For the past 23 years, I've been intimately involved in sportsmedicine. Sports is a major industry in the world today, and the opportunity to contribute from a sportsmedicine point of view seems to fancy many professionals today.

Through my many experiences over the past 21 years, none have impacted me more than my own chronic injuries. For an 8 year period, I suffered calf pull after calf pull; too many to even keep track of. As a long distance runner who'd run 13 marathons over the previous 12 years, calf pulls were tantamount to a heart attack for the average American. I was crippled in the world I lived in. If I attempted to run 4-5 miles, I'd be the victim of yet another pull. By closest estimate over the 8 year period, I fell victim to some 75-80 calf pulls, with each one keeping me out for 4-8 weeks. The emotional and physical toll brought about by this repetition gave me great understanding of both the psychological involvement on injured athletes as well as a persistence to get back to running.

While attempting other sports, nothing gave me the joy that running did. I knew running, from equipment to scheduling to race protocol. Most of my social world was in some way involved in running. To be forced from the ranks because of injury preyed on making me an outcast of my own life. Whether it was ignorance or intelligence that kept me going, I was committed to finding some resolution to this problem. Of the many sportsmedicine specialists I contacted during this period, none had answers to this problem. All had answers, but all were descendants of the original "experts" who didn't have answers. I didn't need to hear about rest, or stretching, or R-I-C-E. These were obvious solutions, but didn't solve my problem. My goal was to run when I wanted to and for as long as I wanted to. And no one could help me get to that point.

In January, 1993, I met Dr. Andrew Bonci, a specialist in muscle physiology. He was the first to bring information that was both new and beneficial. He talked about repetitive motion, trigger point accumulation and the need for muscle management. Immediate results were seen using his advice, but the true results were found over the coming years, compiling more information and useful data. Today, our program is compiled of biomechanics, muscle management and a user-friendly approach to prevention as well as injury treatment. For any athlete frustrated with injuries and no answers, frustrated with the same old information that doesn't cure the injury, you should find this site beneficial. And for all who "comeback" after reading this, welcome to the club.

I've now reached 40 miles per week running and have gained a wealth of experience since my dilemma began in 1985. I wouldn't change a thing if I had it to do over again, because it was only a matter of time before someone came out with new information in the sportsmedicine world. Hopefully, we can help you get to your solution quicker and with less pain. Best of luck.

Trigger Points

Trigger points are the accumulation of waste products in a muscle. These accumulations occur the more a muscle is used. In every sport, athletes have repetitively used muscles, and these muscles both produce and accumulate waste products, ultimately becoming trigger points. Athlete's muscles are repetitively used and the sport an athlete plays as well as the position will dictate the most common sites of potential injury.

Once a trigger point has formed in a muscle fiber, a variety of changes take place In that muscle.

Dominoe Effect of the Trigger Point

BTP Anatomy and Physiology

A more in-depth understanding of the personality of BTP's will allow us to raise this artificial ceiling on muscle ability, whether it be to heal from an injury or to better perform a task. The gross anatomical structure of muscle reveals parallel bundles called fascicles. The available evidence suggests that BTP's, as well as active TP's, involve the shortening of individual bundles in the muscle. These bundles will harbor a single "point" along their length that is very tender or "hyperirritable".

Anatomically, these points have a distinct structure upon microscopic examination. These findings include fatty deposits, loss of oxidative enzymes and disruption of the mitochondrial structure. These changes are generally referred to as dystrophic and appear to be the result of acute local hypoxia. This local hypoxia is believed to be due to the following; during training and competition, or repetitive use of a muscle, microtrauma to the muscle accumulates in the muscle bundles. This microtrauma leaves the muscle bundles taut, which squeezes the capillary beds and the arterioles closed. It's critical to fully appreciate the nature of this microtrauma and the ultimate consequence to a muscle.

The site of the majority of mechanical microtrauma is the sarcolemma membrane itself. The sarcolemma is the actual cell membrane of the muscle fibers. This damage is evident by clinical laboratory studies in which the blood is analyzed for muscle enzymes. The appearance of muscle enzymes, such as CK and LDH, in the blood indicate disruption of the sarcolemma. However, the interest of exercise physiologists who are studying the mechanisms controlling BTP phenomena should be directed to the T-tubule system.

The T-tubule system is a specialized, invagination of the sarcolemma membrane. The T-tubules sequester calcium ions and regulate their concentrations in the sarcoplasm. You may recall that muscle contraction is "triggered" by the release of calcium ions from the T-tubules. Muscle fiber relaxation occurs when the calcium ions are "actively pumped" back into the T-tubules. Therefore, micro-trauma that disrupts the integrity of the T-tubules will cause the "uncontrolled release" of calcium ions into the sarcoplasm. The end result is fiber contracture.

