strength, measured with the three powerlifts and grip strength; strength endurance, measured with pull-ups and parallel bar dips; general endurance, determined by a 1K run; and work capacity and balance, measured with special tests. Lopatin (2000) found a positive correlation between soldiers’ kettlebell sport ranking and their obstacle course performance. Kettlebells improve coordination and agility (Luchkin, 1947; Laputin, 1973). Kettlebells develop professional applied qualities and general physical preparedness (Zikov, 1986; Griban, 1990).

Current research

The English-speaking world still lags behind with kettlebell research.

• An MSc project study on VO2max training has been turned into a book called Viking Warrior Conditioning by Kenneth Jay (overview).
• The American Council of Exercise commissioned a non-controlled study (pdf) that repeated Jay’s work, sadly, without attribution or again without peer review.
• Finally, however, there has been one peer reviewed study, 2009, in the Journal of Strength and Conditioning showing that one rather tame version of a kettlebell protocol (men performing as many two handed swing for ten minutes with as many user-determined stops as desired) is tougher than circuit training.

It’s been hypothesized that the swing also provides the forces necessary to generate increased bone density.

Kettlebell juggling

Kettlebell work is most often in the sagittal (back and forth) plane, but some experienced kettlebell enthusiasts break out of this box with kettlebell juggling, either as a solo or partner activity.

Russian Navy members practicing kettlebell juggling:

Competition

For folks who fall in love with these weights, there are the Girevoy Sport competitions.

In a competition, athletes have a fixed time to achieve a minimum number of reps in particular lifts at specific weight-class loads to attain one of several possible rankings in the sport. Competitions include the Long Cycle which is non-stop clean and jerk, the jerk, and the snatch.

Women’s 24 kg snatch competition featuring Kseniya Dedyukhina

Tactical Strength Challenge

Another form of competition is known as the Tactical Strength Challenge. This includes the kettlebell snatch, a deadlift and a pull up competition. It’s also fun.

Size

As for what size to start with, generally women start with an 8 kg and 12 kg; men with a 16 kg and 24 kg.

Having a lighter and a heavier bell gives beginners the option to work on technique first, and heavier sets later.

Folks who have been sedentary for a long time may happily start lighter; more experienced strength athletes may prefer to go heavier. HardStyle magazine (pdf) has a section each month on how to pick a size appropriate for any level.

Quality

Almost more critical than the right starting weight is quality of the bell.

The shape, size and finish of the handle can make the difference between a good or horrible experience. Poor finishes can be filed down, but poor size or shape cannot be changed. A poorly designed/made bell may be cheap(er) but will be used once and abandoned. A good quality 16 kg kettlebell will cost about as much as a higher end pair of sneakers but will last for a lifetime.

Resources and references

Baszanowski, W., ed. 8 European Weightlifter Federations: a Brief History of Their Centenaries. Special Issue. European Weightlifter, EWF Secretariat. 2005 (pdf).

Farrar RE, Mayhew JL, & Koch AJ. Oxygen cost of kettlebell swings. Journal of strength and conditioning research, 24 (4), 1034-6, 2010. PMID: 20300022

Jay, Kenneth. Viking Warrior Conditioning. Dragon Door Publications, MN, 2009.

Sanchez, Thierry. Kettlebell Sport and Athletic Preparation, Aalborg Sportshøjskole & Trænerakademiet, 2009 (pdf)

Tsatsouline, Pavel. Enter the Kettlebell. Dragon Door Publications, MN, 2006.

Tsatsouline, Pavel, The Russian Kettlebell Challenge. Dragon Door Publications, MN, 2001.

Tsatsouline, Pavel McGill on Kettlebells Power By Pavel Newsletter, 155, (April 30, 2008).

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Then you start to notice impingement due to the atrophy. Then you notice strength and posture imbalances. The downward spiral has begun.

Next thing you know, your kids are dropping you off at the nursing home in time for Thursday afternoon shuffleboard. You’ll have the posture of Quasimodo and arms like T-Rex.

What is the rotator cuff?

The shoulder has an immense range of motion — the most of any joint in the body. But this comes with a catch: because of its range, it’s also the most unstable.

As a result, nearly 70% of us will experience some sort of shoulder disorder in our lifetime. Often, the injury includes one of the rotator cuff muscles.

Of all the injuries that take place during resistance training, 36% occur at the shoulder complex. The supraspinatus muscle is most often involved.

Yeah, we're pretty sure that those arms are facing the wrong way too.

The rotator cuff is made up of four muscles (or you could think of them as “active ligaments”) that collectively compress, depress, protect and stabilize the glenohumeral joint, helping to keep the upper ball of the humerus (think of this as a golf ball) in the glenoid fossa (think of this as a tee). Weak rotator cuff muscles prevent the humeral head from rotating properly on the glenoid fossa.

The supraspinatus, infraspinatus, teres minor, and subscapularis (the 4 rotator cuff muscles) originate on the scapula (shoulder blade) and help with various movements like bringing your arm out to the side, internal rotation (turning your arm inwards), external rotation (turning your arm outwards), and so on.

Attachments and functions of rotator cuff muscles

Source: Ronai P. Exercise modifications and strategies to enhance shoulder function. Strength and Conditioning Journal 2005;27:36-45.

Why is the rotator cuff important?

The challenge of stabilization

Shouder stabilization is a dynamic activity. Many muscles, from small to large, fire in a coordinated effort to stabilize the shoulder as it moves through a range of motion. Along with the rotator cuff, this includes:

• Serratus anterior
• Rhomboids
• Trapezius
• Levator scapulae

When looking at shoulder problems, it’s important to understand the complex roles that all of these muscles play. If they don’t work together — or more likely, if some muscles are strong and some are weak or inhibited, they can’t work together effectively in order to keep that golf ball on the tee.

The result: imbalance and eventually, injury.

68% of people with scapular instability have rotator cuff problems. If these muscles are weak or not firing properly, it’s harder to control that golf ball on the tee. Typically, the shoulder blades and the top of the humerus (upper arm) start to slip forward, which shrinks the subacromial space between the humerus and the acromion (bony structure at the top of the shoulder).

Many tendons pass through this space. When it’s constricted, these tendons can become inflamed. Over time, with repeated trauma, the tendons may become damaged or even — eventually — tear.

In addition, the surfaces and structures of the joint (such as the cartilage that lines the joint capsule) can become inflamed.

Shoulder injuries: You could be next

Head forward, upper spine rounded, reaching forwards... this is shoulder pain city.

Barring an acute event (like falling on an outstretched arm), most shoulder injuries come from repeated, cumulative damage.

The bad news: Almost everyone is at risk for shoulder injuries.

The subscapularis tends to get plenty of stimulation in our “front-of-the-body-internal-rotation” happy gyms. This means it’s usually pretty tight and strong. Combine this with things like:

• desk work
• driving
• using a mouse/keyboard
• stress (which often makes people tighten up their traps and hunch their shoulders)
• sitting/standing in “hunchback” posture
• lack of attention to the muscles you can’t see in the mirror

…and you have the perfect storm for shoulder pain.

Many people ignore the warning signs of shoulder trauma (such as pain and limited mobility) until the situation is serious.

Don’t go like that.

Whether you feel pain while bench pressing, reaching overhead, throwing, punching, paddling, or all of the above… if your shoulder hurts, take the time to deal with it immediately. Don’t push through the pain. It will not get better if you ignore it, and will probably get worse.

The good news: A strong, stable and flexible rotator cuff can preserve shoulder health and increase upper body strength.

Preventing injury

One of the keys to injury prevention is developing flexibility of the subscap and pecs while building strength and endurance in the opposing external rotators.

Anterior shoulder instability, limited internal rotation mobility and posterior shoulder tightness

Remedy – Need to improve posterior shoulder flexibility

Discussion – If you can’t do this, you have some tightness in the back of your shoulder. Posterior shoulder tightness may be a contributing factor in impingement and labral tears. This tightness doesn’t allow adequate internal rotation or horizontal adduction.

Exercises to consider:

Cross arm adduction stretch

Internal rotation sleeper stretch

Scapular wall slides

Shoulder dislocates

Unilateral presses and pulls (one side at a time)

Medicine ball wall tosses

Drop and catch push up (advanced)

Excessive external rotation mobility

Remedy – Need to increase internal shoulder rotation

Discussion – This is a rare shoulder problem to have; though it’s often seen in “overhead athletes”: folks whose sport involves throwing or pressing overhead, such as pitchers. With poor internal rotation flexibility, posterior shoulder tightness ensues. This can lead to the posterior rotator cuff muscles contracting with more force in an attempt to pull the humeral head back into place, leading to rotator cuff muscle fatigue and injury.

