TENS vs. REST? Should you invest on an Electrical Stim Machine?

TENS vs. REST? Should you invest on an Electrical Stim Machine?

Adequate recovery is essential in order to achieve better performance in any sport. Muscle fatigue is a result of changes at the level of the muscle, such as micro tears, depletion of creatine phosphate, accumulation of metabolites, mismatch of oxygen supply/demand or even central nervous system fatigue. The question is, is TENS an effective method to enhance the rate of recovery after exercise? Based on 10 different articles I reviewed, the results are rather disappointing


Milne 2001 negative review of 5 trials of TENS for chronic low back pain
Johnson 2007 positive review of 38 trials of TENS for chronic musculoskeletal pain, “effective”
Nnoaham 2008 inconclusive review of 25 studies of TENS for chronic pain
Khadilkar 2008 inconclusive review of 4 trials of TENS for chronic low back pain
Walsh 2009 inconclusive review of 12 trials of TENS for acute pain
Hurlow 2012 inconclusive review of 3 trials of TENS for cancer pain
Vance 2014 mixed review: “it’s complicated”?? but promising
Chen 2015 negative review of 18 trials of TENS for knee osteoarthritis
Desmeules 2016 inconclusive (but discouraging) review of 6 trials of TENS for rotator cuff tendinopathy

How does TENS work?


Pain is a result of alarm systems that reach your brain. These alarms go off way too loud and way too often, sometimes even without tissue damage. The brain decides what hurts and what doesn’t. The TENS machine blasts the nervous system with “sensory white noise”, and by stimulating the nerves in this way it distracts the brain (temporarily) from pain. Unless you turn the machine up enough to disable your brain, if it thinks you’re in pain , the alarm will go off again sooner or later, most likely shortly after the TENS is turned off.

 Vance et al. believe that “TENS has been shown to provide analgesia specifically when applied at a strong, non-painful intensity.”

This particular study compared the effects of electrical muscle stimulation, massage and passive rest in athletes after 6 different bouts of exhausting supra maximal training. The chart on the left shows the peak power production following each of these modalities. The chart on the right shoes the blood lactate concentrations following the exercise bouts. As you can see, no significant differences were demonstrated between the effects of EMS, massage and passive rest on recovery markers or peak power output.


Even though there is controversy over the topic, some people can find symptom relief following TENS. If your goal is pain reduction, you can buy a TENS machine for less than $100 at your nearest pharmacy!

Stefanie Cohen


Martin N.A., Zoeller R.F., Robertson R.J. The comparative effects of sports massage, active recovery, and rest in promoting blood lactate clearance after supramaximal leg exercise. J. Athl. Train. 1998;33:30-35.

THE BIG CHILL- worth it?

THE BIG CHILL- worth it?


Seems like a lot of people are moving on from the classic ice pack, to this trendy technique called cryotherapy, which offers whole body immersion in chambers where temperatures drop to 150 degrees below zero for about 2-4 minutes in an attempt to reduce pain and speed recovery.


The idea sounds great! The important question always is, what does the research behind it say? Similar to ice packs and ice baths, cold therapy is thought to constrict blood vessels, flush waste products, reduce swelling and diminish tissue breakdown. It definitely lowers superficial tissue temperatures-  it doesn’t penetrate the skin’s surface more than 1/2mm into the skin. A possible explanation for this is that cold slows down the speed at which nerves fire, while constricting arteries and veins, and limiting blood flow. The idea that cold can heal is ancient, but so far, scientists have failed to find strong evidence that cold therapies can help much, if anything with muscle soreness or recovery.


Some studies even suggest that icing dampens or block the body’s ability to repair and strengthen the micro tears in muscle tissue following intense exercise, especially if people use ice too frequently. Trauma to the muscle caused by intense exercises is healed by your immune system using inflammation. Inflammatory cells called macrophages rush into the injured tissue to start the healing process and release a hormone called IGF-1, which helps your tissues heal. Applying ice reduces the swelling, delays healing and may PREVENT  the body from releasing these hormones.

