MASS Issue 04 - Jul

IS S U E NO .
4 JU LY 2017
MASS
MONTHLY A P P L ICATIO NS IN
STR E NG TH S P O R T
E R I C HE L MS | G R EG N U C KOLS | M IC H AEL Z OU RD OS
1
The Reviewers
Eric Helms
Eric Helms is a coach, athlete, author, and educator. He is a coach for drug-free strength and
physique competitors at all levels as a part of team 3D Muscle Journey. Eric regularly publishes
peer-reviewed articles in exercise science and nutrition journals on physique and strength
sport, in addition to writing for commercial fitness publications. He’s taught undergraduate-
and graduate-level nutrition and exercise science and speaks internationally at academic and
commercial conferences. He has a B.S. in fitness and wellness, an M.S. in exercise science,
a second Master's in sports nutrition, and is a strength and conditioning Ph.D. candidate at
Auckland University of Technology in New Zealand. Eric earned pro status as a natural bodybuilder with the PNBA in
2011 and competes in the IPF at international-level events as an unequipped powerlifter.
Greg Nuckols
Greg Nuckols has over a decade of experience under the bar and a B.S. in exercise and sports
science. Greg is currently enrolled in the exercise science M.A. program at the University
of North Carolina at Chapel Hill. He’s held three all-time world records in powerlifting in the
220lb and 242lb classes. He’s trained hundreds of athletes and regular folks, both online and
in-person. He’s written for many of the major magazines and websites in the fitness industry,
including Men’s Health, Men’s Fitness, Muscle & Fitness, Bodybuilding.com, T-Nation, and
Schwarzenegger.com. Furthermore, he’s had the opportunity to work with and learn from
numerous record holders, champion athletes, and collegiate and professional strength and conditioning coaches
through his previous job as Chief Content Director for Juggernaut Training Systems and current full-time work on
StrongerByScience.com.
Michael C. Zourdos
Michael (Mike) C. Zourdos, Ph.D, CSCS, is an associate professor in exercise science at
Florida Atlantic University (FAU) in Boca Raton, FL., USA, with a specialization in strength
and conditioning and skeletal muscle physiology. He earned his Ph.D. in exercise physiology
from The Florida State University (FSU) in 2012 under the guidance of Dr. Jeong-Su Kim. Prior
to attending FSU, Mike received his B.S. in exercise science from Marietta College and M.S.
in applied health physiology from Salisbury University. Mike served as the head powerlifting
coach of FSU’s 2011 and 2012 state championship teams. As an associate professor at FAU,
Mike is the director of the FAU Muscle Physiology Research Laboratory. He also competes as
a powerlifter in the USAPL, and among his best competition lifts is a 230kg (507lbs) raw squat
at a body weight of 76kg. Mike owns the company Training Revolution, LLC., where he has coached more than 100
lifters, including a USAPL open division national champion.
2
Letter from the Reviewers
Welcome to the fourth issue of MASS, and our first issue with a guest con-
tributor. We’d like to thank Derek Miles, DPT, for stopping by to review a
recent systematic review meta-analysis on the Functional Movement Screen
(FMS). Since none of the rest of us are PTs, it’s nice to be able to reach out
to an expert in the field to review an important paper that’s admittedly a bit
outside our collective areas of expertise.
This issue also covers several studies that got a lot of hype in the past
month, including a study hinting that “spot reduction” may be real, and a pa-
per showing that partial-ROM training may be better for hypertrophy than
full-ROM training. In both cases, there were important details and caveats
in the study that weren’t mentioned in the social media chatter. We’ve got
the full breakdowns for you in the July issue of MASS.
This is also our first month trying audio content. That was your guys’ sec-
ond most common request (after the Facebook group), and we heard you
loud and clear. This is a learning process for us as well, so the first three ar-
ticle roundtables are available right now. The last four are coming later this
month; that will give us time to review the first three and start figuring out
how they can be improved.
As always, thanks for reading, and thanks for your continued support. We
think this is our best work yet, and we feel like we’re really starting to hit our
stride. We hope you enjoy it!
The MASS Team

Michael, Eric, and Greg
3
Table of Contents
6 BY G R EG NUCKOL S
Does Periodization Lead to Faster Strength Gains?

A recent meta-analysis showed that periodized training leads to bigger strength
gains than non-periodized training. However, the abstract doesn’t tell the whole
story.
18
BY M I CHAEL C. ZOUR DOS
Cold-Water Immersion Increases Acute Recovery More Than

Cryotheraphy, but Does it Matter?
Recovery techniques that place the body in an extremely cold environment, such as cold-
water immersion and cryotherapy, have become popular. But many questions remain: Is
there a difference between the acute and chronic effects of these techniques? Are they
better than simply performing low intensity exercise for recovery? What are the overall
recommendations? This article answers all of those questions.
28
BY E RI C HEL MS
Micromanaging the Post-Workout Anabolic Window

Like a dog with a bone, the sports nutrition community won’t let go of trying to
squeeze every last drop of optimality out of the post-workout anabolic window. This
time, the ratio of slow to fast protein was tested to see which combination was best
for strength and muscle gain.
40
BY DER EK MI L ES
Functional Movement Screen Is Not Supported for Injury Prediction

With its widespread acceptance comes the need for due diligence to determine whether
the Functional Movement Screen accomplishes what it is purported to do. This systematic
review and meta-analysis looked to pool the current best evidence in order to determine
the ability of the FMS to predict injuries in the general athletic population.
50
BY G R EG NUCKOL S
Constant Tension Training: Were the Bros Right?

A recent study showed that training through a partial range of motion led to almost
twice as much muscle growth as full ROM training. Can we take the results at face
value?
4
63
Myofascial Release Increases Range of Motion, but Does it Enhance

Acute Strength?
Myofascial release techniques are widely used by lifters. Commonly, lifters are rolling
around for substantial periods of time with foam and plastic rollers prior to training.
But are they a viable warm-up strategy and do they actually improve performance?
74 BY E RI C HEL MS
Body Fat Spot Reduction Isn’t a Myth?

Just when you thought you wouldn’t hear the term “spot reduction” mentioned again,
a study comes out that seems to show it’s possible. Dive in to see the details of how
this investigation fits into the puzzle of fat loss.
85
BY G R EG NUCKOL S
Stretching: An Undeserved Bad Rap

While acute stretching before training is often criticized, a recent review found that
stretching can actually increase muscular performance over the long run.
92
VIDEO: Concurrent Training Attenuates Anaerobic Adaptations, Part 2

We know that HIIT as a mode of cardio doesn’t have mechanistic differences from
lifting adaptations and moderate intensity cardio does. So, can we only perform HIIT
for cardio? Maybe not. What are HIIT’s limitations and how could moderate intensity
cardio actually serve a practical purpose for our goals? This video discusses the
importance of practical feasibility when incorporating cardio.
94
BY E RI C HEL MS
VIDEO: Intro to Periodized Resistance Training, Part 2

When people hear “periodization,” confusing or intimidating information that lacks
clear terminology comes to mind. Everyone seems to have an opinion, despite the
fact that most people don’t fully understand the field. In this video, Eric cuts through
the mysticism so you can build your periodization literacy.
5
Does Periodization Lead to Faster
Strength Gains?
Study Reviewed: Comparison of Periodized and Non-
Periodized Resistance Training on Maximal Strength:
A Meta-Analysis. Williams et al. (2017)
BY G RE G NUC KO LS
P
eriodization is defined as “a logical tial for achieving specific performance
method of organizing training into goals while minimizing the potential for
sequential phases and cyclical time overtraining” (1). In layman’s terms, pe-
periods in order to increase the poten- riodized training involves manipulating
6
KEY POINTS
1. A quantitative analysis of the entirety of the literature showed that periodized training
leads to larger strength gains than non-periodized training.
2. However, there were marked differences in study results, with some evidence of
publication bias in favor of periodized training. When accounting for those issues,
the relative benefits of periodization was nearly halved, though they remained
significant.
3. While periodization isn’t a more important factor than simply training hard (training
volume and intensity), periodizing your training will likely increase your rate of
strength gains.
training variables over time instead of non-periodized training, as is often

holding all variables constant. For ex- claimed. Based on the 18 studies that
ample, if you simply do 5 sets of 5 reps met the inclusion criteria, periodized
on the bench press twice per week, training is superior to non-periodized
just adding weight as you’re able, your training, though the relative benefit is
program would be non-periodized, as likely minor, at least over the average
volume, relative intensity, and frequen- study duration in this meta (15 weeks).
cy would be unchanged every week. However, this relatively minor effect
However, if you did 5 sets of 8 reps on may undersell the benefits of period-
week 1 with 70% of your 1RM, 5 sets ization, as most studies don’t system-
of 5 reps on week 2 with 75% of your atically progress training volume over
1RM, 5 sets of 3 reps on week 3 with time, which is one of the strongest
80% of your 1RM, and then start over tools periodization equips you with.
with 5 sets of 8 reps on week 4 with
a slightly heavier load than you used
on week 1, that would be a very simple Purpose and Research
periodized program as volume (volume
load) and relative intensity did change
Questions
over time. The purpose of this meta-analysis
was to see whether periodized train-
This meta-analysis (a quantitative
ing is truly superior to non-periodized
comparison of all the studies on the
training for increasing strength by an-
topic) set out to determine whether
alyzing the entirety of the literature on
periodized training was truly supe-
the subject.
rior for strength gains compared to
7
bias, and identified potential moderators.
Subjects and Methods Don’t worry if this sentence sounds a bit
Subjects overwhelming; it’ll all make sense in the
This meta-analysis drew from all stud- next section.
ies comparing periodized and non-pe-
riodized training, regardless of subjects.
As such, it included studies on both men Findings
and women, people of all age ranges, and The big, bottom line finding of this me-
people of all training statuses. ta-analysis was that periodized training
Methods was superior to non-periodized train-
The inclusion criteria for this me- ing for increasing maximal strength; the
ta-analysis (the rules to determine which mean effect was small (0.43±0.08) and
studies to include) were as follows: significant (p<0.001).
1. The study needed to be peer-re- When adjusting for nested effects,
viewed. the mean effect decreased slightly and
the variability of the effect increased
2. The full text of the study needed to (0.38±0.14), but the effect was still sig-
be available in English. nificant (p=0.012). Nested effects are
3. The study needed to include at least multiple effects found in a single study.
one group doing non-periodized Without adjusting for nested effects, you
resistance training, and at least one can wind up giving a single study too
group doing periodized resistance much weight, if it compared, say, two pe-
training. riodized groups to one non-periodized
4. Maximal strength needed to be group at four different time points (you
measured via the squat, bench press, could extract six effects from that) versus
or leg press. a similar study comparing one periodized
group to one non-periodized group at
5. The studies needed to provide means
only two time points (you could only ex-
and standard deviations for their
tract one effect from that).
strength measures.
The results were found to be sufficiently
Once the eligible studies were identi-
heterogeneous that the difference in the
fied and coded (the key features of the
results between the studies couldn’t sim-
subjects and training plans were identi-
ply be explained by sampling error. As
fied), the authors calculated the effect siz-
such, the authors looked for moderating
es for each study and the mean effect size
factors that could explain the observed
for all effects, adjusted for nested effects,
heterogeneity.
assessed heterogeneity and potential
8
FIGURE 1
7.0 Mean ES = 0.43 (95% CI 0.27-0.58)
Favors periodized training
6.0
5.0
4.0
3.0
Hedges’ d ES
2.0
1.0
Favors non-periodized training
0.0
-1.0
-2.0
Effect sizes from Williams et al. Effects larger than zero favor periodized training and effect smaller than zero favor
non-periodized training.
Periodization model, training status, els, less experienced lifters gained more
study length, and training frequency strength than more experienced lifters,
were all found to be significant moder- people gained more strength in longer
ators associated with changes in 1RM studies versus shorter studies, and people
strength. In other words, undulating pe- gained more strength with higher train-
riodization models led to larger strength ing frequencies versus lower training fre-
gains (in these studies) than linear mod- quencies.
9
Finally, the authors undertook a bias graph, where the funnel widens). As
assessment. This was an important step, you can see in Figure 2, the effects skew
because statistically significant find- right, and quite a few effects fall outside
ings are much more likely to get pub- the 95% confidence interval of the funnel
lished than non-significant findings; – 11 effects on the right side, indicating
with 18 published studies meeting the larger-than-expected effects in favor or
inclusion criteria of this meta-analysis, periodized training, and 3 effects on the
it’s impossible to know how many oth- left side, indicating smaller-than-expect-
er studies comparing periodized and ed effects in favor of periodized train-
non-periodized training were conduct- ing, or effects in favor of non-periodized
ed but never published. The authors training that exceed the variation you
calculated that an additional 1,038 null could attribute to sampling error. When
effects from studies with an average sam- removing these outliers, the previously
ple size would need to be published to observed heterogeneity was effectively
decrease the mean effect size below the eliminated (p=0.91), and the mean effect
threshold of significance. Furthermore, size in favor of periodized training was
a single null finding from a study with nearly halved (0.23±0.05), though it re-
at least 252 participants would decrease mained highly significant (p<0.001).
the mean effect size below the threshold
of significance. In short, it’s very unlike-
ly that publication bias fully explains the Interpretation
observed superiority of periodized train- It’s good to have this new meta-analy-
ing over non-periodized training. sis, as the previous meta comparing peri-
However, it was revealed that there was odized and non-periodized training was
still a high risk of publication bias, so the published all the way back in 2004 and
authors performed a sensitivity analysis actually had to make use of unpublished
and constructed a funnel plot to identi- data since there weren’t enough pub-
fy outliers (Figure 2). You should expect lished studies at the time to analyze (2).
all effect sizes to fall within the funnel There were 10 studies included in this
(which represents the 95% confidence meta-analysis that had been published
interval). With lower standard errors since the previous meta-analysis came
(near the top of the graph), the measured out, so we were due for an update.
effects should cluster right around the Though I’m a strong proponent of
mean effect (the line down the middle periodized training for strength devel-
of the funnel), while you expect more opment, I think the most epistemically
spread due to sampling error as standard honest interpretation of this meta-anal-
errors increase (near the bottom of the ysis is that the true effect in favor of pe-
10
FIGURE 2
0.0
Effects
0.1
0.2
0.3
Standard error
0.4
0.5
0.6
0.7
0.8
0.9
-2.0 -1.0 0.0 1.0 2.0 3.0 4.0 5.0
Hedges’ d ES
Funnel plot of effects. An effect larger than zero indicates greater strength gains for periodized, and an effect
smaller than zero indicates greater strength gains for non-periodized. You should expect most effects to fall within
the funnel.
riodized training is relatively small, and versus non-periodized resistance training