Exercises to consider:

Cross arm adduction stretch

Internal rotation sleeper stretch

Internal rotators stronger than external rotators

Remedy – Need to strengthen the external rotators

Discussion – The teres minor and infraspinatus are major external rotators involved with abduction and overhead motions.

Exercises to consider:

Face down Y exercise

Face down T exercise

Band external rotation at 30 degrees abduction

Seated press ups (advanced)

Power wheel crawls (advanced exercise – starts at 1:42 in video)

Pushup plus

Reverse push up

Cable external rotations at 90 degrees

Side lying external rotation at 30 degrees abduction

Scarecrow

Notes on the above exercises:

Performing these exercises on unstable surfaces can further enhance sensorimotor control.

Placing a towel between the arm and body during internal/external rotations can decrease deltoid activity, relax the supraspinatus, and lessen pain – all good for the prehab/rehab process.

Weak lower traps

Remedy – Need to strengthen the lower traps

Discussion – An important sign of good shoulder function during pushing and pulling movements is the ability to keep the shoulders down and away from the ears.

If the shoulders move up toward the ears during a pushup or row (as in the left-hand photo above), it signifies greater upper trap activity. This yanks the humerus out of alignment within the glenoid cavity (the golf ball on the tee) which results shoulder complex muscle weakness and limited range of motion. This is a particular problem because the upper traps can be so strong relative to other muscles.

Another screening tool is kyphotic posture, aka “the Quasimodo” or “E.T.” Again, this suggests the upper traps are considerably stronger than the mid- to low traps, serratus anterior and levator scapula.

Exercises to consider:

Balance out all of your pushing exercises with pulling exercises (using retracted shoulder blades)

Push up with some shrugging – not good	Push up without shrugging – good

Poor proprioception

Remedy – Need to build proprioception — awareness of where the body is in space.

Discussion – Damage to ligaments around the shoulder cause less sensory information coming in. Without proper incoming information, the shoulder isn’t protected from extreme ranges of motion.

Exercises to consider:

Swiss ball pushups (advanced)

1 arm ab plank on swiss ball (advanced)

Medicine ball wall dribbles or this option

Quadruped rhythmic stabilization

The following are advanced plyometric exercises helpful for later stages of rehab/prehab.

Deceleration med ball catches

Med ball external rotation toss to wall

Tips on rehab/prehab exercises

When shoulder muscles become fatigued, the joint becomes hyper mobile, and prone to injury. Thus, building endurance is important.

When doing shoulder stabilization exercises, use higher reps (10-20), and/or longer duration (e.g. 30-60 sec).

Also, it’s important to train external rotators with an emphasis on the eccentric phase. Use the “4-6” approach for the direct rotator cuff exercises. Use a 4 second count on the concentric phase and a 6 second count on the eccentric phase.

Don’t try this at home

A dangerous position for the rotator cuff (and the shoulder), is the “high five position.” The humerus is abducted (held away from the body) and externally rotated. This overloads the anterior capsule.

Beyond actually high fiving with buddies, this position is often replicated in the gym during old-school machine chest flies, behind the neck pulldowns, and behind the neck presses.

Could cause shoulder injury

Other exercises that may increase shoulder injury risk include bench press (flat and incline), dips, barbell back squats, upright rows, dumbbell flies, and arm curls.

The empty can position (raising the arms up with the palms down/back) can inflame the shoulder by reducing the subacromial space and causing impingement. Instead, use the full can exercise (raising the arms up with palms forward in the plane of the scapula).

Modifying exercises to improve shoulder health

Here are some tips to help you adjust common exercises to maximize shoulder health.

Bench press

• Tuck elbows a bit closer to your body
• Use a neutral grip with dumbbells – like this: Dumbbell Bench Press, Neutral Grip
• Don’t feel like you need to go down all the way until your elbows dip below your body – try floor presses: Lazy Floor Press or Regular Floor Press
• Retract your shoulders before starting a press

Change your squat

Instead of standard barbell back squats, try front, zercher, dumbbell front or goblet squats, which put less stress on the shoulders.

Front

Zercher

Dumbbell

Goblet

Pulldowns and overhead presses

• Bring elbows slightly forward instead of flared out
• Always go to the front of the body

Keep it scapular

When raising your arm out to the side, don’t force it back so it’s directly in line with your body. Keep it in the natural range of motion with the scapula – like this: Scapular Plane Lateral Raise, Neutral Grip

Upright rows

Not worth it. Try face pulls instead.

Posture

Keep a proud chest, tight shoulder blades, engaged core, and overall “good posture” when exercising (and with daily life).

Other exercise modifications

Source: Ronai P. Exercise modifications and strategies to enhance shoulder function. Strength and Conditioning Journal 2005;27:36-45.

Summary and recommendations

1. If it hurts your shoulders, avoid it. And don’t work through pain.
2. Activate your serratus (see shoulder circuits below) to save your shoulders.
3. Move around during the day. Check your posture.
4. If you do a push, follow with a pull. If you work your front, follow with your back. In fact, try to do more pulling than pushing — about a 2:1 ratio if possible.
5. Don’t be afraid to nix shoulder day. Between other exercises, the shoulders get plenty of work.
6. Use massage or active release therapy to keep soft tissues happy.
7. As much as possible, alternate which hands you use for daily-life tasks, such as brushing your teeth.
8. Foam roll the thoracic spine.
9. Be cautious with explosive overhead lifts.
10. Develop shoulder flexibility/mobility/strength with the circuits below.

Extra credit

“There is a fine line between physiotherapy and the training of the elite athlete.” – Dan Pfaff

Co-activation of the traps and serratus anterior are thought to have significant influence on scapulohumeral rhythm.

The infraspinatus and teres minor are extremely active during the “follow-through” with overhead throwing motions (or some overhead exercises like medicine ball slams). Train these muscles eccentrically.

Further resources

Optimal Shoulder Performance

Original Shoulder Savers Article Part 1 |  Part 2 | Part 3

The Amazing Shoulder

References

Wagner P. A comprehensive approach to shoulder-complex maintenance. Strength and Conditioning Journal. 2003;25:65-70.

Kolber MJ, et al. Shoulder injuries attributed to resistance training: a brief review. J Strength Cond Research. 2010;24:1696-1704.

Kritz M, et al. Screening the upper-body push and pull patterns using body weight exercises. Strength and Conditioning Journal. 2010;32:72-82.

Corrao M, et al. Addressing posterior shoulder tightness in the athletic population. Strength and Conditioning Journal. 2009;31:61-65.

Ronai P. Exercise modifications and strategies to enhance shoulder function. Strength and Conditioning Journal. 2005;27:36-45.

Tyson A. Posterior rotator cuff strength: part 1 and 2. Strength and Conditioning Journal. 1995:21-23; 37-38.

Cressey E. Clearing up the rotator cuff controversy. January 2010.

Kolber MJ & Beekhuizen KS. The empty can exercise: considerations for strengthening the supraspinatus. Strength and Conditioning Journal. 2009;31:38-40.

Cressey E. Cracking the rotator cuff conundrum. T-nation.

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Muscle growth — sometimes known as hypertrophy — is the development of mass, density, shape, and function of muscle cells. This adaptation allows the muscle to meet exercise/function-induced stress.

Muscle cells are sort of like a bunch of sticks bundled up for firewood. Myofibrils (“myo”, from the Greek mys, refers to muscle) are cylindrical bundles of filaments composed of sarcomeres. Sarcomeres are the fundamental unit of muscle contraction and are composed of myosin and actin.

All of these proteins comprise about 20% of muscle. Water, phosphates, and minerals comprise the other 80% of muscle.

Where does muscle growth come from?

When someone does resistance training consistently, they may notice muscle growth. The growth is due to an increased water, number of myofibrils, and connective tissue.

Scientists often break hypertrophy down into two types:

• Sarcoplasmic hypertrophy increases muscle size by increasing the volume of sarcoplasmic fluid in the muscle cell.
• Myofibrillar hypertrophy (sometimes called “functional hypertrophy”) increases muscle size by increasing the contractile proteins.

