Six Steps To Youthful, Supple Arteries

How To Slow Down Vascular Aging

Wouldn’t it be great to have the flexible, healthy arteries of a young person again? Arteries that are resistant to heart attacks, strokes, and dementia?

“Maintaining a youthful vascular function beyond age 70 is extremely challenging,” say researchers from the Framingham Heart Study.  But it’s doable they insist, adding that it requires a long term commitment to achieving six goals for good health.

As we age, the aorta, carotids, and other large arteries that keep oxygen-rich blood flowing through our body lose some of their capacity to widen or narrow. They become less compliant. With aging, arterial compliance declines and arterial stiffness increases. Arteries are most supple at about age 30 and then start stiffening.

Framingham Heart Study

The Framingham Heart Study has been tracking the health of several generations of residents of this Massachusetts city. It’s now a collaboration between the National Institutes of Health and Boston University.

Using new data from Framingham, scientists this spring showed exactly how much the six health goals can affect your chances of gaining and keeping healthy arteries.

The researchers defined the sign of healthy arteries as a blood pressure of less than 140/90 without drugs and a rate of blood flow through the arteries typical of a healthy person in their 20s.

Among the 3,196 residents of Framingham they studied, the researchers found healthy arteries in 30 percent of those in their 50s, in 7 percent of those in their 60s, but in only 1 percent — 6 of 617 — of those in their 70s. Hence, the challenge for older individuals.

The healthy goals that the researchers patterned after American Heart Association guidelines and measured in the Framingham residents were:

  • No smoking
  • A BMI of less than 25
  • Regular physical activity
  • Cholesterol level below 200 without the use of drugs
  • Fasting blood glucose below 100 without the use of drugs
  • A healthy diet rich in fruits, vegetables, fish and whole grains and limited in sodium and added sugars.

What the researchers found

Compared with achieving only one or two of these goals, the Framingham residents who met three or four of the goals increased by three-fold their chances of having healthy arteries. Hitting five goals, their odds jumped to seven times. And those who achieved all six were 10 times more likely to have youthful arteries than those who could manage one or two of the goals.

Avoiding vascular aging and stiff arteries can have a big payoff. The Framingham researchers tracked the city’s men and women for 10 years and found that those with healthy arteries had less than half the likelihood of suffering heart attacks or strokes during that time.

Stiffer arteries also increase the risk of cognitive decline. People who entered the Baltimore Longitudinal Study of Aging cognitively intact but with stiffer arteries were more likely to show declines in verbal learning skills and memory over the next decade than those who started out with less-stiff arteries.

The American Heart Association says that each of its healthy goals “have one unique thing in common: any person can make these changes, the steps are not expensive to take and even modest improvements to your health will make a big difference.”

Written by David Schardt for Nutrition Action of the Center For Science In The Public Interest


Bringing attention to our vasculature,

Dr. Phil Kotzan, DC

The Basic Anatomy Of Stretching The Adductor Muscles

This week we are going to take a look at the basic anatomy of stretching the hip adductors.

This is the group of muscles that make up your inner thigh muscles. The muscles specifically are the adductor longus, adductor brevis, gracilis, pectineus, and adductor magnus.

The only one of these muscles that crosses the hip joint and the knee joint is the gracilis. All the others only cross the hip joint.

The implication of this is that when the knees are bent, most of the adductors (especially by mass) are not slacked.

When you go down into a squat or a sumo deadlift where your legs are out to the side, the main muscular limitation is the adductors, especially when you externally rotate your femurs.

In the squat, the hamstrings are slacked because of the knee bend, but the adductors are not. They are the most likely muscular limitation around the hip to preventing good squat depth.

Ok the video goes into much more depth than this because this is really one of those things you need to see to understand!


Video: How To Stretch The Adductors


Written by Dr. Ryan DeBell for The Movement Fix


Looking to see more adductors stretched,

Dr. Phil Kotzan, DC

A Simple Strengthening Program

We tend to overcomplicate everything in life. Tell someone to “eat clean” and you need a 500-page manual to explain it. To get “in shape” might take several thick volumes of work to detail everything.

But, to get strong is one of the easiest things I know. As I often joke, and the research backs me up on this:

If you want to get stronger, lift weights.

The best method I know is simply “One-Two-Three.” It’s an old method that has recently seen the light of day again.

Pick a big movement.


Push: Bench or Military Press

Pull: Pull Up

Squat: Front Squat or Back Squat

Hinge: Deadlift


Find a load that you can do for five. It’s going to really vary for most of us, but a normal trainer will find that 80% of their max is about right. Now, follow this rep scheme:


Do a single, rest a bit, do a double, rest a bit, then do a triple. That is six total reps and the quality should all be excellent. For a solid workout, run through this three times: 1-2-3-1-2-3-1-2-3.

Never miss and never chase fatigue. Try to dominate each and every set. You WANT the weight to feel light and easy. Inch that load up over a few workouts. Like we discover in throwing the shot and discus, inching your effortless efforts up a bit seem to increase your best.