closer to the effect size of 0.23 reported roughly equated for average intensity and
after eliminating outliers, instead of the volume versus single-set non-periodized
larger effect size of 0.43 reported in the resistance training. In those studies,
abstract. you’d extract one effect for challenging
Several of the effects eliminated weren’t periodized versus challenging non-peri-
“fair” comparisons of periodized and odized training, and one effect for chal-
non-periodized training. A few studies lenging periodized versus incredibly easy
compared periodized resistance training non-periodized training. The first effect
11
may have shown a slight benefit for pe- discarded instead of the mean effect size
riodized training, while the second effect (0.43) with all comparisons included.
may have shown a massive benefit for pe- However, it should be noted that the
riodized training, though the second ef- true effect of periodization may be larger
fect would be comparing apples and or- than the effect observed in this meta-anal-
anges. A couple other studies compared ysis. It’s theorized that the true benefits
challenging periodized training to only of periodization manifest themselves in
single set non-periodized training (3, 4, long-term (i.e. a year or longer) training
5, 6). organization. The longest studies includ-
It may be easy to fault the authors ed in this meta-analysis were 32 weeks,
for using inclusion criteria that allowed and the average study duration was 15
studies like that to slip into the analysis, weeks. As such, there’s a distinct gap be-
but I think that would be an unfair crit- tween theory and data. It’s also possible
icism. Inclusion criteria have to be hard, that the benefits of periodization man-
objective cutoffs, and a stipulation such ifest themselves quickly, perhaps due to
as requiring volume and intensity to be varied practice increasing the rate of mo-
matched may have done more harm than tor skill acquisition (7), and that non-pe-
good if, for example, some studies didn’t riodized training would close the gap
specifically report that volume and in- over the long term, or that the gap would
tensity were matched, or if volume and persist and not meaningfully change in
intensity in some studies were very sim- magnitude. I personally think the first
ilar but not perfectly matched. As prac- possibility (the superiority of periodized
titioners, we can read a study and say, training becoming more clear over time)
“these training programs may not have is the most likely one, but we won’t know
been perfectly equated, but they were until a bold, patient (well-funded) soul
definitely similar enough to make a valid carries out a multi-year study to test this
comparison.” That degree of reasonable idea. Incidentally – and counter to my
subjectivity isn’t allowed in a meta-anal- self-admitted biases – the most applica-
ysis, so I like the authors’ decision to use ble 32-week study in this meta-analysis
slightly laxer inclusion criteria and then actually showed that the gap between pe-
axe the less applicable comparisons later riodized and non-periodized may shrink
via the funnel plot and sensitivity analy- over time rather than widen (8). Over
sis. However, since this is the route they three and six months, the periodized
chose, we need to be careful when inter- training group gained significantly more
preting this meta; it’s probably best to strength on the bench press and shoulder
pay more attention to the smaller effect press, but there weren’t significant be-
size (0.23) after the outlier effects were tween-group differences in strength gains
12
ing is that it allows you to logically and
systematically increase training volume
PERIODIZATION DOES SEEM over time. Therefore, it is still reasonable
TO MEANINGFULLY IMPROVE to assume that the relative advantage of
periodized training over non-periodized
STRENGTH GAINS, BUT training would tend to increase over time,
as the training volumes required to sus-
THE EFFECT IS RELATIVELY tain progress also tend to increase over
time.
SMALL, AT LEAST BASED ON I’d also caution against getting too
THIS ANALYSIS – CERTAINLY caught up in the moderator analysis. Re-
member, when looking for moderators
SMALLER THAN THE EFFECTS that could explain some of the observed
heterogeneity, the authors reported that
OF VOLUME AND INTENSITY. undulating periodization models led to
larger strength gains than linear models,
higher frequencies were associated with
larger strength gains, less experienced
after nine months, showing that, in this lifters gained more strength, and people
study at least, the relative advantage of gained more strength when training for
periodization was relatively short-lived. a longer period of time. I hope we can
On the other hand, a four-month study accept the last two moderators as almost
by Willoughby (not included in this re- self-evidently true (training length and
view because it only reported increases training status). However, I think it’s im-
in strength as multiples of body weight, portant to keep the scope of a moderator
rather than absolute increases in strength) analysis in mind when interpreting this
showed that periodized and non-peri- study’s findings regarding periodization
odized training caused similar increases style and training frequency.
in squat and bench press strength over
A moderator analysis tells you about the
4-12 weeks, but that periodized training
effects of a training variable in the stud-
proved superior for the bench from week
ies that met the inclusion criteria for the
8 onward, and for the squat by week 16
meta-analysis. As such, its scope is pretty
(12). It’s also worth pointing out that
narrow. Though there is some evidence
most of the studies included in this me-
that higher training frequencies may
ta-analysis kept training volume (number
be beneficial for strength development
of sets performed per exercise per week)
(9), this wasn’t a meta-analysis to deter-
constant over the duration of the study.
mine the effects of training frequency on
One of the benefits of periodized train-
13
strength development, and the compari-
sons resulting from a moderator analysis
would be apples-to-oranges comparisons IT’S IMPORTANT TO RECOGNIZE
(i.e. higher versus lower frequencies from
different studies with different volumes, THAT PERIODIZATION
intensities, study populations, etc.), so
this meta-analysis shouldn’t be used to
CONCEPTS AREN’T BINARY.
argue for the superiority of higher train-
ing frequencies. Similarly, this wasn’t a
YOU DON’T HAVE TO CHOOSE
meta-analysis constructed to compare BETWEEN LINEAR OR
undulating versus linear periodization
models. A 2015 meta-analysis by Har- UNDULATING PERIODIZATION.
ries et. al (10) specifically set out to com-
pare linear and undulating periodization
models, finding no significant difference
between the two styles for strength gains fect is relatively small, at least based on
in the squat, bench press, or leg press this analysis – certainly smaller than the
(though there was a non-significant effects of volume and intensity. To con-
difference in favor of undulating peri- textualize the mean effect of 0.23±0.05
odization models for leg press strength; (once outlier effects were discarded), that
p=0.07). The authors note that of the 17 means that if a group of people have a
studies included by Harries et al in their500±50kg powerlifting total initially,
analysis, only three included non-peri- people on a periodized training program
odized groups and were thus included in could expect to add an additional 9-14kg
the present meta-analysis. As such, this on their total compared to people on a
meta-analysis shouldn’t be used to argue non-periodized training program over
for the superiority of undulating period- 15 weeks (the average study duration in
ization models over linear models, as thatthis meta-analysis). An extra 3-5kg per
was not the question it was set up to in- lift is great, but it’s probably not going to
vestigate. make or break a training program. You
don’t have to periodize your training to
Finally, I think it’s important that we see results, but periodization is helpful to
think about periodization conceptual- making faster progress.
ly, instead of simply seeing periodized
training as inherently good and non-pe- Furthermore, it’s important to recog-
riodized training as inherently bad. nize that periodization concepts aren’t
binary. You don’t have to choose between
Periodization does seem to meaning- linear or undulating periodization. You
fully improve strength gains, but the ef- may increase intensity and decrease vol-
14
APPLICATION AND TAKEAWAYS
1. Periodized training leads to strength gains that are modestly but consistently larger
than non-periodized training.
2. Don’t waste your time looking for the single best periodization model. Instead,
focus on how you can manipulate volume, intensity, and frequency to solve specific
problems and reach specific goals for yourself and your clients.
ume linearly across a training program, cific practice you need to prepare for the
while undulating volume and intensity platform, or train with very heavy loads
between the training days within each the whole time while sacrificing train-
week of training, for example. In fact, ing volume and perhaps increasing injury
that’s exactly what Dr. Zourdos did in risk. Periodization gives you tools to solve
the study he performed for his disserta- this very simple problem. You could start
tion (11). with lower loads and higher volume and
Periodization is simply a set of tools that then increase load and decrease volume as
helps you solve problems you’ll face when the meet approaches, giving you plenty of
designing a program. For an incredibly practice along the way and still allowing
basic example, if you have a powerlifting for experience with 90%+ loads near the
meet 12 weeks from now, you’re probably meet. You could split your training into
going to want to get some practice with 3-week blocks, working up to 90%+ loads
loads in excess of 90% of 1RM before you on the last week of each block to spread
hit the platform so you’re confident lift- out your practice with very heavy loads.
ing near-max loads. However, you may You could even have one flexible day per
not want to lift 90%+ loads every week, week where you work up to 90%+ loads if
and you almost certainly won’t want to you’re feeling good, or stick with lighter
lift 90%+ loads every session leading up loads for higher volumes if you don’t think
to your meet as this could limit training you could perform optimally on that day.
volume, limit the total amount of reps you This is obviously a very simple example of
could complete for practicing and hon- a problem you can solve better with pe-
ing technique, and lead to wear and tear riodized training versus non-periodized
injuries. If using non-periodized train- training, but the range of problems you
ing, you’ll have to make a sacrifice: Either may need to address are endless: how to
train with somewhat lighter loads for the structure an offseason of training to al-
entire 12 weeks to accumulate adequate low for hypertrophy without sacrificing
volume while sacrificing the highly spe- strength, how to accommodate a week-
long vacation without gym access and
15
ease back into training when you return,
or even how to structure a block of train-
ing focused on a specific lift without let-
ting your other lifts suffer. All of those
examples will benefit from manipulat-
ing volume, intensity, frequency, or exer-
cise selection to address the problem and
reach your goal; hence, they’d all benefit
from periodization.
Next Steps
While a multi-year periodization study
would be amazing and fill a huge gap in
the literature, I don’t expect to see one
anytime soon. Two other facets of pe-
riodization for resistance training that
aren’t adequately studied are the effects
of block periodization and the effects of
combined periodization models versus a
single model in isolation (i.e. DUP with
the same average volume and intensity
each week versus DUP with increasing
intensity and decreasing volume week to
week).
16
References
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10.1007/s40279-017-0734-y.
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2003 May;35(5):889.
9. McLester J, Bishop E, Guilliams E. Comparison of 1 Day and 3 Days Per Week of Equal-Volume
Resistance Training in Experienced Subjects. Journal of Strength & Conditioning Research: August
2000
10. Harries SK, Lubans DR, Callister R. Systematic review and meta-analysis of linear and undu-
lating periodized resistance training programs on muscular strength. J Strength Cond Res. 2015
Apr;29(4):1113-25. doi: 10.1519/JSC.0000000000000712.
11. Zourdos MC. Physiological Responses to Two Different Models of Daily Undulating Periodization
in Trained Powerlifters. 2012.
12. Willoughby D. The Effects of Mesocycle-Length Weight Training Programs Involving Periodiza-
tion and Partially Equated Volumes on Upper and Lower Body Strength. Journal of Strength &
Conditioning Research: February 1993.
17
Cold-Water Immersion Increases Acute
Recovery More Than Cryotheraphy,
but Does It Matter?
Study Reviewed: Recovery from Exercise-Induced
Muscle Damage: Cold-Water Immersion Versus
Whole-Body Cryotherapy. Abaidia et al. (2017)
BY MIC HAE L C . ZO URD O S
M
uscle damage and inflammation will help alleviate the damage re-
tion typically occur after a sponse, it may be beneficial to decrease
training session. While it is inflammation to some extent to enhance
true that a certain degree of inflamma- recovery.
18
KEY POINTS
1. Cold-water immersion is a recovery modality in which the body is submerged in
cold water up to the neck for about 10 minutes following exercise.
2. Whole-body cryotherapy exposes the body to very cold air in an attempt to improve
recovery from training.
3. Cold-water immersion seems to be clearly superior for improving recovery compared
to whole-body cryotherapy.
4. Practically, low intensity aerobic exercise improves recovery, and it is not clear if cold-
water immersion is necessary to perform instead of low intensity active recovery.
5. Although cold-water immersion can improve recovery from a single training session,
when used repeatedly, it can actually harm long-term hypertrophy and strength
adaptations.
Body cooling is one of the methods mediately, 24, 48, and 72 hours after
purported to decrease inflammation, training. The researchers also measured
and it’s commonly accomplished in two creatine kinase (CK: a common marker
ways: 1) Cold-water immersion (CWI), in the blood of muscle damage), mus-
which involves submerging a part or all cle soreness, and subject perception of
of the body (except for the head) in wa- recovery at those same time points. The
ter that is below 15°C (59°F) for 10-12 results showed that CWI outperformed
minutes and 2) Whole-body cryother- WBC for recovery in various measures,
apy (WBC), which involves sitting in a while WBC did not outperform CWI
cold room (-110°C to -195°C; -166°F for any measures of recovery at any
to -319°F) for 3-4 minutes. This study time points. Specifically, there were ef-
had 10 men perform damaging bouts fect sizes (ES) in favor of CWI for the
of resistance training followed imme- following measures and time points:
diately by CWI or WBC. All subjects single-leg and bilateral countermove-
were exposed to both post-exercise ment at 72 hours, soreness at 48 hours,
CWI and WBC in a crossover fash- perception of recovery at 24 hours, and
ion. To measure recovery, the subjects CK levels at 72 hours. Therefore, with-
tested eccentric knee flexion strength, in the first few days following damag-
isometric leg force, and single leg and ing training, CWI enhances recovery
bilateral counter-movement jumps be- to a greater extent than WBC.
fore each training session (baseline
measure), with the tests repeated im-
19
TA B L E 1: S UBJ ECT CH AR ACT E R IST ICS
Number of Age Height Body mass Training
subjects (years) (cm) (kg) experience
Physically
10 23.4±4 178±9 73.4±12.0 active
Data are Mean ± SD

Subjects characteristics from Abaidia et al. 2017 (1).
Purpose and Research Subjects and Methods

Questions Subjects
Purpose The 10 men in this study were described
as “physically active.” To be eligible, sub-
The purpose of the reviewed study
jects could not have had a hamstring in-
was to compare the effects of CWI and
jury for the six months prior to the study,
WBC on the rate of recovery following a
and they had to refrain from exercise for
damaging bout of resistance training in
48 hours prior to the resistance training
physically active men.
sessions. Specific subject characteristics
Research Question 1 are provided in Table 1.
Would CWI or WBC have different Experimental Protocol
effects on the rate of recovery from resis-
Subjects performed 5 sets of 15 rep-
tance training up to 72 hours post-train-
etitions of eccentric-only leg curls on
ing?
an isokinetic dynamometer set to 60°/s
Hypotheses (meaning the contraction speed was
The authors did not provide a work- fixed). Each repetition lasted three sec-
ing hypothesis for this study; however, onds, and three seconds were given be-
to date, there is a greater body of litera- tween repetitions. Immediately follow-
ture supporting CWI, thus I suspect they ing training, a session rating of perceived
predicted an advantage in favor of CWI. exertion score (RPE) was given on a 0-10
scale by the subjects and all recovery mea-
sures were then tested. Importantly, the
20
RT ReM ReM
FIGURE 1ReM ReM
Repeat procedures for

Immediate 24 hours 24 hours 24 hours 2 WEEKS OFF
other condition
EXP1 0 MIN 24 HRS 48 HRS 72 HRS

POST POST POST
This figure depicts the timeline of events for both experimental conditions. EXP1=Experimental Condition 1.
EXP2= Experimental Condition 2. RT= Resistance Training. ReM= Recovery Measure.
RPEs were similar between conditions, WBC, subjects were in a cryocabin (cold
which indicates that the same fatigue room) for three minutes. The room it-
was present after each training session. self was 21°C (69.8°F); however, while
The subjects underwent either CWI or the subjects were in the room, cold air
WBC five minutes after they complet- was produced from liquid nitrogen to set
ed the final recovery test. Each measure the temperature to -110°C (-166°F). In
of recovery was tested again 24, 48, and WBC, the extremities were covered by
72 hours later. Since this was a crossover gloves, socks, and clogs, and the ceiling
design, the order of the conditions was was low enough that subjects’ heads were
randomized and the resistance train- outside of the cryocabin for protection.
ing bouts were separated by two weeks
so that all participants were exposed to
both CWI and WBC. A depiction of Findings
this experimental protocol is displayed The authors used ES and probability as
in Figure 1. All subjects performed two the sole method of analysis for these re-
familiarization sessions to practice with sults. It is important to know that in the
the isokinetic dynamometer in the weeks reviewed study, the ES magnitude was
prior to the testing sessions. interpreted in accordance with Hopkins’
Recovery Protocols guidelines (2).
Both CWI and WBC took place five Overall, CWI outperformed WBC in
minutes following the last recovery test various measures. The WBC condition
after resistance training. During CWI, had no ES in its favor for any recovery
subjects stood in a cold-water pool, in measure at any time point. There were ESs
a swimsuit, and were immersed in cold in favor of CWI for the following mea-
water up to their necks for 10 minutes sures and time points: single-leg (0.68)
at a temperature of 10°C (50°F). During and bilateral (0.63) counter-movement
21
jump at 72 hours (probability: very likely FIGURE 2: TIME COURSE
moderate effects), perception of recov-
ery at 24 hours (0.62; probability: likely OF CHANGES IN RECOVERY
moderate effect), muscle soreness at 48
hours (0.68; probability: likely moderate MEASUREMENTS
effect), and CK levels at 72 hours (0.83;
probability: likely moderate effect). Time Cold-water immersion
series graphs with ES included of the bi- Whole-body cryotherapy
lateral counter-movement jump, muscle ES = 0.38

ES = 0.68
90% CI = -0.08 to 1.43
soreness, and CK levels can be seen in

97/1/2
90% CI = -0.37 to 1.12
74/7/19 ES = 0.03
ES = 0.05 90% CI = -0.76 to 0.71
90% CI = -0.68 to 0.79 39/15/46
Figure 2. 100
CMJ-2L height (% of baseline)

90
80
Interpretation 70
Overall, CWI was better at improv- 60
ing the rate of recovery across various 0
measures for up to 72 hours following ES = -0.68
a damaging training session compared

90% CI = -1.44 to 0.07
(84/14/2) ES = 0.27
ES = 0.54 90% CI = -1.01 to 0.47
90% CI = -1.28 to 0.21 (61/30/9)
10
Soreness (Arbitrary units)
to WBC. These findings are important,

(79/18/3)
ES = 0.08
8 90% CI = -0.82 to 0.65
as the evidence related to WBC is still 6
emerging, while CWI findings are more 2
established. To illustrate, a meta-analysis 0
of cooling methods on recovery that was

Pre 0h 24h 48h 72h
published in 2013 demonstrated a great-

1600
er effect for CWI compared to WBC for 1400
recovery; however, at the time, only two 1200
ES = -0.83
90% CI = -1.6 to -0.07
(77/22/1)
Creatine kinase (% of baseline)
studies using WBC were able to be in- 1000
cluded in that analysis (3). Nonetheless, 800

ES = 0.22
90% CI = -0.52 to 0.95
(8/64/28)
other recent data from Mawhinney et al. 600

ES = -1.4
(2017) also shows CWI to be more ef-

90% CI = -2.21 to -0.58
(99/0/0)
400
fective than WBC (4). 200
There are various mechanisms proposed -200 Pre 24h 48h 72h
for how body cooling may speed recov-

