Posts Tagged ‘Strength Training’

Creatine is Going To Pump You Up?

by Tania Houspian, PharmD 2011

Arnold the Body BuilderYou can picture it now: Your New Year’s resolution to get in shape finally realized. You’re on the beach in your Speedo with your muscles glistening in the sun. Ok, maybe that’s not exactly what you are imagining the finished product to look like. Perhaps your New Year’s resolution was geared more towards building bigger muscles and getting in better shape rather than becoming the next World’s Strongest Man (skin bronzer, shaving, and Speedos may not be your style).  Nonetheless, you do want to become more muscular.  If so then creatine is the one supplement all your Google searches for “build more muscle” will undoubtedly produce.  Creatine is possibly the most widely used and talked about dietary supplement in the world of bodybuilding.   It’s definitely something a lot of people come into pharmacies and nutrition stores looking for. The question, of course, is “Does it work?”

Before we answer that question here’s another one: What is creatine?

Creatine is not, I repeat, is NOT a steroid. Creatine is a protein your body (specifically your liver) makes. You also get creatine from foods like meat and fish. The creatine that is made by your liver or that is absorbed from food is then stored in muscles. An average 70kg (154 lbs) person has about 120g of creatine stored in their muscles and metabolizes about 2g of creatine each day (which is easily replenished from your diet or liver).  Creatine PhysiologyIn the muscles, creatine acts as a battery charger.  In this case the battery is your body’s energy stores called ATP.  When muscles use up ATP to perform an action it is converted into ADP. Creatine is able to convert ADP back into ATP, which can once again be used by your muscles to perform actions.  This is a quick and easy way for the body to create more energy (twice as fast as the bodies normal way of deriving ATP from glucose).  Sounds great, right?  The downside is that the creatine is depleted pretty quickly and the body has to go back to breaking down glucose to make more ATP.  So when an athlete takes creatine, their hope is that it will help their muscles maintain the ATP levels for a longer period of time subsequently allowing them to train longer before becoming fatigued.

Aside from increasing the amount of work your muscles can perform before becoming fatigued, there are other theories about how creatine helps build more muscle:

  1. Creatine pulls water into muscle cells via osmosis (remember osmosis from high school chemistry?), helping keep muscle cells hydrated and making your muscles appear rounder and fuller…possibly the origin of the common gym phrase, “Getting swoll”

  2. By delaying the muscles’ use of glucose to generate ATP, creatine also helps delay the creation of lactic acid (a byproduct of glucose use). Lactic acid is what makes your muscles burn and causes you to feel sore the morning after a tough workout (yes, lactic acid is to blame for the “I was just hit by a big rig” sensation).

So far we have discussed theories about creatine’s ability to improve muscle building.  What we really want to know is if any of them have been proven.  The answer is yes and no. Given the popularity of creatine as a workout supplement there have been hundreds of studies done to examine its efficacy and safety. The studies reviewed asked participants to consume 20 Bench Press Strength Traininggrams of creatine supplements a day for five days (called creatine loading). Then the subjects were asked to consume 5 grams of creatine per day for 21 days. Theoretically, this would increase the stores of creatine in their muscles. The participants were then asked to perform various exercises and their results were compared to their pre-supplementation results. The studies show that creatine does help increase body mass and it does help increase endurance in short-duration, high-intensity exercises (they specifically looked at number of bench press reps, leg press reps, and vertical jump height). However, creatine did not help the men in long endurance exercises such as running a 12 mile race (creatine actually hurt test subjects in long endurance exercises, possibly because they were carrying around excess body mass).  Creatine also did not decrease the amount of post-workout soreness reported by the subjects. The amount of soreness felt was the same before using creatine and after the supplementation period.

The Verdict: Creatine is not a wonder supplement.  You can’t take it, go to sleep, and wake up with bulging muscles.  It is, however, something you can take if you are serious about working out as it may help you increase your stamina and strength with specific workouts.

Now to the most important information: Is it safe and are there any side affects?