This is an old method of strength training that has been ignored for a while. You can train as you usually do and just sprinkle these throughout the workout. Many have found that this does wonders for the Pull Up, but experiment with the squat or deadlift too.

Getting stronger in these key lifts is the “secret” to power, mass and leanness. Speed up your progress by backing off a bit, but striving to increase load.


Written by Dan John of


Simple, easy to execute, appreciated,

Dr. Phil Kotzan, DC

Coaches: Why To Build camaraderie With Young Athletes

Fostering teamwork among any group of individuals is not an easy job.  If you were to analyze coaches with successful careers they would tell you they didn’t win on talent alone. Geno Auriemma led the UCONN Huskies basketball team to seven national championships while John Wooden of UCLA secured ten national championships and is known as a genuine leader. Both coaches were shown to be great leaders in the world of college sports but what defines them. They knew and understood every individual on their team while challenging them in the right ways. They established consistent standards of performance and knew how to motivate their team despite personality differences. Most importantly they were not afraid to take risks to support them in their development to become better athletes. These same principles apply when working with younger teams but at a level that fits their stage of development.

Unfortunately many of today’s youth coaches are focused merely on recruiting and playing the most athletically talented.  A group that exhibits talent alone doesn’t necessarily correlate with team cohesiveness which is defined as a group of individuals who want to work together to achieve a common goal. A team with strong cohesion also has an emotional bond with one another as result of athletes’ investment to be successful as a unit and not just individually. When looking at top businesses, they are successful as a result of selectively choosing their team based on who works well together. The same applies with youth sports. Although they may not always be trying out for the team each athlete brings a variety of strengths that can benefit the group as a whole. Some of the most enthusiastic and hard workers are not always the most athletic, but know how to keep the energy up. While others who are self-disciplined challenge the team to hold each other accountable. Whether you are a new coach or building off an existing team, here are four simple ways to ensure strong team camaraderie.

Establish Team Rules: This is an essential step that should happen on the first day of practice. It sets a foundation of expectations for the team in order to achieve their goals. Rules should never be created with the coach alone, however there needs to be a baseline that guides athletes in creating their rules. As a coach there are several things to consider including the age of development, importance of autonomy, ownership by the players, modeling, consistency and accountability. If the coach doesn’t follow the rules or the athletes don’t hold each other accountable there is no foundation to work from resulting in poor cohesiveness. How you handle a six year old coming late to practice versus a teenager should look much different in consequences. Each athlete should know what they are responsible for and what they are expected to contribute. In today’s generation young athletes are often involved in multiple activities. The team needs to decide what’s acceptable and what’s not in attendance while recognizing the need for full participation from everyone. Rules should always create a safe and trusting environment for the team.

Create an Environment with Open Communication and Role Clarity: Every coach should know their athletes on an individual level including strengths, areas to develop and goals. Athletes will be more invested in the process when feeling cared about. This will also help in clarifying roles of all members on the team, whether it is on or off the field. There will be young athletes that tend to exhibit more leadership skills. They will lead by example athletically but also by their character. Some players respond better to peer instruction and support rather than from the coach. Others will be highly skilled but may not be self-motivated or disciplined. A great coach will utilize all of these skills to bring a team together and foster an environment of open communication. This includes paying attention to any conflicts and addressing them when they arise. When handled well, they provide further opportunity for growth in skill and character building. Coaches need to empower young athletes to solve problems themselves while teaching conflict resolution skills for the future.

Focus on the Vision: With any successful business or organization there is always a vision and the same applies with sports. Teams can be part of a bigger organization or be a representation of a school. Establishing a vision will set a foundation for the coaches, team and players. An important component of this is setting long-term directional goals. This will define the culture and expectations when building a cohesive team. Within the long-term goals there should be a variation of outcome, process and performance goals. Outcome goals include a number of team wins or hitting a specific time for an event. These will include both team and individual goals that the coach will establish with their players. Performance goals will be viewed as mastering a skill or increasing a percentage and process goals, which are often overlooked, are the behaviors and actions needed in order to accomplish the desired outcome. Every coach wants to be successful but will not reach the desired outcome without understanding the process it takes to get there. A vision statement should clarify the purpose of the team, set a standard of excellence, inspire enthusiasm and be easy to understand. All leaders of any team need to embody this message. If they are not connected and carry out the statement themselves through their daily actions the team will not either and therefore lack a sense of direction.