Some people in the fitness industry will argue that bodybuilders demonstrate sarcoplasmic hypertrophy, and that their muscles look “puffy”; while weightlifters demonstrate myofibrillar hypertrophy, and their muscles are “denser”.

Bodybuilder	Weightlifter

Muscle growth and fibre types

Although growth can occur in all muscle fibre types, different types of muscle fibres vary in their potential for growth. Fast twitch fibres are more likely than slow-twitch fibres to grow with intense strength training. This may be one reason why athletes such as sprinters tend to be bigger and more muscular than endurance athletes, and why heavier loads tend to stimulate more muscle growth than light loads.

Marathoner (left) vs sprinter (right)

Muscle growth and hormones

Muscle growth is further influenced by type of exercise, nutritional intake, and hormonal status. The type of exercise and hormonal status influence nutrient partitioning — in other words, whether you increase muscle depends on the kind of activity you do and your hormonal environment, which both tell your body where to allocate the nutrients you eat.

Eat a lot, train hard, and get lots of recovery, and you’ll put on muscle. Be malnourished, be sedentary, and be stressed out — and you won’t.

Hormones that modulate muscle growth include:

• growth hormone
• testosterone
• IGF-1
• cortisol
• beta-endorphin, and
• parathyroid hormone.

For more on a few of these hormones, see here:

• AA Growth Hormone
• AA Testosterone
• AA Cortisol

Why is muscle growth so important?

Subjectively, muscle growth improves the appearance of the body. Women who gain muscle mass while remaining relatively lean appear tighter, firmer, and more “toned.” Men who gain muscle mass while remaining lean appear stronger, larger, and more athletic.

Objectively, muscle growth improves function. Larger muscles are often stronger muscles, leading to improved daily functioning in most individuals. Muscle is metabolically active, and affects the way the body handles nutrients. For instance, people who are more muscular (especially combined with lower body fat) typically have better insulin control.

From a health perspective, advancing age is associated with a loss of muscle mass, better known as sarcopenia. Preserving muscle mass can preserve strength, and strength is a predictor of survival as one ages. Loss of muscle function appears to be due to decreased total fibres, decreased muscle fibre size, impaired contraction mechanisms, and decreased motor unit recruitment.

What you should know

Muscles respond to demands

Muscles respond to the demands we put on them. Ask your muscles to lift loads, and they’ll respond by getting stronger. Ask your muscles to help you make a butt groove in the La-Z-Boy and they’ll shrivel up from disuse, leaving you weak and skinny-fat.

Intense training (such as heavy weight training) damages muscle, which then remodels to prevent future injury. Thus, including relatively intense exercise, particularly resistance training, in your fitness regime is essential — no matter what your ability or age.

Muscles respond to calories

Restrict calories and you risk muscle loss and metabolic slowdown.

Studies show that people who restrict their calories (i.e., diet) without also doing resistance training do lose weight, but it’s an even distribution of muscle and fat — not what you want. Indeed, sometimes calorie restricters who don’t exercise end up fatter (as a %) than when they started!

How many calories to build muscle?

You need roughly 2,800 calories to build a pound of muscle, largely to support protein turnover, which can be elevated with training.

The contractile proteins and fluid (sarcoplasm) in muscle fibres are broken down and rebuilt  every 7 – 15 days. Training alters the turnover by affecting the type and amount of protein produced. Again, muscles respond to the demands placed on them.

However, muscles that are overloaded appropriately can actually grow during starvation (energy from fat stores can be liberated and stored in muscle tissue), although ample nutrients (e.g., protein, carbohydrate, etc.) can greatly enhance the extent of the growth response. Although growth can take place during starvation/restriction, especially for newbies, muscle growth with inadequate calorie consumption is less likely to take place with advanced trainees, as their threshold for growth is elevated.

If you’re more experienced and looking to get big and strong, you’ll probably have to eat more.

Muscles respond to protein

The way our hormones respond to training, and how they affect our muscle growth, depends a lot on our nutritional status — not just how many calories we’re taking in.

In a rested state, muscle protein breakdown exceeds protein synthesis. This net balance can be improved with strength training, but still, normally, we’re breaking down more than we’re building up.

We want the opposite — to be building up more than we’re breaking down, especially after resistance training. We need adequate protein to do this.

One bout of resistance training can stimulate protein turnover for at least 48 hours. During this time, if energy intake is adequate and protein represents at least 12 – 15% of our energy intake, growth can occur.

For those on an energy restricted diet for fat loss, protein needs for muscle recovery and growth are likely closer to 1.5 – 2.0 grams of protein/kg of bodyweight.

What helps stimulate muscle protein synthesis?

• Just 6 grams of essential amino acids can stimulate muscle protein synthesis after training.
• We don’t need nonessential amino acids for this stimulation to occur.
• Elevated levels of insulin can generate muscle growth when amino acid consumption is ample, which demonstrates the importance of carbohydrate consumption after exercise.
• Frequent amino acid consumption (from food or supplements) during the waking hours may also play a role in muscle growth.

For more on this:

• All About Protein
• All About BCAAs

Summary and recommendations

Muscle growth seems to occur best when training with relatively higher volumes, close to muscle fatigue, and with shorter rest periods between sets/reps.

Thus:

1. When training, 6 – 12 repetitions per set is the optimal range for muscle growth.
2. Train towards contraction failure.
3. Take relatively short rest periods — 30 – 90 seconds. Rest-pause techniques can also be effective.
4. Perform 12 – 20 sets per muscle group. Supersets can help add volume and improve efficiency.
5. Be consistent with training.
6. Consume enough energy (calories), with a minimum of 12 – 15% of calories from protein or 1.0 gram of protein per kilogram of bodyweight.
7. Sleep 7 – 9 hours per night.

For extra credit

The amount of muscle growth that occurs depends on upper genetic limits of cell size.

An increase in the number of muscle fibres, rather than just the size of those that already exist, is known as hyperplasia. It has yet to be definitively measured in humans. If it does occur, it probably accounts for a small portion of muscle growth (less than 10%).

Changes in cellular oxygen, reactive oxygen species, ATP levels, and metabolite concentrations during exercise stress may be fundamental stimuli that lead to muscle growth.

Further reading

Limit protein to 20 grams per meal?

Minutemen: Rest Intervals

Leucine vs. Whey

Comparing Number Of Sets For Muscle Growth

References

Spangenburg EE. Changes in muscle mass with mechanical load: possible cellular mechanisms. Appl Physiol Nurt Metab 2009;34:328-335.

Phillips SM. Physiologic and molecular bases of muscle hypertrophy and atrophy: impact of resistance exercise on human skeletal muscle (protein and dose effects). Appl Physiol Nutr Metab 2009;34:403-410.

Kumar V, et al. Human muscle protein synthesis and breakdown during and after exercise. J Appl Physiol 2009;106;2026-2039.

Tipton KD & Ferrando AA. Improving muscle mass: response of muscle metabolism to exercise, nutrition and anabolic agents. Essays Biochem 2008;44:85-98.

Borer KT. Exercise Endocrinology. Human Kinetics. Champaign, IL. 2003.

Borsheim E. Enhancing muscle anabolism through nutrient composition and timing of intake. SCAN’s Pulse. Summer 2005. Volume 24.

Brock Symons T, et al. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc 2009;109:1582-1586.

Elango R, et al. Evidence that protein requirements have been significantly underestimated. Curr Opin Clin Nutr Metab Care 2010;13:52-57.

Mettler S, et al. Increased protein intake reduces lean body mass loss during weight loss in athletes. Med Sci Sports Exerc 2009 Nov 13 [Epub ahead of print]

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The word yoga comes from the Hindi yoga, originally from pre-Indo-European yeug, meaning “union” or “to join.”

Eastern vs Western styles

Classic yoga from the east follows ancient Hindu discipline, incorporating asanas (physical exercises and postures), pranayama (breathing techniques), and meditation designed to move someone towards peace of mind and spiritual enlightenment. For Hindus and Buddhists, the goal of yoga is union with Brahman (the eternal or absolute) and Atman (your true self) – not so much about sculpting a “yoga booty.” Yoga is not a religion, but many followers use it to enrich their spiritual practice.

In the west, modern yoga styles are generally thought of as physical exercises to build flexibility and strength.

East meets West…

Yoga history

T. Krishnamacharya hitting a scorpion pose

Yoga practice can be traced back 5000 years to Indus-Sarasvati civilizations in India. (And we thought using free weights was old school.)

