RICE: The End of an Ice Age

Great Blog.

***Athletic Medicine HAS MOVED***

Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” – Gabe Mirkin, MD, March 2014

In 1978, Gabe Mirkin, MD coined the term RICE. Health care practitioners to laypersons are quick to recognize RICE as the ‘gold standard’ treatment option following injury. Followers of my blog know my stance against ice and now there is support from the physician who coined the term. Yes, the very same physician, Dr. Gabe Mirkin, who coined RICE, is now taking a step back. I reached out to Dr. Mirkin and asked for permission to share his story. As you will read below in Dr. Mirkin’s full post, the lack of evidence for cryotherapy is something we must listen to.

ice-for-injuriesThis is a controversial topic. My blog Why Ice and Anti-inflammatory Medication is NOT the Answer sparked a lot of debate. I had…

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Performing a simple body weight squat.


With the winter almost over (Thank God!!!) I figured I would talk about an exercise that is important to do for all of you looking to get that beach body you’re looking for.  The exercise in question is the SQUAT.  For the sake of keeping it simple, I am going to use the un-weighted squat as an example.  The following are the 5 simple steps to performing a squat.

  1. First stand with your head facing forward and your chest held up and out.  I find that facing a mirror either in the gym or at home helps with watching your form.
  2. Widen your stance so that your feet are shoulder width apart or slightly wider than shoulder width apart.  To help keep your balance place your hands out in front of you.
  3. Now you’re going to begin the squat…you’re going to sit down like you’re sitting in a chair.  Keep your head up and facing forward as your body bends forward.  Keep your back slight arched as you descend to the bottom of the movement.  Don’t round your back as this will force you into bad form and have you leaning out over your toes.
  4. Continue to lower your butt down until your thighs are parallel to the floor with your knees over your ankles.  Keep your weight back on your heels.  (We all have different ranges of motion due to body type, physical limitations, and athletic ability so try to get a parallel to the floor as you can.)
  5. Keep your abdomen tight through out the movement.  At the bottom of the movement (in the actual squat position) you are going to push through your heels and drive your body back up to your starting position.  You have just completed the first of the many squats you will do to get your rear end in shape for the swimsuit season…Congratulations…NOW KEEP GOING!!!

If you have never done a squat before keep it simple to start, do 3 set of 8-10 and see how you feel.  Once you get used to the exercise you can add more reps, more sets, add weights, and you can vary your rest time in between sets to add a higher degree of difficulty.  Focus on your form, squatting with bad form can get you hurt.

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Two months ago I underwent surgery to repair damage to my stomach from a ruptured ulcer.  The damage that was done almost killed me and I spent 11 days in the hospital recovering from the surgery.  I have spent the last two months counting the seconds down until I could return to the gym, well today I get my chance to go back.
Due to the surgery I had an 8 inch incis…ion in my abdomen, and I dropped 20lbs.  That being said I will not be able to jump right back into things as if nothing happened.  I need to take some of my own advice, advice I have given out to both friends, gym buddies, and work out partners very often…”TAKE IT SLOW and DON’T PUSH TOO HARD”.  The easiest way to hurt yourself or suffer a major set back is to rush the recovery process.  Yes it has been two months since my surgery, but I know that my body hasn’t fully recovered.  It would be easy for me to start in on a lifting program and feel good doing it for a few days or weeks, but it is very easy to re-injure yourself after a major surgery.  My surgeon knows me very well and knows I am very impatient and anxious to get back to the gym.  He warned me that if I rush things I could end up with a hernia and need more surgery to repair that, which would set me even further back.  Before he would let me leave his office with his clearance to resume fitness activity he made me promise him that I would take it slow and not push to hard.  I made the promise and got the clearance to get back to the gym.
It is now up to me to swallow my pride, check my ego and do exactly what I said I would do.  I need to take the advice of my Dr. and the advice I give out on a regular basis…”TAKE IT SLOW and DON’T PUSH TOO HARD”.  I have to let my body determine the pace of the rehab process; I can’t rush it and risk re-injuring the area.
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I am always looking for things to write about here on Knucklehead Fitness and yesterday it was suggested to me that I do a blog about “OVERTRAINING”.