Foster a Safe and Playful Environment: This may not be a priority for most coaches when it should be.  In any organization if the environment is all work and no play than don’t expect big results on desired outcomes. This especially applies to the sports scene with the push for specialization at a younger age and an increase in sport specific clinics guaranteeing bigger, faster, stronger athletes. An important question for coaches to consider is what are the top responsibilities when working with youth? This should not include developing superstar athletes as the overarching goal.  Coaches play an intricate role in the teaching process while understanding the developmental needs of their athletes. This doesn’t mean challenging athletes, promoting hard work and teaching skills can’t be fun. However, in order for any athlete to reach their fullest potential they need to stay invested and be allowed ample opportunity for play both on and off the field. This may include incorporating various games into training sessions that also focus on skills. For example tag games are great for working on acceleration and deceleration techniques. Games that include goals such as hitting a set number in juggling, handball and relay races serve as team building exercises. In addition, events should be hosted outside of normal practice times, such as team dinners and other various outings that promote positive social interactions. Coaches who view play as a waste of time are missing several key learning components in building their athletes. These include communication, social skills, a sense of give and take, patience, perseverance and trust. Like adults who juggle numerous tasks the same applies for children and adolescents. They benefit from time away from technology, school and personal lives to engage with others in a playful manner. The end result is a stronger commitment to the team’s mission and mental clarity on the field.

Team cohesion never develops overnight and requires patience in the process. Every coach needs to know their individual athletes before understanding how the team functions as a whole. This will help utilize various personalities and strengths in order to build on areas of growth.  It’s important to recognize success, challenge appropriately and take risks when the team has established trust in their leaders. A coach who follows the vision and encourages direct feedback will have better camaraderie which will translate to desired performance outcomes.

Written by Melissa Lambert, M.Ed, LPC for


Of interest to coaches,

Dr. Phil Kotzan, DC

How To Ice, Timing To Ice?

Does Cooling Method Matter?

It turns out that how you choose to cool down after exercise may be important. A 2013 meta-analysis by Poppendieck et al. found that CWI was more effective than ice packs and cryogenic chambers for performance recovery in trained athletes (92). This findings may be biased due to the large majority of studies that use CWI as their cooling intervention but there’s a reason for this: CWI is by far the most effective method for cooling the body (93) and, as such, it has become the gold standard in both research and athletic settings.

Whole-body cold water immersion also appears to be more effective than cooling only the exercised limb(s) (92). This may be due to a greater reduction in core temperature with whole body cooling than with partial-body cooling (94) in addition to the (potentially) therapeutic effects of hydrostatic pressure experienced during water immersion10. If CWI isn’t available, compression wraps can enhance the intramuscular cooling effects of ice packs (95,96) in addition to providing a compression effect (albeit to a far lesser degree than water immersion), although it’s not quite clear what effect (if any) this might have on recovery.

Whole body CWI is not only the most effective way to cool the body, it may also have the greatest therapeutic benefit, due to the temperature-independent effects of water immersion.

Is There an Optimal Temperature or Duration?

There is no definitive evidence on an “optimal” temperature or duration for cryotherapy; however, the available research provides some insight.

In their meta-analysis, Poppendieck et al. concluded that water temperatures of 12-15ᵒC are sufficient to elicit positive effects on post-exercise recovery in trained athletes and that cooler temperatures are not likely to produce any additional benefit (92).

As for duration, 10 minutes of whole body CWI at 12-15ᵒC is more than enough to elicit a reduction in intramuscular temperature (93) and 20 minutes seems to be the upper limit of what is used in the literature (with the exception of warmer immersions, of course). Logically, the less body mass that is exposed to cold, the longer the exposure needs to be to elicit a similar reduction in core body temperature (94). Similarly, colder temperatures require shorter exposures (97).

Further evidence suggests that CWI for longer durations (30 minutes) may exacerbate the inflammatory response to exercise (64) and there are several documented cases of peripheral nerve injury when ice packs are left on for too long (98,99). Don’t be the guy that falls asleep with an ice pack on!

A 10-minute, whole body immersion at 12-15ᵒC is more than enough to reap the benefits of CWI. Cooler temperatures or longer durations are unnecessary and potentially harmful, so always be sure to err on the side of caution.

What About Placebo Effects?

Despite the placebo effect being well-documented in sports (see Beedie et al. [100] for review), there hasn’t really been an attempt to quantify its role in the positive outcomes we (sometimes) see with cryotherapy. Sugar pills are one thing, but it’s not exactly easy to convince someone they’re taking an ice bath—without actually having them take an ice bath! So, when Broatch et al. published their placebo study in 2014 there was a lot of hype on the internets. And for good reason: it was the first study that compared CWI to, what I consider to be, a pretty decent shot at a placebo condition.

In the study, participants in the placebo group performed 15 minutes of thermoneutral immersion but were led to believe it contained a special “recovery oil” that was just as effective as CWI. And the results were pretty compelling: the thermoneutral placebo was just as effective as CWI at restoring quadriceps strength (MVC) up to 48 hours post-exercise and both groups recovered significantly better than the thermoneutral control group. In addition, both the CWI and the thermoneutral placebo group reported similar subjective ratings of recovery.

Now, we can’t generalize these results to all scenarios because the study looked at recovery of quadriceps strength following four 30-second maximal sprints on a cycle ergometer. We have no idea to what extent placebo effects are involved in recovery from, say, resistance training, endurance exercise, or team sports. I think it’s pretty safe to say they likely play a role, though.

So how do we interpret these results?

