Scientifically Proven Fixes for Your Hunchback - Significant Improvements in Athletes Within 6 Weeks W/ Minimal Effort

Scientifically Proven Fixes for Your Hunchback - Significant Improvements in Athletes Within 6 Weeks W/ Minimal Effort

back bain back problems back training health hunchback hunched over posture shoulder pain shoulders

In contrast to the routines I will discuss in today's SuppVersity feature article (thank you Timo for the inspiration), practicing the ab-pose has not been scientifically proven to help you fix your posture... although, when you look at how it's done, it's certainly not going to make things worse.

In contrast to 90% of the SuppVersity articles, the following text is not about a "recent study". No, it's my analysis of the existing evidence on stretching and exercise interventions to resolve a problem many of the guys at my gym developed either at their jobs, or as a consequence of doing nothing but bench presses and ballistic curls: the hunchback - or, as scientists would say, a "forward shoulder posture" (FSP).

Luckily, gymrats are not the only ones suffering from this problem. This is why an albeit small group of exercise scientists from has spent a considerable amount of time and effort to identify methods to reverse this ugly, and as a 2008 study in 40 university students whose pulmonary function decreased with increasing FSP degree shows (Ghanbari. 2008), even "breathtaking" problem.

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Since swimmers are one of the groups of athletes that appears to be most affected, it is only logical that they were also the subjects of a series of studies by scientists from the Virginia Commonwealth University and the University of Kentucky who investigated the a combined exercise and stretching intervention in two separate studies on hunched over swimmers (Kluemper. 2006; Lynch. 2010).

In the last mentioned study by Kluemper et al., the participants, 29 (14 male and 25 female) elite-level, high-school- and college-age competitive swimmers from 2 swim teams, performed a Theraband® latex-band base resistance training regimen consisting of (see Figure 1)...

• 

  Figure 1: Scapular retraction (top), external rotation (middle) and shoulder flexion for the lower trapezius (bottom | Kluemper. 2006).

  Scapular retraction - With the shoulder abducted to 90° in the scapular plane, the elbows flexed to 90°, and the forearms horizontal, the subject holds a section of the exercise band between the right and left hands and retracts the scapulae, stretching the band (Figure 1, top). The subject must maintain the original 90° position of the shoulders and elbows and then execute a controlled return to the starting position.
• External rotation - The upper arm is positioned at 90° of shoulder abduction and 90° of elbow flexion. The forearm begins in a horizontal position and externally rotates into a vertical position. The subject then executes a controlled return to the starting position. The exercise band is fixed in front of the subject at approximately waist height at the beginning of the exercise (Figure 1, middle).
• Shoulder flexion for the lower trapezius - With arms flexed to 90°, elbows fully extended, and palms down, the subject flexes the shoulders to 180° against the exercise-band resistance and then executes a controlled return to the starting position. The exercise band is again fixed in front of the subject at approximately waist height for the beginning of this exercise (Figure 1, bottom).

These exercises were performed three times per week during the subjectsʼ scheduled morning swimteam practice and with a built-in progression according to which the resistance (at the end of the third week the subjects progressed to the next higher level of resistance) and rep and set numbers progressed (see Table 1).

Table 1: Progression of the exercises | at the end of the third week the subjects progressed to the next higher level of resistance using the Theraband® latex band (Kluemper. 2006).

As the title of the study already tells you, this resistance training regimen was combined with partner-stretches for the pectoralis major and the pectoralis minor the scientists describe as follows:

Figure 2: Photos of the stretches for pectoralis major and minor (Kluemper. 2006) 

"The first stretch, for anterior chest muscles, required the subject to assume a supine position on a 5-in-diameter foam roll, which runs down the center of the back. The subjectʼs partner grasps the subjectʼs shoulders and slowly presses them down in the direction of the floor until instructed to stop and hold for 30 seconds. This was repeated twice per training session (Figure 2, top). The second stretch for shoulder internal rotators required the subject to assume a kneeling position in front of his or her standing partner and lace his or her fingers behind the head. The partner then reaches in front of the subjectsʼ arms and back behind the subjectʼs scapulae, lacing his or her fingers together, as well. The part ner pulls in a diagonal direction, both up and back from the subjectʼs trunk, until instructed to stop and hold by the subject (Figure 2, bottom). The stretch was held for 30 seconds and repeated twice per training session" (Kluemper. 2006).