A lot of you might laugh and say there is no such thing as overtraining, and that you can’t train enough.  Well that is 100% not true.  When I was younger I used to think the same thing.  I would train chest and legs a couple of times a week, and by a couple of times a week, I mean like 4 times a week.  For a little while I noticed minor gains, then I hit a some serious plateaus.  This pissed me off and I tried training twice as hard figuring I wasn’t training hard enough.  At this point I actually started to regress and had some setbacks in relation to the reps and amount of weight I was able to lift.  This was because I was OVERTRAINING.

By definition OVERTRAINING is “A physical, behavioral, and emotional condition that occurs when the volume and intensity of ones exercise routine exceeds their capacity to recover”.  When you overtrain, you stop making progress in your work outs and in some cases can actually begin to lose strength.  Overtraining is a very common problem in relation to weight training, but you can actually over train in other fitness areas as well.  Runners, boxers, MMA fighters, and other athletes often suffer setbacks due to overtraining.

Increases in strength levels and fitness levels are achieved after your body has had a chance to rest and recover after a training session.  This is why you are not supposed to train the same body part two days in a row.  It is often recommended that you take 24-48 hours of rest time before you train the same muscle group again.  This means if you train chest on Monday don’t train that muscle group again until Wednesday or Thursday.  Everyone has their favorite training routine and everyone is different, but rest is still an important part of working out.

Symptoms and Side Effects of Overtraining:





Constant muscle soreness

Constant state of fatigue

Loss of strength

Loss of appetite

Delayed recovery

Unable to complete workouts

Decrease in physical performance

Decrease in aerobic capacity

These are just a few of a long laundry list of issues that can arise from overtraining.  To avoid overtraining make sure you are getting enough sleep, make sure you are eating right (taking in enough of the right kind of calories to match the amount you are burning while working out).  Don’t be afraid to lighten up and reduce the intensity of your workouts or try taking a day off to help your body recover (I know, I know it sounds crazy, but it works and you will benefit from it).  Always remember if these symptoms persist, make sure you go see your doctor because there could be something more serious wrong.

Just remember you are in the gym to improve your overall fitness, strength, and health.  Overtraining is going to set you back and knock you off course.

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The other day I was standing in the gym watching a young kid suck down a Monster Energy drink right before he began his work out and it made me cringe.  As I worked out I continued to notice that all he drank during his work out was that one Monster Energy drink.  At one point I over heard him complain to his friend that he was getting a headache and then he cut his work out short because he said he was fatigued from working out too hard.  I couldn’t help but laugh at him because this kid didn’t even break a sweat during his wicked intense work out (he spent more time playing with his ipod and talking to his friend than he did lifting weights).

The reason for his sudden energy crash was simple… It was due to the Monster Energy drink he sucked down.  Energy Drinks such as Monster Energy contain large amounts of caffeine and sugar.  (I will note that there are sugar free versions of most energy drinks available, but they are just as bad).  The majority of the energy rush you feel after drinking an energy drink comes from the caffeine and sugar.  I am not picking on Monster Energy drink specifically; I am just using it as an example because that is what this kid was drinking.

A typical 16 ounce can of Monster Energy (which is actually a two 8 ounce serving can) contains 54 grams of sugar. One teaspoon of sugar weighs about 4 grams. So one 16 ounce can of Monster energy contains about 13 teaspoons of sugarTry putting that in your coffee and drinking it without throwing up.

Monster Energy does not list Caffeine as a singular ingredient on the Nutrition Label on their can, instead they list it with a group of ingredients they call their “Energy Blend”.  This so called energy blend is made up of 2500mg of this laundry list of goodies: L-carnitine, glucose, caffeine, guarana, inositol, glucuronolactone and maltodextrin.  Caffeine makes up about 160mg of that 2500mg chemistry experiment.  You will notice that guarana is also on that list; guarana contains 2 to 3 times more caffeine than a coffee bean.  So it ends up being a sneaky way to put more caffeine in the drink with out actually saying it on the label.

There are more than a few side effects to these types of energy drinks.  Caffeine can over stimulate your heart and your nervous system, causing an increase in blood pressure and cause seizures and tremors.  When you work out, your body naturally dehydrates as you sweat.  The added caffeine you take in when you drink an energy drink increases the rate of dehydration.