ery, including vasoconstriction to reduce These figures demonstrate the time course of change in
countermovement jump, muscle soreness, and creatine
blood flow and subsequently reduce in- kinase during the recovery time points. ES= Effect Size.
flammation, and influencing the nervous % of Baseline= Percentage change in measurement
from the baseline test. CMJ2L= Countermovement
system to decrease pain and improve jump 2-leg.
22
ing and soreness in the days following
exercise, which can negatively affect per-
OVERALL, CWI WAS BETTER formance. Fortunately, the reduced blood
AT IMPROVING THE RATE flow with CWI has been associated with
decreased swelling (6) and soreness (7)
OF RECOVERY ACROSS in the days following damaging exer-
cise. To finish our discussion of CWI’s
VARIOUS MEASURES FOR UP mechanisms of action we also should
understand that various cytokines (pro-
TO 72 HOURS FOLLOWING A teins released via the immune system)
increase the activity of nociceptors (gen-
DAMAGING TRAINING SESSION erally regarded as “pain receptors”), thus
COMPARED TO WBC. increasing pain sensitivity (8). Therefore,
a certain amount of reduction in inflam-
mation and thus cytokine and myokine
(cytokines released from skeletal muscle)
perception of recovery. Vasoconstriction activity will attenuate nociceptor activ-
occurs involuntarily in response to cold ity and decrease the perception of pain.
temperatures. The blood vessels constrict In the presently reviewed study from
(hence the term vasoconstriction) to try Abaidia et al. (1), perception of recovery
and keep internal organs warm; howev- was improved with CWI versus WBC,
er, muscle temperatures will still decrease demonstrating that this reduction of no-
with CWI due to the extremely low ciceptor activity likely occurred.
ambient temperature. Indeed, the pub- At this point, it might be pretty con-
lication from Mawhinney showed that vincing that CWI should be used to ac-
CWI led to greater reductions in blood celerate recovery. However, there are two
flow and muscle temperature than WBC pieces of information which we must
in the 40 minutes following endurance discuss to fully cover this topic and de-
exercise (4). Additionally, it seems that termine the usefulness of CWI. Those
reduced blood flow helps to blunt the two pieces of information are: 1) We
acute inflammatory response to exercise. know that low intensity active recovery
We should be cautious when explaining (i.e. walking or cycling) can speed recov-
this because it is true that a certain de- ery, so why bother with the cumbersome
gree of inflammation helps to facilitate nature of finding a facility to offer CWI?,
the recovery process to resistance exercise and 2) The study we just reviewed only
(5), thus it is not advisable to completely examined the acute recovery response,
blunt inflammation. However, symptoms but what happens when CWI is repeated
of excessive inflammation include swell-
23
continuously, let’s say after every training
session for 12 weeks? Let’s now explore
some data, to examine both of these ques- IF CWI IS USED AS A RECOVERY
tions to illustrate the totality of evidence
regarding CWI. STRATEGY, IT SHOULD BE USED
1) Low-Intensity Active Recovery. SPARINGLY (I.E. ONCE PER
Although the current data discussed do
seem to support the usage of CWI for MONTH AT MOST), BUT SHOULD
recovery, it must be stressed that a limita-
tion of the present study is that CWI was
NOT BE USED CONSISTENTLY
not compared to a practical and simple
measure of active recovery such as walk-
ing or low intensity cycling. Another re-
findings are quite important in that they
cent study, Peake et al. (2017) showed
cause us to pose the question: “Why
that CWI did not improve recovery
spend the time and effort to utilize CWI
when performed post-resistance training
if we can simply cycle or walk for 10
to a greater extent than a simple 10-min-
minutes following training and receive
ute low intensity bout of cycling (9). Ad-
the same benefits?”
ditionally, this study measured common
cytokines and found that CWI did not 2) Continuous Usage of CWI.
reduce the inflammatory response more Just because an intervention works
than a simple 10-minute bout of cycling, acutely doesn’t mean that it is a good
which calls into question the necessi- idea to use consistently. The reasons for
ty of CWI. Importantly, Peake’s study this could be that the body adapts to the
had subjects perform isotonic resistance effects of the intervention, or it could be
training at a normal cadence, while the that the acute mechanisms, on a cellular
presently reviewed study from Abaidia and molecular level, don’t impact the im-
et al. had subjects perform eccentric-on- mediate performance response, but they
ly contractions at a controlled speed of do impact chronic adaptation if repeat-
three seconds per contraction. Therefore, ed consistently. The latter reason is likely
the presently reviewed study may have in play here. Specifically, Roberts et al.
caused greater muscle damage, causing (2015) had 21 men with at least one year
conditions more conducive to the success of training experience train two times
of CWI. However, while that last point per week for 12 weeks and split them
certainly cannot be verified, it does pro- into two groups (10). The authors had
vide a potential explanation. Nonethe- one group undergo 10 minutes of CWI
less, from a practical perspective, these immediately after every training session
24
1. Cold-water immersion is better than cryotherapy for accelerating recovery from
training.
2. Cold-water immersion may reduce inflammation and pain in the days following
training.
3. Even though cold-water immersion works, it is not clear if it can consistently
outperform a simple method of active recovery such as low intensity walking or
cycling.
4. Consistent usage of CWI (twice per week for 12 weeks) attenuates hypertrophy
and strength adaptations compared to simply performing low intensity cycling for
recovery.
during the 12 weeks. The other group abolic signaling (likely diminishing mus-
simply performed low intensity cycling cle protein synthesis) and satellite cell ac-
for 10 minutes after every session. After tivity between 2 and 48 hours following
the 12 weeks, the cycling group increased training. This second study that Roberts
both muscle mass and strength of the and colleagues performed was on differ-
lower body to a significantly greater ex- ent individuals than the first 12-week
tent than CWI. Further, Roberts et al. study, but the second study provides a
also did a second acute experiment in the logical rationale as to why CWI resulted
same paper, and these findings may in in lower hypertrophy and strength gains
part explain the inferiority of CWI versus over 12 weeks compared to cycling for
active recovery in the long term. The sec- recovery. In short, impaired anabolic sig-
ond investigation was a crossover design naling of mTOR’s targets likely attenu-
in which subjects performed lower body ates muscle protein synthesis, which can
resistance training two times with each function to aid recovery and can be relat-
session followed by either CWI or low ed to muscle growth (11). Additionally,
intensity cycling. The authors measured satellite cells are activated when enough
anabolic signaling by examining targets muscle damage has occurred and serve to
of the mammalian target of rapamycin repair skeletal muscle and donate nuclei,
(mTOR) pathway, which triggers muscle which supports increased muscle size.
protein synthesis, and also satellite cell Therefore, blunting protein synthesis and
activity between 2 and 48 hours follow- satellite cell activity is clearly inadvisable
ing training. It was found that subjects for muscle adaptations.
in CWI had significantly attenuated an- Are you still convinced that CWI is the
25
way to go for recovery? In reality, it seems still occur? That question remains unan-
like a plausible short-term strategy, but swered; however, it must also be stressed
its overuse may very well be detrimental. that if CWI doesn’t outperform low in-
An example of a short-term usage might tensity cycling in the short-term, is it
be Strongman or CrossFit athletes who even worth investigating the point where
have multiple events in the same day. In CWI harms long-term adaptations?
the short-term, the acute attenuation of
anabolic signaling may not be enough to
have a negative effect; but as we see from
the Roberts’ investigations, when CWI is
repeated continuously, the negative acute
changes add up to have decreased long-
term progress. Therefore, if CWI is used
as a recovery strategy, it should be used
sparingly (i.e. once per month at most),
but should not be used consistently. If
you do choose to utilize CWI at certain
times, the following protocol is recom-
mended: 1) Submerge the body up to the
neck, 2) Stay in the water for 10 min-
utes, and 3) Have a water temperature of
about 10-12°C (50-54°F) (1).
Next Steps
As discussed, we do know that CWI can
be effective in the acute sense; however,
it seems clear that when used after every
training session, long-term adaptations
are comprised. Therefore, the next step is
to see just how consistently CWI needs
to be used to negatively affect hypertro-
phy and strength adaptations. Roberts
et al. demonstrated that two times per
week for 12 weeks harms muscle gains,
but what if CWI was used every other
week? Would the same long-term effects
26
References
1. Abaïdia AE, Lamblin J, Delecroix B, Leduc C, McCall A, Nédélec M, Dawson B, Baquet G, Du-
pont G. Recovery From Exercise-Induced Muscle Damage: Cold Water Immersion Versus Whole
Body Cryotherapy. International Journal of Sports Physiology and Performance. 2016:1-23.
2. Hopkins WG. Measures of reliability in sports medicine and science. Sports medicine. 2000 Jul
1;30(1):1-5.
3. Poppendieck W, Faude O, Wegmann M, Meyer T. Cooling and performance recovery of trained
athletes: a meta-analytical review. International journal of sports physiology and performance. 2013
May;8(3):227-42.
4. Mawhinney C, Low DA, Jones H, Green DJ, Costello JT, Gregson W. Cold Water Mediates Great-
er Reductions in Limb Blood Flow than Whole Body Cryotherapy. Medicine and science in sports
and exercise. 2017 Jun 1;49(6):1252-60.
5. Urso ML, Sawka MN. Inflammation: sustaining the balance to optimize recovery of skeletal muscle,
connective tissue, and exertional injuries. Journal of Applied Physiology. 2013 Sep 15;115(6):877-8.
6. Dolan MG, Thornton RM, Fish DR, Mendel FC. Effects of cold water immersion on edema for-
mation after blunt injury to the hind limbs of rats. Journal of athletic training. 1997 Jul;32(3):233.
7. Diong J, Kamper SJ. Cold water immersion (cryotherapy) for preventing muscle soreness after exer-
cise. British journal of sports medicine. 2013 Apr 25:bjsports-2013.
8. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs
and symptoms of delayed-onset muscle soreness. Journal of athletic training. 1998 Jul;33(3):222.
9. Peake JM, Roberts LA, Figueiredo VC, Egner I, Krog S, Aas SN, Suzuki K, Markworth JF, Coombes
JS, Cameron‐Smith D, Raastad T. The effects of cold water immersion and active recovery on in-
flammation and cell stress responses in human skeletal muscle after resistance exercise. The Journal
of physiology. 2016 Dec 1.
10. Roberts LA, Raastad T, Markworth JF, Figueiredo VC, Egner IM, Shield A, Cameron‐Smith D,
Coombes JS, Peake JM. Post‐exercise cold water immersion attenuates acute anabolic signalling
and long‐term adaptations in muscle to strength training. The Journal of physiology. 2015 Sep
15;593(18):4285-301.
11. Damas F, Phillips SM, Libardi CA, Vechin FC, Lixandrão ME, Jannig PR, Costa LA, Bacurau
AV, Snijders T, Parise G, Tricoli V. Resistance training‐induced changes in integrated myofibrillar
protein synthesis are related to hypertrophy only after attenuation of muscle damage. The Journal of
physiology. 2016 Sep 15;594(18):5209-22.
27
Micromanaging the Post-Workout
Anabolic Window
Study Reviewed: Effects of Post-Exercise Protein Intake on Muscle
Mass and Strength During Resistance Training: Is There an Optimal
Ratio Between Fast and Slow Proteins? Fabre et al. (2017)
BY E RI C HE LMS
M
any acute studies (2, 3, 4) and tal muscle remodeling and thus, strength
the odd long-term study (5) and hypertrophy. Given the emphasis on
suggest that timely protein in- the proximity to training, some research-
take post-training may augment skele- ers speculate that post-training consump-
28
KEY POINTS
1. Consuming a 20g post-training protein shake consisting of 50-100% milk soluble
protein (a leucine rich, fast digesting protein similar to whey) will result in higher
levels of plasma leucine and branched chain amino acids compared to a 20g shake
that is 20% milk soluble protein and 80% casein (a slow digesting protein).
2. Despite these acute differences in plasma amino acid levels, body composition and
muscular performance adaptations in response to resistance training will likely be
similar if total protein intake is the same.
3. To hedge your bets and ensure you are maximizing the anabolic response to training,
consume a mixed diet of at least 1.8g/kg of protein per day in at least three roughly
equal boluses per day, ensuring that a protein bolus falls within 1-2 hours pre- and
post-training.
tion of quickly digested proteins (often While FAST and MIX groups had
whey) may be superior to slowly digest- higher levels of plasma amino acids at
ed proteins (typically casein) for eliciting various post-training time points com-
muscular adaptations. Therefore, the re- pared to SLOW, there were no signif-
searchers in this study set out to compare icant differences between groups for
groups supplementing with post-train- changes in strength or body composition.
ing protein of differing compositions.
Resistance-trained men were split into
three groups: a group consuming 20g of Purpose and Research
100% fast protein post-training (FAST, Questions
n = 10), a group consuming 50% fast
Purpose
and 50% slow protein (MIX, n = 11),
and a group consuming 20% fast and The purpose of this study was to exam-
80% slow protein (SLOW, n = 10). Af- ine if the same amount of protein con-
ter nine weeks of resistance training and sumed post-training – yet with differing
post-training protein consumption – de- ratios of fast and slow proteins – would
livered in a double-blind fashion – body have differential effects on strength or
composition and strength were assessed. body composition.
Additionally, blood samples at various Hypotheses
time points post-training were assessed While the authors did not propose a
to compare changes in plasma amino specific hypothesis, simply stating that
acid levels among groups. they wanted to test differences between
29
TAB LE 1 : SUBJE C T C H A RAC TE RIS T I C S
Significant difference
FAST (n=10) MIX (n=11) SLOW (n=10) at baseline?
Age (year) 27 ± 6 23 ± 3 26 ± 5 No
Height (cm) 1.78 ± 0.09 1.81 ± 0.06 1.81 ± 0.05 No
Body mass (kg) 74.3 ± 6.8 76.0 ± 6.8 77.5 ± 6.9 No
BMI (kg/m2) 23.5 ± 2.4 23.1 ± 1.1 23.7 ± 1.6 No
Body fat (%) 17.72 ± 5.3 17.26 ± 5.88 16.96 ± 1.8 No
Subjects’ characteristics from Fabre et al. 2017 (1).
conditions, they did mention that both tance-trained males in this study. While
fast and slow digesting milk proteins no objective criteria were provided for
(whey and casein, respectively) may be “recreationally trained,” subjects who had
complementary due to casein’s ability consumed any protein supplementation
to suppress muscle protein breakdown in the last year were excluded from par-
through a longer elevation in plasma ami- ticipation. Likely, this criterion did not
no acid levels, while whey elevates mus- result in a sample of “hardcore lifters,”
cle protein synthesis (MPS) to a higher who (in my experience) almost univer-
level (although for a shorter time period). sally consume protein shakes in some
Thus, it’s reasonable to assume that the form. Specific subject characteristics are
authors likely suspected the MIX group provided in Table 1.
would have the greatest gains in strength Resistance Training Protocol
and muscle mass due to a blend of fast
Before the nine-week protein-supple-
and slow proteins, theoretically comple-
mented intervention period, subjects fol-
menting one another.
lowed a three-day-per-week standard-
ized resistance training protocol using the
Subjects and Methods same exercise that would be used in the
subsequent intervention period. Subjects
Subjects performed two sessions per week with
There were 31 recreational resis- both lower and upper body resistance
30
TABLE 2 : RE S IS TA NC E
TRAI NI NG PRO TO C O L S
DAY Monday Tuesday Thursday Friday
Back Squat, Leg Barbell Row, Lat Back Squat, Leg Barbell Row, Lat
Extension, Leg Pulldown, Cable Extension, Leg Pulldown, Cable
Curl, Bench Row, Barbell Curl, Bench Row, Barbell
Press, Triceps Curl, Hammer Press, Triceps Curl, Hammer
EXERCISES Extension, Incline Curl, Dumbbell
Extension, Incline Curl, Dumbbell
Bench Press, Press Bench Press, Press
Dumbbell Press, Dumbbell Press,
Dumbbell Curl Dumbbell Curls
WEEKS 1,4,7 Sets of 10-12 with 70-75% of 1RM
exercises and one session with upper Resistance Training Performance

body exercises only. Loads used during On Sunday (48 hours after the last
this preparatory period were lower than training session) in weeks 3, 6, and 9, a
during the intervention period – 50- 3RM back squat and a 1RM bench press
60% of one repetition maximum (1RM) were performed. Following these tests,
– and the intervention period contained isometric strength of the biceps, triceps,
an additional training day (four days per hamstrings, and quadriceps was tested
week). During the intervention training, using an isokinetic dynamometer. Lastly,
a weekly progression rotation was imple- the isokinetic dynamometer was used to
mented whereby reps decreased and load test fatigue resistance of the quadriceps
increased each week for three weeks, and and hamstrings by measuring the differ-
then repeated with updated loads after ence in muscle force of the first two reps
1RM and three-repetition maximum compared to the final two reps during a
(3RM) testing after the final session in 30-repetition test.
week 3 of the rotation. The known details
Protein Supplementation
of the training utilized in the interven-
tion period are provided in Table 2. The FAST, MIX, and SLOW groups
31
FIGURE 1
Leucine FAST
450
* MIX
400 SLOW
LEUCINE (umol/L)
350
300
250
200
150
100
50
0
0 30 60 90 120
TIME (MIN)
* Both FAST and MIX significantly greater than slow
all received 20g of supplemental pro- (i.e. double-blind). All three powder mix-
tein within 15 minutes of finishing each es were chocolate flavored and combined
training session. The FAST group con- with 20g of powdered carbohydrate.
sumed all 20g in the form of soluble milk Dietary Control
protein (similar to whey in amino acid
A one-week food diary was complet-
composition and digestive speed, but in a
ed before the start of the study. Based
less refined form), while the MIX group
on these diaries, individualized food
consumed a 50/50 blend of soluble milk
plans were created for participants such
protein and casein, and the SLOW group
that protein fell between 1.5-2.0g/kg
consumed a 20/80 blend of soluble milk
on all days (while unclear, it seems this
protein and casein.
was including supplementation). A stan-
The composition of powders was blind- dardized dinner was consumed by all
ed to both participants and researchers participants at least three hours after
32
FIGURE 2
Leucine
20
* *
AUC (arbitrary units)
15
10
0
FAST MIX SLOW
* Significantly different than SLOW
post-training protein supplementa- absorptiometry (DXA) scans given

tion, and participants were required to under standardized conditions at the
provide 24-hour food recalls debriefed beginning of the study, and at every
with a nutritionist two days per week three-week interval: weeks 3, 6, and 9
during the study to ensure adherence. (post-study).
(Given this was a French study, I’m Plasma Amino Acids Analysis
not sure what specific qualification the
Plasma amino acid concentrations
“nutritionist” had or whether this per-
were assessed immediately after, 30, 60,
son was equivalent to a dietician.)
90, and 120 minutes following protein
Body Composition Analysis ingestion via blood collection. It is un-
Body mass, fat mass, and lean mass clear when reading the full text if this
were measured by dual-energy X-ray test was performed at the same time
33
FIGURE 3
Plasma BCAA Concentration
50
+
AUC (arbitrary units)
*
40
30
20
10
0
FAST MIX SLOW
* Significantly different than SLOW. + Approaching significance.
points as the other tests (every three kg). Carbohydrate intake was not sig-
weeks and pre), or only at a singular nificantly altered from baseline to in-
time point. tervention; however, fat intake slightly
decreased from baseline (1.1-1.2g/kg) to
the intervention period (0.9-1.0g/kg).
Findings Plasma Amino Acid Levels
Dietary Changes Total and essential plasma amino acid
Protein intake was significantly great- levels did not significantly differ between
er at the end of the study (1.8-1.9g/kg) groups. However, as seen in Figures 1-3,
compared to the beginning (1.5-1.6g/ there were significantly higher plasma
34
leucine levels 60 minutes post-train-
ing for FAST and MIX compared to
SLOW. Additionally, the area under the DESPITE DIFFERENCES IN POST-
curve (the total mathematical area under
all the plotted time points combined) for TRAINING PLASMA AMINO ACID
both leucine and branched chains amino
acids (BCAA) was meaningfully higher
LEVELS, CONSUMING A SHAKE
in FAST and MIX compared to SLOW
(for BCAA, the p-value was 0.07, not
AFTER TRAINING CONSISTING
quite reaching significance between MIX OF 20-100% “FAST PROTEIN”
and SLOW).
Muscular Performance and Body Com- RESULTS IN SIMILAR CHANGES
position
TO BODY COMPOSITION AND
Body composition testing revealed sim-
ilar increases in total, arm, and leg lean MUSCULAR PERFORMANCE IF
mass in all three groups without any sig-
nificant differences between groups. Fat TOTAL AND POST-TRAINING
mass was largely unchanged from start to
finish, also without significant differenc-
PROTEIN INTAKE IS EQUATED.
es between groups.
All groups increased maximal strength
to a similar degree, with no significant be-
after training consisting of 20-100%
tween-group differences. Likewise, most “fast protein” results in similar changes to
measures of isometric strength significant-body composition and muscular perfor-
ly increased in all groups; however, the in-
mance if total and post-training protein
crease for quadriceps isometric strength intake is equated. This is an unsurprising
did not reach significance (p = 0.08). Fi- finding when taking a bird’s eye view of
nally, fatigue resistance did not significantly
the literature. Specifically, a semi-recent
increase after training in any group and did
meta-analysis of post-training protein
not significantly differ between groups. consumption found no significant differ-
ences in strength or hypertrophy when
correcting for total daily protein intake
Interpretation between groups consuming protein in
The primary finding of this study is that the “anabolic window” (1-2 hours after
despite differences in post-training plas- training), compared to groups not con-
ma amino acid levels, consuming a shake suming protein in this window (6).
35
However, when digging a little deeper, but is not technically whey protein (whey
you can appreciate that this study does is produced when refining milk protein
have its place in fleshing out the body of further). Ultimately, the Babault study
literature on protein timing. While there found no significant differences between
is plenty of short-term research – studies the casein or soluble milk protein groups
typically less than a day long – compar- in maximal strength, muscular endur-
ing acute post-training MPS responses to ance, or muscle thickness changes.
casein and whey (check out this previous You might be thinking one of two
review for info on some of the pitfalls of things based on the above information:
extrapolating short term MPS responses
1) In total, it’s a simple one versus two
to long-term muscle mass changes), there
score with fast proteins beating out slow
are actually very few long-term compari-
proteins at best, and simply causing sim-
sons of changes in strength or muscle mass
ilar adaptations at worst. With this line
when consuming whey versus casein. In
of thinking, whey would be your best bet
fact, in a 2016 meta-analysis comparing
post-workout, as it would get you at least
different forms of post-training supple-
the same gains and perhaps get you larg-
mentation to whey supplementation (7),
er gains.
only one of the included studies was a
comparison with casein (8). Interestingly, 2) The reason Cribb found a difference
the findings of this study by Cribb and but Babault and the present study didn’t
colleagues seem to stand in opposition to is due to whey being that much more su-
the present investigation, as greater gains perior to soluble milk protein (which I
in relative and absolute strength, lean highly doubt).
mass, and greater losses in fat mass were Personally, I think the answer is a little
observed in the whey group compared to more nuanced. Cribb supplied a much
the casein group (8). higher dose of protein than was used
However, this is not the only oth- in the present study or Babault’s study.
er study that compared fast and slow Specifically, subjects received ~120g of
post-training protein ingestion. A study either whey or casein, which was ~70%
by Babault and colleagues (9) compar- of their total daily protein intake (8). It
ing soluble milk protein (the same “fast wasn’t just a simple 20g post-training
protein” used in the present study) to shake. Babault supplied 60g of protein
casein wouldn’t have met the inclusion on off-days and 90g on training days (9),
criteria of the 2016 meta-analysis (7), as which is a substantial dose but still only
neither group consumed whey protein. one-half to two-thirds of what was sup-
Soluble milk protein is a fast digesting, plied to Cribb’s subjects. In essence, this
leucine-rich protein very similar to whey, means that Cribb didn’t just investigate
post-training whey or casein consump-
36
1. Regardless of short-term differences in amino acid levels, strength, muscular
endurance, and muscle mass gains are similar when manipulating the ratio of fast
to slow proteins from 20-100% in a 20g post-training shake if total daily intake is
equated.
2. To ensure you are optimizing your response to resistance training, consume at least
1.8g/kg of protein per day, spread roughly equally between at least three meals, and
ensure that a protein-containing meal is consumed 1-2 hours pre- and post-training.
tion, but also total protein intakes largely