Obviously, I wouldn't be telling you all that in detail if the result of Kluemper's study didn't show that this training combination of strengthening and stretching exercises can "reduce the forward shoulder posture present in most competitive swimmers" (Kluemper. 2006) - or, to be more precise, that doing these exercises only 18 times over the 6-week period was enough to significance reduce the scientists primary measure of FPS, i.e. the distance of the acromion from the wall (see Figure 3, left), when the subjects were standing with their backs against the latter in a resting posture (–9.6 ± 7.3 mm).

Figure 3: The photo on the left shows how the scientists measured how severe the subjects were hunched forward; the graph on the right shows the improvements in posture (reduction = subjects were standing less hunched over) - improvements which reached significance only during the especially important relaxed posture test (Kluemper. 2006).

Now, that's unquestionably a quite promising result for a six week study. It's also a result of which we are about to see that it may be that pronounced, because neither the stretches nor the resistance training were done just with the subjects body weight. While the latter, i.e. regular, non-partner-assisted stretches and relatively simple body weight movements can be effective, the increased resistance / force during the strength training and the stretches may explain why Kluemper et al. observed that impressive improvements in such a short timespan.

A 2015 study from the Illinois State University shows that the muscle-energy technique described in this box could be another treatment that can help you reduce your messed up posture by increasing the length of the pectoralis minor and reducing "the hunch" (Laudner. 2015).

Muscle energy techniques - an alternative treatment method? Being passively treated by a physiotherpist appears to be another method that can reduce your postural problems. In a very recent study Laudner, et al. (2015) were able to show that a treatment that involves what the researchers call "muscle energy techniques" will improvements the pectoralis minor length (PML) and forward scapular position in  applied to the pectoralis minor of asymptomatic female swimmers provided - likewise within six weeks. For the MET treatment, participants were asked to lie supine on a standard treatment table with the treatment arm off the table. The treatment arm was then passively moved into horizontal abduction, in line with the pectoralis minor and sternal fibers of the pectoralis major muscle fibers, until the end range of motion was reached.

Due to the possibility of glenohumeral instability among swimmers, the therapists proceeded cautiously in all participants during the MET application. The arm was held at this barrier for 3 seconds. The shoulder was then brought out of the stretch slightly, and the participant was instructed to ‘‘pull against the investigator’s resistance towards the opposite hip.’’ This contraction was performed isometrically with approximately 25% of the participant’s maximal effort for 5 seconds. Immediately after this contraction,  the entire sequence was repeated with the arm again being passively horizontally abducted to the new range of motion.

Obviously, this hypothesis is speculative, but it is hard to ignore the fact that the benefits in the previously cited 2010 study by Stephanie S. Lynch, which used "only" body weight strengthening exercises and regular stretches (see Figure 4), were significant, but, compared to the results of the Kluemper study, which used a progressive resistance training program and more intense, partner-assisted stretches, less pronounced.

Figure 4: Overview and description of the exercises in the Lynch study (Lynch. 2010).

In Lynch's study twenty-eight National Collegiate Athletic Association division I varsity swimmers performed the body-weight exercises that are depicted and explained in Figure 4 likewise three times per week, but for eight, not just six weeks, scheduled around their regular team practice and strength training sessions.

"Subjects in the intervention group were trained using an instructional video of the exercises as well as being provided with an illustrated handout. Descriptions of the exercises are shown in tables 2 and 3. Strengthening exercises targeted the periscapular muscles. Stabilisation of the scapula throughout the exercise routine was emphasized during instruction. Subjects performed three sets of 10 repetitions of all strengthening exercises. The stretching portion of the intervention aimed at increasing the flexibility of the pectoralis muscle group and the cervical neck extensors. [...] Subjects logged the number of times the training was performed. Random checks by the investigator were performed to ensure compliance as well as the correct execution of the exercises." (Lynch. 2010).

Lynch et al. selected the exercises "based on literature which suggests selective activation of the lower trapezius/middle trapezius and serratus anterior, lengthening of the pectoralis minor and improving deep cervical flexor function and improving posture" (Lynch. 2015).

Figure 5: Changes in forward head angle, shoulder translation and scupalar distance (Lynch. 2015); I deliberately chose the same scale for the primary axis as in Figure 3, even though a direct comparison is not exactly scientific.

As the data in Figure 5 goes to show you, there's little doubt that the the exercises worked. A direct comparison with the changes observed in the Kluemper study, however, appears to suggest that adding resistance / pressure during strength training and stretching can significantly accelerate the progress... although, it should be said that without a head to head comparison in a single study, this must remain a very speculative hypothesis.

A 1990 study by Lo et al. reports that 43.8% of athletes who are competing in sports with upper arm involvement complain about shoulder problems, learn how to fix them in six weeks!

