Anatomy Semantics

I got an email from someone who has recently gotten into a regular workout routine, trying to get into better shape with some weight loss and increased strength.  He was wondering if I would look at the program he's been using for a while and make some recommendations on how it could be improved for better gains.  The program was made from snippets he put together from men's health magazine.  So we set up a phone call to go through the program.  I've previously written a little bit about strength training in this post, entitled "What do physical therapists do? We Strength Train."

Biceps - Two Muscle Bellies 

The strengths of the program he already had going were three:
1) He was regularly participating in exercise and the workouts were planned and programmed with ways he could progress them.  In my opinion, the best training program is one you will do consistently.  But once you've got consistency down... all programs are not created equal.
2) Pretty much all the body parts were covered in some way.
3) He had learned to squat and deadlift.  Though we've previously worked on his form via Skype when he was having some pain doing it.  I had him using a broom in his house to hip hinge and weight shift and change his set up and we had a blast doing that probably two years ago.

The key weaknesses that I noticed were:
1) The program was separated out into six different days: arms, shoulders, chest, back, legs, and core.  He spent 1 hour focusing on that body region when he did that training day, and he strength trains about 3 times per week.  Because of that, each body region was only getting targeted twice per month - and that was only if no days were missed due to scheduling complications.
2) There were several single muscle exercises including wrist curls and wrist extensions or hamstring curls that would be fine for some training goals, but really didn't optimize him reaching the goals he stated.  In my opinion, these take up time and energy from bigger bang-for-your-buck activities.  They have a place - and I use them with patients sometimes - but in general I'm team multi-joint exercise.

Triceps: Three Muscle Bellies

3) There were no single leg activities.  I use single leg exercises a lot with patients and have also written about the seven key movements a la John Rusin here. squat, deadlift, lunge, upper body push, upper body pull, and carries.  One of those key movement patterns is the lunge... and this program didn't include those. I really like single leg activities because it gives you a chance to work on balance which also incorporates the core and because it changes the stability demands that aren't present with a double leg exercise.  Also, life requires us to operate on one leg fairly often - going up/down stairs, walking, a curb, getting in/out of the car, playing sports... it's functional to train on one leg.  And when I mentioned this, he noted that he didn't like single leg exercises because of poor balance... soooo obvious solution.
4) It was a very high volume program... three sets of 15 for each of five different exercises that he then repeated a second time through.  He probably got some cardiovascular system development from this scheme, and maybe even some muscle toning, but felt that he wasn't making considerable strength gains, which makes sense.  With a volume like that, you're not recruiting enough muscle fibers.

Since he has no background in strength training or anatomy, we discussed some of the key concepts of training.  Ideas like the three planes of the body, push versus pull, horizontal versus vertical actions, pairing exercises a little more purposefully to either alternate body parts: like a bicep curl to a triceps extension or to overload the same one in different ways.  And then he said - "Oh ya, I've been meaning to ask you about that.  I recently was thinking about muscles while working out and wanted to know more about the semantics of the names biceps, triceps, and quadriceps. Bi = 2, tri = 3, quad = 4... of what?!" This was the moment. 

Quadriceps: Four Muscle Bellies

This was the moment when I realized that there have to be loads of people who go through life never studying anatomy or how the body works.  Working in pediatrics, I generally assume my patient population has not yet learned about anatomy.  Most haven't. Some know a little from playing sports.  But I've taken at least seven anatomy classes in my life and didn't think it was possible for an adult to have gone through all of their schooling (he has a bachelor's and two master's degrees!) without ever taking anatomy. I don't know how to write computer code or how to wire a light fixture or fix a leaky sink... why should I expect that everyone understands basic anatomy?  We're all capable of learning these things... but we don't all know them.  Talk about being a bit close-minded!

This was the moment I realized how much education it takes to be a physical therapist.  This is the moment I gained new appreciation for how people can really hurt themselves when they don't know enough about the human body and try to load it - whether intentionally through training, or unintentionally overloading through sporting activities or daily activities that their body isn't prepared for.  This was the moment when I realized that personal trainers, strength coaches, physical therapists, and anyone else suggesting exercises to clients or patients needs to understand how the body works and the concepts that the clients should understand to be more independent in helping themselves.

And so I taught him about the difference between the biceps, the triceps, and the quadriceps.  The body actually has two different biceps muscles - the biceps brachii in the arm and the biceps femoris in the back of the thigh. "Ceps" comes from the latin word caput which means head, and so each of these muscles has multiple heads.  The biceps of the arm has two heads - also often referred to as muscle bellies.  The triceps on the back of the arm has three muscle heads.  And the quadriceps of the front of the thigh has four muscle bellies.  I had to send him pictures to show what I was talking about because just saying the words was meaningless.  These muscle clusters are named as a group because they work together to elicit the same action. For example, the quadriceps, as a group, straighten the knee.

Combine the new basic knowledge of what a muscle looks like with those key concepts we already discussed such as the three planes the body can move in - front to back, side to side, and a rotational plane and how muscles work in certain directions and how important it is to consider all the directions for a well-rounded program.  We discussed some of the basics of muscle growth - and how there are muscle fibers that are more meant for endurance like high repetitions - which is what he had mostly been doing, but also muscle fibers that focus on strength and need to be more overloaded with heavier weight to use those, which had been missing in his routine.

I really enjoyed this conversation because it opened my eyes to the reality of the world... how could I have thought so many people understood these concepts which just come so much more naturally to me!?  I can't wait to take the opportunity to help more people better understand how their body works.  I also enjoyed the opportunity to educate someone so they can make changes to their workout program and develop a plan that could be more effective, and that they can modify independently.  I'm not an expert in training programs, but now he has three options of workouts and can hit each body region at least four times per month, he has a better understanding of how to change reps/sets and that there's a reason to choose these, that he probably was under loading himself, and that above all else, he has found the number one key to training: consistency.  Just by training regularly and making it part of his weekly routine, he's already miles ahead of everyone on the couch.

Can't wait to see what kind of results he gets!