consisting of whey or casein.
Next Steps
Of the three studies, the present study In my opinion, too much time and ef-
is probably the most relevant in terms fort is spent in the research community
of real-world protein supplementation. comparing the post-training response to
Most strength athletes and bodybuild- protein supplementation in isolation. A
ers I know consume protein powders at snapshot of physiology is only useful for
most twice per day. While some consume a specific purpose, and that purpose is
it more often, rarely are these individuals forming hypotheses to later be tested in
consuming more than two-thirds of their applied research. In contrast to the mul-
total daily protein from powder. In the titude of acute investigations, this study
real world, people largely consume food has a useful design in that it was well-con-
to meet their protein requirements and trolled and examined protein supple-
then supplement their diet with powders. mentation in a real-world scenario. With
Certainly, it may be suboptimal to replace that said, the findings are unsurprising.
a substantial portion of your diet with When total protein is sufficient and some
slow digesting proteins, but it appears respect to protein timing is given, minor
that when consuming a mixed diet suf- alterations in protein composition have
ficient in total protein with supplemen- a predictably negligible effect on applied
tal powder post-training, differences in outcomes. Future research should focus
composition of slow versus fast proteins on other unexplored aspects of protein
in the range of 20-100% of the mixture intake such as the effects of timing and
are inconsequential for body composi- total intake when high volume training
tion or muscular performance. is done concurrently with anaerobic and
aerobic fitness tasks over multiple daily
workouts (such as seen among CrossFit
competitors), or if very high intensity re-
37
sistance training alters protein needs due
to connective tissue stress (such as seen
among powerlifters), or if high-volume
resistance training with some aerobic
training during a caloric deficit modifies
protein needs (such as seen among body-
builders during contest preparation).
38
References
1. Fabre, M., et al., Effects of Post-Exercise Protein Intake on Muscle Mass and Strength During
Resistance Training: Is There an Optimal Ratio Between Fast and Slow Proteins? Int J Sport Nutr
Exerc Metab, 2017: p. 1-23.
2. Tipton, K.D., et al., Postexercise net protein synthesis in human muscle from orally administered
amino acids. Am J Physiol, 1999. 276(4 Pt 1): p. E628-34.
3. Borsheim, E., et al., Essential amino acids and muscle protein recovery from resistance exercise. Am
J Physiol Endocrinol Metab, 2002. 283(4): p. E648-57.
4. Tipton, K.D., et al., Timing of amino acid-carbohydrate ingestion alters anabolic response of muscle
to resistance exercise. Am J Physiol Endocrinol Metab, 2001. 281(2): p. E197-206.
5. Cribb, P.J. and A. Hayes, Effects of supplement timing and resistance exercise on skeletal muscle
hypertrophy. Med Sci Sports Exerc, 2006. 38(11): p. 1918-25.
6. Schoenfeld, B.J., A.A. Aragon, and J.W. Krieger, The effect of protein timing on muscle strength and
hypertrophy: a meta-analysis. Journal of the International Society of Sports Nutrition, 2013. 10(1):
p. 53.
7. Naclerio, F. and E. Larumbe-Zabala, Effects of Whey Protein Alone or as Part of a Multi-ingredient
Formulation on Strength, Fat-Free Mass, or Lean Body Mass in Resistance-Trained Individuals: A
Meta-analysis. Sports Med, 2016. 46(1): p. 125-37.
8. Cribb, P.J., et al., The effect of whey isolate and resistance training on strength, body composition,
and plasma glutamine. Int J Sport Nutr Exerc Metab, 2006. 16(5): p. 494-509.
9. Babault, N., et al., Effects of soluble milk protein or casein supplementation on muscle fatigue
following resistance training program: a randomized, double-blind, and placebo-controlled study.
Journal of the International Society of Sports Nutrition, 2014. 11: p. 36-36.
39
Functional Movement Screen Is Not
Supported for Injury Prediction
Study Reviewed: Do Functional Movement Screen
(FMS) Composite Scores Predict Subsequent Injury? A
Systematic Review with Meta-Analysis. Moran et al. (2017)
BY D E RE K MI LE S
T
he Functional Movement Screen realms. It consists of seven tests scored
(FMS) is a widely used movement on a zero to three scale, the scoring of
competency-based test in both the which can be found on a PDF provided
sport performance and rehabilitation by the company (1). It is often used as a
40
KEY POINTS
1. In order to predict injuries, a screen needs to establish an association between risk
factors and subsequent injuries, validate its testing properties, and have controlled
studies to investigate its effectiveness. These steps have not been taken for the
FMS.
2. There are multiple confounding factors in the studies included in this review, including
lack of definition of “injury,” and issues with time of follow-up that make a proper
meta-analysis difficult to perform.
3. Current evidence does not support the use of the FMS as an injury prediction tool
due to lack of association between FMS composite scores and subsequent injury.
means of identifying athletes at increased study to establish risk factors and cutoff
risk for injury. With its widespread ac- points. For the FMS, this score has been
ceptance comes the need for due dili- set at 14 out of the possible 21 points. The
gence to determine whether the screen score was initially based off of the 2007
accomplishes what it is purported to do. paper by Keisel, where a Receiver Oper-
This systematic review and meta-analysis ating Curve (ROC) was implemented to
looked to pool the current best evidence maximize sensitivity (predicting an inju-
in order to determine the ability of the ry when injury is likely) and specificity
FMS to predict injuries in the general (not predicting an injury when injury is
athletic population (2). There have been unlikely) (6). There have since been oth-
two prior systematic reviews on this top- er studies attempting to develop ROC
ic by Bonazza et al and Dorrel et al, with curves that could not find a test score to
both reviews calling into question the va- optimize those sensitivity and specificity
lidity of the FMS (3,4). In the context of values. A large cohort study conducted
an injury screen, validity is the degree to on Coast Guard cadets found that the
which evidence supports the interpreta- cutoff scores may be different for males
tion of the test scores, or whether the test and females with <11 for men and <14
gives results on what it is attempting to for females (7).
assess. The 2007 Keisel study looked at a co-
To fully appreciate what it would take hort of professional American football
for a screen to possess validity, it is best to players. They reported an odds ratio of
turn to Roald Bahr’s 2016 review on why 11.67, meaning those athletes falling be-
screens will likely never work (5). The low 14 were 11.67 times more likely to
first step of research would be a cohort be in the injured group versus uninjured.
41
This would seem to support the utility meta-analysis with qualitative evidence
of the FMS for injury prediction, but the synthesis due to the methodological het-
study failed to differentiate between con- erogeneity of the studies assessed. Stud-
tact and non-contact injuries. Not dif- ies were selected based on the Preferred
ferentiating between types of injuries is a Reporting Items for Systematic Reviews
major confounder because a cutting injury and Meta-Analysis (PRISMA) guide-
is likely much more in the athlete’s con- lines (9). Risk of bias was assessed using
trol (what the screen would be expected to the “Quality of Cohort Studies” (Q-Coh)
predict) than being struck by an opponent tool specifically designed to assess bias
(no screen can save you from an angry JJ in prospective cohort studies (10). Me-
Watt). Keisel also repeated the study in a ta-analysis was conducted when there
much larger cohort in 2014. This group were at least two studies of “good” or “ac-
produced a much lower odds ratio of 2.33 ceptable” methodology, and the studies
(8). These two studies demonstrate the ne- showed sufficiently similar design, co-
cessity for pooling data via systematic re- horts, and injury definitions.
views and meta-analyses to determine the This review included a total of 24 stud-
true usefulness of screens. The authors of ies, but two reported on the same data
this paper sought to conduct a systematic set. Three studies were eligible for me-
review and meta-analysis using 24 articles ta-analysis and 20 studies for qualitative
with clearly defined criteria for injury in evidence synthesis. Of the 23 studies,
order to determine if the FMS can predict risk of bias assessment yielded six studies
subsequent injury. classified as “good,” two as “acceptable,”
and 16 as “low” according to standards of
FMS Exercises Q-Coh.
• Active Straight Leg Raise There was heterogeneity in all study
cohorts, but included studies needed to
• Deep Squat
be in English, use an observational pro-
• Hurdle Step spective cohort design, report original
• In-line Lunge and peer-reviewed data, define exposure
• Rotary Stability groups using a composite FMS score,
and have musculoskeletal injury as a re-
• Shoulder Mobility ported outcome. Data from conferences
• Trunk Stability Push-up and non-peer reviewed data were not in-
cluded, nor were studies utilizing a retro-
spective or cross-sectional design.
Subjects and Methods
This paper is a systematic review and
42
FIGURE 1
Prospective cohort study to identify risk
1 factor(s) and define cut-off value(s).
Number of athletes (n)
No Injury
Injury
Low High
Screening test score
Validate test and cut-off value in

2 multiple cohorts.
Randomized controlled trial to test effect of

3 combined screening and intervention program.
43
ministering it, the validity of the screen
Findings for injury prediction is not sufficient to
Three studies were of sufficient quality warrant its use. Injuries are multifacto-
and homogeneity to conduct a meta-anal- rial and closer correlated with the sport
ysis. The cohort for this meta-analysis an athlete plays than movement capaci-
was military and police personnel with ty (11). More so, there is increasing evi-
a total of 4,120 subjects. Using a ran- dence that acute changes in training load
dom effects model for relative risk and influence injury risk more than any spe-
a dichotomized cutoff score of 14 points cific movement pattern (12). This is evi-
resulted in a pooled relative risk of 1.47 dent in the 10-year review of hamstring
(95% CI 1.22 to 1.77) and was associ- injuries in the NFL performed by Elliot
ated with moderate statistical heteroge- et al showing the majority of injuries oc-
neity. This would mean in male military cur at the start of the season (13). The
personnel, there is “strong” evidence of FMS dichotomizes athletes (high injury
a “small” association between composite risk versus low injury risk based on a sin-
score and injury. gle cutoff point), when it is more appli-
Low study quality prevented a larg- cable to think in terms of probability. We
er scale meta-analysis across different will never completely eliminate injury,
sports. However, the authors did con- but we can reduce the risk. The data syn-
duct a qualitative review by sport on the thesized by these researchers reports that
evidence provided. The overall evidence the FMS has little utility in identifying
was either “limited” or “conflicting” for those athletes at increased risk for injury.
running, ice hockey, collegiate and high In many sports, the more athletic a per-
school sport, and football. The magnitude son is, the more overall training and com-
of association for all sports between FMS petition volume increases and the more
scores and sport studied was “small” and exposures they undertake. If an athlete’s
there was “moderate” evidence overall to relative risk is decreased by a certain trait,
recommend against the use of FMS as an but they have increased overall exposures,
injury prediction tool. their absolute risk may stay the same. In
arbitrary terms, if an athlete has a 1% risk
of injury and has 100 exposures, they are
Interpretation at the same overall risk of injury as an
While the FMS has demonstrated athlete with a 0.1% risk of injury who has
acceptable reliability in the literature 1,000 exposures. Yet, much like playing
(meaning multiple clinicians will give the lottery, even an infinitesimally small
similar scores to the same athlete), re- probability occasionally will hit on the
gardless of experience of clinician ad- first try.
44
TABLE 2
Number of Studies/
Sport Level of Evidence
For or Against
American football Conflicting 2 pro/1 con
Collegiate level athletes Conflicting 2 pro/2 con
Soccer Moderate 4 con
Military personnel Strong 3 pro (small magnitude)
In male military personnel, there was a for the variability of injuries, whether they
1.47 risk ratio associated with an FMS be acute, overuse, contact, or non-con-
score below 14 and a risk of injury. This tact. The FMS also fails to account for
means that those personnel falling below the changes an athlete experiences while
the cutoff score would be 47% more like- in season (15). The FMS seeks to dichot-
ly to sustain an injury. This sounds like omize injury risk when it will always be
a lot, but it has to be framed in terms of a probability. Risk reduction would ulti-
the injury rate of this cohort. According mately be predicated on an intervention
to Knapik et al, the incidence of injury instead of a screen, as well. If an interven-
varies between 1.35 and 2.6 per 1,000 tion has been shown to decrease the like-
person days (14). A 47% increase in risk lihood of injury, time is better spent hav-
would bring that number to 1.98-3.8 in- ing all athletes perform the intervention
juries per 1,000 person days. This is what than screening for those that may slightly
led the authors to conclude that there have more benefit from it. For example,
is strong evidence of a small correlation performing nordic curls has been shown
with subsequent injury. to decrease risk of hamstrings strains, and
The FMS fails to account for an athlete’s this risk reduction likely applies to ath-
overall training load, history, and the ad- letes at both high and low risk of strains,
aptations that are often necessary to per- making its use a no-brainer for most team
form as an elite athlete. It fails to account sport athletes (16).
45
1. The FMS has shown decent reliability in its scoring, but the cutoff score of 14 lacks
any strong evidence for predicting injury across all sports. Attempting to utilize a
screen to dichotomize injury risk fails to account for the multifactorial nature of
injury risk.
2. Across three different meta-analyses, the FMS has failed to demonstrate utility as
an injury prediction tool.
3. We are likely better served implementing interventions shown to reduce injury risk
across specific athletic populations instead of selecting certain athletes who fall
below a certain threshold on a general movement screen.
There are now three meta-analyses, include longer follow-up periods would
largely considered the highest level of skew the data because movement com-
evidence, failing to demonstrate the va- petency likely changes throughout the
lidity of the FMS as an injury prediction course of a season.
tool (2, 3, 4). Despite its widespread use This is not to say that screens may not
at multiple levels of athletics, there is no have some utility if properly implement-
solid evidence to advocate for its con- ed. There is high level research on the fac-
tinued use to assess injury risk. In this tors that increase an athlete’s injury risk
current study, a male military personnel dependent upon the sport they play (22,
cohort showed a “small” association be- 23). Screening for those factors would be
tween FMS composite score and injury, efficacious in addressing any deficits an
but the clinical utility of a small associa- athlete may possess. The crux of risk re-
tion must be questioned. There are mul- duction research is that if an intervention
tiple confounding issues with the stud- is shown to reduce risk, it can be applied
ies included in the meta-analysis. Even to all athletes, not just those that fall be-
though the FMS is touted as an injury low an arbitrary cutoff point. Attempting
prediction tool, studies included in the to apply a universal screen to specialized
review failed to adequately define “inju- athletes does not account for the adap-
ry” (17, 18, 19, 20). A proper definition tations these athletes need to possess to
of injury is critical to determining the become specialists. We must be careful as
validity of any tool that may predict risk trainers, clinicians, and athletes to not at-
of injury, and consensus statements exist tempt to apply our “normal” to an athlete,
with which to base such a definition (21). especially if that normal has not been
With evidence that movement patterns shown to be a valid means of reducing
change throughout a season, studies that the risk of injury.
46
Unfortunately for MASS readers, there FMS, there need to be clear definitions of
are not yet any studies assessing the utility what constitutes injury and validity crite-
of the FMS for barbell athletes. To date, ria established for particular sports before
there have been no studies looking at the the FMS can be judiciously implemented
validity of the FMS in assessing risk in as an injury risk reduction tool.
powerlifters, weight lifters, strongmen, or Results of three meta-analyses on the
Crossfit athletes. Current best evidence FMS
would call into question the use of the
1. Moran et al 2017: The association
FMS for predicting injury in all four
between FMS composite scores
sports. As a screen, the FMS lacks valid-
and injury does not support its use
ity as a predictive assessment for injury
as an injury prediction tool. There is
risk across all sports which have been
moderate evidence to recommend
studied to date.
against the use of the FMS for inju-
ry prediction in soccer.
Next Steps 2. Dorrel et al 2015: Evidence does
not support predictive validity of the
While the FMS is reliable, it is likely
FMS.
time to discard the FMS as an injury pre-
diction tool. From multiple meta-analy- 3. Bonazza et al 2017: The FMS has
ses, it is unlikely there is a correlation with excellent inter- and intra-rater re-
FMS scores and injury risk in the overall liability, regardless of experience or
athletic population. There is emerging ev- certification of person administer-
idence that acute on chronic training load ing test. The FMS is not supported
and overall fatigue are predictive of inju- as an injury prediction tool; howev-
ry (12, 24). Future studies should exam- er, those with a score of <14 do have
ine interventions and monitoring of load increased odds of suffering an injury.
to reduce the risk of injury to athletes. If
future studies are to be conducted on the
Derek Miles, guest reviewer