A Hindu teacher named Patanjali was said to  have recorded the first principles of yoga in religious scriptures known as the Yoga Sutra. Many forms of yoga have been developed since – each focusing on a new realm of personal development.

Hatha yoga came to the west in the 1920s thanks to T. Krishnamacharya and remains the most popular style today.

Why yoga is important

Yoga’s popular

The number of people practicing yoga in the U.S. has more than doubled since 1998, from 7 million to 15 million.

Nearly 5% of U.S. businesses offered yoga at the workplace in 2008. Approximately 75% of U.S. health clubs offer yoga instruction.

Yoga may make you healthier

Yogis claim numerous physical and psychological benefits result from yoga. But is there any data showing this?

Well, the double-blind test, adored by many Western health professionals, isn’t possible with yoga. If one group in a study is practicing healthy yoga, it’s hard to recruit a blind group that isn’t, and doesn’t know it. Still, yoga data does exist.

Heart disease

Yoga may help reverse heart disease. Well, when combined with aerobic exercise and a low-fat plant-based diet. The author of one study said, “Adherence to the yoga and meditation program was as strongly correlated with the changes in the amount of blockage [in the arteries] as was the adherence to diet.” Yoga may help to control inflammation throughout the body as well.

Pain, balance and flexibility

What is one of the greatest fears among the elderly? Falling. Yoga can help with balance in older folks. Just two sessions of Hatha yoga per week can increase stability. Before you dismiss yoga as a Friday night nursing home activity, yoga can improve balance in people under 60 years old too.

Yoga interventions have been shown to be effective for alleviating back pain and symptoms of carpal tunnel syndrome.

Stress and mood

Yoga has long been used for relieving stress and improving mood. Plus, since some people overeat due to stress, conquering stress with yoga might indirectly improve nutrition.

Women undergoing treatment for cancer have found yoga to be helpful for mood and controlling stress levels.

Yoga may help control anxiety and the meditation aspect of yoga can assist those in prison with self-control.

Most yoga is parasympathetic dominant, which may promote recovery from intense workouts. See the following for more on the importance of parasympathetic activities:

• All About Recovery
• JB’s Getting Control of Stress
• JB’s Ultimate Stress Busting Workout

Disordered eating and weight

Body image disturbances and disordered eating continue to increase. Authentic yoga studios have no mirrors. Rather, students’ awareness is tuned to internal sensations. Yoga offers a non-verbal adjunct to standard eating disorder therapy and provides an opportunity to unite the physical body with inner experience.

When someone encounters awkward or painful postures in yoga, they are trained to observe the tension and breathe while coaxing their muscles or joints open, or just accept it as is. This same technique can be applied to other uncomfortable situations, such as a craving for junk food or drugs.

Since yoga can help to unite the mind and body, it can be useful in regulating appetite, decreasing food preoccupation, enhancing body awareness, and boosting body satisfaction. The longer one participates in yoga, the more self-awareness and positive impact on body image/eating they develop (i.e., years may be more effective than months).

Yoga can help eliminate binge-eating patterns. This may be due to the meditation aspect and ability to heighten mindfulness.

People who practiced yoga regularly for four years or more gained less weight as they got older. Moreover, overweight individuals who practiced yoga for four or more years managed to lose weight over a 10-year period.

Yoga’s effect on neurotransmitters. From: Douglass L. "Yoga as an intervention in the treatment of eating disorders: does it help?" Eating Disorders 2009;17:126-139.

Menopause

Yoga may be useful for alleviating symptoms of menopause.

Lymphatic system

Exercise, particularly yoga can help increase lymph drainage.

Epilepsy

There have been few reliable studies using yoga for epilepsy, but the results are encouraging. Yoga may stimulate the vagus nerve, which can decrease seizure frequency.

Getting injured

This just in: You can get injured doing yoga (like most physical endeavours).

13,000 Americans have visited the ER or doctor’s office during the past three years due to yoga-related injuries. That’s outrageous. Oh, wait a minute, no it’s not. 7.6 million ER visits each year are associated with alcohol.

Yoga is dangerous for people who do too much, too soon — the folks who haven’t stretched since high school band camp and want to show off for the cute girl/guy in the front row of Saturday morning yoga. Goodbye hamstring attachment site; hello physical therapy office. You’ll see case reports of serious injuries in those attempting advanced yoga poses when they shouldn’t be.

Those who are pregnant or have glaucoma should check themselves before trying to perform any postural yoga that increases pressure in the torso and head (like inversions).

Finally, folks with hypermobility of the lumbar spine (lower back) might increase their risk of low back problems and vertebral stress fractures with poses that involve excessive hyperextension of the lumbar spine, like this:

What you should know about yoga

Be aware of your yoga instructor’s background, qualifications, experience and training. Check their style and figure out who attends their classes. Just like a coach, teacher or trainer, we all have different preferences.

Yoga styles

Virtually all forms of yoga can be traced back to the four cornerstones: ritual, knowledge, devotional and tantric.

There are many varieties of yoga to choose from. Here’s a brief description of the more popular styles.

Ayurveda

Ayurvedic yoga combines Asanas, Pranayama, and meditation. Asanas strengthen muscles, improve flexibility, and rejuvenate the body. The aim of this style is to bring natural order and balance to hormones and metabolism. Adherents see this as a natural way to treat stress-related disorders.

Anusara

All levels are invited here. There is a focus on creative freedom and individuality – so get ready to express yourself. This is a “recent” style started in 1997. You’ll probably be doing some chanting here.

Ashtanga

This discipline involves synchronizing the breath with a progressive series of postures. The result is internal heat and sweating, which detoxifies the muscles and organs.

Adherents of Ashtanga, which is the most vigorous form practised, claim that the results include improved circulation, a light and strong body, and a calm mind. It is fast paced and a high strength to bodyweight ratio is necessary.

Bikram (often called “hot”)

Imagine doing yoga in a dry sauna. Bikram yoga is a series of 26 traditional Hatha yoga postures and breathing exercises, all performed in a heated room. The entire workout takes approximately 90 minutes, and will leave you sweaty.

Hatha/Ananda (often called “restorative”)

Hatha yoga is the most commonly practised form in the West – its combination of Asanas, Pranayama and meditation providing a balanced approach to physical and mental health. It is the least strenuous yoga. If you have exercise ADD, you may get bored. If you are intimidated and figuring out where to start with yoga, this is the class.

Iyengar

This is purist yoga, named after B.K.S. Iyegar. It has a slow pace with a priority of mastering poses in isolation. Feel free to get assistance from blocks, straps or pads. Good for learning yoga fundamentals. Folks who need constant variety might get bored.

Kundalini

Are you ready to awaken kundalini? This is a form of vinyasa yoga. More spiritual than others. You’ll be getting your chant on during this class. Kundalini incorporates a number of elements, including Pranayama, Asanas, mantras (chants), and meditation. Regular practice will help you develop a healthy body and balanced mind.

Prenatal

This is an excellent way to stay in shape and prepare for the rigors of both pregnancy and childbirth. The stretching and strengthening work is of great preparation for labor, with exercises which can be safely practiced in all stages of pregnancy.

Vinyasa/power yoga

A breath-synchronized form of yoga. Most modern “power yoga” classes are this format. Requires more strength than most other styles.

Summary and recommendations

Most exercise enthusiasts acknowledge that yoga isn’t the most comprehensive workout. Yet even though it’s not optimal for increasing strength, muscle, or cardiovascular health in isolation, it’s mindful physical movement.

For those who participate in regular forms of exercise, incorporating yoga 1-2 times each week might assist in stress relief, recovery, balance, mood, and flexibility. If you try a class and don’t like it, try another one. They are all different.

For those looking to get a grasp on mindful eating habits, meditation, and body awareness, taking yoga 1-2 times each week may help.

Extra credit

“Learning to meditate means taking back control.” Bernard Young (Prisoner in California)

Further resources

Enlighten Up (DVD)

CNN: Man loses 365 pounds with yoga

References

Sherman KJ, et al. Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial. Trials 2006;11:36.

Hartfiel N, et al. The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace. Scand J Work Environ Health 2010;April 6^th Epub.

Paul P. When yoga hurts. Time 2007;170:71. http://www.time.com/time/magazine/article/0,9171,1668470,00.html

McDonald AJ 3^rd, et al. US emergency department visits for alcohol-related diseases and injuries between 1992 and 2000. Arch Intern Med 2004;164:531-537.