It is important to note here that most of us are aware that contracture of a muscle fiber requires energy in the form of ATP. Very few, however, understand that relaxation of a muscle fiber likewise requires ATP in great quantities. Simple disruption of the T-tubules with leakage of calcium ions can cause rapid depletion of ATP, making it virtually impossible for muscle fibers to relax. It's like filling a bucket with a hole in it; as calcium is pumped into the T-tubules, it quickly leaks back out again. This sustains the fibers to stay in a perpetually shortened state. This cycle of "isometric" fiber contracture resulting in hypoxia resulting in ATP depletion resulting in fiber contracture will be perpetuated until the cycle is broken. In turn, reduced blood flow and its resultant hypoxia are believed to lead to the dystrophic changes mentioned above.

BTP's Effect on Strength, Endurance and Flexibility

Studies conducted on muscles containing trigger points have concluded that trigger point activity limits strength, endurance and flexibility of the host muscle. This is believed to be due, in large part, to the bundle shortening and the attendant hypoxia. The hypoxia can explain the limitation on muscle endurance and rapid muscle fatigue, yet it cannot explain strength and flexibility limitations. In clinical settings, muscle strength can only be explained neurologically and biomechanically.

Limitations on muscle strength appear to be related to trigger point influence on muscle spindle fibers, functional muscle splinting and alterations in the length-tension relationship of the host muscle. When a muscle bundle contains a BTP, there is segmental shortening of the muscle (ie. isolated bundles will become shortened). This isolated bundle shortening shifts tremendous stretching forces to the shortest bundles when the muscle is in its Mormon resting length. This activates the stretch reflex that causes the entire muscle to shorten around the barrier trigger point. In effect, the muscle's tone and resting length is "reset". This "new" or artificially shortened resting length decreases the muscle's potential to generate force according to the length-tension relationship.

Lost flexibility of muscles harboring barrier trigger points follows the same logic. Muscle that is splinted around taut bundles and barrier trigger points cannot elongate efficiently. The magnitude of the importance of trigger point awareness and understanding is best summed up by a quote from Coach Al Miller--- "Trigger points dictate sports".

Warm-Up/Flexibility

When we talk of "warming" a muscle, we often lose sight of what this means. Blood is the component that warms the muscle and our current method of increasing blood flow to a muscle is through mild exercise prior to activity.

If you think of your muscle as a dried sponge, and that dried sponge will be performing for you when you begin your activity, the likelihood of that sponge functioning better depends on your ability to wet and warm that sponge. To attempt to just stretch that dry, cold sponge and hope that it is now ready to perform is ludicrous. However, if you wet the sponge with warm water and then stretch the sponge, the functional capacity increases dramatically.

The same thing applies to a muscle. We've been taught to stretch and then do a mild active exercise to warm our muscles. The negative side to this approach is that it's very difficult to stretch a cold muscle, just as it's difficult to stretch a dry sponge. If you have some method to increase warm blood to a muscle prior to stretching, then perform your stretches of the muscle, then introduce more warm blood to the muscle, and then stretch again, a muscle will now have an increased internal temperature, greatly increasing flexibility. The muscle will now require much less of an "active" warm-up than a cooler muscle will.

When you now perform the active component of a warm-up, the entire muscle will be much better prepared for activity. However, when we only stretch prior to our active warm-up, only portions of the muscle will receive an increased blood flow while secondary parts of the muscle remain cooler and vulnerable to injury. When The Stick® is used for approximately 2-3 minutes over the majority of muscle groups and then the athlete performs the necessary stretches, whether they be isolated stretches with or without the aid of a rope, a warm-up becomes far more effective. By repeating the combination of The The Stick® and stretching 2-3 times per major muscle group prior to activity (approximately 10 minutes of preparation), all muscles will now be significantly warmed, much more flexible, better prepared to perform and far less vulnerable to injury.

Q10 Effect

By warming a muscle 10°, you can double the rate of enzymatic reactions producing a muscle which utilizes food and oxygen much more efficiently while eliminating harmful toxins much quicker. Although an athlete cannot watch this on a meter or graph, the results will be seen with improved flexibility, more complete recovery, reduced injuries and improved performance. This method allows an immediate increase in temperature to all muscles treated.

Ideal Warm-Up: Stick/Stretch 2 x's, 1/2 active warm-up, Stick

Recovery

Recovery refers to the time frame needed for a muscle to return to its' normal physiological state after activity. This doesn't only refer to injured muscles, it also refers to exercised muscles. A muscle that has gone through an active exercise develops micro-tears and those tears produce what is known as DOMS (Delayed Onset Muscle Soreness). The period needed for these micro-tears to heal is your recovery period.

As athletes, we have 2 options when it comes to recovering. The first is to let nature take it's course and recover at the speed our body's require. Although this makes perfect sense, the truth is that most athletes, even though they choose this time frame, train at a schedule greater than what this time frame can handle. The normal result of over-training and under-recovery is reduced performance and injury. The injury can be a pull, inflammation of a tendon or joint, bursitis or a host of other injuries.