Initially, there were reports of creatine causing dehydration, cramping, and kidney & liver damage.  Athletes taking creatine were subsequently warned to not work out on hot days and to be cautious of any cramping the experienced.  That sounds pretty ridiculous to us: if you’ve ever worked out hard you know that cramping is Football Trainingbound to happen from time to time.  To test out these claims more studies were done. The main study on this subject was performed on 14 football players who were told to consume creatine for 8 weeks.  They chose football players as the athletes to use as guinea pigs…I mean test subjects…because football is considered a high-intensity, short-duration exercise (which is exactly the kind of activity creatine is supposed to aid in).  During the 8-week time period the athletes’ kidney function, liver function, and over health were closely monitored. Their results regarding creatine efficacy paralleled those of other previous studies showing that body mass increased and the athletes’ abilities to perform high-intensity, short-duration exercises did improve.  As far as toxicity goes, no signs of kidney or liver damage were seen in any of the patients.  In addition, none of the football players became dehydrated or had more cramping than they did at baseline.

Before we go waving our “Creatine is Safe” flag, a few things should be pointed out.  First, the studies were done on healthy, young males.  People who have liver or kidney problems to begin with should not further challenge their organs unless they are Waterunder the close supervision of a health professional.  Studies have not been done with people who have kidney or liver problems so it is hard to say how it may affect them.  Second, all these studies were short term (8 weeks was the longest one performed) so no one really knows the long-term effects of taking creatine.  Many of the problems initially reported with creatine supplementation could have been due to impurities in the creatine supplement people were purchasing thus it’s always important to buy supplements made by a well known and trusted company (i.e. don’t order it off the web from some no name company just because shipping is free).  In addition, be sure to consume plenty of water when using creatine.  Remember that creatine pulls water into your muscles (and out of your body’s circulation).  You need to make sure that you are replacing this displaced water while using creatine to prevent dehydration.

The Final Verdict: If you are serious about working out and are looking for a supplement to provide you with additional stamina to help you strength train for longer periods of time then creatine may be the way to go.  Some things to keep in mind when shopping around:

  1. Most of the studies used creatine monohydrate powder as their creatine source (there are more expensive formulations with fancy names but this formulation seemed to work well in the studies).

  2. No consistent standards were set for the loading phase of creatine use but 20 grams per day (split into 4-5 grams doses throughout the day) for 5 days seemed to be the most common approach. Note, however, that consuming that much creatine is going to upset your stomach.

  3. It was recommended that the average person who wants to gain body mass should supplement with 2-5 grams of creatine per day when working out.

  4. Make sure you’re buying high quality creatine from a reputable manufacturer at a reasonable price.

Now go hit the gym mister.

Body Building


Bemben M, Lamont H. Creatine Supplementation and Exercise Performance Recent Findings. Sports Med 2005; 35 (2): 107-125

Cancela P, Ohanian C, Cuitiño E, et al., Creatine supplementation does not affect clinical health markers in football players. 2008 Sports Med 42: 731-735 .

Dalbo V, Roberts M, Stout J, et al. Putting to rest the myth of creatine dehydration and supplementation leading to muscle cramps. Br J Sports Med 2008 42: 567-573

Herda T, Beck T, Ryan E, et al. Effects of Creatine Monohydrated and Polyethylene Glycosylated Creatine Supplementation on Muscular Strength, Endurance, and Power Output. 2008. The Journal of Strength and Conditioning Research.

Lopez R, Douglas C, McDermott B, et al. Does Creatine Supplementation Hinder Exercise Heat Tolerance or Hydration Status? A Systematic Review with Meta-Analyses. 2009; Journal of Athletic Training. 44(2), 215-223.


01 2010

Winter Training: Preparing for the Slopes

Killer Skiing

by G. John Mullen, DPT 2011

With Thanksgiving behind us and winter weather in full effect, snow has already begun to cap the mountains across America.  With a layer of white powder on the ground, everyone is counting the days until they can escape from work, school or writing anonymous cynical comments on message boards and hit the slopes.  Whether you snowboard, sled, cross-country ski or bare foot ski, with the rush of mountain adrenaline comes the risk for injury.  We’re here to help you train those hard-to-reach, unused muscles for the slopes so that you are prepared for anything the mountain can throw at you.

Stat Fact: Lower extremity injuries were the most common injury in the Utah slopes from 2001-2006 for both snowboarding (~27%) and skiing (~50%).

