Doing Treatment On Yourself? MOVE! while doing it

When we do treatment on ourselves, it is done to facilitate improvement during movement/use.  It only makes sense to do the movement while we are treating!

Foam rollers

Lacrosse balls


ART-type fascia pulls

Add movement!  Do it while walking/swinging/bending/etc.

Dr. Phil Kotzan, DC

The Best Hip Flexor Stretch

Physical therapist Mike Reinold says, “The hip flexor stretch has become a very popular stretch in the fitness and sports performance world, and rightly so considering how many people live their lives in anterior pelvic tilt.  However, this seems to be one of those stretches that I see a lot of people either performing incorrectly or too aggressively.” He offers the following stretch as a way of preventing too much back extension and anterior hip capsule strain.  Try this stretch out:

Hip Flexor Stretch

Credit: Mike Reinold, PT

Looking to offer the best way to do your hip flexor stretch…

Dr. Phil Kotzan, DC

6,000-Year-Old Knee Joints Suggest Osteoarthritis Isn’t Just Wear And Tear

American doctors have been noticing an increase in osteoarthritis of the knee. They have suspected two driving forces: more old people and more people who are overweight.

A study published in this week’s Proceedings of the National Academy of Sciences argues that’s far from the whole story. Even correcting for body mass index and age, osteoarthritis of the knee is twice as common now as it was before the 1950s.

“That’s an incredible difference,” says Daniel Lieberman, a professor of human evolutionary biology at Harvard University and co-author of the study.

Lieberman started wondering about arthritis a few years ago as he was compiling a list of diseases that modern humans aren’t well-adapted to cope with — such as heart disease, lower back pain and nearsightedness.

“I wanted to include arthritis in the list, but realized that there wasn’t any good data,” he tells NPR.

So Lieberman asked Ian Wallace, a postdoctoral research fellow in his lab, to fly around the country and study human skeletons that had ended up in museums or had been donated to medical schools for scientific research. The skeletons were from people who died as long ago as 4,000 B.C..

“The oldest specimens that we looked at were some skeletons from prehistoric Inuit hunter-gatherers from Alaska,” Wallace says. The most recent were the remains of people who died in Tennessee in 2015.

Conventional wisdom is that osteoarthritis of the knee results mostly from wear and tear, which is why, these days, it’s more common among older people and those whose excess body weight puts extra stress on those joints..

But that’s not what the evidence showed.

“I was actually extremely surprised to find that [osteoarthritis] is much more common today” than it was in Americans long ago, says Wallace.

That higher rate held true even after scientists corrected for body mass and age. So there’s apparently something else driving the increase in knee arthritis. The current study doesn’t pinpoint that cause.

“If I were a betting man, I would guess physical activity is especially important,” Lieberman says. “One of the things that’s really shifted in our world today is that we sit all the time, and kids sit all the time. And that may be affecting how our joints are forming and how our joints are aging.”

This makes sense to Dr. Richard Loeser a rheumatologist who directs the Thurston Arthritis Research Center at the University of North Carolina, Chapel Hill.

“Your joints aren’t just like your automobile tires that wear out as you use them,” he says. In fact, exercise helps nutrients diffuse into cartilage in the knee and keep it strong and healthy.

If cartilage “is formed and more healthy when you’re younger, then your joints are more likely to be functioning better and have less osteoarthritis when you get older,” Loeser says. And exercise also helps fully grown people.

“By strengthening your muscles and by stimulating your cartilage you can still improve the health of your joint,” Loeser says.

That’s not to say that exercise fully explains the trend that the Harvard researchers have noted.

“There may be dietary factors that may be important,” Loeser suggests. And sports injuries, which he says “have become more and more common” may be contributing to arthritis, too.

As Lieberman and his colleagues try to figure out exactly what’s behind the problem, they’re hopeful that a lot of what’s driving it may be preventable.


Written by Richard Harris of NPR.


Protect those knees!

Dr. Phil Kotzan, DC

Does Balancing Cause Stability-Specific Strength Gains?

When using machines to perform an exercise, the balance challenge involved is smaller than when using free weights to perform a very similar exercise. Similarly, when using unstable surfaces, the balance challenge is greater than when using the same exercise on a stable surface.

More stability = less need to balance; less stability = more need to balance.

Does the need to balance cause stability-specific strength gains (part 2)?

Surprisingly, balance training on its own can increase strength.

This could mean that the balance aspect of unstable surface training could lead to strength gains irrespective of the loading used.

Studies show that balance training even without concomitant strength training leads to strength gains (Heitkamp et al. 2001; 2002; Bruhn et al. 2006; Myer et al. 2006; Beurskens et al. 2015; Cug et al. 2016). Such gains seem to be connected with increases in rate of force development (Gruber & Gollhofer, 2004; Bruhn et al. 2006; Gruber et al. 2007; Behrens et al. 2015), probably caused by increases in early phase neural drive, through faster motor unit firing rates (Gruber & Gollhofer, 2004).

What is behind these changes is unclear.

Increases in neural drive after strength training appear to be partly caused by increases in corticospinal excitability (Beck et al. 2007; Griffin & Cafarelli, 2007; Kidgell et al. 2010), and partly because of reductions in corticospinal inhibition (Latella et al. 2012; Weier et al. 2012; Christie & Kamen, 2014; Rio et al. 2015).

At first glance, it might seem that balance training produces completely different neural adaptations, as it causes reductions in corticospinal excitability in balance tests (Taube et al. 2007; Beck et al. 2007; Schubert et al. 2008). However, these reductions in corticospinal excitability are very task-specific, just like improvements in balance (Kümmel et al. 2016). In fact, corticospinal excitability is elevated after balance training in tests that have not been practiced, including strength tests.

This shared mechanism could explain why additional gains in strength do not arise either when balance training is preceded by a period of strength training (Bruhn et al. 2006), nor when a program of balance training is performed together with a program of strength training (Manolopoulos et al. 2016). It may also explain how strength training can improve balance in a range of populations (Heitkamp et al. 2001; Anderson & Behm, 2005; Orr et al. 2008; Manolopoulos et al. 2016), and also increases co-ordination (Carroll et al. 2001).