The high sugar content in energy drinks, such as Monster Energy, can cause your energy level to spike to a high level.  Giving you what you think is an energy boost.  Unfortunately that energy boost doesn’t last very long and will soon turn into a severe energy crash.  The sugar in these energy drinks will also lead to the intake of excess calories and weight gain.  This in itself presents a problem since we are at the gym to get in shape and lose weight, not gain it.

Another thing to take into consideration is that the ingredients in the “Energy Blend” can cause issues with medications you may be taking.  A lot of the herbs in these energy drinks do not interact well with certain medications.  We don’t often pay attention to this issue, people just chug the drink and wait for the quick and short lived energy boost.

At the end of the day the best thing to drink before, during, and after your work out is WATER and plenty of it!!!

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Between playing competitive sports and working out for the better part of my adult life I can say with 100% confidence I have done some damage to my body.  I come from an era where stretching wasn’t exactly forced on you or encouraged by your coaches.  Stretching before practice was more of a chance to sit and relax for a bit before the real work started.  By the time most coaches (not all coaches) told you to stretch it was because you already pulled something.  And god forbid you actually took the time to stretch in the weight room before you started lifting weights.  At that time stretching was viewed more as a waste of time and energy than a benefit and help to your body.  The bad habits I learned at a young age continued to follow me through to my adult life.  I never took the time to stretch.

It wasn’t until I started working with a strength and conditioning coach that I learned about all the damage I had been doing to my body over the years.  I don’t want to bore you with a long list of reasons why you should stretch so I will just use one specific example.

I never and I mean never stretched my hamstrings out.  So naturally they were tight and constantly cramping up, whether it was from running or lifting weights.  Along with hamstring issues I also had some lower back issues I was dealing with.  I never would have guessed that the issues I was having with my lower back were related to my hamstrings.

Tight hamstrings can cause the hips and pelvis to rotate back flattening the lower back and causing a wide range of back issues, such as postural problems and sacroiliac joint pain.  When the hamstrings are tight they will pull the pelvis out of its normal position.  This can often cause a pinching of the sciatic nerve or what is commonly known as sciatica.  The pain caused from sciatica will start in the buttock and will radiate down the leg, it can radiate down as far as the foot and toes.

When muscles tighten up the blood has been squeezed out of them and your muscles are working at less than 100 % of capacity and your performance will be down as a result. Sports massage and stretching to improve muscle condition will not only reduce the likelihood of injury but may also improve your performance in the gym, on the track, or playing whatever sport you play.


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Knucklehead Fitness is proud to announce that we will be entering a team to walk in the 23rd annual North Shore Cancer Walk on Sunday June 23, 2013.  The North Shore Cancer Walk is a 10K (6.2 mile) WALK that winds through historic Salem, MA.  Our goal as a team is to raise at least $1000.00 to donate to do our part to help find a cure for cancer.  Team Knucklehead is open to all members of Knucklehead Nation and their friends and family.

The donation fee for each member of Team Knucklehead is $40.00.  Each member of Team Knucklehead will receive a Team Knucklehead 2013 North Shore Cancer Walk t-shirt to wear for the walk.  All donations go to the NorthShoreMedicalCenter.

If you are interested in joining Team Knucklehead please message us with your e-mail address and contact information.

We hope that you will join us on June 23rd and help find a cure for cancer.


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Ok Knuckleheads, Summer is quickly approaching and a lot of you want to be in shape for the beach, the pool parties, and the summer cook outs.  Its one thing to work your upper body (arms, shoulders, and chest) and lower body…but you can’t ignore your CORE.

The CORE refers to the body minus the arms and legs (the abdominal muscles and the oblique muscles just to keep it simple and not get into an anatomy and physiology lesson.)

We all do sit ups and crunches or at least attempt to do them, but PLANKING is a great alternative and supplemental abdominal work out.  By definition PLANKING exercises are isometric exercises that are done in static positions (meaning there is no dynamic range of motion involved in the exercise).

Today we are going to focus on the two most common types of planking exercises: THE FRONT PLANK and THE SIDE PLANK.

FRONT PLANK:  Is done with the body facing the floor in a push up position with the weight of the body is supported by the hands (instead of using your hands to support the body weight, try using your elbows).  To increase the difficulty of this exercise keep one foot in contact with the ground and raise the other foot up and hold it off of the ground for the duration of the exercise.