Little HerculesWhether you’ve looking for exercises to prevent future knee injuries, strengthen your legs for the slopes, or help make that knee pain from that 1960 football injury (quit living in the past) go away, you can utilize the exercises below to strengthen weak muscles and lengthen tight muscles. We’ll discuss some plyometrics and exercises you can use to mimic skiing or snowboarding. Even if you’re as big as Richard Sandrack (see Lil Hercules at left) your bulging biceps and six-pack abs won’t prevent lower extremity injuries…training those targeted muscles will.


There are hundreds of exercises that can be used to train for the slopes.  We are going to talk about the main muscle groups that will prevent injuries and go over our favorite exercises to strengthen these muscle groups.  Unless you’re like hip hop video girl Vida Guerrera, you, like most Americans, may already experience knee or hip pain (or at least feel a little weak when it comes to these joints), due to weak gluteal muscles,.  As stated, there are hundreds of exercises to strengthen these muscles…so we’ve boiled it down to some key moves to get you started:

Overview of Strengthening:

When you first begin these exercises, start with the beginner exercises in your training of  those gluteal muscles.  At the beginning start with 3 sets of 20 repetitions and after two weeks add weight and try 3 sets of 10 repetitions.  After two more weeks add more weight and go 5 sets of 5 repetitions.  After this progressive process, advance to the intermediate exercises and repeat the same amount of repetitions and sets.


1. Clams:

ClamsLie on your side and bend you knees to 90 degrees and your hips at 30 degree with your legs one on top of the other.  Now just lift your top leg open like a clam, brilliant!

Stat Fact: By increasing the amount that your hips are flexed during this exercise (by bringing your knees towards your chest thus changing the angle from 30 degrees to 60 degrees) you change the gluteal muscle you are working, from gluteus medius to gluteus maximus.

2. Bridges:

BridgesLie on your back with your heels on the ground, but your toes in the air (lifting your toes makes sure you don’t use your calves and helps you to better isolate those gluteal muscles!).  Next, lift your lower back and butt off the ground by pushing through your heels.  At this point only your upper back and feet should be on the ground.  Note: a band can be used just above your knees to keep your legs from coming together, but is not necessary.  However, keep your knees apart!

After you’ve mastered double leg bridges, you can advance to single leg bridges or double leg bridges with weights on your hips.

3. Side-lying Leg Raise:

Leg RaiseLie on one side with one leg on top of the other, keep both legs straight and raise your top leg towards the ceiling.  Make sure your leg doesn’t creep forward.  To do so, keep it aligned with your hip or back (you should form a straight line from your shoulder to your hip to your knee to your ankle).

Stat Fact: If done properly, with your leg in correct alignment, this exercise requires the most gluteus medius activation of the exercises without weight.



We’re not talking about your run-of-the-mill forward lunges.  We need to use exercises that are as close to skiing as possible, thus the use of multi-directional lunges.

Transverse Lunge1. Transverse Lunge:

Start with your hands on your hips and both feet facing forward like your feet are facing 12 on a clock.  Now, with one leg take a large step towards 2 o’clock.  Make sure your back foot rises on its toes and you don’t allow your front leg’s knee to come in front of your toes!

2. Lateral Lunge:

Once again, start with your hands on your hips and both feet facing forward like your feet are facing 12 on a clock.  With one leg take a large step towards 3 o’clock.  Lateral LungeMake sure your back foot rises on its toes and you don’t allow your front leg’s knee to come in front of your toes!

To advance the lunges, you can hold weights (or anything that will add extra weight) in your hands or if you’re at a gym you can put a bar on your back.


1. Single Leg Squat:

Single Leg SquatStand on one leg and slowly lower yourself bending at your hip, knee and ankle until you can touch the floor with your middle finger without reaching your shoulder.  Remember to stick your butt out as you come down and try not to let your knee come in front of your toes.  To advance this exercise, you can hold weights in either hand.

2. Single Leg Deadlift:

This exercise is similar to the single leg squat.  Single Leg DeadliftTo begin bend your knee slightly (~10 degrees).  Now bend at your hip and bring your chest towards the floor, reaching with your hand to touch the ground.  To advance the exercise, you can add dumbbell weights in each hand.