This shared mechanism of strength gains by changes in neural drive may partly account for the larger-than-expected gains in strength after training on unstable surfaces, but given the similarity between the changes after balance and strength training, probably cannot explain stability-specific gains in strength.

Does the need to balance cause stability-specific strength gains (part 3)?

The need to balance seems to affect the co-ordination patterns of muscles during multi-joint exercises. This affects the extent to which force can be produced during specific, dynamic movements.

Performing an exercise in an unstable environment produces greater activation of the synergist and antagonist muscles compared to the exact same exercise performed under more stable conditions, even where agonist activation is similar (Cacchio et al. 2008; Schick et al. 2010; Ostrowski et al. 2016; Signorile et al. 2016).

More importantly, training in the unstable environment reduces the antagonist activation, and increases the activation of the stabilizers.

These changes lead to a more efficient pattern of muscular contractions in that specific, dynamic movement under unstable conditions, which improves strength very substantially, in a  stability-specific way.

For example, when comparing training with cable machines and with fixed bar path machines, Cacchio et al. (2008) found that training with the cable machines led to increases in the EMG amplitudes of the stabilizers, and reductions in the EMG amplitudes of the antagonist muscles during a cable machine strength test, while training with the fixed bar path machines did not.

Given that performance in balance tasks is very task-specific (Kümmel et al. 2016), and also that changes in neural drive after balance training are very task-specific (Beck et al. 2007; Schubert et al. 2008), it therefore seems very likely that such changes in inter-muscular co-ordination during specific dynamic movements are the underlying mechanism that causes stability-specific strength gains.

Since free weight exercises performed on the ground (like barbell squats) are most similar in terms of stability requirements to athletic ability tests (like vertical jumps), this also explains why free weights could indeed be described as “just right” in terms of external load stability, and therefore transfer most effectively to sport.


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  87. Zech, A., Hübscher, M., Vogt, L., Banzer, W., Hänsel, F., & Pfeifer, K. (2010). Balance training for neuromuscular control and performance enhancement: a systematic review. Journal of Athletic Training, 45(4), 392-403.

Written by Chris Beardsley for Strength and Conditioning.


Looking to bring awareness to adding stability drills to strengthening,

Dr. Phil Kotzan, DC

Comparing Training On Stable Versus Unstable Surfaces

The advantages and disadvantages of unstable surface training have been discussed ad nauseam (e.g. Hubbard, 2010; Behm & Sanchez, 2013). Here, I want to focus on if strength gains are stability-specific. To do this, we can look at studies exploring:

  1. Training with stable vs. unstable surfaces, then testing strength on stable surfaces
  2. Training with stable vs. unstable surfaces, then testing an athletic ability

#1. Comparisons of training on stable vs. unstable surfaces on strength on stable surfaces

Very few studies have compared the effects of training on stable vs. unstable surfaces on strength on stable surfaces. Those that have are summarized in a recent systematic review (Behm et al. 2015), although the measures used to test strength were not differentiated from one another, which makes the results difficult to interpret.

The most stable surface typically measured in studies is maximum isometric force, using a dynamometer. Training on unstable surfaces tends to produce similar gains in maximum isometric force as training on stable surfaces (Kibele & Behm, 2009; Sparkes & Behm, 2010; Prieske et al. 2016).

The second most stable surface typically measured in studies is maximum dynamic force, using the strength exercise used in the stable-surface training group, such as 1RM bench press (Cowley et al. 2007; Marinković et al. 2012; Premkumar et al. 2012; Maté-Muñoz et al. 2014), 3RM bench press (Sparkes & Behm, 2010), 6RM bench press (Saeterbakken et al. 2016), 1RM back squat (Marinković et al. 2012; Maté-Muñoz et al. 2014), and 3RM back squat (Sparkes & Behm, 2010). Training on unstable surfaces seems to produce similar gains in dynamic strength in the exercise used during training, compared to training with the same exercise on stable surfaces.

This suggests that there is no evidence of stability-specific strength when testing strength on stable surfaces after either stable or unstable surface training. However, although not as well-researched, there are some suggestions that gains in strength on unstable surfaces might be greater after training on unstable surfaces (Sparkes & Behm, 2010; Saeterbakken et al. 2016), which would mean that stability-specific strength gains still occur, albeit only in one direction.

Importantly, however, all of these studies were performed in untrained individuals. 

Since there are indications that unstable surface training does not lead to greater EMG amplitudes than stable surface training with the same absolute loads in resistance-trained individuals (Wahl & Behm, 2008; Li et al. 2013), training on unstable surfaces may not be as effective as training on stable surfaces in trained subjects.

#2. Comparisons of training on stable vs. unstable surfaces on athletic performance

Very few studies have compared the effects of training on stable vs. unstable surfaces on athletic performance measures. Those that have are summarized in a recent systematic review (Behm et al. 2015), although the measures used to assess athletic ability are not differentiated, which makes the results difficult to interpret.

Looking only at those studies exploring the effects of lower body strength training on countermovement jump height, a majority have found that performing the exercises on stable surfaces is better than performing the exercises on unstable surfaces (Cressey et al. 2007; Oberacker et al. 2012), although a minority have found no differences (Maté-Muñoz et al. 2014).

This suggests that lower body training on unstable surfaces may not transfer as well the same exercises performed on the ground to common tests of athletic ability, such as vertical jumping.

Summary of results

• Unstable surface training does improve strength on stable surfaces to a similar extent as stable surface training in untrained subjects. However, this may not apply to trained individuals.

• Unstable surface training may not improve common tests of athletic ability as well as the same exercises performed on the ground.


Written by Chris Beardsley for Strength and Conditioning.

Looking to bring awareness to adding stability drills to strengthening,

Dr. Phil Kotzan, DC

The Science Of Sore—Delayed Onset Muscle Soreness (DOMS) Explained

We’ve all experienced the agony. The pain of trying to get out of your car, wobble up the stairs, or move normally after a hard workout. This soreness is called delayed onset muscle soreness (DOMS). If you’ve been exercising long enough, you’ve probably felt it. Some lifters relish this pain as an indicator of success, but is that really the case?

