Podcast Episode #97: The Single Injury That Is Responsible for More Than 75% of the Pain You Have While Exercising

In this podcast episode, a mystery injury that you probably have Hornet juice Is protein powder toxic? Dealing with road rash? More on the carb equation Traveling for endurance events. How hard should you race a triathlon? Food and vitamin interactions, stomach problems while running, Recovering from knee surgery, and homemade gels and sports drinks.

Welcome to the Ben Greenfield Fitness Document Podcast. We provide you with free exercise, nutrition, weight loss, triathlon and wellness advice from the top fitness experts in the nation. So whether you're an Ironman triathlete or you're just trying to shed a few pounds, get ready for non run of the mill cutting edge content from BenGreenfieldFitness.com.

Hey podcast listeners, this is Ben Greenfield.

And if today's podcast audio sounds just a little bit different, it is because I am traveling right now. I'm actually in Hawaii and I'm recording this from my portable microphone. So I apologize for throwing you for a loop, but I think you'll survive. So in today's podcast, a really interesting interview with a guy named Tom Vachet who wrote an article that I read in a research publication on an injury that almost everyone that I have ever worked with, whether they be an athlete or just someone who's trying to get more fit, has dealt with. And he has literally turned this injury inside out, explained it in the article. So I got him on the podcast to actually talk about what he has found and why you need to care about this injury. We have a ton of really fantastic Listener Q&As, a few special announcements. So with that being said, we're going to jump right into the podcast. And for those of you who are wondering why I'm in Hawaii, I'm racing a half ironman down here. It's called the Hawaii 70.3.

Special Announcements.

First of all, great news for those of you who have been wanting one of the black BenGreenfieldFitness.comT shirts that say on the back, my personal trainer told me to eat more fat. Those are now available. I've got a bunch ready for you and I'm just going to be giving those out and shipping them to anybody who logs into the show and presses the donate button. If you scroll to the bottom of each post. For example, if you go to the show notes for this episode, episode number 97 all the Way at the bottom, you can see that you can donate to the podcast. If you donate to the podcast and leave me your address, I will send you one of these T shirts. You do need to donate more than $15 to actually get the T shirt. And there's a little button on there that lets you easily do so. Now the other special announcement that I have today is for you triathletes out there, I am actually organizing a group of triathletes to join me in a triathlon that I'm racing down in Thailand this winter. Two triathlons actually, and I'm going to be securing race slots even though one of the races is sold out. I've got race slots. I've got huge discounts on room blocks. I'm going to be organizing group social events and parties, tours of the actual race course. And all you have to do is show up and have a good time. So if you're interested in doing that, it is filling up, but you need to email me BenGreenfieldFitness.com I understand this is probably something you may want to mention to a spouse, if you have one, and talk to them a little bit about it. I would highly recommend that you do that. But if you get a hold of me sometime in the next two weeks after hearing this podcast, then I can get you in. And the actual dates are November 24th through December 7th. I can send you all the details if you shoot me an email and ask for details. If you haven't yet gone to the Get Fit Guy podcast on itunes, check that out. Left a ranking and also checked out this podcast and left a ranking. Go ahead and do so. It really helps both those podcasts out. And the Get Fit Guy is the other podcast that I do that is much shorter and more designed for shaping up and slimming down. Those are this week's special announcements. We're going to move on to our Q and A after a quick message.

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Listener Q and A.

If you have a question, you can email me ben greenfieldfitness.com you can Skype. If you're international, that works pretty well to Pacific Fit. Or you can call toll free to 877-209-9439. And just to give you a heads up for the 100th episode, which is coming up in three podcast episodes from now, I'm only going to be answering audio questions. It's going to be an entirely audio episode so that I can hear some of your voices and others can hear some of your questions the way that you want to ask them. And so be ready to be asking your questions for the next few weeks via audio rather than via write in. So again, the audio is Skype to username Pacific fit or you can call 877-209-9439. The first question this week comes from listener TM and she says, what is your take on Hornet Juice? Well, Hornet Juice, for those of you not familiar with it, is a sports supplement. It's been around for a while. They say that they increase the amount of or the Hornet Juice increases the amount of fat that you burn so that you're able to increase your athletic endurance. And the whole hypothesis behind that is that when you're competing in an event like a half marathon or a marathon or a triathlon, your body taps into fat stores a lot more than if you were say, competing in a soccer game or 100 meter sprint at least, especially for the longer endurance events. And so the idea is that if you can get your body to mobilize fat stores more efficiently, then you would technically be able to compete in those events at a higher level. Now if you go to the ingredient list on the Hornet Juice website, basically what they say when you look at what Hornet Juice actually is is they say it's a unique combination of 17amino acids developed after extensive research of the giant hornet and its amazing ability to fly 50 miles a day. Well, folks, research has been going on for a very long time in humans. I've mentioned it many times on this show that the consumption of branched chain amino acids during exercise can stave off fatigue and allow you to go for a longer period of time and also allow you to recover more quickly after your workout. Now they have done some studies or they list some studies on the Hornet Juice website that show that there may be an increase in fat oxidation or when you combine not only some of these branched chain amino acids with some other amino acids. Now the thing that I'm not seeing on the Hornet Juice website is if you were somebody who was consuming adequate protein anyways, had an adequate pre workout meal so that you already had some of these amino acids in your system if you were consuming a sports supplement. You know, for example, one that I use is a goo, it's a gel called Roctane that already has amino acid supplements in it. Then is there any difference between the fat oxidation and the performance when you're just doing those things normally versus when you're drinking the juice of a hornet. So that's my little issue is that it's not really a mystery what's in it. It's just a bunch of amino acids. And if you're taking care of your body, if you're already consuming a gel or something that has amino acids in it, I'm not convinced, at least by the research to date, that this stuff would offer you any additional advantage. But it does look interesting. And if any of you out there get it and try it right into the show or leave a comment on these show notes, the show notes for episode 97 and let me know. Listener Paul says, I have a question about consuming protein drinks and protein powder. Consumer Reports has put out an article stating that high consumption of these powders can be damaging to your body due to the heavy metals which are ingested. The article talks about high consumption being maybe eight scoops per day. I average just over one scoop. Do you think this level of protein powder intake is putting me at any long term risks?