Bottom line: Obviously the way I previously compared the two studies with different subjects and exercises is not exactly scientific - and still, I would be really interested to see a study test my hypothesis that the use of resistance bands and partner assisted stretches would produce greater improvements than body weight exercises and regular stretches, in general.

Until this head-to-head comparison will have been done and my hypothesis will have been confirmed, though, the only thing I can tell you "for sure" is that doing any of the previously outlined exercise + stretching regimes will help you to improve your posture | Comment on Facebook!

References:

• Ghanbari, Ali, et al. "Effect of forward shoulder posture on pulmonary capacities of women." British journal of sports medicine 42.7 (2008): 622-623.
• Kluemper, Mark, Tim Uhl, and Heath Hazelrigg. "Effect of stretching and strengthening shoulder muscles on forward shoulder posture in competitive swimmers." Journal of sport rehabilitation 15.1 (2006): 58.
• Laudner, Kevin G., et al. "Forward Shoulder Posture in Collegiate Swimmers: A Comparative Analysis of Muscle-Energy Techniques." Journal of athletic training 50.11 (2015): 1133-1139.
• Lynch, Stephanie S., et al. "The effects of an exercise intervention on forward head and rounded shoulder postures in elite swimmers." British journal of sports medicine 44.5 (2010): 376-381.

MSM Cures Exercise Related Joint & Muscle Pain, But May Effect Immunity | Arginine Silicate Delivers, but Practically Relevant Data is Still Missing | ISSN Research Review '15 #5

MSM Cures Exercise Related Joint & Muscle Pain, But May Effect Immunity | Arginine Silicate Delivers, but Practically Relevant Data is Still Missing | ISSN Research Review '15 #5

arginine arginine silicate ASI blood flow chronic pain ISSN15 ISSN2015 Methylsulfonylmethane MSM nitric oxide no booster pain shoulder pain

Exercise induced joint and muscle pain - Can a few grams MSM help?

In this installment of the SuppVersity ISSN '15 Research Re- or rather Overview I couldn't really find a common theme. With two studies on MSM and one on arginine silicate you could probably best call it the "less researched supplement review".

Many people probably don't even know that MSM stands for "methylsulfonylmethane" and the notion that one could benefit from inositol-stabilized arginine silicate was - I openly admit that - complete news to me, too.

Read more about ISSN and other studies at the SuppVersity

Vitargo, Red Bull, Creatine & More | ISSN'15 #1

Pump Supps & Synephrine & X | ISSN'15 #2

High Protein, Body Comp & X | ISSN'15 #3

Keto Diet Re- search Update | ISSN'15 #4

The Misquantified Self & More | ISSN'15 #5

BCAA, Cholos-trum, Probiotics & Co | ISSN'15 #6

• The benefits of inositol-stabilized arginine silicate as a workout ingredient - Over the past years the way people thought and think about arginine has changed significantly. While it was originally considered a super-supplement that would increase pump, gains and vascularity, most recent studies on its effects on relevant markers of exercise performance and training adaptation yield similarly disappointing results as Gary Cooks honor thesis from 2015 in which he observed that neither arginine supplementation 20 minutes prior to exercise, nor arginine supplementation two hours post exercise had an effect on the increase in strength performance or hypertrophy following a 4-week resistance training regime (Cook. 2015).
  
  

  

  Only few studies show ergogenic effects of plain arginine. This one, however reports a sign. increase in to exhaustion in a group of elite wrestlers.

  With more and more consumers becoming aware of the lack of effect of regular arginine, supplement producers are forced to develop "alternatives" - alternatives that promise to finally do what regular l-arginine supplements promised to do: Boost your nitric oxide levels, exercise performance and overall gym experience. With inositol-stabilized arginine silicate (ASI; Nitrosigine®) there's a true newcomer that is set about revolutionizing the pre-workout supplement scene ... that's at least if we believe in what the patent holders tell us about the "new standard for pumped results" (manufacturer's homepage).
  
  In fact, ASI has been previously shown to enhance blood levels of arginine up to six hours post-dose and increase nitric oxide levels, acutely (Kahlman. 2014). In the long(er) term, Whether that would produce practically relevant increases in perceived intra-workout energy, muscle pump, and stamina, as well as post-workout muscle recovery was now the subject of a new study by Rood-Ojalvo et al. (2015).

Future (independent) research necessary: When it comes to supplement research it is absolutely normal that the effects of new products are initially tested by the ones who invent / produce it. In the long run, however, it would be nice to see the results of the study being reproduced by independent research... research that would also include actually meaningful (=performance or hypertrophy-related), objectively measurable study outcomes instead of subjective levels of perceived energy and (on their own) practically irrelevant increases in blood flow.