What is DOMS?

I frequently see DOMS occur after a daunting leg day. It can also occur in experienced lifters after taking a few weeks off. Studies show (1) that it’s not restricted to any particular muscle group, but some people tend to experience it more in certain muscles.

Technically speaking, DOMS is (primarily) caused by a type 1 muscle strain – some degree of fiber damage, but nothing too serious – predominantly as a result of unaccustomed exercise. As you may have experienced, DOMS can range from slight muscle discomfort to severe pain that limits range of motion. Generally, muscle soreness becomes noticeable ~8 hours post-workout and peaks 48-72 hours later, although the exact time course can vary.

There is little doubt that DOMS is correlated with exercise-induced muscle damage to some degree; however, measures of muscle damage at a microscopic level are poorly correlated with reports of soreness. Basically, if you’re really sore, it doesn’t mean you completely “shredded” your muscles. This is supported by MRI images showing little damage to some muscles post-exercise. Not only do the time course of changes in the markers of muscle damage differ from one another, but they also don’t match the time course of muscle soreness (Newham, 1988). It is possible for severe DOMS to develop with little or no indication of muscle damage, and for severe damage to occur without DOMS.

Certain types of exercise can cause significant muscle damage. The image below is taken after an extensive eccentric exercise protocol. As you can see, the muscle fiber just looks messed up. The majority of studies examining exercise-induced muscle injury and DOMS use untrained subjects undertaking large amounts of unfamiliar eccentric exercise. This model is unlikely to closely reflect the circumstances of most people who workout. However, it does give us some insight into what happens in the muscle.

Another DOMS-inducing stimulus that occurs during exercise is metabolic stress (and I’m not talking about the build-up of lactic acid, which does not cause DOMS.  Thinking that lactic acid causes muscle soreness is a dogmatic idea that is thoroughly outdated and flat-out wrong). After high-intensity exercise, rest alone will return blood lactate to baseline levels well within the normal time period between training sessions. However, there is some evidence that hydrogen ions and reactive oxygen species – both of which increase in concentration during exercise – may contribute to DOMS (2). Metabolic stress during exercise can cause changes on a structural level at the cell membrane (sarcolemma). The damage allows fluids and other factors to enter the cell, which promotes inflammation (3).

Does DOMS mean more muscle growth?

Some studies show the presence of DOMS after long-distance running, which indicates it doesn’t just occur during resistance training. This should be an anecdotal indicator that DOMS isn’t a good gauge of muscle growth since running causes minimal hypertrophy.

People who are new to working out often have the most pronounced DOMS. They also happen to grow the most, so you can see how the two may be intertwined. This is due to the new stimulus that exercise provides. Again, they get sore because they aren’t accustomed to exercising – not because they are growing like monsters. Interestingly, there is no difference in DOMS between sexes even for beginners (4).

There is some evidence to show DOMS may negatively affect workouts by altering motor patterns in subsequent workouts. This could cause reduced activation of the desired muscle (5). Hence, DOMS could actually hinder your next workout. In addition, severe DOMS can decrease force capacity by up to 50% (6). This causes functional deficits that may impair training at a certain level, which could hinder muscle growth in the long term.

Exercising while having DOMS does not seem to make muscle damage worse (7), but it may interfere with the recovery process. In extreme cases, exercise-induced muscle damage can cause rhabdomyolysis, a serious condition that can lead to renal failure. So be careful when throwing a newbie into an advanced program – especially if they’ve never exercised. You could do some serious damage.

How do I feel DOMS?

So if you aren’t destroying your muscles or burning them up with lactic acid, then why do they hurt? I recently discussed this concept with a member of my lab.

Nociceptors are free nerve endings that respond to damaging stimuli by sending pain signals to the brain. In muscle tissue, these receptors can sense chemical stimuli such as inflammation or disturbances in microcirculation to blood vessels. These receptors are not inside the muscle because muscle cell death is not painful. In comparison, tearing a muscle can be extremely painful. The pain is due to the release of muscle substrates into the space where nociceptors are located. This also helps us appreciate that DOMS probably doesn’t occur due to something inside the muscle (i.e., in the contractile apparatus) (7).

How can I reduce DOMS?

One of the best ways to decrease the risk of DOMS is to slowly progress into a new exercise program. If you’ve ever had an advanced program, you’ll notice the first week or two may have reduced volume. The “prep” phase of programs has two purposes: 1) allowing the muscle time to acclimate to a new movement, and 2) leaving room for more adaptation.

We all know we should warm-up properly. This is probably one of the only times you’ll hear it doesn’t help. While it may prepare you for exercise (I highly suggest it), neither warming up nor stretching before exercise has been shown to reduce or prevent DOMS.

Something a lot of people use to relieve DOMS is foam rolling. However, it has only been shown to improve DOMS in some studies. During foam rolling, you use your own body mass on a foam roller to exert pressure on an area of soft tissue. The motion places direct pressure on an area, which stretches it. It is considered self-induced massage because the pressure somewhat resembles the pressure exerted on muscles by a massage therapist. Again, there are only a few studies that have measured the effects of foam rolling on performance. These studies found foam rolling can enhance recovery after DOMS and alleviate muscle tenderness. Self-massage through foam rolling could benefit people wanting to recover in an affordable, easy, and time-efficient way.

Another intervention commonly used is massage. Some researchers have shown decreases in pain associated with DOMS after a massage (8). However, massage has no effect on muscle metabolites such as glycogen or lactate. One study found massage decreased the production of the inflammatory cytokines by mitigating cellular stress resulting from muscle injury (8). Many people believe massage can provide increased blood flow to specific areas, reduced muscle tension, and mood enhancement. Massage produces direct pressure, which may increase ROM and stiffness. These benefits are expected to help athletes by enhancing performance and reducing injury risk.  The effects of timing of massage (pre- or post-exercise) on performance, injury recovery, or injury prevention are not clear because the mechanisms of each massage technique have not been widely studied.

