I recently read an article in the April 4^th, 2011 Los Angeles Times paper called “Sticky Issue of Tapes”.  The article stated that kinesiology taping in general had no benefit and only offered a placebo effect on patients that used it. I on the other hand have a different opinion about kinesiology tape, along with the many other sports medicine practitioners I have worked with. Honestly I don’t believe the person who wrote the article had much experience or knowledge on working with the tape or in it’s application. I could be wrong and everybody has a right to his or her opinion, but here is my take on it.

Kinesiology tape is different than other medical or athletic tapes since is it elastic (stretches 40% beyond original length), breathable, hypoallergenic, waterproof, latex free, and does not restrict circulation like other common tapes.  Other tapes such as regular athletic tape do serve an important role and have their time and place for certain applications. However athletic tape does not breathe at all, blocks sweat and evaporation, can cause cuts and blisters, and loses 50% of support within 5 minutes of weight bearing activity.

Kinesiology tape aids in improved range of motion and is useful for muscle inhibition or facilitation depending on which direction it is applied on the muscle or joint.  It also works well for ecchymosis and lymphatic drainage. When it is applied for lymphatic drainage the tape creates convolutions, which lift and pull the skin and anchoring filaments, creating an opening or space between the cells to allow fluids to drain and immune system cells to flow in and out.

Since the kinesiology tapes have an elastic property and allow the skin to breathe they make a lot of sense for the conditions they are used for.  For example an athlete with an acromial clavicular compression injury can find relief from a scapular stability taping. This type of taping inhibits the scapula from moving forward excessively therefore, relieving compression in the AC joint. Understanding the mechanics of this, it just makes sense in why this would help this condition.  For plantar fasciitis taping the arch of the foot helps the plantar fascia from crashing, and provides tremendous relief without immobilizing the foot and suffocating the skin like athletic tape would.  As for edema and ecchymosis it does increase the reduction of swelling and contusions.

Several years ago I had a downhill bike accident, I crashed on a 10-foot drop off.  Even though is was not a considerably big drop, I smashed the palm of my left hand on the ground pretty hard resulting in my hand blowing up to the size of a baseball mitt, and my forearm was severely bruised from the wrist to my elbow, and got a nice concussion as well. After the accident I had an edema taping applied to it and the swelling and bruising dissipated at a record speed.  It completely went back down to normal within 3 days.  This is a condition I had suffered from several times before and it took weeks for the swelling and discoloration to go away without taping.  I have seen the same results on my clients and they all attest to the effectiveness of kinesiology therapeutic taping.  The tape is not going to magically heal any injury instantly, but it does help in these conditions and with joint mobilization, and often acts as a reminder as to body positioning, such as the scapular one I mentioned above.

At our facility we use both Kinesio Tex Tape, and KT Tape preferably over other tapes such as Spider Tech Tape, which is more expensive and less adhesive, and we find it not to be very user friendly.   Balance Tex, another elastic tape is moderately breathable but does not work well around body contours. The difference between the two tapes that we use is that the KT Tape is 25% more adhesive than the Kinesio Tex Tape, and has a better breathing quality due to the improved wave pattern on the back of the tape.  Generally we use the Kinesio Tex Tape on our older or senior population because it is somewhat less adhesive than the KT Tape, and is kinder to their skin during removal.  Here is a funny fact about KT Tape. It was developed by a group of business professionals that had no medical background what so ever, they just copied Dr. Kenzo Kase’s original Kinesio TexTape which was first developed in 1973, and changed the wave pattern on the back of it somewhat. This was because Dr. Kase declined on an offer they approached him with. Nonetheless KT Tape is a great product, even though it is a “knock off” of Kinesio Tex Tape.

Before using any of the kinesiology tapes they should be tested on a small part of the patients skin to see if it causes any irritation, and make sure to teach them how to remove the tape properly by pulling the skin away from the tape. Not the tearing the tape away from the skin.