And when you look at this study.

Basically what they're saying is that these protein powders that they tested had arsenic, cadmium, lead and mercury. And they're claiming, of course, that those metals can have toxic effects on several organs in the body. And it looks like some of the ones that they looked at were muscle milk, eas, Myoplex original rich dark chocolate protein. A lot of these kind of commercial proteins you're going to see at gnc. If you've listened to this show for any period of time, you know that I already preached that you should just if you're going to take in a protein, choose an organic protein. You know, I use an organic goat protein. That one's called Mount Capra double bonded protein and the only ingredients in it are protein, cocoa and stevia. It's very clean. There's not a lot of additives, there's not a lot of artificial sweeteners, there's not a lot of artificial colors, there's not a lot of preservatives. And so when you compare a protein like that to something like the EAS protein, which has a list of ingredients about a mile long, half of which are very difficult to pronounce, then it doesn't surprise me that studies have found that those proteins pose health risks or that those proteins contain heavy metals. Now, because you're consuming eight times less than what the subjects in those studies consumed, then you're probably not going to be at the same risk as the participants in the study. However, why not just play it safe and take in an organic protein base that you know is produced by a company that isn't dumping a bunch of chemicals into their proteins. That Mount Capra one that I mentioned would be one perfect example. If you're vegan or vegetarian or you don't do well with whey protein because that Mount Capra is a whey protein, then you can try, for example, a hemp or pea or a rice protein blend. There's one called Living Protein that's really good. As a matter of fact, what I will do, I'm going to write a note to myself. I'll put in the show notes of this episode a link to the Living protein and the Mount Capra double bonded protein that I talked about so that you can check those out for yourself. Now, next we have a question from listener Chris and Chris says, can you talk? Well, he's kind of got a two part question. First he says, can you talk about the best way to deal with road rash? For those of you listening who don't know what road rash is, it's basically something that cyclists get when they hit the dirt after a crash. Just really quickly, Chris, because you could obviously you could find this stuff on sportsmedicine.com which is a great website that tells you how to treat injuries and work with injuries. As far as what I do, I clean out the wound very thoroughly with soap and water. I'll typically add like an antibacterial type of ointment and then I will cover with a semi permeable dressing that breathes. Tagaderm is the brand that I use. It's a really good one. Second Skin would be another example. They breathe a lot better than like a band aid and you can hold them on with like an adhesive tape. If it's a really deep road rash, of course you may want to look into whether or not you've had your tetanus shot recently. But basically that's how I do it. If you're really concerned about killing off bacteria, you could also, if you want to go the natural route, use a little bit of oil of oregano. That's something that I'll use quite a bit on wounds and injuries, especially around the area to make sure that I kill off any bacteria in that area. There's a really great interview about oregano on the website@BenGreenfieldFitness.com if you go to BenGreenfieldFitness.com oregano. But those would be my recommendations. And as far as the second part of your question, you say, I have always struggled with overeating or feeling like crap later in the day. I'm definitely eating more during and after working and starting to drop my last ten pounds. I've never been able to shed with my post workout carbs being the only variable I've changed recently. My question is, since that part of the equation is based from your ideal body weight, do you have to factor in calories consumed during your workout? So for those of you who are totally confused by that question, basically in the last couple episodes I have mentioned the post workout carbohydrate intake equation. It's very simple. You take your body weight that you want to be at. Let's say you want to weigh 150 even if you already weigh 170. Let's say you want to weigh 150 and within 20 minutes after your workout you consume 2 calories of carbohydrate for every pound of weight that you want to be, which would be 300 calories of carbohydrate. In that situation, Chris's question is can you count the calories that you took in during the workout? The answer is no. And that's assuming that you're not eating calories during workouts that last an hour or less. If you're doing a 90 minute or a two hour or two and a half hour kind of long endurance based workout, you cannot count the calories you consume during those workouts to be part of your post workout meal. Those are simply keeping your blood sugar levels and your muscle glycogen levels or your glucose levels elevated during exercise. They don't count as recovery carbohydrates. If the exercise session is less than an hour, you could count those. But then it comes down to the fact that if it's less than an hour, you probably really don't need to be eating anyways unless it's a very, very intense workout. Listener David asks I need to plan or he says my question really is more around the logistics of traveling to a distant event. I need to plan on at least two travel days to get there during a fairly critical phase of training, plus time to overcome any jet lag, time to acclimatize, train a little on the race course, and then properly taper during the last week. How far in advance would you recommend trying to get to the event location to take all these factors into account? Any suggestions on planning and logistics for something like this would be much appreciated. Three things I take into account David, when I visit an area is the actual time of the place that I'm visiting, which kind of goes right along in there with the jet lag issue, the circadian rhythm issue. Second thing I take into account is the heat. The third thing I take into account is the altitude. Now let's start with kind of the easiest one to tackle the altitude equation. You can either get there a good two weeks prior to get your body used to high altitude, or you can get there just the day before so your body doesn't have time to go into the throes of distress that altitude is going to give it. So with altitude, it's a real, real tricky beast. You either have to get there really early or get there just right before. As far as heat goes, you don't really have to worry too much about the heat if you're acclimatizing at