Derek Miles, PT is a physical therapist at the University of Florida in Gainesville, FL. He
earned his Doctorate of Physical Therapy from the University of Florida (UF) in 2008.
Immediately after he completed an orthopedic residency under Steven George PT, Ph.D.
and Tim Shay, PT, DPT. He has a B.S. in Biochemistry from Clemson University in 2004.
Derek is involved in the running medicine clinic at UF as well as rehabilitation of various
strength athletes in the community. He is a member of the Clinical Athlete community and
writes for thelogicofrehab.com.
47
References
1. Cook, G. (2010) Movement: Functional Movement Systems: Screening, Assessment, Corrective
Strategies. On Target Publications.
2. Moran RW, Schneiders AG, Mason J, Sullivan SJ. Do Functional Movement Screen (FMS) com-
posite scores predict subsequent injury? A systematic review with meta-analysis. Br J Sports Med.
2017 Mar 30.
3. Bonazza NA, Smuin D, Onks CA, et al. Reliability, validity, and injury predictive value of the func-
tional movement screen: a systematic review and meta-analysis. Am J Sports Med 2017; 45:725-32.
4. Dorrel BS, Long T, Shaffer S, et al. Evaluation of the functional movement screen as an injury pre-
diction tool among active adult populations: a systematic review and meta-analysis. Sports Health
2015; 7:532-7.
5. Bahr R. Why screening tests to predict injury do not work--and probably never will….:a critical
review. Br J Sports Med 2016; 50:776-80.
6. Kiesel K, Plisky PJ, Voight ML. Can serious injury in professional football be predicted by a presea-
son functional movement screen? N Am J Sports Phys Ther 2007; 2(3):147-158
7. Knapik JJ, Cosio-Lima LM, Reynolds KL, Shumway RS. Efficacy of functional movement screen-
ing for predicting injuries in Coast Guard cadets. J Strength and Cond Res 2015; 29(5):1157-1162
8. Kiesel K, Butler RJ, Plisky PJ. Prediction of injury by limited and asymmetrical fundamental move-
ment patterns in American football players. J Sports Rehabil. 2014;23(2):88-94
9. Moher, D., et al., Preferred reporting items for systematic review and meta-analysis protocols (PRIS-
MA-P) 2015 statement. Syst Rev, 2015. 4: p. 1.
10. Higgins, J.P.T., et al., The Cochrane Collaboration’s tool for assessing risk of bias in randomised
trials. BMJ, 2011. 343.
11. Schroeder AN, Comstock RD, Collins CL, Everhart J, et al. Epidemiology of overuse injuries among
high-school athletes in the United States. J Pediatr. 2015 Mar;166(3):600-6.
12. Gabbett T. The training-injury prevention paradox: should athletes be training smarter and harder.
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13. Elliot MC, Zarins B, Powell JW, Kenyon CD. Hamstring muscle strains in professional football
players: a 10-year review. Am J Sports Med. 2011 Apr;39(4):843-50.
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factors among army recruits in military police training. BMC Musculoskelet Disord. 2013 Jan
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baseball players over the course of a competitive season: a pilot study. Int J Sports Phys Ther. 2015
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16. Goode A, Reiman MP, Harris L, et al. Eccentric training for prevention of hamstring injuries may
depend on intervention compliance: a systematic review and meta-analysis. Br J Sports Med. 2015
Mar;49(6):349-56
17. Shojaedin SS, Letafatkar A, Hadadnezhad M, et al. Relationship between functional movement
48
screen score and history of injury and identifying the predictive value of the FMS for injury. Int J Inj
Contr Saf Promot 2014;21:355-360.
18. Zalai D, Panics G, Bobak P, et al. Quality of functional movement patterns and injury examination
in elite-level male professional football players. Acta Physiol Hung 2015;102:34-42.
19. McGill SM, Andersen JT, Horne AD. Predicting performance and injury resilience from movement
quality and fitness scores in a basketball team over 2 years. J Strength Cond Res 2012;26:1731-9.
20. McGill S, Frost D, Lam T, et al. Can fitness and movement quality prevent back injury in elite task
force police officers? A 5-year longitudinal study. Ergonomics 2015;58:1682-9
21. Roos KG, Marshall SW. Definition and usage of the term “overuse injury” in the US high school and
collegiate sport epidemiology literature: a systematic review. Sports Med 2014;44:405-421.
22. Tyler TF, Nicholas SJ, Campbell RJ, McHugh MP. The association of hip strength and flexibility
with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med.
2001 Mar-Apr;29(2):124-8.
23. Grimm NL, Jacobs JC Jr, Kim J, Denney BS, Shea KG. Anterior Cruciate Ligament and Knee In-
jury Prevention Programs for Soccer Players: A Systematic Review and Meta-Analysis. Am J Sports
Med. 2015 Aug;43(8):2049-56.
24. Jones C, Griffiths PC, Mellalieu SD. Training Load and Fatigue Marker Associations with Injury
and Illness: A Systematic Review of Longitudinal Studies. Sports Med. 2017 May;47(5):943-974.
49
Constant Tension Training:
Were the Bros Right?
Study Reviewed: Partial Range of Motion Exercise is Effective
for Facilitating Muscle Hypertrophy and Function via Sustained
Intramuscular Hypoxia in Young Trained Men. Goto et al. (2017)
BY G RE G NUC KO LS
M
any evidence-based lifters and ing through a partial ROM. However,
fitness professionals take it as a bodybuilders have been preaching “con-
foregone conclusion that training stant tension” for years, which generally in-
through a full range of motion (ROM) cludes stopping a movement just short of
produces more muscle growth than train- full ROM and not locking out each rep.
50
KEY POINTS
1. Partial-ROM triceps extensions (through the middle of the ROM) caused nearly twice
as much hypertrophy as full-ROM triceps extensions.
2. The authors speculate that a larger drop in muscle oxygenation may explain the
superior hypertrophy.
3. A more likely explanation for the results is that the partial-ROM group could simply
train harder than the full-ROM group. However, that may not explain the entirety of
the difference.
4. Partial-ROM “constant tension” training, if it does prove to be better for hypertrophy,
is probably most useful for exercises where it’s difficult to keep tension on the target
muscle through the full range of motion, such as barbell triceps extensions or pec
flyes.
Most of the prior literature investi- group trained through a full ROM (tak-
gating the effects of ROM on hypertro- ing each rep from 0 degrees of elbow
phy didn’t really investigate the in-the- flexion to 120 degrees of elbow flexion),
trenches “constant tension” approach to while the other group trained through
partial-ROM training. Most studies a partial ROM roughly coinciding with
compared a full ROM to the top half of middle of the movement (taking each
a ROM – deep squats versus half squats, rep from 45 degrees of elbow flexion to
for example – whereas a “constant ten- 90 degrees of elbow flexion). Triceps
sion” approach to squatting may look cross-sectional area (CSA) increased al-
more like cutting a squat off just above most twice as much in the partial-ROM
parallel, and stopping the rep a bit shy of group (48.7±14.5% versus 28.2±10.9%).
lockout to maintain your quad contrac- Furthermore, the partial-ROM group
tion. experienced greater muscle hypoxia (re-
This study compared full-ROM train- duction in oxygen concentrations) than
ing to partial-ROM training the way the full-ROM group, and individual in-
partial-ROM training is typically used creases in triceps CSA within the par-
for hypertrophy, employing an approach tial-ROM group correlated strongly with
that looks a lot like “constant tension” muscular hypoxia. This indicates that lo-
training. Over eight weeks, two groups cal hypoxia is increased with “constant
of young men with at least one year of tension” training, and that local hypoxia
training experience did barbell triceps may be a strong independent hypertro-
extensions three times per week. One phy stimulus.
51
Purpose and Research
Questions FIGURE 1
The purposes of this study were:
0
1. To observe the acute effects of full-
ROM versus partial-ROM training
45
on muscle activation, local hypoxia,
and lactate accumulation.
2. To observe the effects of full-ROM
versus partial-ROM training on
muscle hypertrophy and strength
following training. 90
The authors hypothesized:

1. That partial-ROM training would
increase muscular tension relative to 120
full-ROM training.
induce greater local muscular hy-
poxia.
lead to more hypertrophy and larger
strength gains.
Elbow range of motion: 0-120 degrees for full
ROM, 45-90 degrees for partial ROM.
Subjects and Methods

Subjects
The subjects were 44 young men of 22 participants. Both groups did bar-
(21.2±1.1 years old) with at least one bell triceps extensions three times per
year of training experience, who regular-week for eight weeks, performing 3 sets
ly trained their triceps at least once per
of 8 reps per session with a minute be-
week and reported no upper-body inju- tween sets. The full-ROM group per-
ries in the past year. formed each rep from 0° of elbow flexion
Training (elbows fully locked out) to ~120° of el-
The subjects were split into two groups bow flexion (elbows fully flexed), whereas
the partial-ROM group performed each
52
FIGURE 2
70 *
Area under the Oxy-Hb curve (% · sec)
60 *
+
50
40
+
30
20
10
0
Partial Full Partial Full
ROM ROM ROM ROM
Before 8-week exercise training After 8-week exercise training
* significantly different between conditions. + significantly decreased from pre-training.
rep from 45° of elbow flexion to 90° of el- of the training program, such that the
bow flexion. As such, the partial-ROM participants were always training at or
group’s ROM was roughly three-eighths near 8RM loads for their respective tech-
that of the full-ROM group, with the nique (though the method of progression
entirety of each rep performed through was somewhat opaque).
the midrange of their elbow ROM. All Testing
reps were performed with a standardized
Before and after training, the research-
cadence of one second for the eccen-
ers measured isometric elbow extension
tric, and one second for the concentric.
strength at 90° of elbow flexion, isoki-
Weights were increased over the course
53
FIGURE 3
100 *
90
* + +
80
%MVC-RMS of EMG (%)
70
60
50
40
30
20
10
0
ROM ROM ROM ROM
Before 8-week exercise training After 8-week exercise training
* significantly different between conditions. + significantly increased from pre-training.
netic torque at 120° and 200° per sec- on measurements of triceps thickness
ond, accumulated local muscular hypoxia and arm circumference; the product of
(area under the hemoglobin desatura- triceps thickness and arm circumference
tion curve for all three sets), blood lac- has been shown to correlate strongly
tate (at rest, immediately after the last (r=0.87) with triceps CSA (2).
set, and five minutes after the last set),
and EMG of the long head of the triceps
(peak EMG observed during either par- Findings
tial- or full-ROM triceps extensions as a Cumulative muscle hypoxia during a
percentage of the EMG readings during workout was greater in the partial-ROM
a maximum voluntary isometric contrac- group than the full-ROM group both
tion: %MVIC). Furthermore, they esti- before and after training (p<0.05). Fur-
mated triceps cross-sectional area based thermore, cumulative muscle hypoxia
54
FIGURE 4
250
*
+
200
+
CSA of triceps brachii (cm2)
150
100
50
0
ROM ROM ROM ROM
Pre-training Post-training
* significantly different between conditions. + significantly increased from pre-training.
throughout a workout decreased in both

post-training in the partial-ROM group,
groups following training (-21.7±12.7%
and they increased significantly in both
for the partial-ROM group, and groups following training. However, I’m
-9.6±12.5% for the full-ROM group),not sure the between-group differenc-
indicating local and systemic adaptations
es and the within-group increases are
to keep the muscle better oxygenated
practically relevant; the authors didn’t
during exercise and to restore muscle ox-
provide values, but graphically, the be-
ygenation quicker following a set. tween-group differences look to be only
Peak EMG readings (%MVIC) were ~5%MVIC (a relatively trivial differ-
significantly higher both pre- and ence), and the within-group increases
55
FIGURE 5
Partial ROM (n=22): r=0.59, p<0.01 Partial ROM (n=22): r=0.7, p<0.01
100 100
Percent increase in CSA
80
of triceps brachii (%)
80
60 60
40 40
20 20
0 0
0 20 40 60 80 0 20 40 60 80
Area under the Oxy-Hb curve (% · sec) Area under the Oxy-Hb curve (% · sec)
before 8-week exercise training after 8-week exercise training
Correlation between hypoxia and hypertrophy in the partial-ROM group pre- and post-training.
were similarly small. crease was significantly (and dramati-

Blood lactate concentrations increased cally) larger in the partial-ROM group
significantly after exercise for both (48.7±14.5% versus 28.2±10.9%). Fur-
groups both pre- and post-training, with thermore, in the partial-ROM group,
no differences between lactate concen- individual increases in estimated tri-
trations immediately after exercise versus ceps CSA were significantly correlated
five minutes after exercise. Post-exercise with cumulative muscle hypoxia during
blood lactate levels were significantly exercise both before (r=0.59) and after
higher for the partial-ROM group than (r=0.70) the training program.
for the full-ROM group at both the be- Isometric strength at 90 degrees of el-
ginning and the end of the study. For bow flexion and isokinetic torque at 120
degrees per second increased significant-
both groups, the post-exercise elevation
ly in both groups, while isokinetic torque
in blood lactate was significantly larger at
at 200 degrees per second didn’t increase
the start of the training program than at
the end of the training program. significantly in either group. Isometric
Estimated triceps CSA increased sig- strength was not significantly different
nificantly (and dramatically) in both between groups pre-training, but it was
groups following training, but the in- significantly higher in the partial-ROM
56
TABLE 1
Pre (n=22) Fre (n=22)
Intensity at 1st week (kg) 38.6 ± 7.9 39.3 ± 8.5
Intensity at 4th week (kg) 42.5 ± 8.3 41.4 ± 7.1
Intensity at 8th week (kg) 45.2 ± 8.7 42.6 ± 7.8
group post-training. fairly unsurprising: isometric strength

Both groups trained with similar loads was assessed at 90 degrees of elbow flex-
throughout the training program, though ion, and the partial-ROM group reversed
training loads increased non-significantly every rep at 90 degrees of elbow flexion
more in the partial-ROM group (6.6kg) during training, which would build more
than the full-ROM group (3.3kg). static strength at that specific joint angle.
The differences in peak %MVIC EMG
were relatively unsurprising, since peak
Interpretation triceps EMG occurs somewhere between
45 and 90 degrees of elbow flexion (3),
Most of these findings were relatively and the full-ROM group would have
unsurprising: muscle contraction oc- had more momentum built up when they
cludes blood flow to the muscle, so you’d reached that ROM (thus requiring less
expect the partial-ROM group to expe- active muscular effort to actually make it
rience greater local hypoxia and reach through the part of the ROM when tri-
higher blood lactate concentrations since ceps EMG would peak). Finally, the sim-
their triceps never had a chance to relax. ilar loading between groups makes sense,
You’d also expect local hypoxia and lac- as well. Even though the partial-ROM
tate elevations to be attenuated following group trained through a shorter ROM,
training as your body adapts to the train- both groups’ ROMs included 90 degrees
ing stressor. Furthermore, the post-train- of elbow flexion, which is the most me-
ing difference in isometric strength was chanically disadvantageous point in the
57
movement (3).
With all of that out of the way, let’s
address the elephant in the room: Both THE AUTHORS PROPOSE
groups saw huge increases in triceps
CSA, with the partial-ROM group ex-
THAT INCREASED MUSCLE
periencing almost double the increase. HYPOXIA WAS THE DOMINANT
Is constant tension training really that
much more effective for muscle growth? FACTOR EXPLAINING THE
Right off the bat, there are two reasons
to be somewhat skeptical:
INCREASED HYPERTROPHY IN
1) The increases in both groups were THE PARTIAL-ROM GROUP.
pretty huge. Even the full-ROM group
averaged a 28.2% increase in triceps CSA,
but that pales in comparison to the 48.7%
mean increase in the partial-ROM group.
in one population may not work well in
That would be impressive enough in un-
a different population. However, if this
trained lifters, but these folks had at least
was a source of error, you’d expect it to
one year of training experience, and their
skew both groups equally instead of pro-
pre-training strength backs it up. Their
viding a proportional advantage to one
8RM triceps extensions were around
group. Though estimates always give me
40kg pre-training; that’s not world-class
pause (I wish they would have just re-
by any means, but doing sets of strict
ported muscle thicknesses instead, since
barbell triceps extensions with almost
they actually measured muscle thickness-
90lbs certainly isn’t anything to sneeze
es), I don’t think this issue would have
at. The unexpectedly large increases in
affected the between-group differences
triceps CSA may be attributable to some
very much. As an aside, they actually re-
factor that wasn’t accounted for, such as
ported the product of muscle thickness
an increase in muscle glycogen storage.
and arm circumference instead of actu-
If that was the case, you may expect to
al estimated triceps CSA ... unless they
see larger increases in the partial-ROM
happened to get a group of IFBB pro
group since the acute hypoxic stressor
bodybuilders to participate in the study.
(and thus the stimulus to increase glyco-
The reported pre-training triceps CSA of
gen storage) was larger.
~120cm2 would mean their triceps were
2) The authors estimated triceps CSA. about 12.4cm (4.9in) thick, which is ri-
Much like the issue we saw with VO2m- diculous. It’s a little disheartening that
ax estimates in a study last month, re- this little flub slipped through peer re-
gression equations that work really well
58
ing in normoxic conditions (4). On the
other hand, if hypoxia was truly such a
THIS MAY NOT BE A SEXY major determinant of hypertrophy, you’d
expect blood flow restriction training
INSIGHT OR EXPLANATION, to cause dramatically more hypertrophy
BUT IT’S POSSIBLE THAT THE than training without blood flow restric-
tion (arterial occlusion). However, to
PARTIAL-ROM GROUP BUILT this point, blood flow restriction training
has simply proven itself to be an effec-
MORE MUSCLE BECAUSE THE tive means of hypertrophy that produces
muscle gains that are roughly similar to
STUDY WAS SET UP IN A MANNER non-occluded training. Furthermore, a
directly comparable study by Tanimoto
THAT SIMPLY ALLOWED THEM et al (5) didn’t find that muscle hypoxia
TO TRAIN HARDER THAN THE was a make-or-break factor for hypertro-
phy. It didn’t use partial-ROM training,
FULL-ROM GROUP COULD. but it did compare training with con-
stant muscle tension (with EMG record-
ed throughout the set to verify constant
tension on the muscle) to training with a
view. It doesn’t actually change the find- brief relaxation between reps. The group
ing because the proportional increase training with constant tension did expe-
(which is what we care about) would still rience the most muscle hypoxia, but it
be the same, but based on the regression still experienced hypertrophy similar to
equation provided in the prior study (2, one of the other groups that was allowed
8), mean pre-training triceps CSA was a brief relaxation between reps, leading to
actually closer to 18.7cm. less hypoxia. However, it’s worth noting
The authors propose that increased that load and rep cadence weren’t equat-
muscle hypoxia was the dominant factor ed between those two groups. Since in-
explaining the increased hypertrophy in dividual hypertrophy in this study cor-
the partial-ROM group. I have mixed related well with individual cumulative
feelings about this explanation. On one hypoxia in the partial-ROM group, I do
hand, there is a study showing that train- think the proposed relationship between
ing in hypoxic conditions (in a room muscle hypoxia and hypertrophy holds
with oxygen concentrations reduced by some water, but I’m skeptical that it fully
about 24%) led to more hypertrophy on explains the nearly two-fold hypertrophy
the same training program than train- advantage in favor of the partial-ROM
group.
59
There’s another potential explanation full-ROM (0° to 130° of elbow flexion)
for the superior hypertrophy observed preacher curls against mid-range par-
in the partial-ROM group that the au- tial-ROM preacher curls (50° to 100° of
thors didn’t discuss. Rep cadence was elbow flexion). Rep cadence wasn’t stan-
standardized so that each eccentric and dardized, ensuring participants in both
each concentric took one second in both groups trained with similar relative loads.
groups. However, the full-ROM group In Pinto’s study, hypertrophy was similar
covered 120° of elbow ROM each second, in both groups. However, preacher curls
whereas the partial-ROM group covered may not be a fair comparison to triceps
only 45° of elbow ROM each second. extensions, as it’s much easier to keep
As such, it’s likely that the partial-ROM tension on the biceps through the whole
group was training with heavier relative ROM on preacher curls than it is to keep
loads and working close to failure. To il- tension on the triceps through the whole
lustrate: Your hip ROM in a deadlift is ROM (especially at lockout) on barbell
roughly 120°; if you had to decrease load triceps extensions.
when a pull took more than one second With all of those caveats out of the
to complete, you’d never really be training way, this study really does warm me up
very hard or very close to failure. Once to the idea that partial-ROM “constant
reps got challenging enough that bar tension” training (through the middle of
speed slowed down slightly, you’d need the ROM) may be superior to full-ROM
to decrease load. However, if you were training for hypertrophy in some con-
doing block pulls at a height where your texts. The nearly two-fold larger increase
hip ROM was only 45° (starting from in estimated CSA (with a very large be-
knee height or above), reps that took tween-group effect size of 1.6) for the
you a second to complete could still get partial-ROM group really jumps off the
quite challenging. Even though time un- page, limitations aside. I wouldn’t go as
der tension would be the same, concen- far as to say this proves the “bros” right
tric velocity would be way slower (since about “constant tension” training, but it
each rep would cover a shorter distance), certainly strengthens their case, especial-
which is a good indication that relative ly for exercises such as barbell triceps ex-
load is higher and that you’re closer to tensions or pec flyes, where it’s hard to
failure (6). This may not be a sexy insight keep tension on the target muscle if you
or explanation, but it’s possible that the lock out each rep. However, shortening
partial-ROM group built more muscle the ROM may not provide an advantage
because the study was set up in a man- for many machine or cable exercises that
ner that simply allowed them to train allow for constant tension through the
harder than the full-ROM group could. entire range of motion.
A similar study by Pinto et al (9) tested
60
If training for hypertrophy, training through the middle of the ROM instead of through a
full ROM may allow for greater hypertrophy, perhaps due to increased muscle hypoxia.
If you want to implement this style of

