Rustproofing the Iron Warrior

TAGS: tendonitis, Rustproofing the Iron Warrior, recession, older lifters, cluster sets, blood flow restriction, blood flow, Scott Stevenson, pain, supplements, arthritis

You’ve been at this a long time, battling iron and gravity with muscle, bone, and willpower. You’ve sweated and bled your way to outstanding strength and muscle size. You may have even committed the glorious Ps of brutal lifting along the way (the glorious Ps are pissed, pooped, puked, popped a vessel, and passed out during a workout with bonus points for tallying two or more “Ps” in the same session).

Father Time, however, will have his way with you eventually.

This article is about some ways to make sure that you put up a damn good fight. Unleashing blind fury each time you train (like you may have in your twenties and thirties) might not cut the mustard any more. After putting in decades of sessions and literally hundreds of thousands, if not millions, of repetitions, the rules of engagement must change.

Let’s do some math here. If you’re a bodybuilder training with moderate volume—15 sets per workout, 10–15 repetitions per set—this yields 200 reps in an average workout. Five workouts a week for fifty weeks per year accumulated over twenty years is literally one million repetitions. Most of those million reps were done lifting a load most humans couldn’t even pick up once. Some wear and tear is simply unavoidable. Odds are, you’ve probably torn a muscle, bulged a disc, worn down one or more joints to bone-on-bone, and have more than a few war stories to tell (including the glorious Ps).

In this article, I’d like to convey a few ways I’ve found for “rustproofing” the Iron Warrior. I’ll focus on what us old guys (I’ve been training for 32 years at the spry age of 43) can do to stay in the game. Some of this is a blend of treatment and preventative maintenance and some of it is innovative training. Some of it is grounded in my experience (in the gym and clinically as an acupuncturist) and some of it has deeper origins in the research literature (that I’ve also applied to myself and clients and discussed with fellow competitors and veterans). When it comes to training, those of you who are (currently competing) strength athletes may have less flexibility in applying the below information if your training must be performance oriented. (Certain lifts are unavoidable for powerlifters and strongman competitors.) Bodybuilders who want to maintain a hard-earned physique have a bit more leeway in terms of variety in training and can likely employ many of the strategies presented below year round.

Falling in love all over again

You have a love for the iron, that’s for sure. However, it may be time for a "can and can’t do" inventory and you may need to figure out what your “relationship needs” are when it comes to training. Here are some questions that might help you gain perspective before reading the rest of this article.

  • What exercises can you do without incurring injury, aggravating old injuries, or otherwise debilitating yourself?
  • Can you modify any of the above so that you can keep doing them (i.e., use box squats or a safety squat bar)?
  • What accessory equipment, wraps, straps, belts, or even suits can you make use of?
  • What kind of volume (sets, reps, or simply workout duration) can you recover from?
  • What is at the root of your passion for lifting? Do you like to feel/be strong? Is it the journey into no-man’s land (possibly committing one or more of the glorious Ps) that you love? How much of this kind of training can you realistically get away with?

The answers to the above are many and varied and these topics (recovery strategies, accessory equipment) have already been covered in great detail elsewhere in the growing library of articles here at elitefts™. However, below are strategies I have found particularly effective, some of which you might not be using.

First rule of thumb: Selective idiocy

I suspect I’m “relatively healthy” among serious lifters of my training age. Below is a list of the various and sundry “nuisances” (at least the ones I could recall offhand) that I’ve been able to essentially train through and mainly around over the past three decades:

  • Turf toe
  • Shin splints
  • Torn calf muscles
  • Patellofemoral syndrome
  • Hamstring tendonitis
  • Multiple quad strains and minor tears
  • Pulled adductor magnus
  • Groin pulls
  • Transversus abdominus pull and ischial bone avulsion fracture
  • Displaced ribs
  • Bicipital and supraspinatus shoulder impingement
  • Biceps tendinitis
  • Triceps tendinitis
  • Bilateral triceps tears
  • Tennis and golfer’s elbow
  • Cervical spinal stenosis and degenerative disc disease

I’m generally an “idiot” in the gym (one of the few socially acceptable places where such behavior is relatively tolerated), but I’m very selectively idiotic. Selective idiocy means not doing exercises that cause any obvious injurious (sharp, stabbing, pinching, radiating, or otherwise abnormal) pain. Of course, pain is often your friend in the gym. It tells you when you’re working hard and the hardest workers probably embrace it the most. Not being able to train smartly—distinguish “good” from “bad” pain—can be your ultimate nemesis, perpetuating small injuries (e.g. tendinitis) for weeks and months until they develop into much worse conditions [e.g. tendinosis and even tendon rupture (1, 2)]. If you’re nodding your head (or worse, shaking it), you might be recognizing that your stubborn fortitude can work against you in the battle against Father Time.

