Research Review

Holm L. et. al. The effect of protein and carbohydrate supplementation on strength training outcome of rehabilitation in ACL patients. J Orthop Res. 2006 Aug 17; [Epub ahead of print] Related Articles, Links

Patients with anterior cruciate ligament (ACL) injury experience atrophy and weakening of the extensor as well as the hamstrings muscles at the injured leg. Especially, the weakness of the quadriceps muscle has been ascribed to hamper daily physical tasks. The purpose of the present study was therefore to investigate if nutrient supplementation during 12 weeks of conservative rehabilitation strength training could enhance hypertrophy and strength of the quadriceps muscle in ACL-injured patients. Twenty-six ACL-injured men and women were included and randomly distributed into three supplementation groups: Protein + Carbohydrate (PC), Isocaloric-Carbohydrate (IC), or Placebo (PL), ingesting the supplementation immediately after each of 36 training sessions. Determined from images of thigh cross-sections (magnetic resonance imaging) the hypertrophy of the quadriceps muscle differed significantly between groups at the distal part, with the PC group demonstrating the largest hypertrophy. Peak torque of the quadriceps muscle at constant velocity 60 degrees . s(-1) was significantly elevated in the PC group only, and the time to reach peak torque tended to decrease as well only in the PC group. The results from this study demonstrate that restoration of the distal vasti muscle mass and knee extension muscle strength with resistance training is promoted further by protein-containing nutrient supplementation immediately after single exercise sessions. Thus, exercise-related protein supplementation may seem important for surgery-related rehabilitation of skeletal muscle.

My comments: Ok, sort of a random study but I thought it was interesting. When people get injured and have to curtail training, a very common tendency is to cut calories (especially carbohydrates) due to fear of fat gain with reduced training.

However, for a number of reasons that's probably not a good idea. The single most important of which is that the body can't optimally repair itself if you're not in an anabolic state (which means at least maintenance calories if not a bit higher).

This study sort of expands that by looking at the impact of post-workout carbs/protein done after ACL rehab training. For 12 weeks, while performing 3X/week rehab exercise, subjects received either a protein/carb/fat drink (10 grams protein, 7 grams carbs, 3.3 grams fat), a carb drink with identical calories (17 grams carbs, 3.3 grams fat) or a placebo (1.4 gram carbs, 1 gram fat). Although these amounts will seem small to bodybuilders and athletes, it is consistent with other studies on the topic of post-workout nutrition and metabolic effects. The remainder of the diet was uncontrolled but the subjects completed food records (note: this can be notoriously incorrect).

Results wise, the subjects receiving the carb/protein drink showed significantly better gains in terms of muscle mass gains and peak strength compared to either the carb or placebo groups. Based on previous research on the topic, this isn't a surprising finding but it is interesting to note within the context of injury rehab and determining optimal nutrition to support it. The practical applications of this would seem to suggest that at least some attention to post-workout nutrition is important during times of injury and/or rehabilitation. Of course, this is in addition to providing sufficient calories overall to support the healing process. Injuries can take long enough to go away, not providing the body with sufficient nutrients to support the process simply makes it take that much longer.

Exercise of the month:

Incline DB Bench Press

This month I want to discuss the incline DB bench press as the exercise of the month. As above, I mainly chose those over flat bench because flat bench was going to be too much of a pain in the ass to take pictures of.

The incline DB bench targets the pecs, deltoids and triceps (with a lot of accessory muscles like serratus and stuff in there). The height of the bench can vary from fairly low (20-30 degrees above horizontal) to very steep (nearly upright). Generally speaking, the lower the incline, the more pecs will be involved, with delts and triceps becoming more involved as the incline increases. Many lifters use very steep incline DB presses to support their overhead pressing strength. Using DB's versus a barbell imposes more stabilization around the shoulder. In these pictures, a fairly low (30 degree or so) incline was used.

A full standard repetition shown from the back (left column) and side (right column) appears below. As in flat bench pressing, the shoulder blades should be pulled back behind the body and kept there with the chest up; this improves pectoral involvement.

At the start, the elbows are mostly locked and vertical to the floor, the DB's are directly over the eyes. This is key, the DB's should be pressed perpendicular to the floor, not the body (see error below).

As the Db's are lowered, the fade outwards a bit as they come down, the elbows stay underneath the Db's and the forearms are perpendicular to the floor.

In the bottom position, the forearms are still perpendicular to the floor and the DB's and the elbows are slightly below the horizontal plane of the shoulders.

Also note that the lifter's back is basically flat/slightly arched and her butt is on the seat. Many lifters will bridge their butts off the bench or excessively arch, which turns the incline bench into a bastardized flat bench. I call this the flat incline bench and it's done by guys trying to move too much weight.

Not a whole lot else to say about proper performance, but I do want to point out some common mistakes made in this movement.