home. Case in point, I'm racing in Hawaii here in four days. I have actually been going to my local YMCA dry heat room and sitting in that sauna for about 10 minutes, then going into the steam room, the very hot, humid steam room next door, and, and doing step ups and jumping jacks for 20 minutes just to get my body ready for the heat in cold Spokane, Washington. Now, an ideal best case scenario according to research is 90 minutes of heat acclimatization for two weeks leading up to the event and doing those 90 minutes at least every three days leading up to the event. But what it comes down to is if you can get your body used to the heat wherever you're living at, then you just continue that heat acclimatization whenever you arrive where you're going. That being said, I try and give myself four or five days at least. So I have a race on Saturday and I arrived in Hawaii on Tuesday and I'm doing all my training sessions in the afternoon heat. Now the third thing, the jet lag, lots of remedies for jet lag, as you can guess. A few of the things that I do is I use melatonin. Three milligrams of melatonin usually does it for me, sometimes six. But you take that when you get to where you're going, you take it at the time that you want to be going to bed. Now what you can do if you want to plan in advance is when you're at home, you can actually take the melatonin at the time that wherever you're going, you would be going to bed. So if I'm going to be going to bed at 10pm and I'm traveling to Florida and I live three hours earlier over in Washington state than at 7pm in Washington state I would take melatonin and begin to wind up down. The other thing that I'll do for jet lag is I will exercise as soon as I arrive where I'm going. It's kind of my cure all fix for jet lag. If I can get down an exercise session, it's often very difficult to do right off the plane, but I try and get that in as soon as possible. Now a couple of other little jet lag things that you can do is there are some homeopathic remedies out there that are used as herbs for sleep aids. Chamomile and valerian root would be the 2, 2 that I've actually used and found some success with in terms of helping myself get to sleep. Definitely avoid alcohol, avoid caffeine, keep yourself very hydrated. And there is something out there called the anti jet lag diet which basically, well, I'll break it down for you and if you've tried this, let me know because I haven't. But it's supposed to work pretty well. Three days before you leave, you switch to a high protein diet. And the theory is that these foods all help produce epinephrine, norepinephrine and dopamine, which help your body to really maintain this alert awake state. And then your dinner at night, after you have that high protein day, your dinner at night is carbohydrates. And carbohydrates can cause your body to produce melatonin. And so you do high protein all day and then a carbohydrate based dinner and then the next day is a fast day or where all you're doing is very, very light eating. And the idea is that that depletes your liver stores of their glycogen. And the claim there is that it resets the body circadian rhythm. I'm not quite sure how depleting the liver's glycogen stores resets the circadian rhythm, but that's the way this diet goes. I'm just filling you in on how it goes. The next day you do the exact same diet as you did on day one. High protein all day and then a carbohydrate based meal. Then on your travel day, travel day is basically a fast day until you get to when it's going to be breakfast time at your destination. So for example, if you're traveling from Florida to Idaho and Idaho is three hours earlier than Florida, if you get up at, let's say your plane leaves at 6am from Florida, well, it's 3am in Idaho. You're planning on eating maybe at 7am Your breakfast when you get to Idaho. So while you're traveling you would want to fast until about basically whatever time 7am is in Idaho. So the idea is that on your travel day you begin to eat at the same time that you're planning on eating your meals when you get to the destination that you're going. This is obviously far more relevant for international travel and would require you to do a little bit of finger work online and find out what the times are going to be internationally. And then as you're traveling you eat at breakfast, lunch and if necessary dinner at the times that you're going to be eating when you're traveling. So that's kind of taking it to the extremes, but that is the anti jet lag diet and you can try it out. So the next question comes from Graham and Graham says, I am an Irish guy based in London and found your podcast through the Tri Swim Coach podcast. I have a couple of questions that I can't get out of my head. Question number one I joined the Rockstar Triathlete Academy and downloaded the 70.3 intermediate triathlon plan because I have a 70.3 triathlon coming up in three weeks. I looked over the last four weeks to see what you recommend and was surprised to see power workouts and no long endurance rides or runs. Is it right to do more muscular endurance and then finish up with some power sessions without continuing to do base endurance workouts before the race? And the answer to that question is if you're getting ready for a triathlon, especially an Ironman or a half Ironman triathlon, and you've done the proper training leading up to the final two to four weeks before that race, then you have all the endurance that you need and most of your training should switch to power based explosive race pace style training for those last few weeks. And that is why if you taper correctly when you finally do finish your race, you you're not going to be very fit and you have to rebuild your endurance. If you try to maintain your endurance leading up to the event, you're going to race okay, but pretty subpar. If you kind of forget about maintaining endurance and just focus on power, intensity and speed in those last few weeks leading up to the event, you're going to do very well. And there's tons of research to show that the higher intensity intervals maintain your aerobic fitness. Your next question is kind of long, but I'm going to summarize it to the AUDIENCE Basically what Graham says is that based off of these supplements, like the caffeine based supplements that he takes while he's racing, his heart rate gets really high during his races and he's wondering if he should be adjusting his actual training sessions that he does leading up to that race to be done at that higher heart rate he's going to end up racing at. And it's an interesting question because when you're doing a race, you get all this adrenaline produced. You're a lot of times taking caffeinated supplements that jack up the heart rate. And if you have, say, a race pace heart rate in training that's at 160, that race pace heart rate might be 170 by the race. So