Don’t be a tough guy

Get regular treatments. Take that “whatever it takes” attitude and put it to use in seeking out treatment: allopathic treatments [beware of the overuse of cortisol injections (3–5)], chiropractic, active release technique, deep tissue massage, saunas, acupuncture and oriental body work, naturopathy, prolotherapy, and platelet-rich plasma injections (6). There are a multitude of avenues available depending on what’s ailing you. If you do see a medical practitioner, I suggest getting a definitive diagnosis (often harder than it sounds) and then getting a second opinion if possible. Above all else, educate yourself on your condition.

Supplements

I could hardly do justice in just one article to the enormous variety of supplements you might employ to keep your musculoskeletal system healthy (e.g. fish oil, anti-inflammatory agents like curcumin, and even Chinese herbal remedies). Two sometimes “hit or miss” supplements, glucosamine and chondroitin, may require some experimentation to make them more hit than miss, but in many cases, I’ve seen that these can indeed be helpful.

Evaluating an effective glucosamine and/or chondroitin supplement can take months because their action is to rebuild joints (or simply prevent deterioration, a very slow process). Research suggests that both supplements can indeed work to prevent joint (cartilage) degeneration (7–10) and reduce pain (10), but this effect is hardly universal (11). [Of course, there’s a call for more research to clarify the efficacy of these two nutritional supplements (12).] One of the studies most relevant to plate bangers like you and me found that a combination of glucosamine, chondroitin, and a small (~200 mg) dose of vitamin C reduces chronic knee pain for Navy Seals (13), so there is relevant research substantiating what I’ve seen clinically. I’ll not plug any particular brand, but digging into the research studies showing positive benefits (in particular by reading the methods sections where the actual source of the supplement is explicitly named) is a start to finding a glucosamine and/or chondroitin supplement that will work for you. Patent applications, including original efficacy data, for those formulations that are indeed patented can also be located using Google Scholar.

Liniments for tendinitis and arthritis

Transdermal liniments can also be effective to quell those joint aches n’ pains that crop up periodically. They should, in my opinion, be used sparingly, simply to aid in disrupting an insidious inflammatory cycle, not to mask a chronic (overuse) injury.

In particular, methyl salicylate (MS) has proven very valuable over the years for me, my clients, and my training partners. (Derived from oil of wintergreen, MS has the same active ingredient as aspirin, aka acetylsalicylic acid). The idea of topical (on the skin) application is to target the painful, inflamed area with local administration while minimizing systemic delivery (in the blood) to the rest of the body. Non-steroidal anti-inflammatory agents like salicylate inhibit the cyclooxygenase enzymes (14) responsible for inflammation (prostaglandin synthesis) (15), but in doing so, they also blunt post-workout muscle anabolism (16) and protein synthesis (17, 18). We want to control the inflammation (while training around it), not limit the anabolic stimulus of the training bout itself.

Methyl salicylate formulations penetrate the skin easily (19), especially when it's clean (19), but with larger doses (20), blood levels of salicylate may also be elevated (21, 22). A little goes a long way though. MS can penetrate deep enough to expose underlying muscle in therapeutic doses (19). A hearty topical application can increase tissue concentrations thirty-fold relative to that in the blood plasma (23), raising blood levels only to the same extent as two baby aspirins taken orally (24).

You may find ingredients like camphor, menthol, or even capsaicin combined with MS. Camphor increases sensitivity to both heat (25) and cold (26) but is considered warming in Chinese medicine (this is how it feels to most people). This is why I prefer it before exercise when we want “heat” when warming up. However, camphor is toxic (27, 28) and its concentrations in topical applications are limited to 11 percent by the FDA (29). If so inclined to use a preparation containing camphor, you might test liniments with and without camphor for personal effectiveness to evaluate if the toxicity risk is worthwhile. Menthol has a “cooling” effect (30) and does indeed sensitize to cold (31), but in topical preparation, it increases both skin blood flow and muscle temperature (32). In my experience, menthol is a worthwhile ingredient in a topical pain reliever. Capsaicin seems to have variable (33) effectiveness for pain reduction (34). (Personally, I haven't found capsaicin formulations helpful.)

Some research has suggested that MS topicals are most effective in acute scenarios (35), but the evidence is poor (36). On the other hand, salicylate topicals can be powerful enough to relieve pain from muscle strain (37) and have equivalent analgesic effects to an oral dose of 650 mg of aspirin (19, 38). As I mentioned above, this level of effectiveness can be a double-edged sword if one starts using topical applications to mask pain. “Selective idiocy” (see above) would apply here. The topical formulation should not be a license to do exercises that you know are irritating to a joint, tendon, ligament, or muscle. [Additionally, those taking anti-clotting drugs should know that methyl salicylate may amplify the effects of anti-coagulants like warfarin (Coumadin), increasing the risk of excessive bleeding (22, 28).]