People often ask about the different colors the tape comes in.  I have heard all different kinds of crazy answers like the black is the “extreme injury tape”, suggesting that it is a stronger more durable tape. The fact is that the colors are purely fashion statements. They were to elicit different moods, blue for tranquility, red for excitement, and green camo just in case you’re going hunting.  The other factor is heat transmission.  Darker colors to generate more heat, and lighter to keep the area cooler.   Kind of like when you wear a black shirt and stand directly in sunlight. The colors of the tape may vary but the characteristics of the tape are essentially the same from one color to another.

So there you have it, my opinion on kinesiology tape.  I think people get confused or either misinformed about the role this tape plays in the sports medicine arena.  I think anytime, before someone writes something about anything, that they need to have a pretty good understanding of it.  I don’t write about investment banking because I know so little about it, so I just stick to my area of expertise, and I will say that I know a little something about kinesiology therapeutic taping.

Now I will sit back and wait for all the hate mail that I expect will follow…

Jon Torerk, CSCS

Periodization training was introduced in the 1940’s, and it is basically a set training format that involves different modalities of resistance training, organized within a set or determined time frame.  The concept of periodization was first developed by Dr. Thomas Delorme who was an army physician working with physical therapy patients. During this time he formulated the progression of their therapy routines and exercises, and the need to gradually increase the resistance on particular muscle groups.  Evolving from the SAID principal (Specific Adaptation to Imposed Demand), periodization was born.

Today most professional athletes are trained using this method under the supervision of their team strength and conditioning coaches.  Many trainers and CSCS professionals use this format of training for clients preparing for a specific athletic event because it is an effective means of stimulating the muscles for anaerobic endurance, hypertrophy, strength, power, and speed all done in an orderly manner over a pre-determined period of time.

Typically a basic linear periodization model consists of four stages within a 4 month to a year time period.  The stages are the preparation phase, first transition, competition, and second transition phase.  Linear periodization models consist of linear increases in the workload and volume for each week.

The preparation phase consists of muscle endurance and hypertrophy training, where the exercise volume is high and intensity low. The first transition phase focuses more on muscular strength where work volume decreases as the intensity increases.  The competition phase consists of exercises that are sport specific or consist of power lifting and explosive movements based on speed and velocity.  The off-season or second transition phase is designed to be more non-linear in nature.  Here the athlete performs a variety of training to avoid de-conditioning and to focus on structural or rehabilitative exercises.

Linear periodization models will also use the terminology, macrocycle, mesocycle, and microcycle to better outline training format. A macrocycle is the entire periodization training program set for several months in duration and up to a year. Within the macrocycle are the mesocycles, which may be a month long in duration.  Within the mesocycles are minicycles or microcycles, typically a week to a few days in duration.  These divide the training program down to specific time periods to complete specific training protocols or goals.

Adopting concepts from the classical linear periodization model, nonlinear periodization training has replaced the linear approach to training for many athletes and recreational athletes. Nonlinear periodization calls for more frequent changes in training intensity and volume.  This is changed weekly or even daily.  This form of periodization typically shows minimal plateaus in strength increases than that of linear periodization due to the constant change in exercise variation and muscle stimulus, therefore it demands constant physiological adaptations to the imposed work being performed.  For instance a single training session may work a particular muscle group for strength, hypertrophy, and muscular endurance all within the same workout session.

Nonlinear periodization is sometimes a better method to use when time constraints make it difficult to follow and adhere to a linear periodization program, and the fact that variations of training within the program allow for better muscle recovery time, since the intensity and volume are changed daily.

Linear periodization models are typically used for college and professional team sports, when an athlete can dedicate all of their time to adhering to this type of training under the supervision of their Strength & Conditioning Coaches.   Nonlinear periodization is not as methodically organized and allows for some inconsistencies in one’s daily training routine without a tremendous amount of setbacks.

Jon Torerk, CSCS

Here is a list of common structural and Postural concerns, and exercises to help correct them.  This is from a list of guidelines that I have from when I was working at a NYC Sports Medicine Clinic along with a team of Physical Therapist, Athletic Trainers, Strength & Conditioning Coaches, Exercise Specialist, and Massage Therapist.  Please note that this is only a very basic hit list of items for general reference. Not all corrective exercises are mentioned but I wanted to share it with everyone anyway.

Listed below is each concern followed by exercises to do or avoid for each condition.