Corliss R. The power of yoga. 2001;157:54-63. http://www.time.com/time/magazine/article/0,9171,999731,00.html

Ornish D, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129-133.

Manchanda SC, et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India 2000;48:687-694.

Telles S, et al. Short term health impact of a yoga and diet change program on obesity. Med Sci Monit 2010;16:CR35-CR40.

Michalsen A, et al. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit 2005;11:CR555-CR561.

Javnbakht M, et al. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract 2009;15:102-104.

Faturechi R. Jail’s meditation course is not a hard sell. LA Times. April 18^th, 2010. http://www.latimes.com/news/local/la-me-jail-meditation18-2010apr18,0,2800953.story?page=1

Vadiraja HS, et al. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther 2009;8:37-46.

Oken BS, et al. Randomized, controlled, six-month trial of yoga in healthy senior: effects on cognition and quality of life. Altern Ther Health Med 2006;12:40-47.

Ramaratnam S & Sridharan K. Yoga for epilepsy. Cochrane Database Syst Rev. 2000;3.

Rajesh B, et al. A pilot study of a yoga meditation protocol for patients with medically refractory epilepsy. J Altern Complement Med 2006;12:367-371.

O’Connor D, et al. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev 2003;1.

Bertschinger DR, et al. Yoga can be dangerous – glaucomatous visual field defect worsening due to postural yoga. Br J Opthalmol 2007;91:1413-1414.

Kiecolt-Glaser JK, et al. Stress, inflammation, and yoga practice. Psychosom Med 2010;72:113-121.

Patel SC & Parker DA. Isolated rupture of the lateral collateral ligament during yoga practice: a case report. J Orthop Surg (Hong Kong) 2008;16:378-380.

Schmid AA, et al. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study. Arch Phys Med Rehabil 2010;91:576-583.

Dittmann KA & Freedman MR. Body awareness, eating attitudes, and spiritual beliefs of women practicing yoga. Eating Disorders 2009;17:273-292.

Carei TR, et al. Randomized controlled clinical trial of yoga in the treatment of eating disorders. J of Adolescent Health 2010;46:346-351.

Yoga in the modern world. Eds: M. Singleton and J. Byrne. Routledge. 2008.

Scime M, et al. Group prevention of eating disorders with fifth-grade females: impact on body dissatisfaction, drive for thinness, and media influence. Eating Disorders 2006;14:143-155.

McIver S, et al. Yoga as a treatment for binge eating disorder: a preliminary study. Complementary Therapies in Medicine 2009;17:196-202.

Scime M & Cook-Cottone C. Primary prevention of eating disorders: a constructivist integration of mind and body strategies. Int J Eat Disord 2008;41:134-142.

Mitchell KS, et al. Innovative interventions for disordered eating: evaluation dissonance-based and yoga interventions. Int J Eat Disord 2007;40:120-128.

Lundgren T, et al. Acceptance and commitment therapy and yoga for drug-refractory epilepsy: a randomized controlled trial. Epilepsy & Behavior 2008;13:102-108.

McElroy-Cox C. Alternative approaches to epilepsy treatment. Current Neurology and Neuroscience Reports 2009;9:313-318.

Boudette R. How can the practice of yoga be helpful in recovery from an eating disorder? Eating Disorders 2006;14:167-170.

Douglass L. Yoga as an intervention in the treatment of eating disorders: does it help? Eating Disorders 2009;17:126-139.

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1. Touch toes.
2. Swing arms.
3. Bounce pecs.
4. Put on sweatband.

But is this the optimal way? And what is a warm-up really supposed to accomplish?

Homer shows us how not to warm up

What is warming up?

Warming up prepares the body for more intense movement and activity. It literally “warms up” the body by increasing core temperature.

A proper warm-up consists of movements that:

• Move joints through their ranges of motion (ROM) — and enhance this ROM
• Enhance mobility
• Release connective tissue bonds
• Distribute fluid in the joint space
• Boost speed/force of muscle contractions
• Amplify nerve impulse transmission
• Promote oxygen uptake
• Keep you out of the whirlpool

Movement types

Movements used during a warm-up might include:

• Movements intended to get the core temperature up and the whole body moving, e.g. brisk walking or light jogging while swinging the arms
• Static movements (moving into a position and briefly holding it) — the classic “stretch and hold”, e.g. touching your toes for 30 seconds.
• Dynamic movements such as:
  • stretching while moving (e.g. walking lunges for hip flexibility, or tipping your head side to side for neck mobility)
  • moving against light resistance (e.g. a few single-legged Romanian deadlifts with light or no weight, or jumping)

Why warming up is important

What do athletes, exercisers and old folks complain about? Well, lots of things. But I’m constantly hearing about stiffness, injuries and poor flexibility.

While age-related connective tissue changes and water loss can contribute to inflexibility, most of it comes down to “use it or lose it.” A proper warm-up helps to counteract negative effects of aging while enhancing performance.

Not warming up can lead to poor mobility/flexibility, injuries and stiffness. These are the people at the senior center, on a basketball court or at the family reunion who can’t move, pick up kids, play sports, exercise to their full capacity, or clean up spilled hemp seeds. In all cases, life sucks for them.

Major components of an effective warm up before exercise. Click to enlarge. (Source: Vandervoort AA. Potential benefits of warm-up for neuromuscular performance of older adults. Exerc Sport Sci Rev 2009;37:60-65.)

Flexibility, mobility, and injury

Some consider the warm-up a time to build flexibility and mobility. Flexibility is the capacity of a joint to move freely through a full range of motion. Mobility is our ability to produce a desired movement. Both are based on the elasticity of muscle, ligaments, and connective tissues, but while poor mobility is correlated with injury, poor flexibility is not necessarily.

We want some areas to be more mobile but other areas to be more stable and strong. For most folks, this means it’s important to mobilize:

• front of shoulders
• ankles
• front of hips and IT band
• hamstrings
• thoracic spine

Tightness in these areas can contribute to tears and impingements.

For instance, nearly 70% of the population will suffer from a shoulder disorder at some point in their lifetime — largely due to the inherent instability of the joint combined with our modern “desk monkey” posture that pulls the shoulders forward and hunches the upper back.

While minimal flexibility is related to injury, performing static stretching (exclusively) during a warm-up doesn’t seem to decrease injuries. And too much stretching and flexibility may even increase the rate of injury. Many people, in fact, suffer from injuries caused by excessive movement and flexibility in the:

• shoulder joint
• knees (especially women)
• cervical and lumbar spines

Motor learning

Beyond the physiological benefits of warming up, engaging in movements you’re about to execute during exercise/sport allows for visualization of positive motor outcomes. In plain language, that means you practice the movement pattern so that your body knows what it’s about to do.

Muscle soreness

Despite the many benefits of warming up, it will not prevent muscle soreness — no matter what type of warmup  you choose.

What you should know

Static exercises

Warming up with static movements has pluses and minuses.

Static stretching can improve flexibility at a given range of motion. It can also improve balance — a bonus for yogis and gymnasts.

However, static stretching can create a temporary strength deficit, diminish jump performance and decrease running economy for up to 1 hour, since the sensitivity of tension receptors in muscle is decreased. On the other hand, physiotherapists and strength coaches can actually use this strength inhibition to their advantage, by stretching areas that commonly tighten up and contribute too much to a movement (for example, stretching the front of the hips before running to weaken the involvement of the hip flexors, which tend to be over-strong and tight).

Static exercise examples

Dynamic exercises

A dynamic warm-up can improve nervous system activation, power, and range of motion at the joint. Dynamic exercises performed before exercise/sport that requires high muscular forces can increase blood flow, metabolic activity, temperature, oxygen uptake, muscle compliance, nerve impulses, decrease resistance of connective tissues and reduce muscle tension. This type of warm-up creates minimal (to no) muscle damage, so it’s fine to do on a regular basis.

When you have mobile soft tissue and a rapid response nervous system, you’ll be able to move better and perform exercises that challenge your body. This means more productive workouts and a healthier physique.

Adding static exercises to a dynamic warm-up may diminish the force increases from a purely dynamic protocol.

Dynamic exercise examples

Dynamic exercises should not result in any sharp pains, but should feel challenging and strangely pleasant, especially after you get done. Find the edges of your range of motion, and work to gently expand these edges. If mild discomfort felt during the exercise continues afterwards, find an easier/modified version.

Foam rolling can be included as part of a warm-up since it helps with mobility and breaks down scar tissue/adhesions. This relaxes the fascia and makes muscle more pliable.