Pharmacists suggest only using topical methyl salicylate for a limited time period [e.g. about one week (39)]. I agree with this approach because of the pain masking potential and also because non-steroidal anti-inflammatory agents like salicylate can inhibit the normal increase in collagen synthesis (40) and thus the connective tissue strengthening stimulated by training (41, 42).

My clients and I have had good success applying MS topical (typically with menthol if not menthol and camphor) per a schedule similar to that below (although each case should be considered independently):

  • Week 1: Apply and cover with neoprene sleeve 2–3 times per day with mild heat for approximately twenty minutes per session.
  • Week 1: Before training, apply another application as above (minus heat). This would constitute the third application for that day.
  • Next 1–3 weeks: Apply only before training when aggravation is possible (i.e. the affected joint or tendon/muscle is involved in the exercises in training that day).

Of course, the above would also take place in the context of seeking out professional treatment for the injury, deferring the above to the advice and prescription of said practitioner.

A new kind of pain and loathing

Now for the good stuff. Below are three training strategies that can promote muscle growth but minimize skeletal/joint loading. The descriptions are not explicit exercise prescriptions, but simply strategies that have worked with clients, fellow bodybuilders (and myself). Please apply common sense and recognize that you exercise at your own risk.

Burn, baby, burn (light weight, baby?)

If you do enough sets (43, 44), training with light weight (reps ranging from ~20–35) can induce muscle growth (45, 46) equivalent to that of high(er) intensity training [~10 reps/set (47)]. The key here is that you have to train relentlessly hard. As fatigue ensues and sets are taken to(ward) failure, any and all motor units that can be actively called upon will be (48-51). So while heavy loads activate more motor units than lighter loads at the start of the set, if you push a high rep set to a glorious but safe ending where effort is maximal, a tremendous growth stimulus can be had. The results of those religiously employing 20-rep squat regimens is a primary example of the brutal effectiveness of maximal effort, high rep training.

Even more burning with even lighter weight

Invented in Japan, Kaatsu training (52), also known as blood flow restriction (BFR) training (53) or occlusion training (54), is used to generate muscle growth but limit skeletal and joint loading [e.g. in rehabilitation settings or when training the very frail elderly (52)]. Loads are very light and (<50 percent of a one repetition maximum) blood flow is restricted (blood pools in the capillaries) by using a ligature fitted proximal to a limb muscle(s) being trained. [In research, typically a special apparatus similar to a blood pressure cuff is employed, although knee wraps can be used as well (55)].

The training typically consists of high rep sets (15–30 reps) with short rest periods (1:00) and occlusion during the entire sequence lasting several minutes. [This causes ever increasing metabolite accumulation set by set (56)]. This metabolic stress creates an anabolic effect (57, 58) possibly via a cell volumizing effect (56, 59). (The pump is quite phenomenal.) The metabolic fatigue also shifts activation patterns toward high threshold motor units even though the training loads are low (60, 61). BFR training recruits satellite cells (62) just like high intensity training and other experimental models of muscle growth (63-69) and also reduces myostatin expression (70).

Although the data are essentially limited to studies with untrained individuals, the research literature suggests that BFR training is an extraordinarily powerful hypertrophic stimulus (52, 53, 71, 72). In an extensive review of training variables that produce muscle growth (73), a two-week Kaatsu resistance training program (twice daily sessions) demonstrated the highest rate of quadriceps growth of all studies reviewed (74). Personal experimentation and conversations with others suggest that blood flow restriction training is effective in maintaining size in highly trained bodybuilders (e.g. working around injuries) and producing noticeable growth in intermediate level lifters. However, Y. Sato, Kaatsu training’s inventor, cautions that Kaatsu training should not intentionally induce extreme ischemia (75), as this may cause thrombosis (52) as well as rhambomyolysis [permanent muscle tissue breakdown (76)]. [These risks are less than one in ~1800 sessions in clinical settings in Japan (77).]  Kaatsu training is tolerable even for the untrained under controlled conditions (78), but because variation in the parameters of artificially restricting blood flow (constriction tension, duration of blood flow restriction) can increase risks (79), I can’t currently recommend it without hesitation as a general practice for increasing or maintaining muscle size.