At this point there is insufficient evidence to warrant making clinical claims about its effect in speeding recovery. There are instances in which delaying the inflammatory process might be beneficial, for example in a multiple day competition, where inflammation, swelling and pain would be detrimental for your performance. Despite the fact that there is insufficient evidence to prove how it works or why it works, cold therapies do seem to help especially with pain reduction, but their effect might be based in the brain and not the muscles.

Stefanie Cohen







Banfi, G. and Valentini, P. (2007). Effects of cold-water immersion of legs after training session on serum creatine kinase concentration in rugby players [letter]. British Journal of Sports Medicine. 41: 339. 
Gill, N., Beaven, C. and Cook, C. (2006). Effectiveness of post-match recovery strategies in rugby players. British Journal of Sports Medicine.  40: 260-3. 
Hausswirth, C., Louis, J., Bieuzen, F., et al. (2011). Effects of whole-body cryotherapy vs. far-infrared vs. passive modalities on recovery from exercise-induced muscle damage in highly-trained runners. PloS ONE. 6(12): e27749. Doi:10.1371/journal.pone.0027749 
Purnot, H., Biuezan, F., Louis, J. et al. (2011). Time-course changes in inflammatory response after whole-body cryotherapy multi exposures following severe exercise. PloS ONE. 6(7): e22748. Doi:10.1371/journal.pone.0022748 
Wozniak, A, Wozniak, B, Drewa, G. et al. (2007). The effect of whole body cryostimulation on lysosomal enzyme activity in kayakers during training. European Journal of Applied Physiology. 100: 137-142.


Foam rolling, mashing… What is it? Does it even work?

Foam rolling, mashing… What is it? Does it even work?


When we think Myofascial Release (MR) we think of foam rolling, “mashing”, laying on a lacrosse ball, getting a massage or deep tissue massage, receiving gratin technique, or maybe even manual therapy from physical therapist. You go in to the clinic or you grab whichever torture device you so choose and for the next (5 minutes for most) 10 minutes to an hour or so we allow ourselves to be put in pain. You jump, cry, wince, moan and groan but afterwards we may be bit soar but we feel better, looser, more mobile. But why?

The original thought process for manual therapy (synonymous with MR in this piece) and why it worked was defined as the biomechanical model. Wellens summarizes this model as the following:

“To summarize this model, it is proposed that biomechanical dysfunctions characterized by a combinations of segmental joint hypo or hyper-mobility  suboptimal postures, muscle weakness and/or poor muscle control play a significant role in the emergence of painful MSK conditions by putting too much strain on different tissues which would ultimately lead local and/or distant tissues to sustain damage or to function sub optimally. The end result of this dysfunctional state would then often be pain. The role of manual therapy in such a model is to find these aforementioned dysfunctions and treat them via manual mobilizations or manipulations, stabilization exercises and postural corrections among others. It is proposed that the manual mobilizations or manipulations will restore the joint play by restoring tissues optimal lengths or by reducing a fixation or sub-luxation and thus, restoring optimal joint function which, in turn, will lead to the resolution of the dysfunction and thus, the pain.

Whoa! What does that mean? In Laymen’s terms: Limited mobility or excessive mobility puts improper strain on muscle tissue which can lead to poor function and usually pain. MT finds these dysfunctions and treats them with manual mobilizations or manipulations and exercise and postural correction. Through the MT we can restore tissue’s proper length by making it more mobile or “less mobile” (through stability work) restoring it to proper function and reduce pain.

Again, WHAT? Basically through the pressure in our hands or a simple tool or lacrosse ball we can’t create enough force to tear our fascia. Lets put that in perspective; if I were to dig my thumb into you and could create enough force for your fascia to release, or even cause micro tears, however you want to describe it, humans would be very frail and fragile and we not be able to function in everyday life. Every fall, stubbed toe, shin on desk would cause torn muscles with no question. So then why after massage or self MR do we instantly feel so much better and have more ROM? Foam rolling works, but not how most people thinks it does. There are a few theories out there but the one we are talking about today is the theory of Neurophysiological Effect (NE)


Numerous Studies have demonstrate immediate positive effects on pain after non specific MR or MT. The NE effects could be a combination of the CNS and PNS. The exact mechanism of this model is far from being explained but the basics are that pain is the brains output in response to various stimuli including but not limited to nociceptive input.