here's what I do. I train with heart rate during my training sessions and I monitor my heart rate, but I don't wear a heart rate monitor during the actual race, except for if I'm doing a long race like Ironman. And the reason for that is because I want to be very in tune to my body because I know that those heart rates are going to be highly variable. So what I do is I try to have the same feeling in my body that I do while I am training at the race zone that I want to be in. So to clarify, let's say that I want to do a race in what's called Zone 4, which is the zone where I'm breathing very hard, my legs are burning, and I really feel like I'm racing well during my training. I'm doing all my training sessions in Zone 4 and Zone 4 for me is 160 beats per minute. But while I'm doing those training sessions, I'm paying very close attention to how my body feels at 160 beats per minute. Now, when I get to the race, what happens is even though a bunch of adrenaline and caffeine and all that jazz may throw my heart rate up to 170 beats per minute, at that same feeling, I will not pay attention to that and just race at the same feeling that I had while I was racing or while I was training at that zone 4. Slightly lower heart rate during my training. So that's the tough part about racing is you can get dehydrated, your heart rate values will go off, you can get adrenaline, your heart rate values will go off of what you're used to. The caffeine can throw your heart rate values off. And that's why it's important not to necessarily be married to, to your heart rate monitor. But instead Be very in tune to the way that your body feels during your heart rates that you're producing during training. And that's the other reason that power meters, especially on a bike, are really good, because they're not influenced by things like caffeine and adrenaline. Power is power. It's not going to be affected by blood volume or physiological variables. So your final question is. I take Omega 3 supplements, vitamin C, magnesium, multivitamins, coenzyme Q10, and I just ordered some supplements from your website to add to this list. I consume these together on an empty stomach first thing in the morning mainly so I don't forget to take them. But when should I be taking these supplements together with food? Am pm? What suggestions would you have to maximize their effectiveness? Well, it's a great question and here are some rules to follow. First of all, if you're taking digestive enzymes, take those at the beginning of the meal, okay? Just a few minutes before a meal. For example, breakfast, that would be the time to take something like digestive enzymes. If you're taking iron and you're taking calcium, split those up. For example, take the iron in the morning, take the calcium later on in the day because those interfere with the absorption of each other. So iron and calcium you need to take separately. If you're taking high doses of vitamin B, then those can make you feel a little bit of nausea. And so high doses of vitamin B should be eaten with a meal. And the only exception to that is vitamin B12. If you're taking a high dose of vitamin B12, it's a popular supplement for fat loss. These high, high dose vitamin B12 supplements, those should be taken on an empty stomach. You take some of the supplements that I use, recovery based supplements like Recoveres, and that has a bunch of proteolytic enzymes in it. Those actually work best on an empty stomach. If you take them with food. A lot of times they just work as digestive enzymes. If you take them on an empty stomach, they can help control inflammation. So a perfect example of that would be you do your workout, you take your proteolytic enzymes like recoveries, and then 20 minutes later you eat. And that way you're getting those recoveries enzymes on an empty stomach. A lot of your antioxidants are best absorbed on an empty stomach. So if you have a high antioxidant supplement, even if you have something like Ener prime, that's best on an empty stomach. And then probiotics also would be something that you'd want to take on an empty stomach. Finally, if you're eating something high fiber, you'd want to split up any fat, type of fat soluble or fatty type of vitamins like omega 3 fatty acids, fish oils, flaxseed oils, vitamin D, all that stuff you shouldn't take with a bunch of high fiber supplements. And so to sum that up, what I do is, is I get up in the morning and on an empty stomach I'll take all my enzymes, digestive enzymes, probiotics, stuff like that. I'll stretch out, I'll have a little bit of breakfast and then a little bit later on in the mid morning I'll take my fish oil, my omega 3, my flaxseed oil, my vitamin D, that type of stuff. And then post workout I'll take my recovery supplements, my proteolytic enzymes, and what am I missing? Magnesium electrolyte, stuff like that doesn't really matter. If I didn't mention it then it doesn't matter. But the idea is that yeah it does. There are some things you want to bear in mind. And then finally with anything, coffee and alcohol is going to interfere with anything. So try and not throw your money down the drain on vitamins by having a big cup of coffee right after you take your vitamins. So great question. Listener Eric says, oh by the way Graham, you had some such well thought out questions and I really appreciate you sitting down taking the time to write those. I am going to nominate you as the top question for the week. So I'm giving you a free month of membership to my Body Transformation club where I'll send you a postcard each week during the next month that gives you new recipes, access to a secret video page, workouts. It's just a really cool way to have accountability and new recipes, new workout ideas, stuff like that sent to you. So if you want in, if you want to take advantage of that free membership you just won, then email me ben greenfieldfitness.com now listener Eric says, during my last couple triathlons I've struggled during the run with GI stress. It feels like something bouncing around in my gut. Is this a symptom of something that can be resolved? My usual pre race meal is a yogurt and granola mix, bananas or toast. During a race I usually take in one or two gels and a water Gatorade mix. I'm usually racing in sprint to Olympic distance races and this problem has been most pronounced during longer distance races. Holy cow, there's a lot of stuff in here that could be causing some serious issues. Eric starting off with the fact that you're consuming dairy, gluten and then the fructose based Gatorade, three sugar types of which people who have sensitive stomachs do really poorly with. So the first thing that I would do is I would eliminate those potential triggers. Specifically the way that you could do that is you could replace your toast, your granola and your yogurt with like a sweet potato yam type of mix or a gluten