SIDE PLANK:  Is done with the body facing side ways at a 90 degree angle from the floor.  In the side plank position the weight of the body is supported by one hand (instead of using your hand to support your weight try using your elbow).  To increase the difficulty of this exercise keep one foot in contact with the ground and raise the other foot up and hold it off the ground for the duration of the exercise.

Because there is no motion used during the planking exercise you don’t use a repetition count.  Instead you go by time.  So to start trying holding the front or side plank position for 20 seconds at a time, try this about 5 times.  If you find it easy to do, add 10 seconds and do it 6 times.  Every time it gets easier just add more time and another set.  MAKE SURE YOU KEEP YOUR ABS TIGHT AND YOUR BACK STRAIGHT DURING THE PLANKING EXERCISES!!!

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Are you still scratching your head at the grocery store when trying to choose Healthy foods? Don’t get tricked into buying “low-fat” items that are super high in sugar. Very dark chocolate is super fattening, but contains little sugar– however hard candy, which is marketed as “fat-free” guarantees that you’re consuming more sugar than you can work off, so it all becomes fat anyway. Problem is, nobody wants to spend hours in the supermarket analyzing nutrition labels, so we end up spending hours in the gym instead, working off our supermarket mistakes.


Reach for: Brightly hued fruits and veggies such as carrots, broccoli, sweet potatoes, tomatoes and oranges Romaine lettuce, spinach or arugula. Buy bags full of frozen, unsweetened berries. You can add them to your ice cream or yogurt for extra flavor; when manufacturers make something fruit flavored, they sweeten the fruit. Fruit smoothies are pleasantly sweet and cold also, and if you make them at home they are still great with no added sweeteners.


Some people mistakenly believe you must ban all fruit if you want to lose weight fast. Not so. The key is just choosing wisely. While bananas are definitely considered a healthy food to have, they do tend to raise the blood sugar levels up quickly and are one of the higher calorie fruits to choose from


You know when it’s OK to eat chocolate-flavored cereal? At dessert — not breakfast. Here’s the immutable law of the cereal aisle: When you see a cartoon character on the package, expect to find a mountain of sugar in the box. This is how to win children over at an early age; and get them addicted to sugar.

Reach for: Brands with fewer than 150 calories per cup, at least 3 grams of fiber and no more than 6 grams of sugar per serving. Like Kellogg’s All-Bran Complete Wheat Flakes (1 cup) with a tablespoon of raisins or ¼ cup fresh fruit. Or play it safe: Swap Oatmeal Instead of Cold Cereal


All natural Peanut butter (like Teddie’s unsalted) on celery sticks satisfies my craving for salty+sweet and for something crunchy. Plain yogurt (I prefer fat-free Greek yogurt, but there are obviously other options when buying plain yogurt (low fat, if you choose) instead of flavored. That way you can control the amount of honey or fruit you put in it, and after a while you get used to it and it tastes just as sweet. Try swapping sour cream with plain yogurt for protein filled fat-free dips and sauces. Same goes for cottage cheese with a little drizzle of honey and some fresh berries is a great substitute for a sugary dessert. Munching on soybeans instead of chips. A ½ cup of edamame has 100 calories, 4 grams of fat and 10 grams of protein. One 1-oz. serving of chips, on the other hand, has 150 calories, 10 grams of fat and just 2grams of protein. But for that crispy, crunchy deliciousness, the potato chip is tough to beat so there are a wide variety of apple chips available on grocery store shelves.  Brothers-All-Natural freeze-dried Fuji crisps, Bare Fruit’s organic chips, which are made with WashingtonState apples, Good Health Natural Foods Crispy Original Apple Chips. Then there’s Taro, a starchy, white-fleshed root vegetable, has 30% less fat and more fiber than its cousin, the potato, plus lots of vitamin E. And another suggestion Packed with vitamin A and the essential mineral manganese, sweet potatoes make surprisingly tasty, crunchy, reduced-fat chips. Even a leafy green vegetable can fill in for potato chips, if you bake it right. An added bonus: with kale, there’s no slicing necessary. Packed with vitamins A and C, kale makes a surprisingly elegant and scrumptious salty snack.