• The randomized double-blind placebo-controlled cross-over study study was conducted with 16 male subjects with limited exercise routines prior to participating in the study. The subjects took 1,5g/day of ASI or a placebo supplement daily for 4 days before they completed an intense leg extension exercise protocol to induce muscle soreness. Subjects then returned to the lab after 24, 48, and 72 hours for additional study measurements. After 72 hours, subjects repeated the leg extension exercise protocol to assess whether the provision of ASI (or placebo) had measurable effects on the recovery protocol.
  

  

  Figure 1: In spite of significant changes in blood flow velocity and leg circumference (which is interpreted as increased blood flow / hyperemia by the authors) the study at hand cannot prove practically relevant ergogenic effects of ASI simply because corresponding outcome variables were not assessed (Rood-Ojalvo. 2015).

  The scientists' analysis of the data they got produced two important results: Firstly, the 19-33 year-old subjects felt significantly more energetic and less fatigued (at least based on inertia sub-scores) on the 72 hour retest compared to placebo (p = 0.039). Secondly, the provision of the supplement lead to significant increases in leg circumference. Unfortunately, this increase in leg circumference is not a sudden muscle gain. Rather than that, the increased leg circumference appears to be a result of increased hyperemia (=increase of blood flow).
• In conjunction with the significant decrease in CK levels - a purported, albeit unspecific marker of muscle damage - in the ASI group at 24 (p = 0.040), 48 (p = 0.017) and 72 (p = 0.034) hours, the overall results of the study at hand do thus suggest that short-term supplementation with inositol-stabilized arginine silicate could have ergogenic effects. In the absence of meaningful outcome measures such as the number of reps (=volume) or the maximal weight lifted during the exercise tests, it would yet be premature to say that ASI is a proven ergogenic. 
• MSM for muscle and joint pain in marathoners and other athletes -- As Withee et al. point out in the introduction of the abstract to their poster presentation "[p]articipants in organized running commonly experience muscle and joint pain while training for and competing in distance events" for them a supplement that is able to reduce the pain associated with osteoarthritis could be a true game changer; and methylsulfonylmethane (MSM), a sulfur-based nutritional supplement, could be that supplement.
  
  Several previous studies have shown that MSM has anti-osteoarthritic and anti-inflammatory properties. Whether it would also help managing exercise-induced muscle and joint pain, effectively, was now the research question of a recent study from the National College of Natural Medicine in Portland (Withee. 2015). The design of the study is simple:

  "Twenty-two healthy females (n = 17) and males (n = 5) (33.7 ± 6.9 yrs.) were recruited from the 2014 Portland Half-Marathon registrant pool. Participants were randomized to take either MSM (OptiMSM®) (n = 11), or a placebo (n = 11) at 3g/day for 21 days prior to the race and two days after (23 total). Pain was recorded using a 100 mm Visual Analogue Scale (VAS) for both muscle pain (MP) and joint pain (JP) on a single questionnaire. Participants completed the questionnaire at five time points. Baseline levels (T0) were recorded approximately one month prior to the race. Post-race pain levels were recorded at 15 minutes (T1), 90 minutes (T2), 1 Day (T3), and 2 days (T4) after race finish. Data were analyzed using linear mixed models controlled for baseline, with time point as a repeated factor. Simple contrasts compared post-race time points to baseline, and Student's t-tests assessed between-group time point comparisons" (Withee. 2015)

  Unfortunately, this cannot be said for the study results, which showed nothing but a trend of lower pain levels in the MSM group - with non-significant time-by-treatment effects in either of the groups.
  

  

  Figure 2: Muscle and joint pain  15 minutes (T1), 90 minutes (T2), 1 Day (T3) after half-marathon race with methylsulfonylmethane (MSM | 3g/day) or placebo supplementation (Withee. 2015)

  In view of the fact that the provision of the 3g of MSM did result "in nearly significantly lower MP at T1 (MSM = 27.3mm vs. placebo = 49.8mm, p = 0.063), and lower MP at T2 (27.1mm vs. 40.0mm; p = 0.300), and T3 (30.0mm vs. 41.9mm; p = 0.306)" (my emphasis in Withee. 2015), as well as similar changes in joint pain (see Figure 2), it does still appear warranted to conclude that MSM supplements (3g/day) may be worth trying for anyone suffering from persistent joint and/or muscle pain after workouts.
• MSM as an inflammatory cytokine modulator -- While the previously discussed study by Withee et al. (2015) clearly indicates that MSM supplementation helps managing the level of exercise-induced inflammation, Withee et al. did not investigate the mechanism that was responsible for their observations. A recent study from the University of Memphis, however, did just that: In said study, Godwin et al. determined the effect of MSM on lipopolysaccharide (LPS) - induced inflammatory mediators after a single bout of acute eccentric exercise.
  