free bread like an Ezekiel whole grain sprouted gluten free bread, gluten free pancakes, something like that. Use the vegan meal plan that I wrote over in trainingpeaks, that would be another option. If you go to trainingpeaks, do search for vegan meal plan. I've got a meal plan over there. But basically you would want to eliminate a lot of those triggers of GI distress. The yogurt you just want to eliminate altogether. And a little bit of coconut milk would be okay, but again not a lot of fats and proteins. Pre race take out that Gatorade and switch to a non fructose based gel. Like Goo gels work really well. Probably Goo and Hammer would be my top two gels. The ones that I use are the Goo Roctane gels. And by eliminating some of those variables from your diet that are typical culprits for GI distress, you're going to be on a really good track and then just make sure that you're not eating too much. That's the problem is sprint distance races, you really don't need to eat anything at all. Olympic distance races, you should be doing most of your eating via liquid fueling on the bike and barely anything on the run. And that's the problem is a lot of people try and take their Ironman type of fueling and use it in a sprint or Olympic distance race and it's just too much for the stomach to handle for that short period of time. Listener Christina asks I am a fitness instructor and mom of three who two weeks ago had ACL reconstruction and cartilage repair on my right knee. I don't get to start PT until next week since I have to wait for my script at the three week follow up. So my question is this, if it doesn't hurt, would doing things like mini squats or very narrow lunges be harmful or beneficial? Well Christina, a little bit outside my scope of practice. I'm not a physical therapist or a sports medicine doc and I don't know the status of your post surgery knee health and so it's really tough for me to Say the range of motion you should be going through. I don't know how extensive the cartilage repair that was done, but I can tell you one thing that would be helpful that's surely not going to hurt you. And it's very essential for ACL reconstruction. One of the things that I did during college was I helped out with ACL reconstructions. I had an internship and I, with the Kansas City Chiefs, helped rehabilitate players that were dealing with their or were going through their ACL rehabs. And we did a ton of proprioceptive work. Standing on one leg with the eyes closed while doing light upper body movements, standing on one leg or both legs on balance devices like Bosu balls or air pillows. And again, just focusing on regaining balance, rebuilding the neuromuscular health of the knee and not really focusing from the get go on developing a ton of strength, strength, a ton of fitness in the knee, but making sure that the neural circuitry, so to speak, was sound coming back so that the movement patterns that were emerging during the actual exercises like squats or lunges, were correct. And so I would encourage you to really focus on balance. You can just close your eyes while you're brushing your teeth, stand on one leg, you can do some upper body movements and again, try and shift on one leg. Standing on an unstable surface would kind of be the next step. Once you're able to support yourself very well, you can re injure yourself if you're not careful using an unstable surface and falling off it, brushing your teeth. Standing on one leg typically isn't as much of an issue. So my advice for you is pay attention to what your doc says in terms of rehab. Focus on balance right now instead. And then finally, listener Mark says, I am currently preparing for the Ironman 70.3 World Championships. I follow a Paleo nutrition plan which has included eliminating sugar and artificial sweeteners. One sticking point is sport drinks and gels, most of which contain large amounts of sugar or artificial sweeteners. Do you have any thoughts on this or recommendations of alternatives that can be used both in training and in racing? Well, Mark, the whole idea behind the Paleo Diet is not that you're supposed to eliminate sugar. All those things in the Paleo diet, sweet potatoes, yams, carrots, parsnips, beets, all those carbohydrate sources, those are pure sugar. What the Paleo diet eliminates is grain based sugars, definitely artificial sweeteners. And the sport drinks and gels, a lot of those contain like maltodextrin and fructose a lot of the same types of sugars you're going to be getting from fruit, which is a huge part of the paleo diet. And so I wouldn't be worrying too much about the sports drinks and gels. However, what I would recommend just for your overall health anyways, is that you not make those the crux of your dietary intake during training. What I do is I train with fake foods like sports drinks and gels one time per week during a key training session that's really getting me ready for a race. Like a two hour bike ride at race pace intensity. I'll hammer through four or five sports gels during that training session and then I won't be touching any sports gels the rest of the week and everything else will be real food. Now, if you really want to create your own sports drinks or gels and you want to go just totally all natural, just think about the idea. You need salt, hydration and sugar essentially. So you could do something like coconut water. You could mix it with a sugar source like a brown rice syrup or an agave syrup. You could put some salt in there and voila, you'd have your sports drink for the gels. There's lots of different gel recipes out there. A lot of them again are based with like a brown rice syrup starter, an agave syrup starter, and honey is another example. This is something I used to do when I was a poor college student. I didn't want to spend $1.50 or 2 bucks a pop on gels. I just basically put a bunch of honey in a Ziploc and I'd squeeze that out the Ziploc as I was training. And again, all natural source, but really physiologically not processed much differently at all, especially during exercise, than just a regular gel. So I think that you're probably worrying a little bit too much about this because really you're not breaking the rules of the Paleo diet by having a gel during training. Physiologically, it's all processed pretty much the same and I would be staying away from any gels that have artificial sweeteners in them anyways. Sucralose, acesulfamine, potassium aspartame, all that stuff shouldn't be in a sport drink anyways because it really can cause GI distress and deleteriously affect your gut flora. So be careful with that. So that wraps up our questions for this week and we're going to move on to the interview with with Tom Vachet. And again, everything that I talked about today, I will put links to in the show notes to this podcast episode, episode number 97, including a link to Tom's website.