Well, we could throw the ice out with bathwater. After all, cold water immersion is no better than placebo, right? But I don’t think that’s necessary. As a coach, I think it’s always important to consider the preferences of your athletes. And I think this study supports the use of CWI with athletes who believe it to have a recovery benefit (e.g., Cook & Beaven found that repeat sprint performance following CWI was related to how much athletes “liked” it [67]). Said differently, there’s not enough solid evidence to encourage your athletes to use CWI, but I see no reason to discourage an athlete who sees value in it either.

This last point comes with one major caveat: as long as an athlete’s use of CWI does not impede on your training goals for that athlete. In this sense, it may be valuable to educate athletes who regularly use CWI on its potentially detrimental effects on long-term training adaptations and explain to them it is best used sparingly throughout the competitive season.

Placebo effects almost certainly play a role in the recovery benefits of cryotherapy, but it’s not clear to what extent. Coaches should pay attention to the preferences of their athletes, and not necessarily discourage an athlete who perceives cryotherapy to be beneficial from using it sparingly, and in a manner that is congruent with their training goals.

Practical Recommendations

If you’re an athlete (or if you coach an athlete) that likes using ice or ice baths for recovery, that’s great! Keep doing what you’re doing. But to make the most of it, I suggest you following my recommendations below:

• Use ice baths over ice packs or other forms of local cooling whenever possible.

• Make sure the water temperature is between 10-15 degrees Celsius but not any colder. Colder does not mean better. Warmer temperatures (up to 20 degrees Celsius) for longer durations can also be used.

• Ice baths should last between 5-15 minutes. The colder the water, the shorter the ice bath should be.

• Submerge your whole body (up to your neck/shoulders), or as much of your body as you can.

• After the ice bath, allow time for rewarming and ensure an adequate warm-up before your next game, event, or training session. Avoid using ice baths immediately (<1 hour) prior to exercise, particularly before training or events involving high-intensity or explosive efforts such as sprinting, jumping, or weightlifting. The exception to this rule would be if you’re competing in an endurance event in warm or hot weather. In this case, precooling may enhance subsequent performance.

• Use ice baths sparingly. Regular ice baths kill strength and muscle mass gains! They’re best saved for strategic use during the competitive season when you’re trying to recover performance within a few hours to a few days.

• Important: Be careful! Cryotherapy does not come without its dangers. Exposing your body to cold temperatures for too long can have potentially dangerous effects. (E.g., don’t fall asleep with an ice pack on your shoulder. I used to do this. It’s moronic!) Set yourself a timer and stick to it. And if things start to feel sketchy before the timer goes off, call it quits!

Written by Tavis Bruce for


Looking to bring attention to Cryotherapy,

Dr. Phil Kotzan, DC

Cryotherapy: To Ice Or Not To Ice?

Sports and ice go together like peanut butter and jelly (or steak and eggs, if you’re into Paleo). From ice packs to ice baths, various forms of “cryotherapy” have long held a sacred place in sports medicine to treat acute injuries and facilitate recovery from training or competition. But despite its popularity and widespread use, the evidence in support of cryotherapy remains equivocal.

More recently, cryotherapy—particularly the use of ice baths, or cold water immersion—has come under increasing scrutiny from both the scientific community and the strength and conditioning industry at large…and rightfully so! However, in the process, we may be swinging the pendulum too far in the other direction, indicated by those who have come to the conclusion that “ice baths are a complete waste of time for every athlete in every sport in every possible situation.” Now, others may disagree with me on this one; but, the evidence (or lack thereof) for cryotherapy appears to be a little more nuanced than that.

I guess what I’m trying to say is: I’m not so sure I’m ready to throw the ice out with the bathwater just yet. Perhaps, instead of pondering black-and-white questions like, “to ice or not to ice?” we should be asking:

                         “When is ice appropriate?”

I’d like to examine why.

A quick note before we get started: this article will not discuss the use of cryotherapy for the management and/or rehabilitation of acute soft tissue injuries. I am NOT a medical professional; I just play one on Facebook.

As such, this article will only cover the efficacy of cryotherapy as a post-exercise recovery strategy.

Is there a Physiological Rationale for Cryotherapy?

Note: I’m not going to spend much time discussing the physiological rational (the “why”) behind cryotherapy for two reasons. First, the mechanisms are still quite hypothetical. Second, and more importantly, it’s a bit outside the scope of this article to convey practically relevant and actionable information for my fellow coaches and athletes. We can debate the mechanistic stuff until the cows come home, but in my humble opinion, the gold standard measurement for post-exercise recovery is the measurement of performance variables. And, I like to think that most athletes, coaches, and sports scientists would agree with me. That being said, I do think it’s always a good idea to establish if there is at least a physiological rationale for any method we may use with ourselves and/or our athletes. With that said…

Cryotherapy results in various physiological changes (most of which are temperature-dependent) that have long been proposed to exert a therapeutic effect post-exercise. Although the most cited physiological change is a blunted inflammatory response, there exists a range of other effects through which cooling the body after exercise may accelerate the recovery process. Of note, cryotherapy may:

• Improve tissue oxygenation1 and removal of metabolic waste (2) by reversing exercise-induced muscle edema (3,4).
• Reduce reactive oxygen species (ROS)-mediated muscle damage (5) by reducing local metabolism (1).
• Induce analgesia by decreasing nerve conduction velocity (6) in addition to directly activating sensory afferents (7).
• Restore parasympathetic tone by increasing vagal tone (8,9).