Foam rolling exercise examples

Summary and recommendations

Consider your warm-up period an essential part of the workout – not optional free time. It’ll make you stronger and improve your body control, balance, movement mechanics, and agility.

Find a warm-up that makes your body feel the best, and one that you can stick with. The variation in responses to warming up emphasizes the unique nature of individual reactions to different protocols. Targeting ankles, hips, back and shoulders will likely result in the most benefit. See example warm-up protocols below.

Extra credit

IT band pain

Iliotibial band (ITB) pain is one of the most common complaints among exercisers/athletes. If your ITB hurts, you probably have poor adductor and ITB flexibility along with weak abductors and glutes.

To remedy this, start including stretching exercises for the ITB (like in the following table):

Stretching exercises for ITB. Click to enlarge. (Source: Lininger MR & Miller MG. Iliotibial band syndrome in the athletic population: strengthening and rehabilitation exercises. Strength & Cond J 2009;31:43-46.)

Then, you must strengthen the hips. This includes:

• Hip hikes
• Clams
• Step downs
• Lateral band walks
• Straight leg & 45 degree exercises (with or without bands) that focus on the gluteus medius (straight leg abduction, bridge, monster walks, etc.)

Further resources

Partner relay warm-up ideas (Source: Swanson JR. A functional approach to warm-up and flexibility. Strength & Cond J 2006;28:30-36.)

Movement chain warm-up ideas (Source: Swanson JR. A functional approach to warm-up and flexibility. Strength & Cond J 2006;28:30-36.)

Dynamic warm-up PDF (Source: Carter Schoffer)

Guide to foam rolling

Performance U: Warm-up Progressions

Assess & Correct, Magnificent Mobility

References

Guidetti L, et al. Precompetition warm-up in elite and subelite rhythmic gymnastics. J Strength Cond Res 2009;23:1877-1882.

Judge LW, et al. An examination of the stretching practices of Division I and Division III college football programs in the Midwestern United States. J Strength Cond Res 2009;1091-1096.

O’Sullivan K, et al. The effect of warm-up, static stretching and dynamic stretching on hamstring flexibility in previously injured subjects. BMC Musculoskelet Disord 2009;10:37.

Costa PB, et al. The acute effects of different durations of static stretching on dynamic balance performance. J Strength Cond Res 2009;23:141-147.

LaRoche DP, et al. Chronic stretching and voluntary muscle force. J Strength Cond Res 2008;22:589-596.

Herman SL & Smith DT. Four-week dynamic stretching warm-up intervention elicits longer-term performance benefits. J Strength Cond Res 2008;22:1286-1297.

Hold BW & Lambourne K. The impact of different warm-up protocols on vertical jump performance in male collegiate athletes. J Strength Cond Res 2008;22:226-229.

Fletcher IM & Anness R. The acute effects of combined static and dynamic stretch protocols on fifty-meter sprint performance in track-and-field athletes. J Strength Cond Res 2007;21:784-787.

Curry BS, et al. Acute effects of dynamic stretching, static stretching, and light aerobic activity on muscular performance in women. J Strength Cond Res 2009;23:1811-1819.

Woods K, et al. Warm-up and stretching in the prevention of muscular injury. Sports Med 2007;37:1089-1099.

Lai K, et al. Active isolation stretching does not improve hamstring flexibility better than traditional stretching methods. Med Sci Sports Exerc 2003;35:S79 (Poster).

Vandervoort AA. Potential benefits of warm-up for neuromuscular performance of older adults. Exerc Sport Sci Rev 2009;37:60-65.

Thacker SB, et al. The impact of stretching on sports injury risk: A systematic review of the literature. Med Sci Sports Exerc 2004;36:371-378.

Kikkonen J. Chronic static stretching improves exercise performance. Med Sci Sports Exerc 2007;39:1825-1831.

Corrao M, et al. Addressing posterior shoulder tightness in the athletic population. Strength & Cond J 2009;31:61-65.

Lininger MR & Miller MG. Iliotibial band syndrome in the athletic population: strengthening and rehabilitation exercises. Strength & Cond J 2009;31:43-46.

Swanson JR. A functional approach to warm-up and flexibility. Strength & Cond J 2006;28:30-36.

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What is strength training?

Strength training, sometimes referred to as resistance training, refers to a specialized method of conditioning that involves the progressive use of assorted resistive loads and a variety of training modalities intended to promote health, fitness, and sport specific performance.

That’s a mouthful. Let’s put it another way.

Strength training is using muscular force against resistance. Muscles adapt to any type of resistance.

The resistance can be a heavy object, one’s own body weight, elastic resistance from bands, or other types of machine resistance from pulleys or hydraulics. The heavy object could be a kettlebell, free weight, log, beer keg, rock, another person — anything that has mass.

Some types of resistance training

Why is strength training so important?

Most obviously, strength training makes you stronger. It does this in several ways, including:

• building muscle tissue
• improving inter- and intra-muscular coordination — in other words, the ability to coordinate your moving parts
• improving rate of force production — how quickly you can generate force to move against the resistance
• strengthening connective tissues such as tendons

It can also make your muscles bigger while creating a demand for blood delivery, engaging the cardiovascular system.

How else can strength training be useful?

Bodybuilder Clarence Bass at 70, showing the benefits of lifelong strength training

Strength training:

• Preserves and enhances muscle mass

• Preserves and enhances metabolic rate

• Improves bone density

• Improves glucose tolerance and insulin sensitivity

• Lowers risk of injury

• Improves ability to engage in daily activities

• Improves balance

• Improves self-esteem

• Enhances strength and endurance

• Enhances speed, power, and agility

• Improves overall body composition

• Decreases bad cholesterol levels

• Decreases blood pressure

• Improves aerobic capacity

When muscle metabolism is altered, it can influence the development of many chronic diseases. Maintaining muscle mass with strength training can help to prevent some of the most common and increasingly rampant health conditions, including obesity and diabetes.

Who can strength train?

In the past, strength training was primarily used by athletes to enhance performance and/or increase muscle size.

However, strength training is now recognized as critical to everyone’s health and fitness — regardless of gender, age, or ability. Leading health organizations, including the ACSM and NSCA, recommend regular strength training as part of one’s fitness regimen.

With a properly constructed workout program that is tailored to individual goals and skills, anyone can strength train: men, women, children and adolescents, older people, and people with disabilities or movement limitations.

What you should know

It’s not just about the workout

Residual effects of strength training can last up to 72 hours. There seems to be a dose-response relationship between exercise intensity and observed changes in muscle mass and protein composition.

The role of SAID

The term SAID refers to specific adaptations to imposed demands. This means that our bodies adapt directly to whatever demands we give them.

• If we do particular movements, we’ll get better at those movements.
• If we do a partial range of motion, we’ll get stronger in that range of motion only. If we do a full range of motion, we’ll get stronger through that full range.
• If we use light weights and long-duration sets (i.e. high reps), we’ll gain endurance.
• If we use medium weights and medium-duration sets, we’ll gain muscle mass. We’ll also gain muscle mass using heavier weights and shorter sets, provided there’s enough overall volume to the workout.

Sets and reps

Generally, resistance training workouts are divided into sets of repetitions (aka reps).

Often the number of reps reflects the amount of weight used, or the technical complexity of the exercise. For example:

• To do a set of 15 reps requires less resistance than an all-out set of 2 reps.
• It’s easier to do a set of 15 biceps curls than a set of 15 burpees, or 15 clean and jerks.
• If you’re looking for explosiveness, you might use lower reps. If you just want to do a moderate, controlled repetition, you can use higher reps.

However, it’s also important to consider the total number of reps performed, and how heavy the weight is. (See “Volume” and “Intensity”, below.)

For example:

You could lift a weight for 3 sets of 10 reps.
Or you could lift it for 10 sets of 3 reps.

In the second case, you can probably use a lot more weight. In both cases, you end up doing 30 total reps. Which one you choose depends on your goals.

Volume

Volume refers to the total amount of reps/work within a given workout or training program. For instance:

3 set of 5 reps = 15 total reps — relatively low volume
10 sets of 10 reps = 100 total reps — relatively high volume

Intensity

Intensity in this case doesn’t mean how hard you feel you’re working, but rather how heavy the weight is relative to your maximum. High intensity means you’re lifting a heavier weight; low intensity means you’re lifting a lighter weight.

For example, if you can only do an all-out rep with 100 lbs in a given exercise, that’s your 1 rep max (1RM).