training for hypertrophy purposes, I’d
Next Steps
recommend: A future study designed very similarly
a) Don’t chop off too much of the to this one that measured CSAs instead
ROM. Take the eccentric as low as you of estimating them, and that allowed the
can while still feeling active tension on participants to train to failure instead of
the muscle, and take the concentric as with a standardized rep tempo would
high as you can while still feeling active provide much better evidence regarding
tension on the muscle. They used three- “constant tension” training. I’d also like
eighth reps in this study, but my hunch to see three-fourths reps tested instead of
is that three-fourth reps (knocking off the three-eighths reps used in this study,
maybe the top and bottom one-eighth as that’s what you tend to see in practice.
of the movement) would be even better. It would also be interesting to see exer-
Taking the muscle into a stretched po- cises directly compared where it’s easy to
sition has been shown to independently keep tension on the target muscle (i.e.
increase activation of signaling pathways hamstrings if performing back raises, or
associated with hypertrophy (7), which is biceps if performing preacher curls) ver-
a benefit they potentially missed out on sus exercises where keeping tension on
in this study since the triceps wouldn’t the target muscle is more difficult near
really be stretched at 90 degrees of elbow lockout (i.e. lying triceps extensions or
flexion. Utilizing about a three-fourths pec flyes).
ROM is also how you tend to see “con-
stant tension” training implemented in
the real world.
b) Save this style of training for ac-
cessory exercises if you’re a powerlifter.
With your squat, bench, and deadlift, you
should practice the same way you plan on
competing.
61
References
1. Goto, Masahiro; Hamaoka, Takafumi; Maeda, Chikako; Hirayama, Tomoko; Nirengi, Shinsuke;
Kurosawa, Yuko; Nagano, Akinori; Terada, Shigeru. Partial range of motion exercise is effective for
facilitating muscle hypertrophy and function via sustained intramuscular hypoxia in young trained
men. Journal of Strength & Conditioning Research: June 2017
2. Akagi R, Kanehisa H, Kawakami Y, Fukunaga T. Establishing a new index of muscle cross-sectional
area and its relationship with isometric muscle strength.J Strength Cond Res. 2008 Jan;22(1):82-7.
doi: 10.1519/JSC.0b013e31815ef675.
3. Pinter IJ, Bobbert MF, van Soest AJ, Smeets JB. Isometric torque-angle relationships of the elbow
flexors and extensors in the transverse plane. J Electromyogr Kinesiol. 2010 Oct;20(5):923-31. doi:
10.1016/j.jelekin.2010.05.001.
4. Nishimura A, Sugita M, Kato K, Fukuda A, Sudo A, Uchida A. Hypoxia increases muscle hypertro-
phy induced by resistance training. Int J Sports Physiol Perform. 2010 Dec;5(4):497-508.
5. Tanimoto M, Ishii N. Effects of low-intensity resistance exercise with slow movement and tonic
force generation on muscular function in young men. J Appl Physiol (1985). 2006 Apr;100(4):1150-
7. Epub 2005 Dec 8.
6. Helms ER, Storey A, Cross MR, Brown SR, Lenetsky S, Ramsay H, Dillen C, Zourdos MC. RPE
and Velocity Relationships for the Back Squat, Bench Press, and Deadlift in Powerlifters. J Strength
Cond Res. 2017 Feb;31(2):292-297. doi: 10.1519/JSC.0000000000001517.
7. Russ DW. Active and passive tension interact to promote AKT signaling with muscle contraction.
Med Sci Sports Exerc. 2008 Jan;40(1):88-95.
8. 0.155 × (relaxed triceps muscle thickness × relaxed arm circumference) + 0.134 = triceps CSA
9. Pinto RS, Gomes N, Radaelli R, Botton CE, Brown LE, Bottaro M. Effect of range of motion
on muscle strength and thickness. J Strength Cond Res. 2012 Aug;26(8):2140-5. doi: 10.1519/
JSC.0b013e31823a3b15.
62
Myofascial Release Increases
Range of Motion, but Does It
Enhance Acute Strength?
Study Reviewed: Higher Quadriceps Roller Massage Forces do
Not Amplify Range-of-Motion Increases or Impair Strength and
Jump Performance. Grabow et al. (Published Ahead of Print)
BY MIC HAE L C . ZO URD O S
A
s you look around in your gym, types of myofascial release are foam-rolling
you’re almost guaranteed to see or roller massage (RM), which involve us-
someone engaging in some form ing a foam tube or a plastic cylinder, respec-
of “self-myofascial release.” The common tively, to massage muscles prior to exercise.
63
KEY POINTS
1. Myofascial release can be implemented via foam-rolling (roller made of foam) or
roller massage (hard plastic roller).
2. Roller massage at low applied forces can improve ROM without positive or negative
acute changes in strength.
3. Since roller massage does not improve strength, it is not a requirement for a warm-
up; however, if mobility is an issue for a specific person, then roller massage may
be advisable in addition to dynamic stretching to improve ROM without decreasing
performance.
However, does myofascial release actually the quadriceps (from patellar tendon up
increase performance when used as part to the hip crease and back) every four
of a warm-up? And at what pressure or seconds. Active and passive ROM were
“force” should the roller be applied? This tested between each set of RM. Finally,
study examined if low (RMlow), moder- all outcomes measures were re-assessed
ate (RMmod), and high (RMhigh) force twice more, once immediately follow-
RM of the quadriceps could increase ing the last set of RM, and again fol-
acute knee joint range of motion (ROM) lowing 10 minutes of rest. As expected,
or lower body strength and power per- both active and passive range of motion
formance. In a crossover design, 16 males increased significantly by an average of
(n=8, age=27) and females (n=8, age=26) 7.0% [p=0.03, effect size (ES)=2.25] and
completed the study composed of three 15.4% (p<0.001, ES=3.73) respectively,
testing sessions. During each session, the across all RM forces with no significant
individuals performed a five-minute cy- difference between conditions. Howev-
cling warm-up followed by tests of active er, measures of performance (i.e. DJ or
and passive knee joint ROM, single-leg MVIC) were not significantly affected
drop jump (DJ) height, and knee flexion either positively or negatively. Important-
and extension maximal voluntary iso- ly, ROM increase occurred regardless of
metric contraction (MVIC) force. These the force applied by RM. Therefore, this
tests were all repeated following 10 min- study demonstrated that RM (common-
utes of rest. Next, subjects performed ly described as foam rolling) causes large
RM for 3 sets of 60 seconds at one of acute increase in ROM, even at low forc-
the three pressures (RMlow, RMmod, es, but does not improve or harm acute
or RMhigh). During each 60-second strength performance.
set, the participants completed a roll of
64
TAB LE 1 : SUBJE C T C H A RAC TE RIS T I C S
Males
subjects (years) (cm) (kg) Experience
Resistance or aerobic, currently

8 27±5 178±5 87±9 training 3 times per week for 20
minutes each time
Females
subjects (years) (cm) (kg) Experience
Resistance or aerobic, currently

8 26±2 170±4 69±8 training 3 times per week for 20
minutes each time
Subjects characteristics from Grabow et al. 2017 (1).
Hypotheses
Purpose and Research
The authors hypothesized that RM at
Questions all applied forces (low, moderate, and
Purpose high) would produce improvements in
The purpose of the reviewed study was to ROM without affecting performance.
examine if performing RM on the quad- Further, it was hypothesized that higher
riceps at low, moderate, and high forces applied forces (RMhigh and RMmod)
acutely increased active and passive knee would produce greater increases in ROM
joint ROM, lower body strength, or drop than lower applied forces (RMlow).
jump performance.
Research Question 1 Subjects and Methods
Does RM acutely improve ROM, and
Subjects
are changes in ROM influenced by the
amount of applied force? There were 16 individuals in this study:
8 males and 8 females. All subjects were
Research Question 2
young, healthy, and physically active in
Does RM affect acute strength and pow- either resistance or aerobic training. To
er performance? If so, do the effects differ be included, subjects had to be current-
based on the amount of force applied? ly performing at least three workouts
65
TABLE 2: BREAKDOWN OF LOAD USED,
AVERAGE FORCE APPLIED, AND RPP IN
EACH CONDITION
Average Rating of
Percentage of Average
Condition percentage of
daily max used force (N) perceived pain
body mass
RMlow 50% 116.7±27.5 15% 3.9/10±0.64
RMmod 70% 160.6±29.4 21% 6.2/10±0.64
RMhigh 90% 205.9±34.3 27% 8.2/10±0.44
RMlow= Roller Massage Low Force; RMmod= Roller Massage Moderate Force; RMhigh= Roller Massage High
Force. Average Force= The average force in Newtons applied in each condition.
per week of at least 20 minutes and have session, subjects did full cycles of RM
no experience with RM. A breakdown while adding weight plates to each side
of these criteria and additional subject of poles sticking out of the roller until a
characteristics are provided in Table 1. maximal value of “10” on the 0-10 rat-
Familiarization and Load/Force De- ing of perceived pain (RPP) score was
termination reached following one 4-second roll of
the quadriceps. This was done to calcu-
Subjects completed the study over four
late the weight to be used for each ses-
visits to the laboratory, with the first vis-
sion. Whatever the subjects recorded as a
it serving to familiarize the individu-
10/10 RPP was the daily “max” roll, then
als with the testing procedures, and the
50% of that max was used as the load for
three subsequent visits to test a different
RMlow, 70% was used for RMmod, and
condition (i.e. RMlow, RMmod, or RM-
90% was used for RMhigh. The investi-
high). At the beginning of each testing
gators also calculated the average force
66
applied by the RM in each condition, before again testing all five measures, ex-
and expressed that force both in absolute cept only one set of MVIC tests was done
terms (Newtons) and as a proportion of this time. Subjects then performed 3 sets
the subjects’ body mass. Further, subjects of 60 seconds of RM at either low, moder-
rated the average RPP during each ses- ate, or high applied force (whatever con-
sion, which resulted in average RPPs of dition they were doing that specific day).
3.9, 6.2, and 8.2 out of 10 in RMlow, During each 60-second set, a full roll of
RMmod, and RMhigh, respectively. This the quadriceps was done every 4 seconds;
information can be seen in Table 2. thus, 15 rolls were completed in each set.
There are also many implement vari- Knee flexion and extension ROM and
ations for myofascial release. The RM DJ were tested between each RM set.
used in this study was made by Ther- A post-test of all outcomes (again with
aband®, and the roller itself was made only one MVIC test for both flexion and
of plastic with foam wrapping around extension) was completed immediately
it. Thus, the roller itself was plastic, but following the third set of RM. Finally,
foam surrounded it; to be classified as all tests were completed once more after
foam rolling, the roller itself would have 10 minutes of rest. A complete depiction
to be made of foam. This important dis- of the methods is displayed in Figure 1.
tinction is why the present study uses the
term RM.
Testing Session Protocol
Findings
Active and Passive ROM
Upon arriving to the laboratory for
each testing session, subjects cycled for Active ROM increased significant-
five minutes at a low intensity, then test- ly across all conditions from pre-testing
ed all outcome measures, which included to immediate post-test (+7.0%, p=0.029,
five total measures: ES=2.25) and 10 minutes after the in-
tervention (+6.9% p=0.026, ES=2.38),
1. Active knee flexion ROM
with no differences between conditions.
2. Passive knee flexion ROM Similarly, passive ROM also increased at
3. Two single-leg DJs both the immediate post-test (+15.4%,
4. Two knee extension MVICs p<0.001, ES=3.73) and the 10-minute
post intervention test (+11.9%, p<0.001,
5. Two knee flexion MVICs ES=2.90). Additionally, there was a
The MVIC tests measured both total small ES (0.43) in favor of RMlow ver-
force and force during the first 200 ms sus RMmod and a moderate ES (0.55) in
(F 200) of exertion. favor of RMlow versus RMhigh for in-
Next, subjects sat quietly for 10 minutes creases in passive ROM from pre-test to
67
FIGURE 1: DISPLAY AND TIMELINE OF
TESTING DAY PROCEDURES
st
t te r
es e- n fte n
up e-
t pr nt
io a
. o
- pr nd rv
e in ti
ar
m t
ec
o m ven
W Firs S Int
e
10 ter
10 MINUTES REST 10 MINUTES REST in
5 minutes Active ROM Active and 60s roller massage (RM1): Active and
passive ROM active and passive ROM, passive ROM
Stationary bicycle Passive ROM
two single-leg DJs Two single leg
at 60-70 RPM Single leg DJ Two single leg
drop jumps 60s RM (RM2): active and drop jumps
Two MVIC knee passive ROM, two
One knee One knee
extensions
extension and single-leg DJs extension and
Two MVIC knew knee flexion MVIC knee flexion MVIC
flexion 60s RM (INT post): active
and passive ROM, two
single-leg DJs, one knee
extension and knee flexion
MVIC
This figure shows the timeline of procedures.
the immediate post-test. These ESs sug- ES=1.74) for knee flexion. Additional-
gest a greater increase in passive ROM in ly, F 200 during knee flexion was 11.8%
RMlow versus the other conditions. lower immediately post-intervention
Drop Jump and Knee Extension/Flex- compared to the first pre-test across all
ion MVIC conditions. For knee extension MVIC,
there was an average decrease in force of
There were no significant changes in
-4.8% from the first pre-test to the sec-
drop jump at any time point in any con-
ond pre-test, with no other changes or
dition or differences between conditions
differences between conditions. This is
(p>0.05).
an interesting finding because knee flex-
Results for MVIC were interesting. ion F 200 actually decreased at post-test;
Specifically, MVIC force was lower at the however, this decrease may have resulted
second pre-intervention test (which oc- from simply performing the test so many
curred 10 minutes after the first pre-test) times and may not have been a result of
across all conditions with no difference the RM itself.
between conditions (-6.0%, p<0.038,
68
Interpretation
The main results demonstrate quite WHEN USING RM, YOU DON’T
clearly that RM is an effective way to
increase acute active and passive ROM NEED TO UNDERGO A LOT OF
without causing a decrease in maximal
strength as measured by MVIC. There PAIN TO EXPERIENCE LARGE
was actually a decrease in knee flexion F
200 (rapidly generated force) at the im-
INCREASES IN ROM. IN FACT,
mediate post-test across all interventions; USING HIGHER FORCES MIGHT
however, it’s quite possible this decrease
was simply due to the fatigue of hav- EVEN BE LESS EFFECTIVE.
ing already performed five knee flexion
MVICs by that point (Figure 1). Addi-
tionally, knee flexion MVIC was lower at
the second pre-test compared to the first discussed the acute mechanistic reasons
pre-test, which also suggests that fatigue for static stretching decreasing perfor-
occurred due to the prior tests, as performance. In short, holding a stretched po-
mance declined before any RM sets oc- sition causes a decrease in stiffness of the
curred. Therefore, it does not seem that musculotendinous unit, which compro-
RM had an effect of any kind on perfor- mises the benefits of the stretch reflex
mance. (4), and longer stretches decrease perfor-
The findings of the present study are mance more than short ones (5). When
consistent with previous research show- you think of foam-rolling or RM, there is
ing no effect of RM on performance. no consistent “holding” of the stretching
Specifically, Halperin et al. (2014) composition (at least not for any significant
pared the impact of static stretching and amount of time); rather, there is a contin-
RM on plantar flexion force and demon- uous rolling motion. Thus, from a mech-
strated that RM allowed subjects to pro- anistic perspective, we wouldn’t expect a
duce a 9.2% greater plantar flexion force performance decrease. However, I would
than they could following static stretch- caution that if RM is used for too long,
ing (2). Indeed, a recent systematic re- it could indirectly harm performance
view concluded that RM and all forms of simply due to fatigue. This theoretical
myofascial release do not have any effects decrease is not for mechanistic reasons
(positive or negative) on acute strength necessarily, but logically, if you spend 20-
performance (3). The results for strength 30 minutes utilizing this technique prior
should not be surprising when you re- to training, fatigue could set in. Addi-
call previous issues of MASS which have tionally, it should be stressed that there is
69
FIGURE 2: THEORETICAL WARM-UP
USING RM FOLLOWED BY DYNAMI C
ST RETCHING
Roller Massage
3x60s
at 3-5 RPP
Dynamic Warm-Up
3+8-12 reps on 5-8 exercises
Duration: 5-10 minutes
Begin Workout
with first lifting exercise
This figure shows a theoretical order of events in a warm-up if using roller massage.
no performance increase following RM,

of this study is that RMlow increased
meaning that the positive reasons that
acute ROM just as much as RMmod
performance is increased after dynamic
and RMhigh. In fact, RMlow actually
stretching (increased core temperature
had effect sizes showing a small to mod-
and specificity) (6), do not seem to oc-
erately greater increase in passive ROM
cur with RM. Therefore, if you choose to
compared to the other conditions. There-
utilize some form of myofascial release to
fore, when using RM, you don’t need to
improve ROM, it’s likely a good idea to
undergo a lot of pain (RMlow=3.9/10
include a short bout of dynamic stretch-
RPP) to experience large increases in
ROM. In fact, using higher forces might
ing (5-10 minutes) afterward to elicit an
increase in performance. even be less effective. Previous research
One of the most important findings from Vigotsky et al. (2015) did not show
70
myofascial release to improve acute knee
flexion ROM (7). However, those au-
thors used foam-rolling and not RM, and RM DOES NOT NEED TO BE USED
the foam rolling was done by the subject.
In the present study, the investigator ad- IN A WARM-UP, BUT 3 SETS OF
ministered the RM to apply consistent
force for all 60 second during a RM set. 60 SECONDS OF RM AT A LOW
Further, Vigotsky et al. (7) used 2 sets
of 60 seconds of rolling, and the present
FORCE WILL LIKELY INCREASE
study used 3 sets of 60 seconds. I point ROM WITHOUT NEGATIVE
this out to demonstrate that even though
Grabow et al. (1) in the reviewed study EFFECTS ON PERFORMANCE.
reported significant increases in knee
joint ROM, the increase may be depen-
dent on the amount of rolling you do and
the implement you use. rolling pressures that cause low-to-mod-
So, ultimately, should you use a form of erate pain levels. So, RM does not need
myofascial release in your warm-up? To to be used in a warm-up, but 3 sets of 60
quote Leonid and Chen (2017), “There seconds of RM at a low force will likely
is no evidence that foam rolling, self-my- increase ROM without negative effects
ofascial release, is effective in improve- on performance. Thus, individuals with
ment of muscle strength or performance low mobility in a certain joint might
and cannot be recommended as a warm- consider RM prior to dynamic stretching
up routine before activities [requiring] if the joint is involved in that day’s train-
strength or enhance performance” (8). ing session. With that in mind, a sample
In that sense, the evidence is clear: My- warm-up guide that involves RM can be
ofascial release does not enhance acute seen in Figure 2.
performance, thus it is not a require-
ment for all individuals in the warm-up.
However, it is equally clear that RM can Next Steps
provide large increases in ROM (6.9- This study was the first to examine
15.4% in this study). Therefore, individ- acute changes due to RM among differ-
uals who may have restricted mobility in ent forces applied; however, different vol-
a particular joint may safely utilize RM umes or durations of RM have not been
to increase ROM without concurrent investigated across low, moderate, and
decreases in performance. Important- high RM forces. So, the next logical step
ly, changes in ROM are seen even with is to replicate the low, moderate, and high
71
1. Roller massage provides large acute changes in ROM.
2. Roller massage can cause increases in ROM without inducing significant pain during
rolling.
3. Strength is not affected positively or negatively in response to roller massage.
4. Myofascial release is not as essential as dynamic stretching as part of a warm-up,
but can be used safely and should precede dynamic stretching if you choose to use
it.
RM forces used presently along with also