In addition, cold water immersion (or “ice baths”), a popular form of cryotherapy, may have additional benefits resulting from the compressive forces experienced during water immersion, but I won’t be covering them in this article (see Wilcock et al. [10] for a good review). For more information on the physiological effects of cold water immersion and other forms of cryotherapy, I encourage you to check out this (open access!) review by White and Wells.

The Effects of Cryotherapy on Recovery from Sport or Exercise

Perceptual Measures of Recovery

Cold water immersion reduces perceptions of fatigue (11-16) and increases perceptions of recovery (17,18) and physical readiness (19) between training sessions; however, it doesn’t seem to have much of an effect on ratings of perceived exertion (RPE) during subsequent training bouts (20-23).*

*Except for when CWI is used as a precooling strategy before exercise. (More on precooling later.)

Delayed-Onset Muscle Soreness

Though it’s pretty well accepted that cooling injured tissue can temporarily reduce or relieve pain (24), it’s not really clear if post-exercise cooling has any effect on delayed-onset muscle soreness (DOMS): the type of soreness you feel in the days following a bout of intense or novel exercise.

There is some evidence that cold water immersion (CWI) alleviates DOMS better than passive recovery (25), particularly when CWI is used following exercise that involves a large degree of metabolic stress (26) (e.g., running, cycling, or team sports). However, this effect is less clear when CWI is compared to warm (27), thermoneutral1 (4,28), or contrast (27,29,30) immersion, and recent evidence suggests that CWI may be no more effective than a placebo (19) for relieving DOMS. Collectively, these findings highlight the perceptual nature of muscle soreness and the importance of athletes’ perceptions of cryotherapy (or any recovery method, for that matter).

Icing and cold water immersion may help reduce delayed-onset muscle soreness after running or team sports, but the effect likely depends on the athlete’s belief in cryotherapy as a method of recovery.

Range of Motion

There is conflicting data on the effect of cooling on range of motion (ROM). Cooling alone does not appear to improve ROM (28,31-38), but it may enhance the effects of stretching (39-43) by increasing stretch tolerance (44). On the one hand, this increased tolerance to stretch does not appear to translate into long-term improvements in ROM (45-47). On the other hand, heat combined with stretching may have more lasting effects than stretching alone (44).

If your goal is to restore lost ROM following exercise, combine heat (not cold!) with stretching.


The short-term effects of post-exercise cooling on recovery of strength characteristics are mixed and seem to depend on the type of exercise stress from which you’re trying to recover before you hit the weights.

There is some evidence that CWI may reduce or recover losses in maximal voluntary contraction (MVC) following simulated team sports (48-50) or intermittent sprint exercise (51-53), but not after downhill running (54) or cycling (55,56). And, in the only study of its kind, Broatch et al. found that CWI following high-intensity sprint intervals recovered MVC no better than a thermoneutral placebo (19).

Roberts et al. demonstrated that CWI was effective for restoring submaximal (but not maximal) strength between two lower body training sessions within the same day (57). Vaile et al. found both cold and contrast water immersion were effective at restoring strength up to three days after heavy eccentric strength training (27)*, but most studies show no or non-significant improvements over this time period (28,58-62). However, it’s important to note that all of these studies used (potentially) “less effective” cooling methods (such as when only the exercised muscle is cooled) compared to more therapeutic methods such as whole-body CWI.

*I highlight the study by Vaile et al. because it is the only study that compared multiple hydrotherapy modalities in trained males, and in a cross-over design with a “washout” period between treatments of sufficient duration to eliminate any residual effects of the repeated bout effect. Thumbs up for study quality!

Cold water immersion may help recover muscle contractile properties following running or team sports. Benefits following resistance training are less clear and may require the use of cold water immersion over local cooling of exercised tissue.

Jump Performance

Most studies show significant recovery of jump performance within 24-48 hours post-exercise with no clear additional benefits to CWI (18,49,53,63,64). Furthermore, CWI may impair jump performance within the first two hours (57) possibly due to the acute effects of cold exposure on force production (65).

Here’s the deal: jump performance seems to recover just fine on its own. However, there is some evidence that CWI may maintain jump performance in scenarios of accumulated fatigue, such as during tournament play in team sports. One study of basketball players found that the CWI maintained jump performance better in players who saw more playing time throughout a 3-day tournament (66).

Sprint Performance

Like jump performance, many studies report that sprint performance returns to baseline within 24 hours after exercise, regardless of treatment intervention (18,49, 61). Accordingly, most studies do not find a benefit in favor of CWI compared to other recovery interventions because the initial exercise bout was not sufficiently intense to elicit a significant 24-hour performance decrement.