• If you use 50 lbs, that’s 50% 1RM, and low intensity
• If you use 75 lbs, that’s 75% 1RM, and medium intensity
• If you use 98 lbs, that’s 98% 1RM, and high intensity

Rest between sets

Generally, lifters rest between sets to allow ATP (muscle fuel) to regenerate. The rest length is also based on goals. The heavier the weight, and the more complex the lift, usually the longer the rest.

• When training with heavy loads for strength or power, about 3 to 5 minutes of rest between sets seems to allow for greater performance in subsequent sets.
• When the goal is improving overall body composition, the combination of moderate-intensity sets with short rest periods of 30-60 seconds might be most effective due to the metabolic cost and greater levels of growth hormone and testosterone.
• Very short rest periods of 20-40 seconds can result in better muscular endurance.

Exercise/movement types

In most cases, complex movements that involve many moving joints are best.

• For strength and power, focus on complex, multi-joint, “movement plane” exercises such as squats, deadlifts, pullups, rows, weighted jumps, etc. You can also use “functional” type exercises such as sandbag carries, sledgehammer swings, and tire flips.
• For muscle mass gain, you can use strength and power-type exercises (with medium loads) as well as targeted body part isolation exercises, such as biceps curls or triceps extensions.
• For endurance (for sport or rehab), you can use strength and power-type exercises (with lighter loads) as well as targeted body part isolation exercises.
• Many rehab-type exercises involve building endurance in specific body parts using very small movements (such as arm raises) with very light loads.

The chart below shows approximately what types of reps, sets, and other variables might help you meet specific goals.

Frequency

2 to 3.5 hours per week of strength training, divided over the course of the week, is enough for most people.

Examples include:

Monday/Wednesday/Friday for 60 minutes
Or
Monday/Tuesday/Thursday/Friday for 45 minutes

However, with sufficient variation in intensity, volume, and exercise choice, along with proper rest and recovery, more experienced trainees can do up to 5-7 hours/week.

Exercise sequence

In general, put the harder exercises before the easy exercises (e.g., multi-joint before single-joint, free weights before machines, etc). For example:

Squats before hamstring curls
Deadlifts before lower back extensions
Pullups before biceps curls

As you fatigue, it’s harder to coordinate and support the movements.

Progression

There are many different ways to make progressions.

• You can increase the weight lifted, the repetitions performed, or the sets completed.
• You can also decrease the tempo of each set to allow greater time under tension. Decreasing the rest between sets doesn’t allow your body to fully recover and is metabolically taxing.
• Even changing the biomechanics of how we do an exercise can be a method of progression (e.g., flat to incline, supinated to pronated, bent to straight, etc.).

Making it tougher

Finally, there are many ways to boost intensity with strength training. Here are some examples:

Supersets

Supersets alternate two or more exercises from set to set.

Example – 1 set of bench press; 1 set of dumbbell rows; 1 set of bench press; 1 set of dumbbell rows, etc.

Drop sets

Drop sets start with a heavier weight, then decrease the weight on subsequent sets.

Example – 10 reps with 100 pounds on squats, 8 reps with 80 pounds on squats, 6 reps with 60 pounds on squats, and so on….

Rest/pause

Rest/pause sets involve reps to fatigue, rest briefly, then do a few more reps, rest briefly, do a few more reps, and keep going until total failure.

Example – 10 reps with 100 pounds on squats, rack it, rest, 4 reps with 100 pounds, rack it, rest, 3 reps with 100 pounds

Circuits

Circuits string two or more exercises together with minimal rest in between. The lifter typically rests for a longer period after each “round”.

Example – 8 reps of pushups, 8 reps of deadlifts, 8 reps of rows, 8 reps of lunges, 30 seconds of jumping jacks, rest.

Density training

Density training involves the lifter selecting a given time limit, then trying to do as many reps as possible within that time limit.

Example – Doing pushups and pull ups for 10 – 15 minutes with minimal rest.

Negatives

Each rep has a “positive” or concentric portion (the portion where resistance is heaviest, as in the “up” part of a biceps curl), and a “negative”, or eccentric portion (the portion where one is simply resisting/controlling the resistance as it returns to the start, as in the “down” part of a biceps curl). Negative sets involve slow, controlled eccentrics, and usually an assisted concentric.

Example – Jump up to a pullup bar so your chin is above the bar; slowly lower yourself down. Here, the jump provides assistance on the “up” part.

Isometrics

Isometrics involve holding a particular static position under resistance.

Example – wall sit for 30 seconds

Planned variation

You won’t get very good results if you just wander from machine to machine, or do the same things all the time.

You also won’t get good results if you choose the wrong approach for your goals (e.g. an endurance workout if you actually want to improve your maximal strength).

Plan your workout so that:

• you know in advance what you’re doing;
• you’re not always doing the same exercises/sets/reps;
• you vary the loading; and
• you get enough rest and recovery.

Summary and recommendations

Strength training involves moving against resistance.

Anyone can strength train.

Strength train for 2 to 3.5 hours per week, distributed evenly.

Participate in a progressive warm up before strength training.

Your strength training routine should reflect your goals.

• For strength, try more heavy sets with fewer reps.
• For metabolic conditioning and endurance, try fewer moderate weight sets with higher reps.
• For hypertrophy, aim for more total reps, with moderate to heavy weights.

Think about movement choice.

• Focus on body part workouts if you are more interested in regional hypertrophy.
• Focus on complex, “movement plane” workouts if you are more interested in function, performance and strength.

Do the most taxing exercises first in your routine.

Vary your routine. The best program, as the saying goes, is the one you’re not currently doing.

Don’t forget about progression — otherwise, you probably won’t progress.

It’s virtually impossible to excel at strength training without good nutrition habits. No matter how awesome your routine is, if your nutrition is poor then you won’t make many gains.

For extra credit

Those undergoing cancer treatment, or who have previously undergone cancer treatment, may benefit from strength training.

Isometric strength training (static) can develop strength and hypertrophy.

Preparing the body for strength training with a dynamic warm-up can increase strength and performance.

Save static stretching for after strength training sessions – unless you are trying to “turn off” a certain muscle group (e.g., stretching hip flexors before squatting).

Strength training reduces the incidence of falls in older people.

Further resources

Pushin’ Iron for the Gridiron Part 1 & Part 2

The Creation of a T-Man

PN Exercise Plans

PN Exercise Videos

1 vs. 3 Sets for Strength & Muscle

Resistance Training FAQ

References

Howley ET & Franks BD. Health Fitness Instructor’s Handbook, 4th ed. Human Kinetics. Champaign, IL. 2003.

Baechle TR & Earle RW. Essentials of Strength Training and Conditioning. National Strength Training Association, 2nd ed. Human Kinetics. Champaign, IL. 2000.

Rennie MJ, et al. Control of the size of the human muscle mass. Annu Rev Physiol 2004;66:799-828.

Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr 2006;84:475-482.

Morton JP, et al. The exercise-induced stress response of skeletal muscle, with specific emphasis on humans. Sports Med 2009;39:643-662.

de Salles BF, et al. Rest interval between sets in strength training. Sports Med 2009;39:765-777.

Faigenbaum AD, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res 2009;23 5 Suppl:S60-S79.

De Backer IC, et al. Resistance training in cancer survivors: a systematic review. Int J Sports Med 2009;30:703-712.

American College of Sports Medicine. American College of Sports Medicine position stand. Progressive models in resistance training for healthy adults. Med Sci Sports Exerc 2009;41:687-708.

Guadalupe-Grau A, et al. Exercise and bone mass in adults. Sports Med 2009;39:439-468.

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High intensity interval training (HIIT) is when you alternate between high and low intensity exercise(s) or between high intensity exercise and a short period of rest.

For example, a short sprint up a flight of stairs followed by a walk back down is interval training. Or a set of burpees followed by bodyweight rows.

Example of HIIT on a Treadmill

Example of HIIT with Body Weight

If you’ve ever participated in HIIT, you know that alternating body weight conditioning exercises for 15 minutes can be a lot more challenging than a walk around the block.

Why is high intensity interval training so important?

It’s physiologically impossible to sustain maximal intensities during exercise for an extended amount of time. This is because of how our bodies use fuel.

Let’s say I tell you to go outside and run as fast as you can for 20 minutes.

Stage 1 – Phosphocreatine

OK! The first 10 to 20 seconds are going great! You’re sprinting like the wind! That’s because you’re using a high-intensity energy source known as phosphocreatine.