Supplements to reduce DOMS

Caffeine has long been known to increase alertness and endurance, shown by the the average person’s morning grumpiness before drinking the black gold. Interestingly, a recent study by Hurley et al., reported caffeine has the ability to reduce DOMS. They mesured perceived soreness in males consuming caffeine one hour before a workout. They found a lower level of soreness in the biceps on day 2 and 3 compared to a placebo after subjects completed a bicep curl protocol.  Using a dosage of 5mg/kg bodyweight they found a beneficial effect of caffeine on soreness. For comparison, a 185lb (~84kg) male would take about 420mg of caffeine preworkout. That is a ton of caffeine! An 8oz Red Bull contains roughly 85mg. Does your preworkout supplement have that much caffeine? Probably not. If you’re wondering when caffeine peaks in the blood, it’s about one-hour post ingestion. Caffeine is an adenosine antagonist and affects the activity of central nervous system (CNS) by blocking adenosine receptors, thus resulting in decreased levels of soreness. This suggests that short-term caffeine ingestion before a strenuous workout may decrease overall soreness levels.  However, the subjects who took caffeine were able to perform more reps than the control group, which could be a confounder.

Taurine is found in muscle and has multiple biological functions. Remember that Red Bull I mentioned earlier? Well, it has about 1,000mg of taurine. For reference: Up to 3,000mg a day of supplemental taurine is considered safe. One double-blind study (10) of males completed over 21 days measured the effects of 50mg of taurine (20x less than the content in a Red Bull) after 7 days of eccentric exercise.  The researchers found a reduction in DOMS and oxidative stress markers after exercise; however, there was no effect on inflammatory markers. Could this be a way to battle the other side? If inflammation is one component to DOMS and oxidative stress is another component, we need a study to combine the two. That probably won’t happen soon, but it would be fun to see if they were synergistic.

Omega-3 fatty acid is found in fish and is becoming increasingly used to fortify foods. You can also find EPA/DHA in those lovely pills that make you burp fish all day. Several studies reported positive effect of omega-3 fatty acids on DOMS, presumably due to the decrease in pro-inflammatory factors such as IL-6 and TNF-alpha. There are a ton of studies to show taking an omega-3 supplement is good for you in many ways, and this seems to hold true for DOMS. If you’re interested in the results, the main table from Jouris et al 2013is below.

Cryotherapy, on the other hand, probably doesn’t reduce DOMS.  This goes directly against the current trend of athletes jumping in a tube surrounded by liquid nitrogen to help recovery. Whole body cryotherapy exposes athletes to cold, dry air below -100C for between two and four minutes in a specialized chamber. A recent Cochrane Review by Costello et al., found that there was insufficient evidence to determine whether cryotherapy can reduce muscle DOMS or improve recovery.

No guidelines currently exist for its clinical effectiveness or for safe usage. Cryotherapy is thought to work by reducing  temperature in the skin, muscle, and core. The theory is muscle soreness is relieved by reducing muscle metabolism, skin microcirculation, nerve conductivity and receptor sensitivity. In addition, it could have a placebo effect by reducing the subjective feeling of DOMS post-exercise. Using a meta-analysis based on four eligible studies, it seems cryotherapy does not reduce DOMS or improve recovery. Furthermore, insufficient evidence exists on whether this therapy could actually be harmful.  We do know, however, that cold water emersion post-exercise can decrease rate of muscle growth. For the time being, cryotherapy and cold water emersion are probably two things you should avoid – you probably won’t recover any faster, and you may not build as much muscle.


Soreness can provide some insight, but don’t use it as a marker for a good workout. High levels of soreness indicate the lifter has exceeded the capacity for the muscle to undergo repair. Indeed, soreness can impede the ability to train properly, and it may decrease motivation.

The consensus among researchers is that there is no single component that causes DOMS. Instead, there are a number of complex events that may explain this phenomenon. It is the main cause of reduced exercise performance including decreased muscle strength and range of motion for both athletes and non-athletes. Common supplements to combat DOMS include caffeine, omega-3 fatty acids, and taurine.


  1. Sikorski EM, Wilson JM, Lowery RP, Joy JM, Laurent CM, Wilson SM-C, Hesson D, Naimo MA, Averbuch B, and Gilchrist P. Changes in perceived recovery status scale following high volume, muscle damaging resistance exercise. J Strength Cond Res 27: 2079–2085, 2013.
  2. Close, Graeme L., Tony Ashton, Tim Cable, Dominic Doran, and Don P. M. MacLaren. “Eccentric Exercise, Isokinetic Muscle Torque and Delayed Onset Muscle Soreness: The Role of Reactive Oxygen Species.” European Journal of Applied Physiology 91, no. 5–6 (May 2004): 615–21. doi:10.1007/s00421-003-1012-2.
  3. Stauber WT, Clarkson PM, Fritz VK, and Evans WJ. Extracellular matrix disruption and pain after eccentric muscle action. J Appl Physiol 69: 868–874, 1990.
  4. Flores, Débora F., Paulo Gentil, Lee E. Brown, Ronei S. Pinto, Rodrigo L. Carregaro, and Martim Bottaro. “Dissociated Time Course of Recovery between Genders after Resistance Exercise.” Journal of Strength and Conditioning Research / National Strength & Conditioning Association 25, no. 11 (November 2011): 3039–44. doi:10.1519/JSC.0b013e318212dea4.
  5. Trost Z, France CR, Sullivan MJ, and Thomas JS. Pain-related fear predicts reduced spinal motion following experimental back injury. Pain 153: 1015–1021, 2012.
  6. Paulsen, G, Mikkelsen, UR, Raastad, T, and Peake, JM. Leucocytes, cytokines and satellite cells: what role do they play in muscle damage and regeneration following eccentric exercise? Exerc. Immunol. Rev. 18: 42-97, 2012.
  7. Cheung, Karoline, Patria Hume, and Linda Maxwell. “Delayed Onset Muscle Soreness : Treatment Strategies and Performance Factors.” Sports Medicine (Auckland, N.Z.) 33, no. 2 (2003): 145–64.
  8. Proske U and Morgan DL. Muscle damage from eccentric exercise: Mechanism, mechanical signs, adaptation and clinical applications. J Physiol 537: 333–345, 2001.
  9. Zainuddin, Zainal, Mike Newton, Paul Sacco, and Kazunori Nosaka. “Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function.” Journal of Athletic Training 40, no. 3 (September 2005): 174–80.
  10. Crane, Justin D., Daniel I. Ogborn, Colleen Cupido, Simon Melov, Alan Hubbard, Jacqueline M. Bourgeois, and Mark A. Tarnopolsky. “Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage.” Science Translational Medicine 4, no. 119 (February 1, 2012): 119ra13-119ra13. doi:10.1126/scitranslmed.3002882.
  11. Sikorski, Eric M., Jacob M. Wilson, Ryan P. Lowery, Jordan M. Joy, C. Matthew Laurent, Stephanie M-C Wilson, Domini Hesson, Marshall A. Naimo, Brian Averbuch, and Phil Gilchrist. “Changes in Perceived Recovery Status Scale Following High-Volume Muscle Damaging Resistance Exercise:” Journal of Strength and Conditioning Research 27, no. 8 (August 2013): 2079–85. doi:10.1519/JSC.0b013e31827e8e78.