comparing different times of application.
For example, new conditions could be
added to examine 4 sets of 45 seconds
versus the 3 sets of 60 seconds used in
this study. In that example, total time of
RM would be equated (180 seconds), but
there would be less total force in each
bout. Similarly, 6 sets of 30 seconds could
be used to achieve the same total time of
RM. However, it is also possible that less
time provides the same benefits, so differ-
ent time applications could be of interest
to future researchers as well. Finally, the
subjects in this study had some training
background, but were not well-trained
and had no experience with RM. There-
fore, future research should also examine
if the dosage or RPP when using RM
needs to be increased as training status
increases or RM experience increases to
continue to see similar ROM benefits.
72
References
1. Grabow L, Young JD, Alcock LR, Quigley PJ, Byrne JM, Granacher U, Škarabot J, Behm DG. High-
er quadriceps roller massage forces do not amplify range-of-motion increases or impair strength and
jump performance. Journal of Strength and Conditioning Research. 2017 May 10.
2. Halperin I, Aboodarda SJ, Button DC, Andersen LL, Behm DG. Roller massager improves range
of motion of plantar flexor muscles without subsequent decreases in force parameters. International
journal of sports physical therapy. 2014 Feb 1;9(1).
3. Beardsley C, Škarabot J. Effects of self-myofascial release: A systematic review. Journal of bodywork
and movement therapies. 2015 Oct 31;19(4):747-58.
4. Nelson AG, Driscoll NM, Landin DK, Young MA, Schexnayder IC. Acute effects of passive muscle
stretching on sprint performance. Journal of sports sciences. 2005 May 1;23(5):449-54.
5. Behm DG, Blazevich AJ, Kay AD, McHugh M. Acute effects of muscle stretching on physical per-
formance, range of motion, and injury incidence in healthy active individuals: a systematic review.
Applied physiology, nutrition, and metabolism. 2015 Dec 8;41(1):1-1.
6. Zourdos MC, Bazyler CD, Jo E, Khamoui AV, Park BS, Lee SR, Panton LB, Kim JS. Impact of a
Submaximal Warm-Up on Endurance Performance in Highly Trained and Competitive Male Run-
ners. Research quarterly for exercise and sport. 2017 Jan 2;88(1):114-9.
7. Vigotsky AD, Lehman GJ, Contreras B, Beardsley C, Chung B, Feser EH. Acute effects of anterior
thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test.
PeerJ. 2015 Sep 24;3:e1281.
8. Kalichman L, David CB. Effect of self-myofascial release on myofascial pain, muscle flexibility, and
strength: a narrative review. Journal of Bodywork and Movement Therapies. 2017 Apr 30;21(2):446-
51.
73
Body Fat Spot Reduction
Isn’t a Myth?
Study Reviewed: Effect of Combined Resistance and Endurance
Exercise Training on Regional Fat Loss. Scotto di Palumbo et al. (2017)
BY E RI C HE LMS
F
or years, educated personal trainers rightly so). There is a sizeable body of liter-
have been telling well-intentioned ature showing “spot reduction” of fat mass
exercisers to stop doing daily 100-rep (losing extra fat adjacent to the muscles be-
sets of crunches and to put that time and ing exercised) does not occur to any greater
energy into nutrition and aerobic training extent than would be achieved by a different
that burns calories more efficiently (and form of exercise resulting in similar caloric
74
KEY POINTS
1. This study stands in contrast to previous research showing that localized fat loss
adjacent to trained muscle does not occur. No study stands on its own, especially
those with small sample sizes. It’s possible the unique findings in this study are
due to statistical chance or measurement validity. However, it’s also possible the
unique feature of this study – aerobic training performed after resistance training –
produced the localized fat loss.
2. For MASS readers, these results may be applicable for weight class-restricted
athletes or physique competitors attempting to reach lower levels of body fat. As
one gets leaner, lean mass losses increase, which may occur in part due to the
difficulty in mobilizing “stubborn body fat” for fuel. Thus, performing aerobic training
after resistance training for specific regions (gluteal, lower abdominal, hip, and
quadriceps fat seem to be the culprits depending on sex and individual genetics in
most people) may be a viable strategy to aid fat loss at lower body-fat levels.
3. However, caution is advised when implementing this strategy, as excessive aerobic
exercise can interfere with recovery, performance, and muscular adaptations to
resistance training. Cardio done in excess when calories and body fat are low may
do more to harm your physique than help it.
expenditure (2, 3, 4, 5, 6, 7). However, this Conversely, LOWER lost more fat mass in
study stands in contrast to previous find- their lower limbs (-11.5 ± 8.2%) compared
ings. Inactive women were split into two to their upper limbs (-2.3 ± 7.0%; p = 0.02).
groups: one that performed upper body Likewise, LOWER gained more lean mass
resistance training followed by lower body in the lower limbs (+8.4 ± 5.8%) compared
cycling (UPPER, n = 8), and a group that to their upper limbs (-2.7 ± 5.0%, p < 0.01),
performed lower body resistance training yet no differences between upper and low-
followed by upper body cycling (LOWER, er limb lean mass changes were detected in
n = 8). Both groups performed the same UPPER.
number of exercises, sets, and repetitions at
the same relative intensity with the same
rest periods. They both performed aerobic Purpose and Research
training after strength training for 30 min-
utes at 50% VO2max, three days per week
Questions
for 12 weeks. Regardless of similar total fat Purpose
mass losses, UPPER lost more fat mass in The purpose of the present study was
their upper limbs (-12.1 ± 3.4%) compared to examine the effect of combined cir-
to their lower limbs (-4.0 ± 4.7%; p = 0.02). cuit-based resistance training followed
75
TABLE 1: SUBJECT CHARACTERISTICS
Variable Upper (n=8) Lower (n=8)
Age (year) 32 ± 4 30 ± 4
Height (m) 1.63 ± 0.04 1.64 ± 0.09
Body mass (kg) 70.3 ± 7.0 71.7 ± 8.7
BMI (kg/m2) 27.7 ± 2.3 27.4 ± 1.9
VO2max (mL*kg*min-1) 26.4 ± 2.7 26.1 ± 3.0
Subjects’ characteristics from Scotto di Palumbo et al. 2017 (1).
by steady state endurance exercise, per- study. (Inactivity was defined as less than
formed separately in different body re- one hour per week of physical activity.)
gions (lower body resistance training Specific subject characteristics are pro-
combined with upper body cardio), on vided in Table 1.
body composition, with specific regard to Training Protocol
fat-mass distribution.
A 12-week, machine-based resistance
Hypothesis: The authors hypothesized
training program was performed three
that the combination of exercise types
days per week by both groups. Resis-
performed in different bodily regionstance training began after a ten-minute
would likely induce diverse effects on re-
warm-up. While it was stated that resis-
gional body composition. tance training was performed in a circuit
fashion, upon reading the full text, it was
apparent that three successive sets were
Subjects and Methods performed for each exercise, and then the
Subjects entire process (which I suppose could be
There were 16 inactive females with considered a circuit) was repeated. Thus,
BMIs between 23 and 30kg/m2 and ages my best guess is that three sets were per-
between 25 and 40 who completed this formed on the same exercise before mov-
76
TABLE 2: RESISTANCE
TRAINING PROTOCOL
Variable Upper (n=8) Lower (n=8)
Chest Press, Low Row, Arm Curl, Gluteus Machine, Seated Leg Curl, Abductor
Exercises Machine, Leg Extension, Adductor Machine
Deltoids Machine, Triceps Machine
Rest period 30 seconds between sets 30 seconds between sets
Tempo Maximal intended concentric velocity Maximal intended concentric velocity
3x10x60% 1RM, performed twice 3x10x60% 1RM, performed twice

Scheme
(6 total sets per exercise) (6 total sets per exercise)
ing to the next, then once all five exercises so I assume immediately after), the par-
were completed, the entire process was re- ticipants performed low-intensity, steady
peated again. While no specific progres- -tate cardio at matched intensities. The
sion plan was stated, they did specifically UPPER group performed 30 minutes of
state that each repetition was performed arm cycling at 50% VO2max, while the
explosively at maximum intended con- LOWER group performed lower body
centric velocity, and the training sessions cycling at the same intensity and dura-
were supervised by an exercise specialist. tion.
Thus, even though the load, sets, and reps Aerobic and Resistance Training Per-
did not change, maximum effort was giv- formance
en on each repetition, which can be con-
One-repetition maximum testing
sidered a form of progression (or at least
(1RM) was performed for each exercise
intent to progress). The known details of
in both groups at the start and end of the
the training utilized in the intervention
training protocol. However, as this was
period are provided in Table 2.
not a variable of interest, 1RM strength
Following resistance training (it was comparisons were not made within group
not indicated how soon after completion, pre to post, or between groups; no pre or
77
post test means or standard deviations Neither group lost a significant amount
were provided. Similarly, VO2max was of total body mass, largely due to vari-
tested at the start of this study with an ability between individuals; however,
incremental exercise test, but was not re- there was a moderate within-group effect
tested, as the researchers were not inter- size (ES) change in UPPER (ES=-0.68),
ested in fitness outcomes. but the between-group ES was trivial.
Dietary and Activity Control Both UPPER (p =0.05, ES=-0.32) and
LOWER (p =0.04, ES=-0.20) lost sig-
Participants were asked to maintain
nificant total fat mass without a signif-
normal dietary and activity patterns. This
icant or meaningful difference between
was confirmed with four-day food logs
groups (p=0.75, ES=0.15). Neither group
and physical activity questionnaires ad-
gained significant total lean mass, but
ministered at the start, mid-way point,
both groups had a small ES change in to-
and conclusion of the study. Participants
tal lean mass and relatively low (but not
who altered their nutrition or activity
significant) p-values.
were excluded from analysis.
However, both within- and be-
Body Composition Analysis
tween-group differences were found in
Total body mass, fat mass, and lean lower and upper limb fat mass and lean
mass of the upper limb, lower limb, and mass. The only variable that was not statis-
trunk were measured by dual-energy tically significant when comparing limbs
X-ray absorptiometry (DXA) scans at was lean mass gain in UPPER group for
the start and finish of the study. Addi- the upper limbs. However, a moderate ES
tionally, skinfold thickness was measured change did occur, and the change nearly
at the triceps and anterior thigh at the reached significance (p=0.06, ES=0.54).
beginning and end of the investigation. Likewise, for skinfold thicknesses, there
was a greater decrease in the anterior thigh
skinfold thickness in the LOWER group
Findings compared to the UPPER group, and
Dietary and Training Compliance compared to their within-group change
in triceps skinfold thickness. Similarly, the
No significant nor meaningful chang-
same outcome was observed for the tri-
es occurred in the energy intake of either
ceps skinfold thickness reduction in the
group from pre- to post-testing. Addi-
UPPER group compared to the LOWER
tionally, participants who did not com-
group and their own anterior thigh skin-
plete at least 85% of all training sessions
fold thickness. A visual schematic of lean
were excluded from analysis.
and fat mass changes within and between
Body Composition groups is shown in Figures 1 and 2.
78
FIGURE 1: LEAN MASS CHANGES IN
UPPER AN D LOWER GROUPS
20
Upper
* § * Lower
15
10
LM % of change
-5
Arms Legs Trunk Whole body

-10
* indicates a significant between-group difference, and § indicates a significant within-group difference.
is actually quite surprising, as all the pre-

Interpretation vious research I’m aware of on this topic
The primary finding of this study is is in opposition to this finding (2, 3, 4,
that, in contrast to previous research, lo- 5, 6, 7). There are essentially two ways of
calized fat mass loss specific to the region looking at this outcome: 1) the findings
of the body that was resistance-trained are incorrect for some reason or, 2) the
occurred, which was significant and findings are correct, due to a unique as-
meaningful when comparing regions pect of the training protocol compared to
within groups and between groups. This prior research.
79
FIGURE 2: FAT MASS CHANGES IN
UPPER AND LOWER GROUPS
Arms Legs Trunk Whole body
-2
-4
FM % of change
-6
-8
-10
-12
-14
Upper
* * Lower
-16 § §
* indicates a significant between-group difference, and § indicates a significant within-group difference.
Let’s explore both possibilities in depth. hypothesis. It is not like the LOWER
First, it is certainly possible that the group lost more lower limb than upper
findings are due to chance. This is a study limb fat while the UPPER group didn’t
of a rather low sample size, and it’s bound lose more upper limb than lower limb fat
to happen that some findings are incorrect (or vice versa). Rather, the outcome was
simply due to statistical odds. However, I very similar between and within groups,
highly doubt that is the case in this study, as you’d expect if the hypothesis was cor-
as the findings are so consistent with the rect. Another possibility as to why these
80
findings might be misleading is due to
the way they were measured.
Believe it or not, site-specific reduc-
IN CONTRAST TO PREVIOUS
tions in skinfold thickness were observed
in another 12-week resistance training
RESEARCH, LOCALIZED FAT
protocol in the trained limb compared MASS LOSS SPECIFIC TO
to the untrained limb (5). However, they
also assessed fat mass changes in each THE REGION OF THE BODY
limb with MRI, and found no significant
difference in fat mass changes despite the THAT WAS RESISTANCE-
decrease in subcutaneous tissue thickness.
It is thought that this change in skinfold
TRAINED OCCURRED, WHICH
thickness may be due to geometrical fac-
tors secondary to hypertrophy of the un-
WAS SIGNIFICANT AND
derlying muscle (3); meaning, the muscle MEANINGFUL WHEN COMPARING
growth shifted the position of the sub-
cutaneous fat at the skinfold site in such REGIONS WITHIN GROUPS
a way that it was lower when measured
(but in actuality there was not a local re- AND BETWEEN GROUPS.
duction in fat mass, just position). Unlike
MRI, where a cross-sectional image “slice”
is analyzed by a researcher, DXA scans
use equations to calculate body composi- to realistically entertain the possibility
tion based on certain assumptions which that spot reduction is possible and that it
are affected by changes in body segment was achieved in this study due to its spe-
cific protocol. The only meaningful dif-
thicknesses (8). Therefore, it’s certainly a
possibility that these findings are due to ference in this study compared to previ-
measurement validity issues. ous investigations was the combined use
However, taking this position with of resistance and aerobic exercise.
complete certainty is problematic, as two Thus, we need to speculate as to how this
of the previous studies that found no spot could mechanistically make a difference.
reduction effect also used DXA to ana- Most likely, the issue is blood flow. It has
lyze changes in local fat mass (6, 7). For been hypothesized that fat mobilization
this reason, it would be inappropriate to is hampered to some degree when there
dismiss the findings of this study purely is poor blood flow delivery to adipose
based on the body composition analysis tissue (9). Likewise, it has been demon-
tool used. All of this means that we have strated that exercising muscle increases
81
1. This is the only study to ever show that spot-reduction is possible; thus, its results
should be interpreted with caution.
2. It is possible that performing steady-state cardio after resistance training could
result in fat mass reduction proximal to the trained muscle due to enhanced blood
flow, which could be useful for avoiding lean mass losses at the tail end of a diet
when “stubborn fat” remains.
3. If you decide to try to implement this protocol, make sure you refer to the video
series in the present issue and in last issue and read our previous articles (here and
here) on the potential downsides of concurrent aerobic and resistance training so
you can implement strategies to minimize interference.
blood flow to nearby adipose tissue (10).