Stat Fact: Single leg squats and single leg deadlifts have been shown to have the highest gluteus maximus activation of any non-weighted exercise…buns of steel, here we come!


It is hard to predict what muscles will be tight on each individual, but if we were to grab 10 people off the Red Line subway in Los Angeles and test their muscle flexibility I would bet a liter of cola that 9 of those people have tight hamstrings, piriformis (a muscle in your butt… that’s all you need to know), calves and hip flexors.  What do you say we try and loosen those bad boys up.

Overview of Stretching:

As you move through the stretches outlined below, remember to stretch both legs, completing each stretch twice for 30 seconds or more.  It is hard to overstretch these tight muscles, so the more you do the better.

Hamstring Stretch:

Hamstring StretchLie on your back, grab the back of your thigh of one leg and begin to pull that leg towards the ceiling.  If done correctly, you should feel a stretch in the back of your leg and possibly in your calf.

Stat Fact: It is estimated that 80% of persons suffering from low back pain have tight hamstrings.

Piriformis Stretch:

Piriformis StretchOnce again, lie on your back but this time bend one leg over the other.  Now push your bent leg towards the ground, without lifting your back off the ground.  If done properly, you should feel a stretch in your butt.   You have now officially located your piriformis muscle.

Calf Stretch:

Calf StretchBeing by standing facing a wall with one leg in front of the other. with the leg to be stretched extended behind you.  With your hands on the wall at the level of your head lean forward.  You should feel a stretch in your calf.  The more you lean forward, the more stretch you will feel.  Repeat these same steps on the other side as well.

Hip Flexor Stretch:

Hip Flexor StretchPlace one knee on the ground and lunge forward with the other leg, keeping your back straight.  If done correctly, you should feel a stretch in the front of your leg around your hip on the kneeling leg.  As you push forward with your pelvis, you should feel the stretching increase in this area.


Plyometrics are activities that enable a muscle to reach maximal force in the shortest possible time.  These exercises are meant to be explosive, but need to done carefully and under proper conditions (outlined below):

  • Good landing surface (grass field, suspended floor, rubber mats)

  • Plenty of space

  • Proper footwear (no flip flops)

  • Supervision, it is highly advised to do plyometrics with a training professional (personal trainer, physical therapist)if you are new to the exercises

Since this is a high intensity exercise we will start with one basic exercise as well as some strategies for plyometric training.  First, it is important to complete a proper low intensity warm-up.  Begin with skipping, marching, or jogging. The total amount of time you spend on these activities needs to be strictly monitored.  It is recommended that beginners do a maximum of 80 contacts.  80 contacts simply means each foot should only hit the ground 80 times including the skipping and jogging warm-up.  Anyone doing plyometrics should also include the appropriate amount of rest between exercises (at least a minute per exercise).  Below are a few examples of beginner plyometric exercises that mimic skiing and snowboarding.  We highly recommend doing these beginner exercises with an exercise professional (at least when you’re first starting off…the only thing worse that hurting yourself on the slopes is hurting yourself while training for the slopes).

Forward/Lateral/Diagonal Jumps:

Just as they sound, these jumps are performed with both feet together and you jump either straight forward, to your side or diagonally.  To begin start by jumping, landing and then jumping again.  As you progress you can begin performing multiple jumps in a row.

Now that you know what strengthening, stretching and plyometric exercises to perform, make sure you always warm-up first (at least fifteen minutes of cardiovascular work to get your heart rate elevated and muscles warm).  Perform these stretches exercises every day and the strengthening/plyometrics no more than three times a week.  When you hit the slopes tell Shaun White hello for us.

Shaun White


Distefano, L., Blackburn, J., Marshall, S., Padua, D. Gluteal Muscle Activation During Common Therapeutic Exercises. Journal of Orthopaedic and Sports Physical Therapy.  2009 Jul; 39 (7): 532-540.

Torjussen J, Bahr R. Injuries among competitive snowboarders at the national elite level. Am J Sports Med. 2005 Mar;33(3):370-7.

Wasden CC, McIntosh SE, Keith DS, McCowan C. An analysis of skiing and snowboarding injuries on Utah slopes. J Trauma. 2009 Nov;67(5):1022-6.


12 2009

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