  To do so, they had five recreationally active, healthy men consume either 3g/day of MSM or a placebo supplement for 28 days. At the end of the supplementation program, a single bout of acute exercise (10 sets of 10 repetitions of eccentric knee extensions) was performed and blood samples were collected (immediately = 0 h, as well as 24 h, 48 h and 72 h post exercise) and analyzed.
  
  

  

  Do you remember that MSM can also act as a GH booster & bone builder | more

  The most significant results of the analysis are hardly surprising: The supplementation of MSM blunted the increase in the systemic levels of inflammatory cytokines (IL-6 and IL-1β) immediately after exercise.
  
  What is surprising, though, is the fact that the inflammatory response to LPS exposure in an ex-vivo study with blood that had been drawn at various time-points during the study shows a "dramatic increase in inflammatory cytokine secretion (IL-6, IL-1β and TNF-α) only after exercise for samples that was exposed to MSM" (Godwin. 2015).
  
  So what does that mean - practically speaking? Well, the authors are certainly right, when they point out that ...

  "[t]his response is specific to the stimulation with LPS as secretion of LPS-non responsive proteins is not increased, as evident by the stable levels of IL-17a [... and thus suggestive of the fact that] MSM is able to reduce the initial cytokine surge that is induced by acute exercise, while allowing for an efficient response to infectious stimuli after a single bout of acute exercise" (Godwin. 2015).

  On the other hand, this assumption stands in contrast to the 2-3 fold increase in IL-10 production after LPS stimulation for the subjects in the MSM group whose pre-exercise levels of the IL-10 levels before exercise. Previous research did after all suggest that greater IL-10 production my be the motor of the exercise induced "depression of immunity commonly reported in athletes engaged in high training loads" (Handzlik. 2013). Whether the chronic use of MSM supplements entails an increased risk of infection may thus warrant further investigations.

3x 1.3g/day cordiceps synensis can significantly increase time to exhaustion and have (individually different) beneficial effects on the ventilatory threshold (Hirsch. 2015).

Two more to go... two more studies that is: While the total number of ISSN '15 studies I haven't discussed or at least mentioned in this series yet is larger than two, there are only two studies I'd like to single out before the end of this installment of this Suppversity series. The Cordyceps synensis study by Hirsh et al. who were able to show that 4g of the mushroom can improve oxygen kinetics, and peak power non-significantly, as well as time to exhaustion significantly in recreationally active subjects who completed  a maximal graded exercise test, 6 min sub-maximal cycle test, and 3 min all-out cycle test, each separated by at least 24 hrs when the supplement is consumed chronically, i.e. in thee servings of 1.3 g equally spread across the day for three weeks (Hirsch. 2015).

Also worth mentioning, but in the absence of hard evidence of causality hardly worth discussing in much detail is Marc Bubbs' observation that basketball players who are training at high-intensity "seem more likely to have insufficient levels of vitamin 25(OH)D" (Bubbs. 2015) - if a follow up shows that normalizing these levels with supplementation will have performance enhancing effects, though, this would be really news-worthy | Comment on Facebook!

References:

• Bubbs, Marc. "Observational case study-Vitamin 25 (OH) D status of professional basketball players and its impact on athletic performance and recovery." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P55.
• Cook, Gary. The Effects of Chronic Arginine Supplementation on Muscle Strength and Hypertrophy Following Resistance Training. Diss. Ohio Dominican University, 2015.
• Godwin, Simone, et al. "MSM enhances LPS-induced inflammatory response after exercise." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P48.
• Handzlik, Michal K., et al. "The influence of exercise training status on antigen-stimulated IL-10 production in whole blood culture and numbers of circulating regulatory T cells." European journal of applied physiology 113.7 (2013): 1839-1848.
• Hirsch, Katie R., et al. "Chronic supplementation of a mushroom blend on oxygen kinetics, peak power, and time to exhaustion." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P45.
• Kalman, Douglas, et al. "A clinical evaluation to determine the safety, pharmacokinetics and pharmacodynamics of an inositol-stabilized arginine silicate dietary supplement in healthy adult males.(LB418)." The FASEB Journal 28.1 Supplement (2014): LB418.
• Rood-Ojalvo, S., et al. "The benefits of inositol-stabilized arginine silicate as a workout ingredient." Journal of the International Society of Sports Nutrition 12.Suppl 1 (2015): P14.