Forward Head: strengthen all areas of the upper back; stretch scalene and monitor anterior neck activity.  Minimize recruitment of neck flexors with exercise keeping head neutral and relaxed.

Protracted shoulders: Focus on scapular retraction exercises and posterior deltoids. Perform upper back exercises such as overhand pulling activities.  Perform oscillation exercises to help teach scapular stability. Use a 2:1 or 3:1 pull/push work ratio.

Stiff Thoracic Spine: (decreased normal lordosis or kyphosis) Strengthen mid /low trapezius and rhomboids. Perform unilateral work, reciprocal work and stretch latissimus dorsi muscle group.

Sway Back: Strengthen abdominal musculature, oblique and core.  Stretch hamstring muscle group and strengthen hip flexors.

Flattened Lordosis: Strengthen lumbar extensors and abdominal group. Stretch hamstrings and hip flexors.

Immobile Thoracic Spine: Perform reciprocal upper body exercises such as quadrupeds, single arm rows, funky chickens, and Upper Body Ergometer (UBE).

Structural Scoliosis: This is an irreversible condition, but the effects can be minimized by doing upper body reciprocal movements, strengthening core, and all back musculature.  Consulting a Physical Therapist is highly recommended.

Functional Scoliosis: This is a reversible condition that is caused by repetitive unusual body positioning from daily activity.  Balance and increase flexibility along spine. Look at asymmetries of flexibility of legs and stretch accordingly. Try and identify what is causing the imbalance and change/modify  daily activity leading to this.

Herniated Disk: (Lumbar) Avoid active hyperextension of back, but this can be individualized and passive extension can be used such as prone press-ups and knee to chest stretch.  Incorporate lower body flexibility and lumbar stabilization exercises. Neck should always be in neutral position and when in prone position, head should be supported by a rolled towel at forehead.

Lower Back Pain: Maintain neutral spine in all exercises (five point contact rule) and avoid unsupported weighted squats if client can’t maintain neutral spine.

Meniscus Tear: Typically avoid deep squats beyond 80 degrees as this can compress meniscus in joint space. Weighted leg extensions are usually contraindicated.

Patellofemoral Pain: Seated, weighted leg extensions are contraindicated. High step-ups and running should be avoided. Increase VMO strength with compound lower body motions and standing TKE’s. Increase flexibility as tight musculature and tendons can contribute to compressing forces on knees.

Ligament laxity in Knees/ Tears/ Absence: Strengthen surrounding musculature of knee (quadriceps, hamstrings, abductors, adductors, core). Avoid quick lateral pivots and motions with absent cruciate ligaments.

VMO Weakness/VLO Dominance: Increase VMO strength by performing leg extensions with ankle dorsi flexion, step down with good eccentric control, straight leg raises with external hip rotation, adduction with leg press, dumbbell squats and ball squats.

Ankle Ligament Laxity: Strengthen everters, invertors, plantar flexors, dorsi flexors and include proprioception exercises (lateral and forward step ups, BAPS board, Bi and Uni Calf raises, single leg standing hip flexion and extension, trampoline work) Avoid running until stable.

Pronated / Flat feet: Pronated feet are less stable and can change alignment of the patellofemoral joint which can contribute to lower back pain and knee pain, by increasing repetitive forces along the lower kinetic chain. Avoid running and ballistic high impact movements.

High Arches / Rigid Arches: High arches are poor shock absorbers and arch supports in shoes can be beneficial to avoid overstretching of plantar fascia.  Kinesiology taping aids as well.

Shoulder Impingement syndrome: Avoid chest and triceps dips, pull-ups, bench press, shoulder press, and deltoid lateral raises.  Use an underhand grip for most pulling activities and work on strengthening middle and low trapezius, rhomboids, serratus anterior, and latissimus dorsi.

Cervical / Trapezius Tension: Avoid upright rows, and abdominal crunches until discomfort is minimal or absent.  Focus on scapular stability exercises, and minimize trapezius recruitment with all pulling exercises. Re-teach correct shoulder mechanics if traps are being used excessively during exercise.

Lateral Epicondylitis: Avoid chest and triceps dips, chin / pull-ups, push-ups, lateral shoulder raises, and strong gripping exercises.  Perform a strength-based program utilizing cuff weights and manual resistance until pain free.  Maintain a neutral wrist extension and flexion and monitor for progression.