Wellness simplifies the thought: “a simple explanation for a good part of the effectiveness of manual therapy could be that the novel stimulation introduced in the CNS by manual therapy may help the brain down regulate the perceived threat of current stimuli and thus decrease the pain by means of descending inhibition and other peripheral and central mechanisms (which include a placebo response).”

Lastly, I am not saying Manual therapy does not work. I am a recent graduate from PT school and Manual therapy is used in every one of my patients in some form or fashion. Everyone should use self MR by rolling on a roller or lacrosse ball. But what I do believe is that the mechanically lengthening tissue to reduce pain and symptoms is not a sound argument anymore with current research and that another avenue of thought should utilized. The nuerological avenue is my “main street” right now. But MR or MT we can nuerologically calm down the brain which then will calm down the area of pain and thus we may be able to move with improved ability and pain free.

Wellens, F; The Traditional Mechanistic Paradigm in the teaching and practice of manual therapy: Time for a reality check. Clinique Physio Axis.

Written by: Dr. CJ DePalma, DPT, CSCS

Get Your Traps Out of Your Ears

Get Your Traps Out of Your Ears

It seems a lot of the fitness community remains in a state of reverie for the mountainous, python-like upper traps sported by enthusiasts everywhere.Unknown They are the functional cushion for your back squats. They make you look mildly badass in your tank tops. They also have potential to be problematic if you’re not careful.


Rhomboids and mid-and-lower traps

These are two largely discounted members of the group of muscles responsible for (among other things) scapular movement. Both play a large role in the maintenance of a pair of solid, healthy shoulders, yet a massive number of people neglect their upkeep.


A brief example of an action this pair of muscles is responsible for, is retraction of the scapula, also cued as “pinching” your shoulder blades together. It is easy to walk around in public and visually pick out any number of people – fitness junkies or otherwise – with their shoulders rolled forward, upper back hunched over, upper traps so high it just makes your neck hurt to look at, and palms either occupied with a cellphone, or facing totally backwards (see the picture below for proper anatomical position).

This overly frequent problem that is weak or under-active lower traps and serratus anterior can lead to a host of problems both chronic and immediate: injuries to the rotator cuffs, subacromial impingements (ouch, and more common than you might think) and unstable overhead positions, for example. As long as these muscles remain weak or under-active, the upper traps will continue to compensate, and the problems will persist.

Force Couples

A force acting on a body has two effects, one to move it and two to rotate it. A force couple is a system that exerts a resultant movement, but no resultant force.

What does this mean for the shoulder?

In a force couple, the force generated by one muscle requires the activation of an antagonistic muscle so that a dislocating force does not result (Nordin & Frankel, 2001). As you can see on the image below, several muscles aide in the movement of your arm during elevation.

Particularly important for this discussion is the fact that the mid and lower traps are the primary stabilizers during abduction of the arm. What happens if we have an overactive muscle is that we break the force couple relationship. This is when abnormal movement patterns begin to occur and we increase our risk of injury.

Two muscles that are particularly important to target are the Serrates Anterior and the Lower traps 

  • The serratus anterior is the only muscle that rotates the scapula forward, along the shape of the rib cage. Having full strength and motor control of this muscle is extremely important in order to have optimal stability over head.
  • The lower traps act as one of the main stabilizers as the arm reaches 90 degrees.

note: The deltoid is NOT A PART OF THE FORCE COUPLE mechanism, but over recruitment of the deltoid can also lead to impingement.

There are, however, a number of fixes.