However, when exercise was sufficiently intense to affect 24-48 hour sprint performance, CWI maintained repeat-sprint performance (a measure of speed-endurance) better than thermoneutral immersion (67), contrast water therapy (12,13,48), and passive recovery (12,13,48,67).

The effect of CWI on absolute speed is less clear. Of the two studies I found, one found no benefit to CWI over passive recovery on immediate and 24-hour recovery of 50-m dash time (68), while the other showed that CWI maintained 20-m speed better than compression or stretching over a 3-day simulated basketball tournament (66).

There’s not a lot of data on the effects of CWI on same-day recovery of sprint performance, but one study showed no significant differences in repeat-sprint performance between CWI and passive recovery immediately and up to two hours after intermittent sprint exercise in the heat (61). This ties in well with the research in sprint cycling that shows neutral—or even detrimental—effects on 30-second Wingate performance following CWI when sufficient re-warming does not occur (69,70). This makes sense: reduced muscle temperature will negatively affect muscle contractile properties (71), impair energy metabolism (72), and slow nerve conduction velocity (6,73), which collectively will negatively affect the force- and power-generating capabilities of muscle. Thus, caution should be taken when using CWI between or prior to exercise that requires a high-degree of muscular force (sprinting, jumping, etc.). Athletes should allow sufficient time to rewarm following CWI and make sure to include a dynamic warm-up before their next event, which has been shown to offset the negative effects of cold exposure on power production in the vertical jump (65).

When exercise is sufficiently intense, CWI may help restore short-term (<48 hour) sprint and jump performance. However, reduced muscular temperatures negatively affect the force-generation capacities of muscle. Thus, when using ice baths between two training sessions or events within the same day, it is important to allow the body sufficient time to re-warm and/or to include an extensive dynamic warm-up.

Endurance Performance

Given the number of endurance athletes that use ice baths to recover between workouts or events, it was somewhat surprising that very few studies looked at endurance performance following recovery periods of 24 hours or longer. Two of those studies showed that CWI improves endurance performance following a 24-hour recovery period (17,74), and two other studies demonstrated similar recovery benefits across 3-day (75) and 5-day (23) training blocks.

Most studies that looked at the effects of CWI on recovery from endurance exercise utilized recovery periods of <60 minutes between exercise bouts. But here’s the thing: When an athlete takes an ice bath between two bouts of exercise with a short (<1 hour) duration between bouts that ice bath creates a “precooling” effect for the second bout. Precooling is proposed to increase performance (particularly in hot conditions) by increasing heat storage capacity, reducing thermal strain, and decreasing perceived exertion by reducing core body temperature prior to exercise (76).* And, based on the abundance of data showing a benefit to precooling on endurance performance** (particularly in hot conditions), this is probably why we see such an immediate recovery of endurance performance following CWI (56,77-81). This effect diminishes with longer recovery periods (82), presumably as core body temperature returns to baseline.

*If you’re interested in learning more about precooling check out this (open-access!) systematic review as well as the results of two recent meta-analyses here and here.

**Just to reiterate: the beneficial effect of precooling likely does not hold true for short-duration, maximal efforts (see above).

Ice baths may be useful for recovering endurance performance, particularly when an athlete has to compete in multiple games or events in one day.

The Effect of Regular Cold Water Immersion on Long-Term Training Adaptations

Very few studies have looked at the effects of ice baths on long-term training adaptations. But, the evidence-to-date paints a pretty clear picture:

Strength Training

The evidence is pretty clear on this one: regular use of CWI impairs long-term gains in muscle mass and strength (83-86) at least in part by blunting the molecular response to resistance exercise (84). This seems to apply to both trained (84) and untrained (85,86) individuals.

Ice baths blunt the acute molecular response to resistance training and impair long-term gains in muscle mass and strength. Athletes should reconsider using ice baths after strength training, particularly in the off-season or preparatory period when the focus is on adaptation rather than performance.

Endurance Training

The evidence for the effects of CWI on adaptations to endurance training is not so clear. One study in competitive cyclists found that regular CWI neither enhanced nor interfered with cycling performance over a three-week training block (87). Furthermore, recent evidence suggests that regular CWI may actually enhance molecular adaptations to endurance training (88). However, it’s important to interpret these results with caution, as molecular adaptations do not always reflect functional outcomes and the study did not measure changes in performance. Of note, there is some evidence that regular CWI at very cold temperatures (5ᵒC) for very long durations (>30 minutes) may disrupt local vascular adaptations and attenuate improvements in VO2max to endurance training in untrained subjects (85).

There is no direct evidence to suggest that ice baths enhance nor interfere with endurance training adaptations. In trained athletes, ice baths can be used sparingly after endurance training, but regular use is not recommended, particularly during the preparatory period when the focus of training is on adaptation. Finally, ice baths of excessive duration or at extremely cold temperatures should be avoided.