Written by Brandon Roberts for The Science Of Sore

Bringing awareness to DOMS,

Dr. Phil Kotzan, DC

31 Flavors Of Protein Shakes

Thanks to local fitness and nutrition coach Brien Shamp (650-654-4604) for the following article:

Protein is an essential macronutrient for building lean muscle mass and protein shakes can be an important tool for health, fitness gains and fat loss.

Not only does a protein shake meal replacement take only a few minutes to prepare, it keeps you on point with your nutrition while making it easy to avoid unhealthy fast food alternatives for a quick meal. However, blending up the same combination of protein powder, ice and water sure does get boring.

The following 31 Flavors of Protein Shakes will destroy your protein shake boredom once and for all! For each of the recipes below simply combine the ingredients in a blender and blend until smooth. Add extra water, milk or ice as needed to create your desired consistency. Serve immediately and enjoy!

Oatmeal Shake

  • ¼ cup dry oats (look for gluten free)
  • 1 serving vanilla protein powder
  • ½ teaspoon ground cinnamon
  • 1 teaspoon pure maple syrup
  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • handful of ice cubes

Banana Nut Shake

  • ½ banana
  • 1 cup milk (raw organic pastures, coconut or cashew) or water
  • 10 almonds
  • 1 serving vanilla protein powder
  • handful of ice cubes

Vanilla Coffee Shake

  • ½ cup vanilla almond milk
  • ½ cup cold brewed black coffee
  • 1 serving vanilla protein powder
  • liquid stevia to taste
  • handful of ice cubes

Café Mocha Shake

  • ½ cup milk (raw organic pastures, coconut or cashew)
  • ½ cup cold brew black coffee
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • liquid stevia to taste
  • handful of ice cubes

Sunny Morning Shake

  • 1 seedless, peeled orange
  • 1 cup milk (raw organic pastures, coconut or cashew)
  • 1 serving unflavored protein powder
  • handful of ice cubes

Orange Creamsicle Shake

  • ½ frozen banana
  • ½ cup vanilla organic, whole fat Greek yogurt
  • 1 cup fresh squeezed orange juice
  • 1 serving vanilla protein powder
  • handful of ice cubes

Thin Mint Shake

  • ½ frozen banana
  • 1 cup milk (raw organic pastures, coconut or cashew)or water
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • ¼ teaspoon peppermint extract
  • 4 fresh mint leaves (optional)

Bright Berry Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • 8 raspberries
  • 4 strawberries
  • 12 blueberries
  • handful of ice cubes

Strawberry Vanilla Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • 1 handful of ice cubes
  • 1 teaspoon vanilla extract
  • ½ frozen banana
  • 3 frozen strawberries

Raspberry Cheesecake Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • 15 frozen raspberries
  • 2 Tablespoons organic low or whole fat sour cream
  • liquid stevia to taste

Peanut Butter Cup Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • 1 Tablespoon creamy organic peanut butter
  • handful of ice cubes

Creamy Chocolate Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving chocolate protein powder
  • 1 teaspoon unsweetened cocoa powder
  • 2 Tablespoons organic low or whole fat sour cream
  • liquid stevia to taste

Papaya Ginger Mint Shake

  • ½ cup fresh chopped papaya
  • ½ teaspoon fresh minced ginger
  • 4 fresh mint leaves
  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • handful of ice cubes
  • drizzle of honey to taste

Blueberry Mango Shake

  • ½ cup fresh or frozen chopped mango
  • ¼ cup fresh or frozen blueberries
  • ¼ cup plain organic, whole fat Greek yogurt
  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder

Spinach, Kiwi and Chia Seed Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 cup packed spinach
  • 1 ripe kiwi, peeled and cut into chunks
  • 1 serving vanilla protein powder
  • 1 Tablespoon chia seeds
  • handful of ice cubes

Oatmeal Cookie Shake

  • ¼ cup dry oats
  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ½ frozen banana, peeled and chopped
  • 1 teaspoon honey
  • ½ teaspoon ground cinnamon
  • ½ teaspoon vanilla extract
  • pinch of ground ginger, nutmeg and salt

Peanut Butter and Jelly Shake

  • ½ frozen banana
  • 1 cup milk or water
  • 2 Tablespoons creamy organic peanut butter
  • ½ cup frozen strawberries
  • 1 serving vanilla protein powder
  • handful of ice cubes

Vanilla Matcha Avocado Shake

  • 1 ½ cups milk (raw organic pastures, coconut or cashew) or water
  • 1 serving vanilla protein powder
  • ¼ teaspoon vanilla extract
  • ½ an avocado, pitted and peeled
  • 2 teaspoons matcha powder
  • 1 handful of spinach

Cherry Almond Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ½ cup frozen, pitted cherries
  • 2 Tablespoons almond butter
  • handful of ice cubes