  1. Pull

Single arm dumbbell rows, barbell rows, pendlay rows, seated cable rows, resistance bands (think: face pulls, more rows, shoulder “Y”s and “T”s – keep your shoulder blades down and back!).

Note: Whichever exercise you chose, make sure to keep your shoulders down and back. DON’T allow your traps to do all the work, and focus on really recruiting your rhomboids and keeping your scapulae down. 

Face Pulls: https://www.youtube.com/watch?v=HSoHeSjvIdY

Wall angels

  • Keep your entire posterior FLAT against the wall-
    • This includes your butt, lower back, mid back, upper, the back of your head
  • Keep your neck neutral and face forwards
  • Slowly try and work your arms up the wall whilst maintaining contact at all of the points mentioned above – the backs of your hands should be brushing the wall
  • Note: the model in this picture is insanely mobile, and if you don’t get there right away, that is A-OK! Keep working at it, but only go as far as you can while maintaining contact and good position (no arching your back!!)


2. Work on your pecs 

Stretching the pecs will allow you to improve your internal rotation, which is often restricted in most people. Our every day habits such as sitting down, eating, driving, typing are all done with forward shoulders and forward head, which increase the tension and shorten our pecs.  A simple way to stretch out the muscles that may be tight and responsible for some of your internal rotation is illustrated below.


A straight arm will target the serratus and pec minor, while an arm bent at 90 degrees will have your pec major feeling *fantastic*. Think about retracting (pinching) your shoulder blades back and DOWN!

3. Push up Plus

This one is a personal favorite for the serratus anterior! slide_43

Of course, habits take time to break. In due time your shoulders, back, neck, and training will thank you!


Written by: Jamie Brynn Hamilton,

in collaboration with Stefanie Cohen




A recent study suggested that 2/3 female lifters, and 1/3 male lifters prefer sumo over conventional. Has any of you sumo-ers been blamed of “cheating” because of preferring this technique? I certainly have. People claim that sumo is easier than conventional all the time, without taking into account hip structure, femoral angles, muscular tension and energy systems.

The main claim I hear is that sumo is easier because it requires less range of motion to complete a lift. This is not entirely false. Sumo deadlift has approximately 25% less range of motion than a conventional deadlift. This difference however matters very little when it comes to a one rep max- MAJOR KEY. Your muscles have more than enough energy stored to produce 8-10 seconds of maximal effort contractions, which is approximately how many seconds a deadlift grind last for. Range of motion would matter, if we are talking about deadlifting for maximal REPS.

Other factors like the shape of your pelvis, orientation of your hip socket and femur will determine your hip range of motion AND the amount of muscular tension you can develop by placing your legs in different positions. Refer to my older articles for more info on this! If you don’t know which style works better for you, you don’t really need an advanced measurement system. Simply try both methods and see which positions feel stronger for you.


Knee moment is 3x higher in sumo than conventional, this just means that Sumo’s hit your quads harder. EMG studies found that there is 10% more activity in your spinal erectors in conventional, so this form is harder on your erectors. My favorite quote by Greg Nuckols is “You miss a lift because you were too weak through your very weakest part of the movement”. This is applicable because if you do prefer sumo over conventional, maybe you need to strengthen your back, and if you prefer conventional, maybe you can incorporate more exercises to strengthen your quads.

In conclusion, NEITHER ONE IS HARDER THAN THE ORDER!!  If sumo were truly easier than conventional, why would Eddy Hall chose to pull conventional when he broke the world record deadlift at 1100 pounds?



By: Stefanie Cohen, SPT

Bench plateau? Try changing your bar path

Bench plateau? Try changing your bar path


After reading McLaughlin’s book, which is probably one of the best resource for the bench press I have ever encountered, I ran across one of Greg Nuckols article, where he talks about some key points from this book. He does a great job going over the biomechanics of the bench a lot more in depth than I will cover in this article so if that is something that interests you I highly recommend you check it out!