Major Take-Aways

The evidence for cryotherapy is pretty mixed, but there are some patterns that seem to emerge from the literature:

• Cold water immersion and other forms of cryotherapy reduce exercise-induced inflammation.
• This reduction in inflammation may lead to reduced perceptions of fatigue and muscle soreness and increased perceptions of recovery which may benefit performance in the short-term.
• Importantly, the short-term recovery benefits of cryotherapy may depend considerably on the mode exercise (i.e. the type of stress), the physiological and perceptual qualities one is trying to restore, and (as I will discuss further in Part 2) the athlete’s belief in cryotherapy as a recovery modality.
• Meanwhile, a growing body of evidence indicates that inflammation is a necessary process for tissue regeneration and, as such, regular use of cold water immersion may impair long-term muscular and vascular adaptations to exercise.
• As such, cryotherapy should be used sparingly, particularly in the off-season when the goal is to maximize training adaptations.


Written by Tavis Bruce for


Looking to bring attention to Cryotherapy,

Dr. Phil Kotzan, DC

Om Your Way To Better Health Through Yoga

Yoga’s benefits stretch beyond boosting flexibility.  Researchers keep finding new reasons why everyone should hit the mat.

Relieve Lower-Back Pain

Forget bed rest–today’s docs often prescribe exercise, yoga included.  Practicing yoga may ease back pain better than avoiding exercise, concluded a scientific review tallying results from over 1,000 men and women, all suffering from low-back pain for three-plus months.  It may be better to do yoga than to skip your workout because of its relaxation, meditation and breathing elements.  Most studies asked participants to attend a 60- to 90- minute class (typically Iyengar-style) once or twice a week and practice at home on non class days.  Beginners should find a class designed to ease low-back pain so an experienced instructor can help you protect your back.

Foster Your Bones

Less than 15 minutes of yoga a day may keep your bones strong, according to a study published in Topics In Geriatric Rehabilitation.  Over 200 individuals, mainly women averaging 68 years old, did 12 minutes of yoga daily (or at least every other day) for two years.  They held 12 poses (including tree and twisted triangle) for 30 seconds each.  The result: improved bone density.  In fact, the progress surpassed bone-building results typically seen with osteoporosis-countering drugs.  Why?  Using your muscles makes your bones stronger.  Since yoga uses several muscle groups at once, you’re exerting force on the bone from multiple angles, possibly enhancing the bone-building process.

Help Your Heart

Move over, cardio.  Researchers evaluated almost 40 trials and found that yoga came with numerous heart-friendly benefits: lowering LDL (“bad”) cholesterol and triglycerides, increasing HDL (“good”) cholesterol and improving body weight, blood pressure and heart rate.  Yet how does this stack up against aerobic activity like jogging?  Surprisingly high.  “Yoga achieved similar improvements to aerobic exercise,” says Myriam Hunink, M.D., Ph.D., study co-author from the Netherlands.  The study points to several factors about yoga that may be responsible for these changes, including the strengthening, stretching, breathing, meditation and relaxation aspects.

Written by Karen Asp for Eating Well magazine.


Looking to bring attention to the importance of yoga,

Dr. Phil Kotzan, DC


5 Headache Fixes To Try

Chiropractic and Active Release Technique work great at alleviating headaches!  5 great additions include:

Chill Out: Your headache risk soars fourfold when a stressful situation ends.  That’s when the stress hormone cortisol–which also blocks pain–ebbs away.  One possible solution: People who meditated for about 30 minutes daily experienced shorter and somewhat less-intense headaches compared to those who did not meditate, reported a recent study in Headache.  Practicing stress-reduction techniques could keep cortisol lower when you become stressed, helping you avoid a crash later.

Get More Magnesium: When brain cells have adequate magnesium, they’re less likely to switch on the pain pathways if they meet up with a pain trigger.  The American Academy of Neurology says to hit the recorded daily allowance for magnesium (310 to 420mg) for migraine prevention.  Three servings of whole grains plus a cup of cooked spinach can get you your daily magnesium.  Other sources include pumpkin seeds, black beans and dark chocolate.

Drink Up: Mild dehydration could double your risk for a headache, according to a Journal of Nutrition study.  Fortunately, upping your water game is a simple fix, Dutch researchers found.  Regular headache sufferers added four 8-ounce cups of water to increase their total beverages from 7 to 11 cups daily.  This lessened the impact of headaches on their quality life.

Go Exercise: Pedaling an exercise bike for 40 minutes, three times a week, blocked migraines as effectively as taking a migraine-preventing prescription drug, found a Swedish study.  Any movement may help by activating feel-good brain chemicals (called endocannabinoids) and muting signals in pain-sensing areas of the brain.

Quit Chewing Gum: Giving up gum for a month halted head pain for 19 out of 30 kids and teens with chronic headaches, found Israeli researchers.  And for those who restarted their gum habit, the headaches returned. All that grinding may put excess pressure on the jaw joint, causing skull-wide discomfort.