Featured topic.

Hey podcast listeners, this is Ben Greenfield. And if you've listened to this podcast for any period of time or you've tuned into the show, you know that we've mentioned a couple of times the importance of one of the central bones or structures in your body, the pelvis, in terms of your athletic performance and also the health of your low back and your hips. Now, today on the show, I have a guest who has rehabilitated everyone from super professional athletes all the way down to weekend warriors and has helped people overcome this problem with hip rotation discrepancies and pelvic imbalances, and also help to diagnose and recognize the problem when it occurs. And the gentleman that's on our call today is Tom Vachet. And Tom has a very comprehensive biography. He's worked with the NHL, he's worked with the NBA. He, he's been interviewed in ESPN for both ESPN Insider and ESPN Television. He's a member of the National Strength Conditioning association, the Rehabilitation Engineering Society of North America, the Rehabilitation Nurses association, the American Nurses Association. He is a highly respective medical advocate. He's a sports and conditioning expert and has a pretty comprehensive sports background himself. But in terms of being somebody who understands the unique movement of the hips and the importance of the hips in the development of your training, Tom is one of the, really one of the top people in the world for you to be listening to today. So make sure that you pay attention to what Tom is about to tell you. And Tom, thank you for coming on the call.

Yeah, you're welcome. Thanks for the invitation. I appreciate it.

Now, Tom, for the people who are listening in, who really need to understand the importance of the pelvis and how it actually dictates movement, can you explain exactly what role the pelvis plays in movement?

I think the first appreciation for the contribution of the pelvis for me was in the. In the mid-80s, I attended a course for physical therapists in Nashville, Tennessee. And that instructor started this course by telling all of us that proximal stability provides for distal mobility. And it actually was a fancy way of explaining this whole concept of core that's, you know, that's become so important in most training circles.

Now, if I could interrupt you for just a second. When you say proximal stability influences that distal mobility for the listener, would they basically take that to mean that movement in a part of the joint that would be, for example, higher up on the body, like up in the Hip would affect the performance of a joint farther down the body, like the knee?

Well, yes, but more correctly, it actually means that from that strength, endurance, stability that you have in the center of your body. So the pelvis allows you to express power, be more efficient, stronger at the end of your limbs, both arms and legs.

Okay, so moving on from that point, how is the pelvis actually responsible for movement and how does it actually dictate performance?

Well, the pelvis is the central part of the body to which most of the major muscles are connected. And the pelvis is not one single bone. It's made up of multiple bones, but basically two halves connected by ligaments. And so to provide for sports performance, athletic performance, to reduce injuries. I think we've all read a lot about doing core strengthening. And what we're talking about are basically all of those central muscles that surround the pelvis from the. From the buttocks up through the abdomen and the pelvis. What I've discovered is that from time to time, it will actually get rotated. One side will be rotated in one direction, the other side in the opposite direction. And when that happens, it creates an instability that has a pretty dramatic on those central core muscles in terms of inhibiting some muscles so that they actually can't function appropriately. And then there are consequences to that dysfunction that we call it up and down the kinetic chain. So both up the spine and into the shoulder girdle, as well as down from the hips, through the. Through the knees and ankles and all the way to the feet.

Now, when you say a mal rotation in the hips or rotation of the hips, you don't mean something that would be an issue of people's hips rotating, for example, as they walk? You mean an issue with one hip kind of being permanently stuck, rotated in one direction with the other hip stuck. Rotated in the other?

Exactly. So it's not a dynamic situation. Once it's rotated, it does actually get stuck. Stuck into that position. And in fact, when someone goes into that mal rotation, that pelvic dysfunction, they actually become cemented into that position through adaptation of muscle movement.

Okay. And so when this happens and someone's actually stuck in that position, I guess the first question before we talk about the anatomical impact of what occurs, what would a person be feeling if one hip were rotated or stuck in rotation? And kind of as a follow up to that question, Tom, how would something like that actually happen in the first place?

My sense of how this occurs. And again, looking at the anatomy and all of the major muscle groups that are attached to the pelvis and that sports exerts a force on both the bottom of the pelvis and the top of the pelvis and often in a diagonal or X shaped position. And that one side of the pelvis will be pulled downward by movement, by contraction of a muscle, and the opposite side will be pulled, the other side will be pulled in the opposite direction by another group of muscles. I think that it often happens with runners and I've also seen it in other field athletes that are doing ballistic movements, lateral movements, diagonal movements. And so it gets pulled. It's basically a sprain because the ligaments that surround the joints all get stretched out. And so you've got, and in fact you have a lot of symptoms of sprain that go along with this. As to how people sense that, the answer is generally they don't. They really have no idea. But what they will experience are a number of different, different symptoms. Again, both up and down the kinetic chain into the shoulders. But more generally in the lower extremities in the form of Achilles tightness, they'll begin to have knee problems, perhaps ankle and foot problems. All of those are really connected to this and result from this pelvic torsion.

Now, in a runner, obviously they're not engaged in impact based activity that would be on par with, for example, getting hit by a linebacker in the sport of football. But with a runner, is it simply the chronic repetitive impact that can cause enough movement in the pelvis to result in a sprain in the pelvis being locked in one direction or the other?

Yeah, absolutely. In fact, the majority of the athletes that I see with this problem, this isn't the result of contact. These aren't contact related injuries. I mean, if you look at the NBA, which represents the largest portion of my experience in professional sports, 60% or better of their injuries are non contact related. I mean, that was really the curiosity about those types of injuries that started to drive my interest in finding out, you know, why, what were the biomechanics that set that up so runners in the same way, just through chronic overuse, small injuries that develop compensations and those compensations feed into the creation of this dysfunction.

So now that we kind of have an understanding of how something like this could happen. In terms of what you called in.

An article that I read by you.

What you called anatomical impact, as far as all the interconnected compensations that occur when someone's hips are malrotated, what are the anatomical impacts that you notice in people when you look at them? And they have this issue.

When I'm Evaluating someone. And the. One of the first things that I do after I've taken an injury history, which always kind of leads me in the direction of how to look at a person. What I'll look for is in standing hip height symmetry. And by that I mean the pelvic crest on either side of the body. With the person standing directly in front of me facing forward. I can note that one hip may be higher, one pelvic crest may be higher or lower than the other. That's a pretty easy thing to spot. The other thing that's fairly simple to spot is that if one hip is higher than the other, so that creates an obliquity of the pelvis, you can think about the Leaning Tower of Pisa. If someone has an obliquity, what you would think would occur, you'd actually see them leaning to one side or the other. But they don't. What we do is correct ourselves so that our gaze is always horizontal to the earth. And so you'll actually, from the front, you'll notice a little bit of curvature. The navel may be out of line, for example, with the sternum. And the other thing that you'll pretty easily see, because it's a component of this, is that little self correction we can call a spinal scoliosis, an abnormal curvature of the spine. And with that, there's always a rotational component. So one shoulder will often be slightly lower than the other shoulder, and it'll be a little bit forward of the other shoulder. So both the pelvic crest height, the little bit of curvature that you'll notice from the front, and the shoulder depth are all key indicators for this particular problem.

