Blog - Barbell Medicine

Dec 14

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The Shoulder, Part III: Internal Impingement

by Dr. Michael Ray and Dr. Austin Baraki In part 2 of our shoulder series we discussed the topic of “shoulder impingement”, which is commonly understood as the mechanical compression of the tissues beneath the acromion process, resulting in pain or dysfunction — better known as external impingement. We described the biomechanical theory behind this diagnosis, and examined the available research evidence on the topic. Ultimately, we found a lack of compelling evidence — and in fact, a substantial amount of contradictory evidence — for our historical mechanically-focused understanding of this topic. Another lesser-known type of impingement, known as “internal” impingement,…

Jan 17

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Nutrition Science, Part I: How Did We Get Here?

By Alan Flanagan | Nutrition | No Comments

Introduction To anyone versed in biomedicine, the so-called “hierarchy of evidence” is well-established and unquestioned. The randomized, double-blind, placebo-controlled trial (RCT) is considered the gold standard trial design, because it offers the ability to randomly allocate a treatment, minimize potential sources of bias, and compare the exposure or intervention of interest to a placebo. There is absolutely nothing wrong with this model, or this hierarchy … if the subject of inquiry is pharmaceutical drugs or the molecular mechanisms of disease. At its core, the biomedical model is based on a presupposition that all disease can be studied with such a reductionist…

Nov 20

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The Shoulder, Part II: External Impingement

By bbmedicine | Mobility, Training, Uncategorized | 4 Comments

by Dr. Austin Baraki, Dr. Michael Ray, and Dr. Derek Miles. In the first article of this series we discussed the concept of “normal” or “abnormal” scapular movement (i.e., scapular dyskinesis), which is the pathomechanical foundation upon which other shoulder-related diagnoses and narratives are built. “Shoulder impingement” is one of these ideas that is commonly discussed in the coaching, rehab, and orthopedic worlds. The narrative describes soft tissue structures around the shoulder (e.g., rotator cuff tendons and bursae) becoming compressed between the bony surfaces of the joint. Two types are discussed in the scientific literature: “internal” and “external” impingement. Let’s…

Nov 06

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The Shoulder, Part I: Scapular Dyskinesis

By Austin Baraki | Training | 3 Comments

The shoulder joint is complex, and pain affecting its use in daily activities and sport is common. This article series will review common shoulder diagnoses, critically assess the associated narratives provided to patients, and describe their impact on real-world outcomes. We will begin with the assessment of the scapula and its movement. The interaction between the scapula, thorax, and humerus during shoulder movement has been termed “scapulohumeral rhythm” or “glenohumeral rhythm”. The underlying assumption in this context is that normal scapulohumeral rhythm is well-defined in humans. Scapular dyskinesis, then, refers to any abnormality or deviation from “normal” kinematics of the…

Oct 06

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The Pendulum of Specificity in Application: Part I

By Jordan Feigenbaum | Training | 3 Comments

Updated 10.06.2018 This article was originally published in September of 2014 as the first of four blog posts addressing The Principle of Specificity. Since then, the coaches at Barbell Medicine have learned a great deal more about the topic and felt that these posts deserved an update and expansion. We’ll be releasing the updated articles and corresponding YouTube videos throughout the month of October. In an effort to show how our thinking has evolved, I am highlighting the parts of the article that are being updated using italics and quotation marks accompanied by the updated commentary in the normal font with additional clarifying…

Aug 21

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Mobility Explained

By Michael Ray | Mobility | 10 Comments

Rolling through Instagram or Facebook, we find narratives and interventions claiming to improve something called “mobility”. We can select from options including stretching, foam rolling / body tempering, lacrosse ball smashing, voodoo flossing, power tools converted to guns being sold as therapeutic, and the list goes on. The level of marketing would make even Donald Draper of Mad Men proud. But are these implements doing what we think they are? Are we just hidden pliable versions of Gumby walking around, waiting for our supple potential to be released? Or, are we committing the post hoc ergo propter hoc fallacy? Before…

Aug 14

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When Logic Fails: Part 1

By Austin Baraki | Training | 7 Comments

Take home points: In the context of complex systems, logical analysis can be useful in generating hypotheses, but not for drawing conclusions with a high degree of confidence, because there are almost always confounding factors that have not been discovered or accounted for. We must therefore always be cautious with the claims and conclusions we draw from our own observational experience. This is why scientists and evidence-based practitioners carefully qualify their statements in order to avoid overstepping, and should clearly identify conjecture that lacks supporting evidence. In contrast, we must be deeply suspicious of anyone making very confident claims in…

Jul 20

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How To Measure Your Waist Correctly

By Jordan Feigenbaum | Nutrition | 21 Comments

If you’ve been paying attention to our latest podcasts, articles, Q/A’s, and other content then you’ve likely heard us discuss the importance of waist circumference in determining who is a good candidate for weight gain and who could stand to lose a bit of weight. Waist circumference is a quick, low-cost piece of data with reams of scientific evidence relating the distance around your abdomen with health outcomes like premature death, diabetes, heart disease, stroke risk, etc. While the aforementioned disease processes have many variables contributing to their development and burden, we have large, well-designed studies showing that males and…

Jul 06

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Navigating Potholes: My Back Pain Experience

By Sarah Al-Khayyal | Recovery, Training | 5 Comments

I’ll spare you my lengthy back pain origin story and set the scene in 3 bullet points: Pre-back pain, I was a pretty killer athlete with a promising future in powerlifting and strongman. Also pre-back pain, I partially tore my hamstring tendon, which led to hamstring and hip pain. I rehabbed my way back to the platform from this injury, but its lasting impact lay in the consequent mistreatment of my back pain by medical professionals. One day in the Spring of 2016, I “tweaked” my back on a heavy axle deadlift in a strongman show. I finished the competition…

Jun 23

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Fear, Catastrophizing, and Training

By Austin Baraki | Training | 4 Comments

Introduction Regular followers are likely familiar with our interest in a “biopsychosocial” approach to both training and injury, particularly the modifiable psychological factors that can have significant effects on performance, recovery, and subsequent adaptation. One important phenomenon we discuss frequently in the context of acute injury and persistent pain is catastrophizing. Catastrophizing is a complex psychological process (sometimes described as a cognitive distortion) in which an individual appraises a situation in a maladaptive, excessively negative way — for example, immediately thinking of the “worst-case scenario”. It consists of three fundamental components: 1) Rumination, e.g.: “I can’t stop thinking about how…