When A Headache Is More Than Just A Headache:

Call 911 right away for a “thunderclap headache”–a sudden, violent head pain that’s the worst of your life.  “Severe head pain that comes out of the blue could be a sign of bleeding or a blockage in your brain, meningitis (which may also come with a stiff neck and fever) or another life-threatening condition,” saysMatthew Robbins, M.D., of Albert Einstein College of Medicine.  Also get help for a headache after a head injury that comes with symptoms like slurred speech, vision changes, trouble moving your arms or legs, or with nausea, fever, stiff neck or vomiting.  It could be a sign of a concussion.

Written by Sari Harrar for Eating Well magazine.


Looking to provide natural fixes to headaches,

Dr. Phil Kotzan, DC

Head Off Headaches, Naturally

One in four people who get headaches, and 30 percent of migraine sufferers, blame certain foods and drinks.  Fortunately, science can help you protect your noggin.  Beyond the great results of chiropractic and Active Release Technique, here are a few other medicine-free options to try:


Caffeine: Throbbing caffeine-withdrawal headaches affect nearly half of caffeinated-beverage drinkers.  Caffeine narrows blood vessels, so missing your daily dose lets major arteries in the brain expand…ouch!  “The more caffeine you regularly get, the bigger your chances for a headache if you miss your morning cupful or have it later than usual,” notes Vincent Martin, M.D., director of the Headache and Facial Pain Center at UC Health in Cincinnati.  Aim to keep your caffeine habit consistent day-to-day.

Skipping Meals: Giving up lunch to power through your day leaves you more than just hungry.  Plummeting blood sugar can make your head hurt when brain cells react to low levels their favorite fuel.  One in five migraine sufferers, and one in seven people who get headaches say that hunger can kick-start the pain.  In fact, daytime fasting (eating only at night) nearly tripled migraine risk in people who regularly get them, according to a study in the Journal of Headache and Pain.

Alcohol: Hungover?  Thank dehydration for your headache.  Plus, when you drink, your liver makes excess acetaldehyde as it breaks down alcohol, and this compound can make blood vessels in your brain expand and throb.  As for migraines, in a recent survey of 116 patients at a neurology clinic, 39 percent reported that sipping alcoholic drinks triggers migraines–but there’s more at play than just the alcohol.  Alcoholic drinks, particularly red wine, contain artery-dilating histamines and flavonoids that affect serotonin levels (researchers believe that changes in this brain chemical may cause or worsen head pain.)


Maybe/Maybe Not Triggers:

MSG: Forget “Chinese restaurant syndrome,” says a review of MSG food tests involving 635 people in the Journal of Headache and Pain.  One early study found that women reported headaches after eating MSG.  But the researchers cautioned that MSG’s distinct taste (at the high does subjects received) could have resulted in a placebo effect.  Add caution for now.

Chocolate: Two decades ago, estimates said up to 42 percent of migraine sufferers got smacked down by this treat.  But chocolate’s been downgraded to a niche nuisance.  When 326 migraines tracked their diets for 3 months, only 2.5 percent of them named chocolate as at rigger, reported a 2016 study.

Tyramine: Found naturally in many foods, including beer, cheese, sausage and yeast breads, this amino acid was demonized as a migraine trigger in the 11960’s and ’70’s.  But scientific opinion has shifted, Martin says: “Older studies that found a link were not well-designed and more-recent studies have not found a clear connection.”

Sulfites: Migraine-sparking wine may contain sulfites, but the sulfites might not be to blame.  A recent review out of the Headache Center of Rio in Brazil found that foods that also contain sulfites (often at higher levels than wine), such as dried fruit aren’t pain triggers, while low- or no-sulfite wine can still trigger head pain.

Written by Sari Harrar for Eating Well magazine


Looking to prevent headaches naturally,

Dr. Phil Kotzan, DC

Isometrics for Better Shoulders and Pull Ups

Time to use your body-weight to build shoulder support.  This article is about training the shoulders during pull-ups.

Why Isometrics?
They’re under-trained (or maybe untrained?).
They don’t require the joint to move (which you might want sometimes). They train stiffness. They build body awareness. They teach full body control.
When you do reps, you are training the joint to move. But what about training it NOT to move?
This whole training thing we know..the stuff at the gym…it’s supposed to make us better, not just a place where we can ‘do reps’.
Training should reflect the pursuit of becoming better. One of the ways we get better is by training the things we don’t always train.
What I mean is if you always do kipping pull ups or strict pull ups, you have an opportunity for growth by training the same body area, but in a different way.
You can train high rep; you can train explosively for neural drive; you can train for coordination; and after this series of videos, hopefully you have some good options for training isometrics (aka resisting the joint’s desire to change position).

Watch the video showing how to use your body weight during pull-ups to develop strength and support for the shoulder:



Written and published by Dr. Ryan DeBell, DC of The Movement Fix


Looking to bring awareness to isometrics for shoulder development,

Dr. Phil Kotzan, DC