Now, when you say the sternum not lining up with the navel, for the people listening in who aren't anatomy experts, basically the middle of their chest would be kind of offset in terms of its center over their belly button.

Yeah. In fact, there's a little indentation, the sternal notch that sits right below your Adam's apple. And you can look at that notch. That's a great landmark because it's easy to see on everyone. And the navel should be directly below it or in line with it. With someone with this dysfunction, their navel will be off to the left or the right. And you also often see someone that they're their gym shorts or their jeans. And if you question them about this, they'll notice or they'll acknowledge that they always sit higher on one side than on the other.

Interesting. Now, how about shoulder range of motion or the movement of the shoulders. Is there anything that happens when the hips are out of place to the shoulder complex?

Well, as part of this dysfunction. And again, we think about the scoliosis and the rotation that happens. There's a rotational component to the scoliosis at the top end of the spine toward the shoulder girdle. With that shoulder being forward, you'll almost always have some impingement, particularly in the shoulder that is forward, meaning that it's difficult for them to do an overhand movement. They'll be restricted in posterior to the back motion of an extended arm. So trying to bring an arm, a straight arm, up in front of them, you may notice that the left hand, if you do both arms at the same time, that their reach will be extended on the unaffected side.

Interesting. Now, one other question in terms of anatomical impact, Tom, and that is, if someone were to see themselves running or someone were to watch someone else running and look at them, would it actually look like the person's hips weren't moving properly?

No, you normally wouldn't see that. If you can see them. It's really difficult to see in motion unless you're able to take film and then slow the motion down. Probably the thing that would be most striking is that they have what would be called a moment of valgus, where when the foot strikes the pavement, the extended foot, that the knee will actually collapse the midline just slightly. There'll just be a moment of this collapsed midline. And that's indicative of the long leg side.

And the long leg side would be the side that's posteriorly rotated.

Actually, long leg side is normally anterior rotation. Okay, so if I have a right long leg, my right hip is going to be rotated forward, and the right.

Long leg, in terms of the chicken coming before the egg, would that be because someone actually was born with the right leg that was longer, or would the hip rotation actually result in that leg being functionally longer?

It is a result of a functional change in the positioning of the right and left sides of the pelvis. All of us are born, the vast majority of us are born with some slight discrepancy in our leg length. I think most people probably are familiar with the fact that they may have one foot slightly larger than the other. It's normal. But that anatomical leg length discrepancy is usually very, very slight, less than half of a centimeter. So it's clinically insignificant and functionally insignificant. The functional leg length discrepancy, though, is usually greater than a half a centimeter. And so it becomes. It becomes Functionally significant in terms of the consequences.

Gotcha. So moving on from some of the things that can happen anatomically when you have this hip malrotation, what about functionally? What type of things are going to be manifested in people as they're moving symptoms.

Down? So down the leg? We start in that direction first. They'll begin to develop patellar tendonitis, lateral knee pain, tight IT band. They will begin to notice they may have symptoms that resemble plantar fasciitis. In the foot, they'll be susceptible to lateral rollover sprains of the ankle. So there are a number of things, number of symptoms down the kinetic chain down the leg.

And do you typically notice those symptoms down the leg on the same side or on the opposite side as the actual hip rotation?

Same side. It'll be the one leg side. In fact, I've seen athletes with injury histories, for example, going back to high school, I'm talking about, for example, NBA athletes that have had exclusively all right side injuries from the ankle, through the knee, all the way up through the shoulder, and all on the long leg side.

Interesting. Okay, so anything else moving up from the legs as far as performance in the upper body.

Those are the primary symptoms that you'll hear from people. Well, the other thing is there is one other. On the backside of the leg, they'll have hamstring tightness because the hamstrings will generally be slightly lengthened on the side of the long leg because the pelvis is rotated forward and it puts a hamstring on a stretch.

Okay. And anything related to. We talked a lot about soft tissue injuries, but as far as bone is related, are there any issues that occur in terms of stress fractures when this is present?

There are, because you tend to load more on one side than you do on the other. So there become these cumulative problems that come from chronic overuse. And one of those is stress fractures of the foot. And I've seen repetitive stress fractures of the foot in more than one client who's been later found to have a functional leg. Then there are a number of other issues then up the chain from the foot, knee being probably the most prevalent because you'll begin to see symptoms of patellar tendonitis, ACL strains or tears. The next injury that's likely to occur than our meniscus injuries, almost exclusively lateral meniscus injuries, because they're loading the outside of the knee when it falls to midline and, you know, untreated or undiagnosed, they often then progress to chondral defects where they basically wear a pothole in the knee from going bone on bone because the meniscus is been destroyed, which results in micro fracture surgery.

Interesting. What about sports hernias? I coach several triathletes who have to deal with this issue and it seems that adductor problems could be related to pelvis movement.

You know, sports hernias are interesting because that term is just a catch all phrase for a lot of problems that generally aren't understood until you do exploratory surgery. And when you have a pelvic rotation on that one side, and again, thinking about a lot of the structures that are connected to it, the adductors and the upper leg and the inguinal ligament, for example, it's very, very common on the side that's rotated forward that someone will have inflammation and tenderness just above the pubic bone on that side. And that happens because the pubic bone, again being right and left sided with the rotation, one side will actually have a translation or movement toward the feet. So it will be, you think about it almost as a dislocation. When that happens, it puts strain on the connective tissue there and it becomes inflamed. The interesting. Well, you know, actually the kind of cool thing is that once the pelvic torsion is addressed and your pelvis is put back into symmetry, I've had any number of clients that had that very symptom and they got off of the treatment table completely pain free.