Thus, it is plausible that muscular work
Next Steps
does indeed increase the mobilization of First, let’s be cautious before we confi-
local adipose tissue stores to a greater de- dently accept these findings as fact. This
gree than adipose tissue stores in other is one study, and it is a low sample size
areas of the body. But, why haven’t pre- cohort with less-than-ideal measure-
vious spot reduction studies resulted in ment tools, so it is possible these findings
the same outcome as the present study? are erroneous. But, as I said before, there
Well, just because fat is mobilized doesn’t is a distinct possibility they are not. That
mean it’s then oxidized and “burned off.” means we need to do two things before
After entering the bloodstream, if fat is we start doing cardio after hip thrusts
not burned off, there is nothing to pre- and leg raises on the daily. First, we need
vent it from being stored again. However, to replicate this study with a larger sam-
if one was to perform low-intensity aer- ple size of well-trained lifters who are
obic exercise (which predominantly uses reasonably lean (who might not have ad-
fat for fuel) after getting these “locally ipose tissue blood flow issues), using dif-
grown” free-fatty acids into the blood- ferent methods (MRI would be a good
stream, they would likely be used to fuel choice). Then, if the results are replicat-
this activity. Therefore, it’s possible that ed, we need a ton of applied research to
the key factor in realizing spot reduction assess how large the effect is in athletes
in this study was the performance of car- looking to reach lower body composition
dio after training to burn off the fat that levels (because honestly, spot reduction is
was mobilized. not something you need to worry about
when you have a lot of body fat every-
82
where). We would also need to assess
whether spot-reduction is worth the po-
tential downsides of performing a lot of
steady state cardio (see the video series in
this issue).
83
References
1. Scotto di Palumbo, A., et al., Effect of combined resistance and endurance exercise training on re-
gional fat loss. J Sports Med Phys Fitness, 2017. 57(6): p. 794-801.
2. Gwinup, G., R. Chelvam, and T. Steinberg, Thickness of subcutaneous fat and activity of underlying
muscles. Annals of Internal Medicine, 1971. 74(3): p. 408-411.
3. Krotkiewski, M., et al., The effect of unilateral isokinetic strength training on local adipose and
muscle tissue morphology, thickness, and enzymes. Eur J Appl Physiol Occup Physiol, 1979. 42(4):
p. 271-81.
4. Katch, F.I., et al., Effects of Sit up Exercise Training on Adipose Cell Size and Adiposity. Research
Quarterly for Exercise and Sport, 1984. 55(3): p. 242-247.
5. Kostek, M.A., et al., Subcutaneous fat alterations resulting from an upper-body resistance training
program. Med Sci Sports Exerc, 2007. 39(7): p. 1177-85.
6. Ramirez-Campillo, R., et al., Regional fat changes induced by localized muscle endurance resistance
training. J Strength Cond Res, 2013. 27(8): p. 2219-24.
7. Vispute, S.S., et al., The effect of abdominal exercise on abdominal fat. J Strength Cond Res, 2011.
25(9): p. 2559-64.
8. Lee, S.Y. and D. Gallagher, Assessment methods in human body composition. Current opinion in
clinical nutrition and metabolic care, 2008. 11(5): p. 566-572.
9. Frayn, K.N., Regulation of fatty acid delivery in vivo. Skeletal Muscle Metabolism in Exercise and
Diabetes. 1998, Springer. p. 171-179.
10. Stallknecht, B., F. Dela, and J.W. Helge, Are blood flow and lipolysis in subcutaneous adipose tissue
influenced by contractions in adjacent muscles in humans? Am J Physiol Endocrinol Metab, 2007.
292(2): p. E394-9.
84
Stretching:
An Undeserved Bad Rap
Study Reviewed: Influence of Chronic Stretching on Muscle
Performance: Systematic Review. Medeiros et al. (2017)
BY G RE G NUC KO LS
W
ithin the sports science com- stretch before exercise to reduce injury
munity, it has become trendy risk, though there’s not actually strong
(for good reason) to pooh-pooh evidence that static stretching helps keep
static stretching before lifting. People you safer (2). Furthermore, there is good
85
KEY POINTS
1. The studies in this review found mixed results, with half showing that chronic
stretching doesn’t affect muscle performance, and half showing that chronic
stretching increases muscle performance. Crucially, however, none showed that it
decreased muscle performance.
2. The studies that examined the effects of stretching on dynamic tasks tended to
show benefits more consistently than the studies examining isometric tasks. This
may be due to stretching’s ability to alter the stiffness of the muscle-tendon unit.
3. Stretching seems to be a no-risk, small-to-moderate reward strategy to increase
strength in the long run, as long as it’s not performed directly before a training
session.
evidence indicating that static stretching beneficial effect), while beneficial effects
before exercise may acutely decrease per- were more consistent for various dynam-
formance (3). ic tasks (12 out of 18 studies found a
Unfortunately, people have taken the beneficial effect). Notably, no studies re-
recommendation against pre-exercise ported negative effects. Therefore, adding
stretching and misinterpreted it to be a stretching to your training program may
recommendation against all stretching. lead to larger strength gains with no real
This sort of black and white thinking – downside.
stretching must either be good or bad,
with no middle ground – is almost al-
ways misguided, including here. Purpose and Research
This systematic review set out to uncov- Questions
er the long-term effects of stretching on The purpose of this systematic review
muscle performance, including dynam- was to identify the long-term effects of
ic tasks with a stretch shortening cycle, stretching on various measures of muscle
isometric muscle strength, and isotonic performance.
muscle strength. Of the 28 studies that
met the inclusion criteria, 14 identified
beneficial effects of stretching on mea- Subjects and Methods
sures of muscle performance, while none
found detrimental effects. In general, Subjects
beneficial effects weren’t seen for isomet- This review drew from a large group of
ric strength (2 out of 10 studies found a studies examining the effects of stretch-
86
ing on muscle performance. As such, it
included studies on both men and wom-
en, people aged 18-40 years, and people OF THE 28 STUDIES ANALYZED,
of all training statuses.
Methods
14 OF THEM FOUND THAT
The exclusion criteria for this system- CHRONIC STRETCHING HAD
atic review (the rules to determine which
studies to ignore) were as follows: BENEFICIAL EFFECTS ON
1. The study examined people with MUSCLE PERFORMANCE.
some sort of disease or dysfunction.
2. The study lasted for fewer than 3
weeks or 12 sessions.
3. The participants of the study were ficial effects on muscle performance.
younger than 18 or older than 40 Seven studies examined the effects of
years old. chronic stretching on dynamic perfor-
4. The study didn’t include a stretching mance involving the stretch shortening
intervention. cycle. Of the seven, four found positive
5. The study didn’t include an assess- effects for all variables measured, one
ment of muscle performance. found some positive effects for one mea-
sure (counter-movement jump) and no
The 28 studies that were included were
effects for others (drop jumps from var-
too heterogeneous to conduct a meta-anal-
ious heights), and two found no effects.
ysis, so the authors opted for a systematic
review instead. They split the studies into Ten studies examined the effects of
three groups, based on the type of mus- chronic stretching on isometric strength.
cle action studied: dynamic tasks involv- Of the ten, eight found no effect of
ing the stretch shortening cycle, isometric stretching on isometric strength, while
contractions, and isotonic contractions two reported a beneficial effect.
(dynamic contractions without the stretch Thirteen studies examined the effects
shortening cycle, such as eccentric-only or of chronic stretching on isotonic muscle
concentric-only contractions). performance. All 13 studies examined
concentric performance, while only three
also looked at eccentric performance. Sev-
Findings en studies found that chronic stretching
Of the 28 studies analyzed, 14 of them benefited concentric performance, while
found that chronic stretching had bene- six found no effect. Chronic stretching
87
FIGURE 1
Overall Dynamic with SSC Isometric
Benefit
20.0%
No difference No difference No difference
50% 35.7% 80.0% 2
2.5 8
14
14 4.5
Benefit Benefit
50% 64.3%
Concentric Eccentric
No difference
46.2%
6
3
Benefit Benefit
53.8% 100.0%
Proportion of studies showing benefits for long-term static stretching on muscular performance based on type of
muscle action.
led to increased performance in all three muscle-tendon unit (MTU), and po-
of the studies that examined eccentric tentially its ability to add sarcomeres to
muscle performance. muscle fibers. It’s also well-known that
stretching can simply increase stretch
tolerance, but that’s unlikely to increase
Interpretation performance.
Though this review paints a somewhat Stretching decreases the stiffness of the
hazy picture, it seems that the beneficial MTU, and more compliant MTUs have
effects of stretching primarily hinge on been found to more efficiently store ener-
its ability to decrease the stiffness of the gy during eccentric muscle actions to be
88
released during the concentric phase of a
movement (4). This effect would explain
the increase in performance seen in many
TABLE 1
of the studies examining the effects of
stretching on performance involving the Stretching Recommendations
stretch shortening cycle (which makes
use of the MTU’s ability to store ener- Frequency per muscle 2-3 times per week
gy during the eccentric). A decrease in
MTU stiffness would also potentially ex-
Duration per set 10-30 seconds
plain the consistent observed increase in
eccentric performance, if more compliant
Intensity To the point of slight
tendons meant less actual muscular work discomfort
was required for a given eccentric action.
Until you accumulate at
Sets
Sarcomeres are the primary contractile least 60 seconds per
muscle
units of muscle fibers; they’re arranged in
series to allow a muscle fiber to contract
along its entire length simultaneously. experienced benchers added two weekly
It’s theorized that stretching increases pec stretching sessions on top of their
the number of sarcomeres in series, ef- normal training (in sessions separated
fectively making your muscle fibers lon- from their bench training), while one
ger (7). A longer muscle fiber will be able group simply maintained their normal
to shorten faster, more sarcomeres in training without additional stretching.
series should also increase the maximal Both groups tested their touch-and-go
force generating capacity of a muscle, bench press and concentric-only bench
and more sarcomeres in series will theo- press before the start of week 1 and af-
retically shift the optimal joint angle for ter week 8. Neither group increased their
producing maximal torque toward joint concentric-only bench press. Howev-
angles coinciding with longer muscle er, the group that performed two pec
lengths (8, 9). The first two effects of in-stretching sessions per week increased its
creased sarcomeres in series help explain mean bench press from 133.3±24.6kg to
the observed increases in concentric per- 140.6±24.2kg concurrent with a decrease
formance (for high velocity and high in stiffness of the pec MTU, while the
force tasks, respectively). group not performing additional stretch-
ing didn’t experience a significant change
Of the studies included in this sys-
in strength (129.2±14.1kg pre-training,
tematic review, the most applicable for
and 129.9±20.4kg post-training) or a
MASS readers comes from Wilson et al
change in pec MTU stiffness (10).
(5). In this eight-week study, one group of
89
KEY POINTS
Chronic stretching may be an effective way to increase muscular performance, as long
as it’s not performed directly prior to a training session. Don’t expect it to make a huge
difference, but it’s a no-risk, low-to-moderate reward strategy that may enhance the
effectiveness of your training, with the nice added benefit of increasing flexibility.
It’s worth remembering that the results is a nice way to start your day or to wind
of the studies included in this systematic down in the evening. The ACSM recom-
review were pretty heterogeneous. Half mends stretching each muscle 2-3 times
of them indicated that chronic stretch- per week for 10-30 seconds per stretch
ing increased muscular performance, to the point of slight discomfort, accu-
while half of them indicated that chronic mulating 60 total seconds per muscle
stretching didn’t affect muscular perfor- (7). That’s not going to get you to gym-
mance; additionally, very few studies used nast-levels of flexibility, but it’s probably
lifts we care about to assess performance. sufficient for most strength or physique
However, crucially, none of the studies athletes. To ensure that you don’t wind
included in this systematic review indi- up spending an obnoxiously long time
cated that chronic stretching decreased stretching, it’s probably wise to direct
muscular performance. your efforts toward the muscles that feel
As such, I’m not going to promise you the tightest or that are most involved
that chronic stretching will increase your in performance of the lifts you want to
performance, but I am confident in saying improve (quads, hamstrings, adductors,
that there’s potential upside (for strength glutes, pecs, and triceps for powerlifters).
that is; there’s clear upside for flexibility) You can stretch more than that, of course,
with no apparent downside. If stretching but most people don’t want their stretch-
benefits your performance, it’ll probably ing sessions to turn into massive daily
help more with squat and bench press per- time commitments.
formance than deadlift performance, as the
concentric phase of the squat and bench
press are preceded by an eccentric phase. Next Steps
If you add stretching into your training Future studies should specifically ex-
routine, your best bet is to do it at the end of amine the effects of chronic stretching
a training session, or away from your train- performed away from strength training
ing sessions. Nighttime or early morning sessions on powerlifting performance
is convenient for most people; stretching and hypertrophy.
90
References
1. Medeiros DM, Lima CS. Influence of chronic stretching on muscle performance: Systematic review.
Hum Mov Sci. 2017 May 17;54:220-229. doi: 10.1016/j.humov.2017.05.006.
2. Thacker SB, Gilchrist J, Stroup DF, Kimsey CD Jr. The impact of stretching on sports injury risk: a
systematic review of the literature. Med Sci Sports Exerc. 2004 Mar;36(3):371-8.
3. Junior RM, Berton R, de Souza TM, Chacon-Mikahil MP, Cavaglieri CR. Effect of the flexibil-
ity training performed immediately before resistance training on muscle hypertrophy, maximum
strength and flexibility. Eur J Appl Physiol. 2017 Apr;117(4):767-774. doi: 10.1007/s00421-016-
3527-3.
4. Kubo K, Kanehisa H, Fukunaga T. Effects of viscoelastic properties of tendon structures on
stretch-shortening cycle exercise in vivo. J Sports Sci. 2005 Aug;23(8):851-60.
5. Wilson GJ, Elliott BC, Wood GA. Stretch shorten cycle performance enhancement through flexi-
bility training. Med Sci Sports Exerc. 1992 Jan;24(1):116-23.
6. Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain
DP; American College of Sports Medicine. American College of Sports Medicine position stand.
Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal,
and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci
Sports Exerc. 2011 Jul;43(7):1334-59. doi: 10.1249/MSS.0b013e318213fefb.
7. Zöllner AM, Abilez OJ, Böl M, Kuhl E. Stretching skeletal muscle: chronic muscle lengthening
through sarcomerogenesis. PLoS One. 2012;7(10):e45661. doi: 10.1371/journal.pone.0045661.
Epub 2012 Oct 1.
8. De Deyne PG. Application of passive stretch and its implications for muscle fibers. Phys Ther. 2001
Feb;81(2):819-27.
9. Lieber RL, Bodine-Fowler SC. Skeletal muscle mechanics: implications for rehabilitation. Phys
Ther. 1993 Dec;73(12):844-56.
10. You may have noticed and Mike and I say different things about MTU stiffness/compliance and
strength in this issue. We’ll discuss some of the ambiguity concerning optimal MTU stiffness in our
audio roundtable this month. Essentially, it’s clear that increased MTU stiffness tends to be better for
high power/high velocity movements involving the SSC (i.e. sprinting, jumping, etc.); however, tendon
extensibility decreases when muscle forces get very high, so increased tendon compliance (to a degree)
may actually allow the tendon to better potentiate concentric force when muscle forces get very high.
91
VIDEO: Concurrent Training
Attenuates Anaerobic
Adaptations, Part 2
Click to watch Michael's presentation
92
References
1. Hickson, R. Interference of strength development by simultaneously training for strength and en-
durance. European Journal of Applied Physiology. 1980, 45:255-263.
2. Howatson G, Milak A. Exercise-induced muscle damage following a bout of sport specific repeated
sprints. The Journal of Strength & Conditioning Research. 2009 Nov 1;23(8):2419-24.
3. Dolan C. The influence of time-equated training programs on muscle hypertrophy, strength, and
body composition. Florida Atlantic University; 2015.
4. Coffey VG, Hawley JA. Concurrent exercise training: Do opposites distract? The Journal of physi-
ology. 2016 Oct 1.
5. Zourdos MC, Klemp A, Dolan C, Quiles JM, Schau KA, Jo E, Helms E, Esgro B, Duncan S, Meri-
no SG, Blanco R. Novel Resistance Training–Specific Rating of Perceived Exertion Scale Measuring
Repetitions in Reserve. The Journal of Strength & Conditioning Research. 2016 Jan 1;30(1):267-75.
93
VIDEO: Intro to
Periodized Resistance
Training, Part 2
Click to watch Eric's presentation
94
References
1. Rhea, M.R. and B.L. Alderman, A meta-analysis of periodized versus nonperiodized strength and
power training programs. Res Q Exerc Sport, 2004. 75(4): p. 413-22.
2. Harries, S.K., D.R. Lubans, and R. Callister, Systematic review and meta-analysis of linear and un-
dulating periodized resistance training programs on muscular strength. J Strength Cond Res, 2015.
29(4): p. 1113-25.
3. Williams, T., et al., Comparison of Periodized and Non-Periodized Resistance Training on Maximal
Strength: A Meta-Analysis. Sports Med, 2017. Epub ahead of print.
4. Helms, E.R., et al., Recommendations for natural bodybuilding contest preparation: resistance and
cardiovascular training. Journal of Sports Medicine and Physical Fitness, 2015. 55(3): p. 164-78.
5. Zourdos, M.C., et al., Modified Daily Undulating Periodization Model Produces Greater Perfor-
mance Than a Traditional Configuration in Powerlifters. J Strength Cond Res, 2016. 30(3): p. 784-
91.
6. Zourdos, M.C., et al., Novel Resistance Training-Specific Rating of Perceived Exertion Scale Mea-
suring Repetitions in Reserve. J Strength Cond Res, 2016. 30(1): p. 267-75.
7. T. Williams, personal communication, July 26, 2016.
8. Kiely, J., Periodization paradigms in the 21st century: evidence-led or tradition-driven? Int J Sports
Physiol Perform, 2012. 7(3): p. 242-50.
9. Klemp, A., et al., Volume-Equated High and Low Repetition Daily Undulating Programming
Strategies Produce Similar Hypertrophy and Strength Adaptations. Applied Physiology, Nutrition,
and Metabolism, 2016.
95
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Graphics and layout design by Lyndsey Nuckols.
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IS S U E NO .

The MASS Team

Does Periodization Lead to Faster Strength Gains?

Cold-Water Immersion Increases Acute Recovery More Than

Micromanaging the Post-Workout Anabolic Window

Functional Movement Screen Is Not Supported for Injury Prediction

Constant Tension Training: Were the Bros Right?

Myofascial Release Increases Range of Motion, but Does it Enhance

Body Fat Spot Reduction Isn’t a Myth?

Stretching: An Undeserved Bad Rap

VIDEO: Concurrent Training Attenuates Anaerobic Adaptations, Part 2

VIDEO: Intro to Periodized Resistance Training, Part 2

training variables over time instead of non-periodized training, as is often

-2.0 -1.0 0.0 1.0 2.0 3.0 4.0 5.0

riodized training is relatively small, and versus non-periodized resistance training

BY MIC HAE L C . ZO URD O S

Data are Mean ± SD

Purpose and Research Subjects and Methods

Repeat procedures for

EXP1 0 MIN 24 HRS 48 HRS 72 HRS

series graphs with ES included of the bi- Whole-body cryotherapy

lateral counter-movement jump, muscle ES = 0.38

soreness, and CK levels can be seen in

CMJ-2L height (% of baseline)

Overall, CWI was better at improv- 60

ing the rate of recovery across various 0

measures for up to 72 hours following ES = -0.68

a damaging training session compared

to WBC. These findings are important,

as the evidence related to WBC is still 6

emerging, while CWI findings are more 2

established. To illustrate, a meta-analysis 0

of cooling methods on recovery that was

published in 2013 demonstrated a great-

studies using WBC were able to be in- 1000

cluded in that analysis (3). Nonetheless, 800

other recent data from Mawhinney et al. 600

(2017) also shows CWI to be more ef-

fective than WBC (4). 200

for how body cooling may speed recov-

Height (cm) 1.78 ± 0.09 1.81 ± 0.06 1.81 ± 0.05 No

Body mass (kg) 74.3 ± 6.8 76.0 ± 6.8 77.5 ± 6.9 No

BMI (kg/m2) 23.5 ± 2.4 23.1 ± 1.1 23.7 ± 1.6 No

Body fat (%) 17.72 ± 5.3 17.26 ± 5.88 16.96 ± 1.8 No

Subjects’ characteristics from Fabre et al. 2017 (1).

WEEKS 1,4,7 Sets of 10-12 with 70-75% of 1RM

WEEKS 2,5,8 Sets of 8-10 with 75-80% of 1RM

WEEKS 3,6,9 Sets of 6-8 with 80-85% of 1RM

exercises and one session with upper Resistance Training Performance

post-training protein supplementa- absorptiometry (DXA) scans given

tion, but also total protein intakes largely

Validate test and cut-off value in

Randomized controlled trial to test effect of

American football Conflicting 2 pro/1 con

Collegiate level athletes Conflicting 2 pro/2 con

Soccer Moderate 4 con

Military personnel Strong 3 pro (small magnitude)

Derek Miles, guest reviewer

The authors hypothesized:

Subjects and Methods

VO2max (mLkgmin-1) 26.4 ± 2.7 26.1 ± 3.0