Meat and fish

Reach for: Ground chicken or turkey breast (100 percent white meat) or lean ground beef (at least 90 percent lean) also try swapping creamy or cheesy sauces for tomato- or vegetable-based sauces on your pasta, meat or fish dishes.

Brown Rice Instead of Pasta, Green Tea Instead of Coffee
Swap from whole milk to semi-skimmed, 1% fat or even skimmed milk.

Remember, small changes can add up to make a big overall difference to your Health.

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You’re standing in the grocery aisle, faced with a choice. You reach, somewhat grudgingly, for the healthy option, since experts tell you that 50% of your grains should be whole grains. What you don’t realize is that unbleached wheat flour is the main ingredient; whole wheat flour is the third on the list, “indicating that the product contains relatively little,”  And beware of the “wheat bread,” a claim that simply means the loaf was made from wheat flour, which might very well be refined and colored with molasses to appear darker. Some companies will use molasses or caramel to mimic the dark coloring of whole grains. The only trustworthy claim for whole grains is “100 percent whole grain.”  So much for healthy whole grains (or truth in advertising). 

Hey Mom’s :

The claim “100 percent juice” deserves a big asterisk. Some juices, such as apple, grape, and pear, are cheap, abundant, and loaded with sugar.

Case-in-point: Gerber Fruit Juice Treats for Preschoolers. Its package blooming with pictures of ripe oranges, raspberries, cherries, peaches, grapes and pineapple, its only fruit-like ingredient is fruit juice concentrate, which the Dietary Guidelines for Americans considers just another form of sugar. Not surprisingly, the primary ingredients are also sugar and … well, (corn syrup). It’s candy.  It’s still 100 percent juice, but in reality it’s nothing more than a blend of inexpensive sucrose-loaded fillers tinged with a mere splash of what you really want. Moreover, many juice “cocktails” contain as little as 20 percent real juice; sugar pads the rest.  Just add up all the sugars that go by different names: sugar, corn syrup, high-fructose corn syrup and juice concentrate.  Look at Kellogg’s Smart Start. It claims to be “lightly sweetened,” yet it has more sugar per cup than a full serving of Oreo cookies!

Flavored yogurt seems like an ideal breakfast or snack on the go — after all, it’s a protein-packed dairy product paired with antioxidant-laden fruits in one convenient little cup. Unfortunately, the sugar content of these seemingly healthy products is sky-high, especially in the fruit-on-the bottom varieties. The fruit itself is swimming in so much thick syrup that high-fructose corn syrup and other such sweeteners often must be listed in the ingredients before the fruit itself. A similar dilemma presents itself with flavored instant oatmeal. Some brands even proudly display the American Heart Association (AHA) check mark on their products’ boxes. However, the fine print next to the logo will simply read that the cereal meets AHA’s “food criteria for saturated fat and cholesterol.” In other words, it could have as much sugar as Fruit Loops and still get this particular AHA logo! And sugar, a low-quality refined carbohydrate, is the last thing you want for breakfast.  “fat-free.” They’re not lying—these empty-calorie junk foods are almost 100 percent sugar and processed carbs.  Problem is, fat-free snacks that are loaded with sugar are digested rapidly, sending your blood sugar soaring; as soon as it drops again, you’ll crave more fat-free” empty calories. Every item in the grocery store claims to be “low in,” “free of” or “good for” . . . something. Problem is, that reduction in fat often comes with an increase in sugar and sodium and, ultimately, no net nutritional gain to speak of. so-called “low-fat” or “reduced-sodium” products.  So any way you look at it, the equation is simple and designed to make you fail:  MORE SUGAR + MORE FAT + MORE SALT = LESS NUTRITION

Then there’s The beverage aisle:

The rainbow-colored rows of “enhanced” waters have a different dirty little secret. The crutch of every bottle of Vitamin water for instance, is a host of B vitamins. Everything that goes in after that — zinc, chromium, vitamins A, C, or E, etc.— hinges on whether said beverage is trying to provide “focus,” “sync,” “balance,” or any number of claims. The problem is that this collection of nutrients isn’t worth the stiff sugar tariff that Vitamin water charges,32.5 grams—8 teaspoons’ worth—stuffed into each bottle. Pop a daily multivitamin instead.


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