Honey Banana Shake

  • 1 ½ cups of water or milk (raw organic pastures, coconut or cashew)
  • 1 frozen banana
  • ¼ cup plain organic, whole fat Greek yogurt
  • 1 serving vanilla protein powder
  • 1 teaspoon honey
  • sprinkle of ground nutmeg

Carrot Cake Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ¼ cup shredded carrots
  • ¼ cup chopped walnuts
  • ¼ cup plain organic, whole fat Greek yogurt
  • ¼ teaspoon ground cinnamon
  • pinch of ground nutmeg and ground ginger

Key Lim Pie Shake

  • ½ cup vanilla organic, whole fat Greek yogurt
  • 1 cup milk (raw organic pastures, coconut or cashew) or water
  • 1 serving vanilla protein powder
  • 1 Tablespoon lime juice
  • stevia to taste
  • handful of ice cubes

Peach Oatmeal Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ¼ cup dry oats(choose gluten free)
  • 1 peach, pitted, peeled and chopped
  • handful of ice cubes
  • ½ frozen banana, peeled and chopped
  • stevia to taste

Vanilla Chai Shake

  • 1 cup milk (raw organic pastures, coconut or cashew)or water
  • 1 serving vanilla protein powder
  • ¼ cup strong brewed, chilled tea
  • ¼ teaspoon vanilla extract
  • pinch of ground cinnamon, cloves and cardamom
  • handful of ice cubes
  • sprinkle of chia seeds

Apple Pie a la Mode Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 apple, peeled, cored, and finely chopped
  • ¼ cup vanilla organic, whole fat Greek yogurt
  • 1 Tablespoon apple butter
  • ½ teaspoon ground apple pie spice
  • 1 serving vanilla protein powder
  • stevia to taste

Cinnamon Roll Shake

  • 1 ½ cups water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ¼ teaspoon ground cinnamon
  • ½ cup vanilla organic, whole fat Greek yogurt
  • ¼ cup dry oats (choose gluten free)
  • ½ banana, peeled

Hawaiian Sunrise Shake

  • 1 cup milk (raw organic pastures, coconut or cashew)or water
  • 1 serving vanilla protein powder
  • ½ banana
  • ½ cup pineapple
  • ½ cup plain organic, whole fat Greek yogurt
  • stevia to taste
  • handful of ice cubes

Snickerdoodle Shake

  • 1 cup water or milk (raw organic pastures, coconut or cashew)
  • 1 serving vanilla protein powder
  • ½ banana
  • 1 Tablespoon creamy almond butter
  • ¼ teaspoon ground cinnamon
  • ¼ teaspoon vanilla extract

Chocolate Chip Cookie Shake

  • 1 ½ cups milk (raw organic pastures, coconut or cashew) or water
  • 1 serving vanilla protein powder
  • ¼ cup dry oats (choose gluten free)
  • ¼ teaspoon Kerrygold butter
  • ¼ teaspoon vanilla extract
  • pinch of salt
  • handful of ice cubes
  • 1 Tablespoon mini chocolate chips
  • stevia to taste

Chocolate Brownie Shake

  • 1 frozen banana, peeled and chopped
  • ¼ cup brewed coffee, chilled
  • ¾ cup milk (raw organic pastures, coconut or cashew)
  • 1 serving chocolate protein powder
  • 2 Tablespoons unsweetened cocoa powder
  • ¼ teaspoon vanilla extract
  • pinch of salt
  • 1 Tablespoon mini chocolate chips

Pina Colada Shake

  • 1 frozen banana, peeled and chopped
  • ½ cup fresh pineapple, chopped
  • 1 cup coconut milk
  • 1 serving vanilla protein powder
  • 1 Tablespoon shredded, unsweetened coconut

There you go! 31 Flavors of Protein Shakes to keep you happily sipping those fitness friendly macronutrients needed to achieve your big transformation goal. Now your only protein shake dilemma is deciding which of these amazing shakes to try first!

Remember that exercise is an essential component to achieving any fitness goal, so supplement your protein shake regimen with high intensity bouts of exercise as tolerated.

We will adapt your program as needed to progress you to high intensity bouts over time!


Looking to encourage healthy protein consumption…

Dr. Phil Kotzan, DC



A Better Way To Stretch Your Latissimus Dorsi (Lats)

I want to bring some pieces together from rolling out to active stretching to loaded stretching to show you some ways that will get you thinking beyond just holding a static stretch as the answer to all ‘stretching’ needs.

The Lat Flow:

For 8-10 minutes:

  • 20-30 seconds roll out your lats on a foam roller
    • We are doing this to decrease muscle tension, not ‘break’ anything down
  • 10 reps active lat stretch each arm
    • We are doing this as a way to do an active, unloaded stretch of the lats
  • 3-5 reps accentuated negative chin up
    • Here we want to do a slow negative rep with a hollow body position. Hold the bottom of the chin up with an engaged anterior chain for 10 seconds. Drop down from the bar and hop back up between each rep. Don’t pull into the next rep out of the dead hang. This concept of accentuated eccentrics is something Dr. John Rusin talks about a lot and is shown in his FHT program and our joint educational program Bulletproof Muscle.


Here is the video showing the stretches:



I hope you found this helpful!

Written by Dr. Ryan DeBell of The Movement Fix


Looking to illustrate a few great lat stretches.  Lat tightness is something I see as a problem on so many patients.  Time to loosen them…


Dr. Phil Kotzan, DC

The Need For PREVENTION In Sports-Related Injuries

Despite a dramatic Super Bowl, the National Football League has taken quite a few hits lately concerning player injuries, particularly concussions. As famous sports commentator Frank Deford said last fall, citing recent reports, “[A]lmost one-third of NFL players will suffer long-term cognitive problems.

Granted, that’s professionals; but obviously younger brains are at jeopardy on all gridirons. What mother or father can any longer willfully allow a son to play such a game with such odds? Verdict: Football is dangerous to your brain.”

Even if there is room for debate on the numbers, Deford hits on a point: A major shift in the public’s perception of sports and recreation is underway. And it’s not just football; across the sports world, from pro leagues to Little League, fans, parents, players and coaches are increasingly aware of the potential for serious, even life-threatening injuries from contact sports.