However, with continuous contractions above about 50–60 percent of maximal effort, especially with slower rep cadence (80), blood flow is limited due to intramuscular forces (81–83). Impressive post-exercise hyperemia (the “pump”) just after prolonged, continuous (non-stop) contractions is tangible evidence of limited blood flow during such a set (84). So one way to create blood flow restriction without the complicating (risk amplifying) issue of occluding blood flow artificially is to maintain muscle tension between high rep sets by stretching the muscle under tension (and possibly superimposing a small amount of voluntary contraction as well).

A sequence of sets employing this strategy might look like this:

  • Perform a high rep set (20–30 reps) with controlled continuous tension using a very light weight (<50 percent 1RM).
  • Maintain a continuous stretch for 1:00 between sets, contracting the muscle lightly if necessary to minimize blood flow. (The burn/pain in the muscle should be quite noticeable if blood flow is limited.)
  • Perform another set of ~15 repetitions.
  • Repeat the procedure of stretch/contraction to increase metabolic stress and minimize blood flow.
  • Repeat for 1–2 more sets as above.

Initially, just two sets as above should be enough to get an idea of appropriate load and safe ways to use a stretch to limit blood flow between sets. The load should be almost embarrassingly light for these, such that you can perform quality, slow, continuous reps.

To limit blood flow between sets of different exercises (different muscles or muscle groups) one might:

  • Set up the knee extension to maintain a safe stretch at the bottom of the range of motion during the interval between sets. (Do not overstretch such that the joint capsule is compromised.)
  • Set up a pec deck such that the chest muscles stay on stretch (perhaps while holding a lighter load than is lifted during the sets) between sets (i.e. you stay in the machine between sets).
  • Using straps, hold on to a pull-down or rowing machine handle for an occluding stretch between sets.
  • Maintain your hold on a biceps curl or triceps extension machine (muscle under stretch) between sets.
  • Perform a bilateral delt stretch between sets by grasping a bar behind you and squatting down to create an appropriate stretch.

The stretches/positions that you maintain between sets for the above strategy should never compromise a joint (e.g. create torque on a hinge joint outside the normal plane of motion of that joint). If you feel joint pain or tendon pain rather than a burning sensation in the belly of the muscle (as during normal training), the stretch should be terminated, of course.

"If I could go back and do things differently..."

 

Cluster sets

Ironically, I’ve also found that performing cluster sets (85), whereby set ending fatigue is postponed by performing the set in a discontinuous fashion, can be especially helpful for those who have arthritic spines. In cluster sets, reps are clustered together (typically 1–5 reps) and interspersed with short rest periods. This technique of prolonging a set (doing more repetitions than you could during a continuous straight set) and thus adding training volume has a long history, dating back at least half a century (86). Cluster sets are really only feasible with exercises where racking and unracking the weight is very simple (e.g. a back squat where one would be repeatedly walking the weight in and out of a rack poses too much injury risk, in my opinion, but one could use a monolift or a Smith machine to do squats in a cluster set fashion).

I've had clients who couldn't do exercises like stiff-legged deadlifts or any squat variations find that they could once again do those exercises if they performed them in a cluster set fashion. In all cases, these clients noted that their back pain would escalate, rep by rep, over the course of a normal straight set, eventually forcing them to terminate the set long before they had incurred even a reasonable amount of muscle fatigue (and training stimulus).

More specifically, the solution for these clients (one of perhaps several) has been to cluster six sets of four very clean, controlled, continuous reps interspersed with about ten seconds of recovery. (This ends up being about a 1:1 work-to-rest ratio.) The load should be light enough to get at least five sets before reaching a failure repetition somewhere in the sixth set, if at all. (Usually, this works out to a load equivalent to a 15-repetition maximum. Naturally, one could progressively increase the load used for the cluster sets, as long as they are still pain-free.) The short periods of deloading (during this particular cluster set configuration) don’t permit complete muscle recovery, so fatigue does accumulate. However, for these clients at least, the intermittent deloading was long enough to prevent the accumulation of set ending joint/back irritation. These clients actually found that there was little to no joint discomfort using this cluster set technique. Again, “selective idiocy” should apply here. The cluster set strategy shouldn't be used as a way to reduce pain but still exacerbate chronic injuries. Cluster set or not, one should prefer exercises that do not cause abnormal, injurious pain whenever possible.

Controlled insanity

Like a parachutist packing his chute or a daredevil motorcyclist strapping on his protective clothing, the above are strategies I’ve come up with over the years so that I can continue to enjoy “less than sane” (or perhaps the sanest of all) moments in the gym. I hope you can apply some of the ideas here either preventatively or retroactively to prolong your years in the iron game. Please be safe (and sane) if you decide to incorporate any of the above into your own training and recovery regimen. I would love any feedback or to hear about other strategies that you may like to share in the comments section.

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