Carpel Tunnel Syndrome: Stretch wrist extensors and flexors before and after workouts, and maintain a neutral wrist position. Perfeorm oscillation exercises and utilize ice massage.

Joint Hyper mobility: Avoid end range of motion where full extension occurs at joint, and overloading with heavy weight.  Teach client to maintain a slight bend in joints and not to lock joints out.

Jon Torerk, CSCS

Not in any particular order

1) Be a leader, take charge of the session. Be assertive and speak loud and clear.

2) Structure the workout towards the client’s goals, along with their structural and metabolic needs.

3) Be a motivator and commend them on a job well done.

4) Be really strict on proper form. If they have poor form, break the exercise down and work on proper mechanics. Re-teach the exercise if need be. If they are not capable of doing the movement right, come back to it at a later date rather than having them doing it wrong.  This cannot be emphasized enough! Proper form is paramount as there is no excuse for poor form, and this reflects upon you as a trainer.  You don’t want to be that Bozo that is known for teaching bad form or wrong mechanics.

5) Give plenty of Cue’s and direction. Communicate with your client and give lots of feedback. Tell them exactly how you want a particular movement done. Be clear, exact, and concise.

6) Be aware of your clients body position from head to toe in relationship to what they are doing, watching things such as 5 point contact, neutral spine, head positioning, scapular stabilization, activated core, etc……

7) Be very “hands on” give them parameters to work within, or palpate the muscles they are recruiting during a particular movement. Your focus on the client means a lot. They should have your undivided attention at all times, and minimize cell phone usage while with a client. They are not paying you to talk on the phone.

8) Spotting, get in close and make them feel safe for each and every thing they do.  You don’t need to be hands on all of the time, but be in a position where you can prevent something from going wrong.  Having your client fall off a Bosu ball and onto the ground should never happen in the first place, you are in charge of their safety and you are to blame if you were not there to spot them.

9) Think and move quickly. If someone is on a machine or using what you were planning on using next do something else similar instead of waiting.  Keep the client moving and their heart rate up. Keep the intensity up according to what the client is capable of doing.

10) Set particular goals for each workout to make it fun and challenging. Chart their progress and give them a sense of accomplishment. They will always look forward to the next workout and want to come back for more.

All of these are simple to do things that will help you gain more respect from your clients, and increase your retention rate. When I lived in NYC, I had the same clients for 10 plus years, and the majority of my present clientele are the same people that I started with back when I first moved to LA nine years ago, despite moving to two different facilities and then my own. I had a 100% turn around when I expected about 40% because of the increased distance they would have to travel to my new facility (BioMechanix).

Jon Torerk, CSCS

How specific are your clients training program in correlation to the activities they participate in and their daily lives, and what exactly is functional training?

The answer is broad but yet specific for each individual whether they are athletic or not.  The foundation of functional training is going to first stem from an initial musculoskeletal evaluation which should consist of a full body flexibility, posture, body composition, Sub maximal V02, heart rate, blood pressure, metabolic and structural assessments.  Here we will find out what structural and metabolic issues we may need to address and make recommendations for exercises to help correct any conditions found.

For instance, if the individual displays genu valgus of the knees, then this is an indication that this person needs to perform more quadriceps work in relation to the hamstring group.  A good starting recommendation would to prescribe a 2:1 Quad to Ham work ratio, for every one hamstring exercise done, two quadriceps exercises are performed.   Recommended guidelines for functional biomechanics of the quadriceps and hamstring group is a 3:2 strength ratio, so it is around a 60/40 strength differential.

If the client exhibits a forward head rounded shoulder posture (FHRS), then this would be an indication to prescribe a routine that involves more latissimus dorsi, posterior deltoids, rhomboids, and scapular work.  A 3:2 back to chest work ratio should be recommended.  This will help pull the shoulders back in to anatomically correct position, and stretch out the anterior musculature of the neck.  Having a FHRS posture sets the individual up for a greater risk of shoulder injuries, so this is an important factor to implement into their strength training routine.