The other option an athlete has is to work with the normal recovery process and naturally accelerate that process. This can be done through the following method; after a muscle has exercised, inherently it will both shorten and tighten. This increased internal muscular pressure makes it difficult for fresh copious blood to enter the muscle barrier, despite the fact that new blood is needed for ultimate recovery. When working on Mother Nature's schedule, the muscle will slowly relax over a period of 24-72 hours, and new blood will slowly cross the muscle barrier providing the needed food and oxygen for full recovery. Research has found that if you can increase the "external" pressure to a muscle and encourage fresh, new blood into the muscle, which can begin immediately after exercise, the recovery process will begin immediately. With this encouragement of fresh blood into the muscle and the flushing of harmful toxins from the muscle, which were produced from the activity or exercise, the recovery process becomes accelerated.

Several recent studies have also determined there is a "recovery window" after exercise when the muscle is most hungry for recovery nutrients. This means that any nutritional support, along with the encouragement of fresh blood to the muscle within a 15-20 minute period after exercise will dramatically increase the recovery-ability of a muscle. "The longer you wait to encourage nutrition into your muscles after exercise, the 'less hungry' your muscles will become", states Dr. John Ivy, Ph.D., director of the exercise science laboratory at the University of Texas.

Instead of acting like your workout is over, remember the value of taking care of the exercised muscle. Complete recovery is the key to long term muscular success, and the above approach maximizes the speed with which your muscles can recover.

Ideal Recovery: Stick®/Stretch 2 x's (w/in 20 minutes of exercise) then once at end of day.

Injury Prevention

Injury prevention only comes with preparation. For those athletes who put no time or effort into their schedule other than to practice their sport, this section will not apply. This section is for those athletes who want to fully prepare for the best outcome. With age, most of us learn to spend more time in preparation and less time in training, as that is the only balance that will allow us to continue. The key to success is to spend this time as efficiently as possible.

The first is to learn your structural fingerprint, those uniquities that are you, and then go through the necessary treatment and exercise program to improve your structural status. This is a timely and costly process, but we have only one structure for the duration of our life, and if we don't invest in it early on, it may be too late by the time we do.

The second concern is to tend to our muscular system on a daily basis. Management is the key. If we use our muscles to exercise, we must spend time doing those things that will help them to warm-up and recover efficiently.

There are many exercises and precautions that will help an athlete to prevent injuries. But, when it comes to muscles, all athletes are extremely limited in what they can do. Keep in mind that activity produces the production and accumulation of waste products in the muscles, and unless the athlete is making a concerted effort to clean the muscle continuously, the priority muscles tighten and work with a deprived blood flow. This is the perfect precursor for injury.

The key to keeping a muscle healthy and uninjured is to keep it well circulated and clean. Everyone should perform the necessary exercises daily to keep muscles healthier, cleaner and more functional. The The Stick® is an effective means to keep muscles working the way they're intended to work.

With multiple massages of 20-30 strokes per muscle performed 2-3 times per day, a muscle will have the ability to perform and recover from normal activity, stay clean and function without the fear of injury. Ideal Prevention: Stick®/Stretch 3-4 x's (during the course of the day)

Treatment of Injuries

Most athletes can assume that at some point in their active careers they will become injured. In athletics, many injuries are both common and predictable. The predictability comes with the fact that many muscle and joint injuries are due to repetitive motion with the inability of a muscle to fully recover before being asked to perform again. The joint injuries are due to the fact that everyone has biomechanical weaknesses and imbalances, and with the increase in both weight and stress through the body of an athlete, these sites of increased stresses can and will become aggravated at some point in time. This further validates the benefits of an initial biomechanical evaluation for athletes to determine where the areas of increased stresses are and corrective measures can begin before injuries occur.

With this lack of recovery, muscles will slowly begin to contract more than normal in a defensive mode. As the muscle contracts, there is an increased tension in the involved muscle and the associated joint, as well as decreased performance and recoverability. In many cases, the athlete continues to perform, and ultimately, there is an injury. Once an injury occurs, there are basic principles that will help an athlete to reduce pain and swelling, detoxify the involved area, restore normal blood flow back to area and gain recovery as fast as the body will allow.

Too often, athletes think only in terms of getting over the immediate injury and once the pain and swelling is gone and some form of exercise can be resumed, the false impression is that the injured area is healed. This is typically not the case. The injured site may be capable of motion without pain and even some level of activity without pain, but there are other considerations that need to be looked at.

First of all, most injuries are due to congestion or shortening of a repetitively used muscle. The full recovery of this injury will require a detoxification of the muscle, an improvement in muscle length and an improvement in tone and preparation of the muscle for activity. Trigger points, once accumulated in a muscle, cannot be ignored, especially once an injury has occurred in a muscle.

The muscle needs to be cleaned and rejuvenated for improved circulation (nutrition and oxygenation to the muscle). The muscle then needs to be systematically stretched over a period of time to increase flexibility and the muscles' ability to withstand tension.

Acute injuries generally require less time for full improvement than chronic injuries. Most injuries to athletes are chronic in nature, as our imbalances require certain muscles to work overtime, thus increasing the accumulation potential of the toxins in the muscle. Very seldom are injuries of the acute nature, but in those cases, self-treatment typically requires less time than chronic injuries.

Acute Injury: Stick®/Ice 4 x's (during day) w/ Proper nutritional support
Chronic Injury: Stick®/Stretch 4 x's (during day) w/ Proper nutritional support