Need Meets Opportunity

Data from the Centers for Disease Control and Prevention show that incidents of “sports and recreation” injuries are rising; emergency-room visits for traumatic brain injuries in particular increased 62 percent from 2001 to 2009.1 High-school athletes are especially susceptible, with three times as many catastrophic injuries occurring on the high-school football field as on the collegiate.2

According to the National Athletic Trainers’ Association, 39 youths died from sports-related injuries in 2011.3 Are youth sports inherently more dangerous than they once were? Possibly. But the numbers are more likely a reflection of the public’s increasing awareness of sports-related injuries, which is a positive – parents and coaches are insisting on professional help sooner and more frequently.

But while this is important, it’s not good enough; an injury suffered on the field can have consequences that last a lifetime. As chiropractors, we are uniquely positioned among our health professional peers to make a difference. No other profession looks at the delicate interplay of the body’s neurological, skeletal and musculoskeletal systems, and the biomechanics that animate them. Our rehab and stabilization programs can address the subtle, often asymptomatic flaws in these systems that can help prevent major injury from occurring in the first place. With knowledge of the Sport Concussion Assessment Tool (SCAT-3), DCs can also help players and parents develop safe return-to-play protocols should a concussion occur.

Conventional screening for a prospective team athlete is an eyes, ears and throat exam, plus a scoliosis screening – often administered by the family MD. While useful, passing these tests “is like saying the absence of terminal cancer means you’re healthy,” writes my colleague, Tim Maggs, DC, director of sports biomechanics at Christian Brothers Academy in Albany, N.Y. Chiropractic can offer more.

Focusing on Prevention

Consider marketing your prevention services to the young athletes and their parents in your community. The youth sports demographic is so large it’s difficult to quantify; between 21.47 million and 35 million play sports each year (the latter figure is more than the population of California in 2000). In fact, few American kids do not play sports. For children between the ages of 8 and 17, only 13 percent of boys and 18 percent of girls have never joined a team or club.4

We also know parents are willing to invest in kids’ sports involvement. A recent consumer survey found that parents spend $671 a year, on average, on sports-related costs per child, and 21 percent of parents spend more than $1,000 per child.6 In Cincinnati, one father tracked sports-related spending on his three active children and found the family sunk $9,076 into sports equipment, uniforms, fees, lessons and travel to events in 2010 alone.5

If parents are willing to spend hundreds, if not thousands, on these goods and services, it seems a modest investment in protecting their child’s health would be a “no brainer.” Most simply don’t know preventative biomechanical exams and care are an option. We are the biomechanics experts. It’s about time the public hears about it.

In your own practice, you may wish to brush up on your sports injury prevention knowledge before marketing your services. With plenty of “basics” or “refresher” courses available online or in person to help you get in the game, there is no better time. Nearly all of the major chiropractic colleges offer postgraduate coursework aimed at taking care of athletes; you can pursue a certification or simply work at building your knowledge.

In 2011, the Foundation for Chiropractic Progress funded the creation of Athletic TIPS (Toward Injury Prevention in Sports). TIPS offers online learning, grassroots events and supportive initiatives aimed at reducing the epidemic of youth sports injuries. Training focuses on four core categories: dehydration, musculoskeletal injuries, nutrition and concussions. The program was developed by a multidisciplinary advisory board comprised of recognized experts in these fields, many of whom are DCs.

TIPS has already made great strides, including the training of more than 200 chiropractors to conduct community workshops in 2014. Nearly 1,000 coaches nationwide have participated in TIPS Training, and an interactive online learning platform allows for education anywhere, anytime. Becoming a TIPS-certified practitioner empowers you to teach parents and coaches about sports injury prevention, and positions you as an expert on these topics within your community.

Many doctors I’ve spoken to have found that emphasizing sports injury prevention in their exam rooms, especially with young athletes, has helped to usher in new patients and revitalize their practices. Moreover, they’ve told me it’s professionally rewarding to be able to reach, empower and protect such a vulnerable demographic. I encourage you to be proactive in your practice and help coaches, parents and players be proactive about young athletes’ health.


  1. Centers for Disease Control and Prevention. Nonfatal Traumatic Brain Injuries Related to Sports and Recreation Activities Among Persons Aged ≤19 Years, United States, 2001-2009. Morbidity Mortality Weekly Rep, (MMWR), 2011;60(39);1337-1342.
  2. Boden B, Tacchetti RL, Cantu RC, et al. Catastrophic head injuries in high school and college football players. Am J Sports Med, 2007;35(7):1075-1081.
  3. National Athletic Trainers’ Association.
  4. Kelly B, Carchia C. “Hey Data Data – Swing!” ESPN The Magazine, July 11, 2013.
  5. “Youth Baseball: Are Private Lessons Worth the Money?” Blog post,, July 8, 2012.


Written by Kent Greenawalt for Dynamic Chiropractic


Looking to bring awareness to prevention,

Dr. Phil Kotzan, DC

3 Exercise Program Design Mistakes That Lead To Plateaus–And How To Fix Them

Is your training program making you a better, more efficient athlete — or is it leading you straight to a frustrating plateau? In this article, I’ll highlight three big program-design mistakes that inevitably lead to stalled progress and subpar results. Plus, I’ll show you how to fix them by doing the opposite of what most athletes and trainers do.

Mistake #1: Trying to improve everything at once.
Solution: Narrow your training focus (especially if you’re a newbie).

When it comes to programming, one of the most common mistakes both coaches and athletes make is to try to improve too many different things at once.  While it’s easy to think you can get stronger, improve your conditioning, build muscle, and burn fat all at the same time, it’s just not realistic for anyone but a beginner.

If you’re a beginner, then training many different areas of fitness all together does in fact work. That’s because when fitness levels are very low, just about anything works, simply because there’s so much room for improvement.

But as your level of fitness increases, continuing to train in the same way is a recipe for frustrating plateaus and lack of progress. That’s because the higher your fitness level, the more stress your body needs to change and adapt. Which means your training has to get more targeted.