McLaughlin pointed out a really good observation about the difference in bar path between novice and advanced lifters. He showed that both groups lower the bar using a similar pattern, almost a straight line, but the path changed dramatically during the ascent. Novice lifters move the bar straight UP THEN BACK, while advanced lifters do the opposite. They move the bar up AND BACK right off the bat and finish the lift by pressing almost in a straight line up.


                                                      Image property of Greg Nuckols- Strength Theory

He pointed out that elite lifters were able to add pounds to their bench, with no real change in total force output. This is done by  changing their bar path by shortening the moment arm, which is the distance from the bar to your shoulder in the frontal plane (from your armpit to an imaginary line that drops straight down from your hand at the point that you hold the bar). You can accomplish this by decreasing the distance between the bar and your shoulder faster during the ascent part of the lift. This doesn’t necessarily change the amount of work you are doing, but its simply a more efficient way to push.

bar path

In conclusion, McLaughlin noted in his research that elite lifters didn’t increase their maximum force output that much year after year, but the ones that continue making the most progress where the ones that make adjustments on their bar path.

The “total work” done won’t necessarily change, as this is defined as the VERTICAL distance that the bar travels, and not the total distance. This is not a question about reducing work or decreasing range of motion but rather about finding a position that will be the most efficient to bench press in. 


Stefanie Cohen,  SPT




The common reasons why you lose overhead mobility are deficits in the thoracic spine, shoulder, scapula and lumbo-pelvic area. In this post I will address the importance of proper thoracic spine mobility for over head motions.

Deficits in movement of tforward-head-posture-manhe thoracic spine and ribcage area is a common problem most people face nowadays,
especially in people that have desk jobs, who’s posture is slouched. The relationship between the T-spine and ribcage lays the foundation for the scapula. Their alignment will dictate the function and movement of the scapula. In the image below you can see how positional faults in the T-spine, as it’s seen with increased rounding could yield to limited movement of the shoulder girdle. As we raise our arms overhead, the scapula is supposed to ride along the T-spine. If the position of the thoracic spine is not optimal, the shoulder blade wont be able to move how its supposed to.


Putting your arms over your head requires  160-170 degrees of motion from the shoulder, but this doesn’t get our arms completely over head. We achieve 180 degrees of motion with thoracic spine extension. The biggest issue comes when compensation from other segments occurs, as T-spine extension is lost, it leads to increased lumbar extension to compensate for this deficit, which increases the risk of low back injuries as well. In addition, we need proximal stability before distal mobility. This means that if the scapula is not sitting in a strong stabilizing position, this can also be a limiting factor for how much weight we can put over our head.


The point on mobilizing your spine is to help improve your efficiency with overhead lifts. Remember the shoulder only achieves 160-170 degrees of overhead flexion and in order to get that personal record lift you need the last 15 degrees to come from your T-spine.


Foam rolling

DON’T simply go back and forth over your spine. The main goal is to real the spine over the roller and mobilize each segment. DO relax your spine at every single level along the T-spine, segmentally. 


Quadruped Rotation

 DON’T allow your hips to move along with your arms. DO maintain your core tight and hips aligned. Open to each side while taking a deep breath in. You should have 50 degrees of motion available on each side.


Foam roll vertical stretch

DON’T rush through the movement. DO lie on your back, with the foam roller along your spine, support your hips and head on the roll, stretch out your arms to the side and RELAX! 


Standing overhead stretch

DON’T over extend your lower back DO start by bringing your arms overhead to a position where you feel restricted. Hold this stretch for 20-30 seconds at a time until you can no longer make any more gains.

Hope you find these tips helpful!

Stefanie Cohen, SPT


Pretty Squats vs. Ugly Squats

Pretty Squats vs. Ugly Squats
Recently I’ve been hearing a lot of talking about what constitutes a “perfect” squat.  What’s often overlooked is the fact that the proportions of your femur and torso play an important role on what your squat’s gonna look like.
Someone with short femurs relative to their torso, will be able to keep chest up during a squat, without leaning forward. Someone with long femurs will dramatically lean forward, almost like a good morning, due to their proportions. What I’m trying to get to is, if your biomechanics are a result of your morphology, then don’t worry. If you developed faulty movement patterns as a result of poor coaching or muscle imbalances, then you better get it fixed before it becomes an issue.