One of the most important things in developing a strength and conditioning routine is to address all of the structural and metabolic concerns the client may have, and use this information as the foundation of their routine.  It is very important to keep in mind what the client does outside the gym.  Once they walk out the door after their workout, how you train them will have a reflection on every musculoskeletal movement they make the rest of the day.  Specificity is key to a well-balanced training program.

So it is important to include exercises that are specific to the goals of the individual, and ones that are specific to any activity they do outside of the gym. Remember their routine should be designed to be functional to their daily activities, in other words specific to their needs.  For example, if your client is a downhill and freeride mountain bike rider then performing squats, jump squats, anaerobic sprints on a stationary bike, and lower and upper body plyometrics would be good sport specific activities for them.  The jump squats would help with eccentric loading techniques, and power. This would correlate with landing the bike on a jump, high freefall drops, and preloading the bike right before a jump.  Remember before implementing jump squats they must be tested for plyometric training to see if they possess the speed, strength, and agility to do so (see previous article “The Rules of Gravity”).

If a client is a mother to young children, then her program should incorporate exercises that will help her in her daily routine outside of the gym.  She will spend much of the day picking up her children so teaching her proper squat mechanics, hips first then knees follow, while maintaining normal lordosis of the spine, and chest up, would be tremendously beneficial to her.  Performing postural exercises and how to maintain good scapular stability would be another area to focus on.  Utilizing a non-linear periodization protocol that incorporates, strength, power, and anaerobic endurance could be highly valuable in her training program, as well as cardiovascular activity.

In general the majority of the exercises performed should be compound in nature utilizing a lot of core musculature. Then train the smaller auxiliary muscle groups.  The baseline of all strength comes from the core musculature.  An athlete cannot exhibit any real strength or power by just having strong extremities alone.  They need a solid core to back it up.   If the clients core is weak and unstable then it will be the missing link to all of their potential strength.  A well-designed and balanced program should include all of these important factors, core strength, musculoskeletal and metabolic concerns, functional exercises, proper mechanics, and systematic progression.  Workouts that have no rhyme or reason or specificity are kind of senseless.   You can’t just train someone without first looking at his or her structural needs. You need to develop a stable and biomechanical efficient platform (their body) in order to make structurally sound gains and improvements, otherwise you are just throwing that person together much like Frankenstein was with random parts.

Jon Torerk, CSCS

Most athletes that participate in collision and high impact sports, such as football, ice hockey, mogul skiing, and downhill mountain biking, commonly see acute and repetitive trauma injuries to the acromioclavicular joint.  Other common shoulder injuries reported are, impingement syndrome, A/C problems, shoulder instability, and bicep anchor damage (SLAP lesions).

In these cases the sports medicine professional, Athletic Trainer, or Strength & Conditioning Specialist should be able to make correct decisions on the progression of a rehabilitation program, and the prevention of subsequent injuries from weight training.

The following are some modifications of the bench press, shoulder press, and lat pulldown. Many times these three movements along with other multi-joint exercises are main components in an athletes periodization based training program.

BENCH PRESS:

Benching with a straight bar places a tremendous amount of stress on the humeral head stabilizers of the rotator cuff (infraspinatus, supraspinatus, subscapularis, and teres minor), and the long head of the bicep brachii muscles.  One repetition, max lifts (1RM) can attribute significantly to shoulder lesions, and should be limited to 2-3 times a year or avoided all together.  The risks on 1RM lifts typically outweigh the benefits.

Anterior shoulder instability:

a) The athletes hand spacing should be no wider than 1.5 biacromial width. This will minimize peak shoulder torque in pressing motions.  Biacromial with is measured from the superior portion of right acromioclavicular joint to the left acromioclavicular joint. The distance between the two acromioclavicular joints are considered 1x biacromial width.

b) Having the trainer assist the athlete to lift the bar from bracket, is what is called a “Mandatory handoff”, and will prevent shoulder subluxion, and dislocation.

c) Incline Bench pressing should be avoided

d) Supine and decline bench press should be systematically alternated every other training session that involves chest work.

e) Be certain of proper form.  The barbell should be lowered slowly to sternum, 2-3 inches superior of xiphoid process. Press bar upwards, in line with shoulders, and maintain a “five point” contact throughout the entire lift.