The key to successful program design — especially for non-beginners — is to set the right goal from the start.

The single most important way to avoid frustrating plateaus is to start by building your entire program around a single training goal. The real key here is to make the goal as specific as possible.

Instead of saying, “I want to get stronger,” you need to be much more specific:

  • Which lifts do you want to get stronger in?
  • What type of strength do you want to develop?
  • How much stronger can you realistically get in the next six to twelve weeks?

Why beginners should avoid “getting stronger”.

If you’ve been training five years or more, your strength goals need to based on a single lift or a single movement pattern. (Beginners can easily see improvement in strength across 4-5 different lifts in a given program.)

If squatting is your biggest weakness, don’t build a training program with the general goal of getting “stronger.” Instead, build it specifically around improving your squat.

Make the squat your primary exercise in two or three sessions per week. Build your accessory exercises around improving squat strength. Work on improving your squat technique.

The same thing applies to conditioning-based goals as well. Instead of starting with the goal of “improving conditioning,” first look at no more than two or three markers of conditioning and build your program around increasing those. Make your goal to lower your resting heart rate by three to five beats-per-minute, or cut 20 seconds off your mile time.

A narrowly defined goal — especially for more advanced athletes — will ensure that you actually make progress instead of spinning your wheels.

Mistake #2: Using too many methods and exercises
Solution: Use less variety

As a direct result of starting with goals that are overly broad, another common programming mistake is to use too much variety within the program itself. Think of it this way: if you’re trying to improve ten different things, there’s no way to avoid lots of different methods and exercises.

It may seem counterintuitive, but too much variety is the enemy of progress because the body doesn’t get the consistent and targeted stimulus that it needs to improve.

A lot of programs today are filled with endless variety — a consequence of Crossfit and group-fitness style training. But if “fitness” was simply a matter of shoving the most exercises into the shortest timeframe, then avoiding plateaus would be easy and everyone would be in great shape.

The truth, though, is that using twenty different exercises per workout and totally different exercises each and every workout, is a surefire way to quickly hit a wall.

Consistency, not variety, is what you should be aiming for when it comes to programming.

This means that another one of the keys to avoiding plateaus is to do the opposite of what most people think and use less variety. In fact, if you’re a high-level athlete, or are just in great shape, I suggest that you use dramatically less variety.

The higher your level of fitness, the fewer training methods and core exercises you should be using within your program. Again, to increase fitness to higher and higher levels means the stress you place on your body must be more and more targeted. Using too many exercises and methods spreads the stress out too much and reduces its effectiveness.

Here’s a good general rule of thumb to determine what’s appropriate:

  • Low fitness: 4-5 methods, 12-15 exercises
  • Moderate fitness: 3-4 methods, 8-12 exercises
  • High fitness: 3-4 methods, 6-8 exercises
  • World-class fitness: 2-3 methods, 4-5 exercises

For example. Let’s say you’ve already got a high level of fitness, but you want to improve your conditioning to an even higher level. Using the guidelines above, you’d want to focus on using no more than 3-4 primary methods. You’d want to select higher intensity methods like threshold training, cardiac power intervals, and high resistance intervals. (

When it comes to exercises, again you’d want to limit them to no more than 6-8 and select them based on the chosen methods and where your specific weaknesses are. If you struggle with running, for example, you’d want to use one or two sprinting variations for the threshold and cardiac power intervals. Keep the same exercises throughout the program and resist the temptation to add variety just for the sake of variety.

Fewer methods and exercises means your body will see a much more consistent stimulus — and this consistency is what drives progress. Once you’ve set your goals and selected the minimum number of methods and exercises necessary, the final step to avoiding plateaus is understanding the relationship between intensity and frequency.

Mistake #3: Training like a beast all the time.
Solution: Train like a beast some of the time.

If the 1980’s were about big hair and aerobics class, the 2000’s have been about intensity. Everywhere you look, you see someone trying to interval themselves to death.

Who knows where it all started. Whether it was with the Tabata research, the explosion of CrossFit, or something else, the “no pain, no gain” motto has taken over almost every area of fitness and programming.

Though intensity is no doubt a big driver of improving fitness, it’s not the only one. Even more important to understand is that there is a direct trade-off between intensity and the other side of the equation: volume and frequency.

In other words, the higher the intensity, the lower the volume and frequency has to be. Try to put together a program any other way and sooner or later, you’ll not only hit a plateau, you’ll likely get injured.

The dark side of high-intensity training

Here’s sympathetic overload in a nutshell: Intensity (how hard you work) drives high levels of sympathetic hormones like adrenaline. When these hormones get too high for too long, bad things happen. First, the receptors they bind to start to downregulate. Second, inflammation starts to become chronic.

In other words, high intensity has a downside. So you have to use it carefully if you want to avoid plateaus and injuries.

What to do next

What’s the best way to achieve the right balance of intensity, volume and frequency? How about we wrap this article up with a nice little bow and give you some direct action steps.

Here are some guidelines to follow:

  1. Look at your current training program (or your client’s program) and ask yourself: “What is the one single area of fitness that I really need to improve the most?”
  2. Design an 8-12 week training program where you spend roughly 70% of your total training time working on the particular training goal that you chose in step one. For strength related goals, you’ll want to train the core lift(s) and accessories that you’re trying to improve 3-4 days per week. For conditioning goals, you’ll need to up that to 4-5 days per week.
  3. Select the appropriate number of different methods and exercises based on the fitness level guidelines I mentioned earlier. Make sure to choose exercises that are specific to your individual weaknesses and goals — and don’t go overboard. Just pick enough to get the job done.
  4. Use high intensity in your training 2-3 days per week at most. This will prevent sympathetic overload, overtraining, and chronic overuse injuries. Always strive to use only as much intensity as necessary, rather than as much as possible.

In my experience, most people — whether coaches or athletes — tend to overlook simple fixes to make their programming more effective. But just like most things in life, the more you simplify and focus your efforts, the better results you get.

By Joel Jamieson of Weeks Out Blog


Looking to help break plateaus,

Dr. Phil Kotzan, DC