Because femur length can affect torso positioning during squatting, there really is no “one size fits all squat”. Hopefully the images above and this explanation will help further clarify these points. Dr. Ryan DeBell of The Movement Fix wrote a great article discussing in detail how hip anatomy changes squat mechanics, and inspired me to make this follow up post.

Besides mobility, which is known as the pliability of our muscles and connective tissue, anatomy differences can explain why some people can squat deeper than others, why some point their toes out, why some squat wide and some squat narrow. These anatomical differences will dictate form and comfort of the athlete. We can all agree on what a proper squat should look like, right?

  1. Back neutral
  2. Knees tracking your toes
  3. Keep your core tight

Click to see slideshow 

This slideshow requires JavaScript.

Pic 1- one femur head points up, one points down

Pic 2- one neck is a lot longer than the other

Pic 3- the angle between the shaft and the ball is greater in one femur than the other

Pic 4- large versus small hip socket, one oriented up, one oriented down

Trying to force a movement pattern upon someone who’s anatomy isn’t conductive for it can be disastrous. If the athlete is uncomfortable in their stance despite how much mobility work they do, it’s important to look at their anatomy and let the stance and depth be dictated by comfort. The key point is to rule out mobility deficits first and making sure the athlete is taught how to perform a squat with proper form.


Stefanie Cohen, SPT


You can’t build mass while you cut- MYTH BUSTED

You can’t build mass while you cut- MYTH BUSTED


There is a common misconception amongst the general population of gym-goers that the only way to gain strength and increase size us to be in some sort of “bulking” phase. And that cutting means you need to sacrifice strength and size in order to achieve a more aesthetic physique. This is not necessarily true.

Luckily for you I’m writing this at the beginning of beach season so I can save some of you strength athletes from the dreaded summer bulk. Let’s start simple and with something we can all agree on. Being in an overall caloric deficit for a long period of time will cause weight loss and being in a caloric surplus for a long period of time will cause weight gain.

The type of weight loss or gain that occurs can be manipulated by the type and intensity of exercise you choose as well as where your calories come from i.e. macronutrient distribution. Now this is the part where we lose some people so let’s return to the idea of a long cut. In this situation you are in an OVERALL caloric deficit. What is overlooked is the fact that during this time you will be cycling between both catabolic and anabolic stages over and over again.


For simplicity sake let’s pretend you start your day at maintenance level energy balance; you haven’t expended any energy or taken anything in, you walk to the kitchen and eat a meal, but you still haven’t expended much energy – you are now effectively and temporarily in a caloric surplus. Next you go to the gym and expend more calories than you took in at breakfast and now you are now in a caloric deficit. This can occur many times per day and if you’re cutting all it means is that you are in a caloric deficit for more of the day than you are in a caloric surplus. The end result is weight loss, but you had many opportunities to build lean mass as you were in an anabolic state multiple times

Our bodies are not programmed with an “on and off” switch for anabolism (building) and catabolism (breakdown), but rather our bodies go through anabolism and catabolism repeatedly throughout the day. 



If you’re still not buying it let’s use an example most of us can relate to. I’m sure everyone had an overweight friend or acquaintance in high school who decided to start hitting the gym. They lost a significant amount of weight over a long period of time due to being in an overall caloric deficit and eventually, once they got lean enough, they revealed the muscular physique they had been building the entire time they were cutting.

If your goal is solely to gain lean mass and you’re already satisfied with the amount of body fat you have the a slight overall caloric surplus is optimal, but this isn’t the case for most people. For those who wish to lose body fat don’t be deterred by the idea of losing strength or muscle mass as you can build lean mass effectively in a caloric deficit if you have BOTH a permissive diet AND an effective training program. Just remember you cannot have one without the other and expect desired result.

Hayden Bowe