Interesting. And that kind of leads into the question that I wanted to ask you, that I'm sure everyone who has kind of self diagnosed themselves during our discussion is going to be wondering and that is the fix. What do people do if they've been diagnosed with this issue?

You know, pelvic torsion, functional leg length discrepancy has probably been better recognized by the chiropractic profession than any other clinical specialty group. Unfortunately, it's generally been the practice in chiropractic to cure the problem by simply putting a lift on the short leg side and in an attempt to equalize the length of the legs. All of the current research demonstrates that that's not really effective because neurologically your body knows that it's still asymmetrical. And so all of the symptoms and the problems still continue. It is actually very simple to correct the pelvis. It's a combination of physical therapy, soft tissue release work, and then a little bit of chiropractic. And the clinicians that I've seen that are successful in doing this will just use muscle energy to bring the pelvis back into alignment.

Did you say muscle energy?

Muscle energy. So you'll use. The therapist will take you through a treatment regimen where you're activating very small, specific muscles. And by using your own body's muscles activated appropriately, you can pull your pelvis back into its proper position. The trick in this is again that if you've been in this position for any length of time, what happens is some connective tissue gets shortened and some of it is stretched out. And so those things that are tight have to be released first. And then the other piece that complicates this is the sacrum, because the sacrum rotates in multiple dimensions at the back of the pelvis. And so the sacrum also then has to be corrected. And that's often done with manual therapy. But we're talking about a process that generally takes no more than a one hour therapy session with someone that's knowledgeable.

So the trick would be to actually find someone who had experience diagnosing or working with athletes who have this condition within your local medical community.

Absolutely.

In your experience, would the best initial, I guess, type of gatekeeper person to approach be a doctor, a physical therapist, a chiropractic physician, or does it really depend?

In my experience, I think the best insertion point into the process is probably with physical therapy. Physicians generally MDs, unless there's someone with a great deal of experience in sports medicine, often don't understand or appreciate pelvic torsion. It's just, it's just not part of their training and it's not part of the way that they view problems with the body. Chiropractors understand the problem, but again, the general treatment that's been used traditionally has been doing lifts. Physical therapists have the ability to assess someone from the ground up and to be able to understand how all of these issues that they're seeing can be connected to the pelvis and then to understand what the fix is. But it requires a therapist, really that's on. You know, there are a lot of schools of thought, physical therapy, and it requires a therapist that's kind of on the chiropractic end of the spectrum, Someone that uses hard, what we would call hard manual physical therapy. And I'm not trying to say that the fix is difficult or painful, but it requires someone with not quite so soft a touch.

So someone who's actually willing and able to manually manipulate the body.

Yes.

Okay. Interesting. In terms of other resources that you think that people should be able to utilize after hearing our discussion today or other advice that you would like to give to people who have heard this interview and feel as though they may be experiencing this issue themselves. Do you have anything else that you would like to say?

Well, I think the thing that I would say to your listeners is the same advice that I give to the athletes who I work with, and that is don't ignore the small problems, the nagging patellar tendonitis or the nagging planter foot tenderness. Those things are all red flag warning signs of a larger problem to come. And they're almost always the result of a biomechanical dysfunction, something that's easily treatable and it's not necessary for an athlete to function in pain just because they perform in their sport. And those problems, if overlooked, are the things then that turn into more debilitating problems or problems that end up having to be solved through surgery. So pay attention to your bodies and understand that it's not acceptable that you should have to function in pain.

Do you have a website or somewhere where people can go to actually read more or to find out more about you and what you're doing? Tom?

I do. My website is www.performance P E R F O R M A N C E M G M T.

For those of you who didn't write that down, I will put a link in the show notes. And if I could just briefly say, one of the reasons that Tom's article really resonated with me when I first read it in a journal was because I had many of these same issues as a triathlete and I went down the frustrating road of trying to figure out what was going on for a long time before I found a chiropractor physician who was able to manually adjust me. And literally within two physical therapy sessions and the implementation of a stretching and core protocol that was able to maintain my alignment, I was fixed and haven't struggled with that. Again, it's very important that you understand that this is a problem that plagues many athletes. But it's also a problem that is not something that you have to deal with the rest of your life if you take care of your body correctly.

So if you have more questions about.

This or if you would like me to relay any messages to Tom, you can of course leave your comments on the show notes to this episode or you can click through and check out Tom's website, performancemgmt.org and Tom, I'd like to thank you for coming on the call today.

Thanks Jim. I appreciate it. It's been fun.

So be sure to check out Tom's website that I'll put a link to in the show notes for this podcast episode episode number 97. The other website that would probably really help you out is a resource that I actually wrote after I dealt with this injury myself and that's over@runwithnopain.com that's run with no pain.com and just a couple of other things. Remember that if you want in on that Thailand triathlon trip, you need to email me very soon BenGreenfieldFitness.com and I'll fill you in on the details and I can get you into the race, get you the room blocks, etc. Be sure to go to itunes and leave the podcast a ranking if you haven't yet. Really helps out the podcast and really lets us get good guests on the show like Tom. And then the other thing is that if you are planning on wanting to be on podcast episode 100, you need to ask your question via voicemail, so you may want to get used to doing that. Right now the toll Free number is 877-209-9439. The Skype username is is Pacific Fit. Remember that the T shirts are available if you donate to the podcast. And until next time, this is Ben Greenfield signing out from BenGreenfieldFitness.com.

Sam.