The Hydration Equation

Nutrition, Pain

To Hydrate or Not to Hydrate?


So, I need 8 glasses of water at 8 ounces apiece and I am good, right?  Well, what if you are a coffee drinker?  What if you are an endurance athlete?  Is it different for a weight lifter?

For athletes and people on a low sodium diet, they can complain of cramps not from lack of hydration, but of hyponatremia or lack of sodium.  Muscles contract and relax using a system of gradients.  On one side is sodium and the other side is potassium. If your sodium level is depleted, the muscle will contract and spasm the same as you would with dehydration.

The Caffeine Myth:

In 1928 a study was published that showed caffeine was a diuretic.  Since, the prevailing advice has been to replace your cup of coffee or tea with a cup of water to offset the effects.  However, a study in 2014 showed that this was not accurate and that although caffeine is indeed a diuretic, 1-2 cups of coffee is equivalent to your water intake.

“Our research aimed to establish if regular coffee consumption, under normal living conditions, is detrimental to the drinker’s hydration status,” lead author Sophie Killer, a doctoral researcher, said in a statement. The study was published online today in the journal PLOS ONE.

Killer and her colleagues enrolled 50 men, all moderate coffee drinkers who didn’t take diuretics or caffeine-containing medication. Women weren’t included in the study because menstrual cycles may cause fluid balance fluctuations. In the study’s first phase, investigators randomly assigned the men to drink 4 cups of black coffee or an equal amount of water daily for 3 consecutive days. After a 10-day “wash-out” period, the groups switched. Coffee drinkers changed to water and vice versa.

The investigators analyzed hydration status with several established measures—body mass, total body water, and blood and urine tests. They found the hydration effects of coffee or water did not differ significantly. The study participants lost a small but significant amount of body mass each day during both study phases, 0.2%. Several factors may explain the body mass loss, the investigators wrote. One possibility is that the men simply didn’t drink enough fluids during the study. Even so, the men weren’t near the clinical dehydration level of 1% to 3% body mass loss, the investigators noted.

“Consumption of a moderate intake of coffee, 4 cups per day, in regular coffee-drinking males caused no significant difference across a wide range of hydration indicators compared to the consumption of equal amounts of water,” Killer said.

For athletes:

Proper hydration during training or competition will enhance performance, avoid ensuing thermal stress, maintain plasma volume, delay fatigue, and prevent injuries associated with dehydration and sweat loss. In contrast, hyperhydration or overdrinking before, during, and after endurance events may cause Na(+) depletion and may lead to hyponatremia. It is imperative that endurance athletes replace sweat loss via fluid intake containing about 4% to 8% of carbohydrate solution and electrolytes during training or competition. It is recommended that athletes drink about 500 mL of fluid solution 1 to 2 h before an event and continue to consume cool or cold drinks in regular intervals to replace fluid loss due to sweat. For intense prolonged exercise lasting longer than 1 h, athletes should consume between 30 and 60 g/h and drink between 600 and 1200 mL/h of a solution containing carbohydrate and Na(+) (0.5 to 0.7 g/L of fluid). Maintaining proper hydration before, during, and after training and competition will help reduce fluid loss, maintain performance, lower submaximal exercise heart rate, maintain plasma volume, and reduce heat stress, heat exhaustion, and possibly heat stroke.

The big takeaway from this study is that if you are an endurance athlete or your activity is higher level you could be flushing a much needed electrolyte, in this case Sodium out of your system.  General advice (always check with your MD for individual advice) is to drink regular water with food that has a little salt, otherwise include a little sodium into your water for regular consumption.  Trust in Kelly Starrett.



The Upper Body Exercise to Stop Right Now

Injury, Pain, Uncategorized

In the history of weight training there have been numerous examples of exercises that are fantastic: the squat, deadlift, lunge, pull-up, push-up. However, there are also exercises that make any anatomical professional cringe to the point of white-knuckling. Here are some examples:

I mean, really there is no explanation needed.

I mean, really there is no explanation needed.

Isolation:  Yes, from everyone around you who can't stand listening to your knees crack

Isolation: Yes, from everyone around you who can’t stand listening to your knees crack

Just, no.

Just, no.

The exercise I want you to throw away today, forever…no I mean it, FOREVER is the upright row.

The anatomy is simple:  The exercise is designed to target the traps.  However, to get the traps you have to put yourself into the position of shoulder impingement and the repetitive position that can lead to tennis elbow.


Yep, that's the one

Yep, that’s the one



With each of these exercises I know the argument:  “It isolates blah, blah, blah muscle.”  Well, the upright row isolates alright, it isolates the supraspinatus rotator cuff tendon right up under the acromion.  The only pump you’ll get from this exercise is a pump of corticosteroid the ortho doc will be giving you, unless surgery is the better option:



So, please….don’t do this exercise.  Your body will thank you.

Can’t Stop, Won’t Stop – Posture and Pain


The emergence of pain science as a reliable, researched intervention has significantly improved physical therapists’ understanding of symptoms.  Practitioners across the world are now armed with insightful literature, schematics, and even video.  This new found knowledge has changed examination, assessment, and treatment with the promise of reducing symptoms with education and simple movement.

Recently, the idea of posture and pain was the subject of an interesting debate.  In the pain science community it has become vogue to denounce former anecdotal treatment in favor of cognitive behavior training.  As a therapist who routinely uses pain education I will not question the validity of pain science or its impact, but I do question the willingness to discredit other interventions due to semantics.  While posture may not “cause” pain, it certainly can influence pain, and should not be dismissed.  For example, I have a tendency to sit  with my leg tucked underneath me and after a period of time I sense lateral knee pain.  I realize that the nociceptors are transmitting an input to the brain that is in turn posting an output of “Hey, this needs to be addressed.”  When I move my knee I occasionally have a “pop” which I assume is my fibular head, and then my brain stops the threat message and my pain resolves.  Now, you can call the output of pain a result of misalignment, posture, my memory of past experience or just needing to move, but you can not deny the contribution of sitting on my sense of pain.

Now, I am not promoting going backwards and blaming everything on static posture, but another can of worms to open is if there truly is a “static” posture.  During sitting or standing, there are muscles firing to maintain balance, keep the horizon, etc. so “static” posture may be an inaccurate term.  In addition, for clients who are strapped to a desk all day and in the “flow” they may not notice the subtle messages from the brain alerting them to the presence of nociception.  So, I say do not pin everything on posture, but do not dismiss it either.