Stage 2 – Lactic acid and anaerobic glycolysis

After about 20 seconds, your phosphocreatine start to run low, and anaerobic glycolysis would predominate. At this point, more lactic acid would be produced and used as a fuel source.

You’re still be running as hard as you can, but you’d be slowing down, and your lungs are working overtime.

If you were a member of the Canadian Olympic Hockey team or an elite speed skater, you could probably maintain this for up to 10 minutes. But those who are not well conditioned would need to slow down and even stop. If this is your first time off the couch, you might even consider throwing up, thanks to the change in blood pH levels.

Well, it looks like the spirit is willing but the flesh is weak. 20-minute sprint challenge: FAIL.

So why can’t you work at maximal intensity for an extended amount of time?

Oxygen: The molecule that makes the magic

One reason is the supply and demand of oxygen when working so hard.

Nature is full of trade-offs. In this case, we trade efficiency for intensity.

When you work at a lower intensity (such as during a brisk walk), aerobic metabolism predominates.

Your body uses oxygen to break down carbohydrate and fat for energy. This is very efficient, but you can’t work at top speed. With aerobic metabolism, you gain efficiency but lose intensity. Evolutionarily, this would be useful for traveling long distances while foraging for food or water.

On the other hand, when you work at a higher intensity (such as sprinting), anaerobic metabolism predominates.

Your body can’t get oxygen to where it needs to go fast enough. This is very inefficient, but it lets you produce short bursts of speed or high energy — very handy when you’re running away from a sabre-toothed tiger or a rock-wielding Grok.

So, we have these two systems, both of which have their own advantages and disadvantages. What if we could have our cake and eat it too? (Or, in this case, lose the fat we gained by eating the cake in the first place.)

Enter HIIT.

With HIIT, you alternate short bursts of very intense exercise (such as 10-20 sec of sprinting) with periods of lower intensity (such as 1 min of walking).

• The higher intensity periods create a metabolic demand that is very effective for long-term fat loss and overall conditioning.
• The lower intensity periods let you recover and use the aerobic energy system.

Contribution of different energy systems to exercise, depending on how long the exercise takes

Hormones

In addition, hormone release during exercise depends on exercise intensity.

Gentle movements such as yoga, tai-chi, or a pleasant stroll outside can lower stress hormones.

But when you approach 85 to 95% of VO2max, growth hormone, testosterone, endorphins, epinephrine (adrenaline), norepinephrine (noradrenaline), cortisol, and aldosterone all increase. These hormones all have effects on body composition and anabolism.

What you should know about HIIT

Exercise can range from gentle movements to maximal efforts.  HIIT and heavy weights can elevate stress hormones.

Most every high intensity physical activity is a state of “crisis” in the body. It endangers oxygen supply to tissues, increases body temperature, reduces body fluids and fuel stores, and causes tissue damage.

Intense exercise creates endocrine and defense reactions that are similar to those elicited by low blood oxygen, high blood carbon dioxide, acidosis, high body temperature, dehydration, low blood sugar, physical injury and psychological stresses.

Hormonally, your body basically freaks out. Then it brings out the big guns to deal with the problem. High intensity exercise stresses the body so much that it’s forced to adapt.

As Nietzsche gasped during a 20-rep squat set, “That which does not kill me makes my quads bodacious.” (It makes more sense in German.)

Why HIIT?

HIIT is excellent for:

• losing body fat (while retaining lean body mass)
• strengthening the cardiovascular system
• developing sport-specific energy systems (e.g. training for that Olympic hockey team)
• developing “work capacity” (i.e. the ability to tolerate a high level of intensity for a longer period)
• improving fat and carbohydrate oxidation in skeletal muscle
• developing “mental toughness”
• making you a badass
• challenging the fast twitch muscle fibres — the fibres that are great for strength, power and looking buff

HIIT is extremely efficient. It lets you get a bigger training effect with less time spent. And compared to a 45-minute jog, 5 min of HIIT is a lot easier on the joints.

How to do HIIT

There are many ways to do HIIT. All you need to remember is the basic principle: Alternate short bursts of very high intensity with periods of recovery/low intensity.

The longest 4 minutes of your life: The Tabata study

One of the most famous studies of HIIT is known as the Tabata study. In this study (see abstract below), subjects performed rowing intervals: 20 sec of ultra-fast rowing alternated with 10 seconds of relaxed recovery rowing, for a total of 8 intervals, or 4 minutes.

At the end of the study, participants showed a 28% increase in anaerobic capacity along with a 14% increase in V02max. Pretty impressive!

The “Tabata protocol” — 20 seconds on, 10 seconds off — has become one of the most common methods of doing HIIT.

Weighted circuits

Using resistance exercises can be a very effective method of doing HIIT.

To use resistance training, choose compound exercises that are good “oxygen suckers”, such as:

• burpees
• kettlebell swings or snatches
• jumping squats

Combo exercises are also good choices. For instance:

• do a pullup, drop down, do a pushup, jump back up to the pullup bar for another pullup, and so on
• hang clean + front squat + overhead press
• dumbbell snatch + wrestler’s sprawl

You can also combine resistance exercises with “cardio” type exercises.

For example

• alternate a set of dumbbell swings with 100 m sprints
• sprint up a hill, then do a fast set of pushups at the top
• carry a heavy sandbag for speed

Customizing HIIT for your goals

You can mix up your HIIT choices to avoid overtraining and overuse injuries, and to keep things fresh and interesting.

If you’re a competitive athlete who needs energy systems work for your sport, incorporate some sessions of sport-specific HIIT work. For example:

• sprints for soccer players
• jumps for volleyball and basketball players
• heavy bag intervals for boxers
• etc.

You can also vary the length of your intervals.

• High intensity intervals can last anywhere from 10 to 60 seconds
• Low intensity recovery periods can last anywhere from 10 seconds to a minute or more

If you’re new to HIIT, opt for shorter high intensity periods and longer low intensity periods.

And note: “high intensity” means “high intensity for YOU”. If you’re a beginner, a fast jog or uphill walk for 10 seconds is a better start than trying to handle an all-out sprint workout.

Don’t forget: Perform an adequate warm up and cool down when performing HIIT.

Further resources

How to do interval training

Interval training – are you doing it?

Lots of conditioning options…

Training the energy systems

For extra credit

The benefits of HIIT are exercise specific. If you do squat jumps and running, you get better at squat jumps and running.

You can maximize your HIIT performance by using non-competing exercises. Instead of doing split squat jumps alternated with squat jumps, which use the same muscles, you could pair up body weight rows and squat jumps.

With really intense bouts of exercise, the body’s energy requirement can increase 2 to 20 fold!

During the first 1-2 hours after intense exercise, your body’s energy requirements remain high.

So what is high intensity? Well, during your next sprint, envision a crazy grizzly bear chasing you. That should suffice.

HIIT will not only improve body composition, it may extend your life. The Harvard Alumni Health Study, a 4-year study of more than 17,000 men, found that only vigorous – not moderate — exercise reduced risk of death.

The Gymboss is a handy timer for interval workouts.

More examples

References

Tabata I, Nishimura K, Kouzaki M, Hirai Y, Ogita F, Miyachi M, Yamamoto K. Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max. Department of Physiology and Biomechanics, National Institute of Fitness and Sports, Kagoshima Prefecture, Japan

Talanian JL, et al. Two weeks of High-Intensity Aerobic Interval Training increases the capacity for fat oxidation during exercise in women. J Appl Physiol 2007;102:1439-1447.

Perry CG, et al. High-intensity aerobic interval training increases fat and carbohydrate metabolic capacities in human skeletal muscle. Appl Physiol Nutr Metab 2008;33:1112-1123.

Tremblay A, et al. Impact of exercise intensity on body fatness and skeletal muscle metabolism. Metabolism. 1994;43:814-818.

Yoshioka M, et al. Impact of high-intensity exercise on energy expenditure, lipid oxidation and body fatness. Int J Obes Relat Metab Disord 2001;25:332-339.

Borer KT. Exercise Endocrinology. 2003. Human Kinetics. Champaign, IL.

Tremblay A, et al. Effect of intensity of physical activity on body fatness and fat distribution. Am J Clin Nutr 1990;51:153-157.

Burgomaster KA, et al. Similar metabolic adaptations during exercise after low volume sprint intervals and traditional endurance training in humans. J Physiol 2008;586:151-160.

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