Posterior shoulder stability:

a) The athletes hand spacing should be increased to be 2x biacromial width. This angle will allow better structural approximation of the humeral head in the glenoid fossa, and decreases the strain on the posterior soft tissue.

b) Perform a mandatory handoff.

c) Perform this lying in the supine position only, no incline or decline pressing.

Slap lesions (superior labrum antero-posterior lesions), glenoid labrum and bicep anchor damage:

a) Same guidelines as anterior stability.

b) The athletes grip should be varied from underhand to an overhand grip on alternate days. This will decrease the micro-traumatic injuries and stress on the long head of the biceps tendon.

c) The overhand grip removes the bicep tendon from beneath the acromion by internally rotating the humerus, but due to the full pronation of forearm, it stresses the attachment of the long head of the biceps.

d) The underhand grip places the long head of the biceps tendon (supination) in a preferred position to decrease the stress on the tendon, but places the long head of biceps tendon beneath the acromion, allowing it to impinge.

e) Overhand and underhand grip should not be used in same day and should follow a periodization protocol.

SHOULDER PRESS:

The barbell shoulder press starts with hand spacing slightly wider than shoulder width.  Starting position is when bar is at the anterior portion of the deltoids, and sternoclavicular joints, and it is pressed overhead.   Behind the neck shoulder press should be avoided all together due to the physiological effects of this movement, until full function is achieved.  It should be replaced with posterior deltoid specific exercises, such as rows, rear deltoid raises, and dumbbell rows.

The barbell shoulder press starts with shoulder abduction, in the “high 5 position” and external rotation. This position places significant strain on anteroinferior glenohumeral ligaments. It also stresses the cervical region, by placing the head into excessive flexion, and stressing the rotator cuff through the impingement mechanism.   The high 5 position is when the athlete has their palms pronated outward, facing away from them, at about chin level, with the arms in the saggital plane.

Modification of movement

a) A functional isometric program is implemented within the confines of a power rack, and performed by athletes that are required to perform overhead movements.

b) Two sets of pins are set up in rack. One to support the weight, and one to limit range of motion starting at 60 degrees of shoulder flexion and one at 120 degrees.  This provides minimal torque in external rotation and provides significant glonohumeral joint approximation.

c) An isometric hold of 5-10 seconds is held per repetition at each angle, and 6-10 repetitions performed at each of the three 60, 90, 120 degrees.

d) Be sure to watch for resistance training machines with excessive high five positions, and internal rotation. Machines that typically have safe positions are Nautilus, Hammer Strength, and Hoist Roc-it strength machines.

LAT PULL DOWN:

This exercise involves a combination of movements in the saggital plane (flexion/extension), and the coronal plane (adduction/abduction). The bar is pulled from overhead to the base of the neck to the first thoracic vertebrae or just inferior of the clavicle .The behind the neck pulldown should be avoided for similar reasons as the behind the neck shoulder press.  Pulling the bar behind your head and forward tilting chin to far anterior, can create excessive compression in the shoulder complex and cause transient brachial plexus nerve impingement (TBPNI).  Transient upper extremity paralysis after completion of behind the neck pull downs is typically noticed in the hands first.

Modification of movement

a) Start with the upper body in a 30 degree reclined position, with bar inline with xiphoid process.

b) Handgrip should be 1.25-1.5 biacromial width.

c) This position prevents athlete from being in high five position, and increases the activation of the shoulder adductor and scapular retractor muscles which assist in stabilizing the humeral head throughout the movement.

d) Raise bar slowly upward, and increase elbow flexion as much as possible, just before scapular elevation occurs.  Otherwise this can cause instability in the glenohumeral joint.

e) For the reverse grip pulldown, the hands are placed at 1x biacromial width, and the start and end positions are performed in the same manner.

Remember these are modifications for competitive athletes for these three particular movements, and after the completion of physical therapy.  They must also be done under the supervision of a sports medicine professional. If the athlete experiences acute pain while performing these exercises, then they should stop, and consult their physical therapist, due to the fact that they may not yet, be ready to perform these particular motions.

Jon Torerk, CSCS