One of the most common, usually done by newbies who have only done flat benching is to press the weights perpendicular to the body instead of perpendicular to the floor. The finish position of that kind of movement appears below (left picture). It can really only be 'gotten away with' with light weights; do it with anything heavy and the Db's will end up in your lap. This seems to also be a common error with women (who typically aren't heaving big weight around and can get away with it). Compare this finish position to the proper position (right picture) with the weights above the eyes.

Incorrect Start/Finish Position

Correct Start/Finish Position

A couple of bad things can happen on the way down. The first is for the weights to break in towards the lifter's body (left picture) instead of the forearms staying perpendicular. This is shown below next to a proper midpoint position (right picture).

DB's collapsing into body

DB's in proper position

Related to that, the weights can also drift too far out (making the movement into a weird press/flye hybrid). Again, the forearms should remain perpendicular to both the floor and the Db's throughout the movement. The picture we took didn't come out as well as I'd liked so I'm not using it.

As a final error, although some might argue that this makes the exercise more beneficial, some lifters try to bring the DB's too far down. I mention that some think this is beneficial by increasing the range of movement. I consider it an error and dislike the practice since I feel it overstretches the shoulder capsule and doesn't improve pec involvement very much. A too low bottom position is shown (left picture) next to what I consider a proper bottom position (right picture) elbows slightly below the plane of the shoulders).

DB's too low

Proper finish position

Another technique that is often seen is to rotate the Db's towards one another (the bottom of the DB's come towards one another) at the top of the movement; this is usually done in an attempt to hit the 'inner pecs'. I don't see any real benefit to this technique and don't advocate it.

Oh yeah, one last comment: don't slam the DB's together at the top. It's not necessary, it doesn't impress anybody and, if you're unlucky, you will crack off a metal chip which will fall into your eye. Which, if you're deliberately crashing the DB's together to get everyone's attention, serves you right.

Questions and Answers

Q: I'm 47 years old and hope to lose over 100 lbs. I've been obese since my early 20's. I'm really determined to do it this time. I'm really worried I'll have a lot of ugly extra skin when I reach my goal. Is there ANYTHING I can do while losing fat to minimize this? Thank you.

A: The general consensus seems to be that a lot of it is a matter of time, luck and choosing the right parents. Some people seem to have skin that bounces right back with weight loss, others don't. Some have suggested topical vitamin E as well. Beyond that, I'm not aware of anything but I can't say it's something I've looked at in great detail. Hopefully someone getting the newsletter will send me some feedback if they have any more advice.

Q: What are the benefits of ephedrine? Is it only an appetite suppressant? Does it help with fat loss?

What about Creatine? What are the benefits and does it help with fat loss?

A: Ephedrine does a number of things in the body. One is to act as an appetite suppressant and some studies suggest that a majority of its effects on fat loss are due to this effect. However, it also increases thermogenesis (a big word meaning the production of heat, from the burning of calories); some studies suggest that it can correct a metabolic defect that is often present (due to low nervous system activity) in obesity. It is probably one of the most studied products for weight/fat loss and, used correctly, it is safe and effective. However, it does have side effects (because it is a stimulant) including a possibility of increased heart rate and blood pressure (which can be problematic in individuals who have pre-existing cardiac issues). Many also report jitters (again, common with stimulants). It can keep people awake if they take it too late in the day.

Creatine has more potential benefits then I can list here but most of them are related to athletic performance. It's conceivable that, by allowing someone to work harder, it might indirect help fat loss. However, at least one study found that creatine loading slightly decreased muscular fat utilization (the effect was only a couple of percentage points) which would tend to hurt fat loss.

Q: I have a question that I am getting from the the 17 Aug 06 Newsletter, the article about pre-W/O ingestion of sucrose & EAA's- Does this mean that I am to take about 15g (total, not individually) of free-form EAAs (Phenylalanine, Tryptophan, Valine, Threonine, Methione, IsoLeucine, Leucine, Lysine, Hystidine, Arginine) pre workout to get the effects?

Thats seems like an awful lot of ass pain for an "arguable" training effect.

Id rather take a scoop of whey pre-workout or just eat a small easily digestible meal (like eggs and some brown rice) 3 hours prior and take my chances.

A: Yes, that's what it's saying. The studies have used an essential amino acid (EAA) formulation containing 15 grams of EAA (in some specific amino acid pattern, which I imagine is mimicked in the commercial products) with 35 grams of sucrose. Whether this has any actual long-term impact on muscle gains is unknown. At best it's been shown that doing this pre (versus post workout) has an acute impact on protein synthesis when subjects who have been fasted consume it.

The key thing to remember is that folks have been getting big and strong long before any of this stuff was available and they did it by eating good old food (the ultimate anabolic). A meal 2-3 hours out or a scoop of whey 30-60 minutes out probably accomplishes the exact same thing: providing aminos to the muscle when they are needed. And both food and whey taste better than any free form amino acid formulation.