Boston Sports Medicine and Performance Group, LLC Blog

The Puke Bucket

Posted by Boston Sports Medicine and Performance Group on Mon, Oct 11, 2010 @ 07:10 AM

everything basketball
“Do you know what all those names on that bucket mean?”

“Um, no I’m not sure. What?”

“Each name is a kid that puked during one of our training sessions. Isn’t that awesome?  See the one that has the number four scratched off and a five put beside it? He really blew some chunks!  I let them sign it after they puke.”

(The above is an actual conversation from a “performance coach” at a “sports performance” center just outside Boston )

Now accepting your child for only $600 for an eight week session!

When did squat, clean and puking become the standard for which we measure success?

What’s next, bicep and hernias?

The challenge for sports performance centers is not necessarily developing a bigger bench, squat and clean, but developing performance measures that correlate directly to success in their client's individual sporting events and filling the gaps in their training and performance profile.

Either way, puking isn’t an indicator of success in any sport.


Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at


Topics: Strength Training, Strength & Conditioning, sports performance, mental toughness

Mental toughness training meet your good friend Rhabdo

Posted by Boston Sports Medicine and Performance Group on Thu, Aug 26, 2010 @ 06:08 AM

Just in case you missed it, earlier this week 19 Oregon Football Players were hit with a “very weird” illness after a  workout session.  One doctor called it a compartment syndrome, I’m guessing this one smells a bit more like Exertional Rhabdomyolysis (RAB-DOE-MY-O-LIE-SIS) or Rhabdo. 

What is this strange animal you may ask? Simply stated, Rhabdo is a rapid breakdown and destruction of skeletal muscle resulting in the release of muscle fiber contents or myoglobin into the bloodstream. Symptoms include:muscle pain, weakness and swelling along with cola colored urine.

No problem right? That’s how you build big muscles, you tear um down first to then build them bigger and better! What doesn’t kill you makes you stronger!

dunk shot
Well, not exactly. You see, Rhabdo can ultimately lead to death via kidney failure.

So what causes Rhabdo?

The list includes but not limited to:

• muscle trauma or crush injury
• severe burns,
• physical torture or child abuse
• prolonged lying down on the ground (people who fall or are unconscious and are unable to get up for several hours)
• prolonged coma,
• severe muscle contractions from prolonged seizures
• cocaine use with related hyperthermia (increased body temperature),
• extreme physical activity (running a marathon),
• low circulating phosphate, potassium, or magnesium levels in the blood (electrolytes)
• prolonged drowning or hypothermia (low core body temperature)
• lack of blood perfusion to a limb

Pretty extreme stuff isn’t it?  Here is some more info:

Other contributing factors include: initial fitness level at the beginning of a training program, extreme heat and levels of dehydration.

Now I wasn’t in Oregon this week, nor do I have any additional information regarding the type of training these young men were doing and for the purpose of this rant it doesn’t matter.  My only goal is to provide a basis for conversation between your Sports Medicine and Performance Departments on how to recognize the onset of Rhabdo, and better yet avoid it all together.  And although there’s plenty of football and hockey dads out there that pay good money to coaches around the country to make their kids puke during workouts, I hope that a culture of “superdiscipline” and common sense instead becomes the standard conditioning test this fall.

Now drop and give me 500!


Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at

Topics: athletic training, Strength & Conditioning, Health, mental training, rhabdomyolysis, discipline, evidence based medicine, mental toughness

Fatigue is just an untapped reserve tank

Posted by Guest Blogger on Mon, May 3, 2010 @ 13:05 PM

As strength and conditioning coaches, it is imperative that we have a good understanding of what fatigue really is. A dictionary definition might be a decrease in energy, but most of us would say that fatigue is a decrease in force production. That might be acceptable to tell your athletes, but do you really understand what is going on? Let’s take a close look into what fatigue really is and it’s untapped potential.

There are two classes of fatigue: “peripheral” and “central”. The more commonly known and understood is peripheral fatigue. Peripheral fatigue is what is happening in the extremities, more specifically the muscles. This is usually due to action potential failure or impairment in the cross-bridge cycle. Studies have shown that there is an increase in lactic acid concentration and a decrease in pH, ATP, and creatine phosphate. Also, there is a decrease in muscle or liver glycogen stores during sub maximal exercise which is all believed to cause fatigue. These metabolic processes add up together to prevent the muscle from a forceful contraction. Essentially, you can look at peripheral fatigue as the muscle no longer capable of producing the force that it is being asked to produce. An example would be doing 1,000 bicep curls and getting the “BURN”.

Less commonly known is central fatigue. Central fatigue is a decrease in neural drive or a disruption in the efferent fibers. In more simple terms, central fatigue originates in the brain. There is limited research on this phenomenon, but studies show that during exercise there is a change in neurotransmitters, such as increase in serotonin, which can regulate muscle contraction among other things, and a decrease in dopamine and acetylcholine which play a role in voluntary movement, motivation, attention, working memory, and learning; and then opens ligand-gated sodium channels in skeletal muscle to produce muscle activation, respectively. Now, I know neurology wasn’t my favorite class either so to develop the big picture, let's just say when there is increase in neural drive, there is an increase in neurotransmitter activity which results in a decrease in brain capacity to recruit motor neurons. This is that feeling of your body just not doing what you ask it to do although your muscles aren’t on fire, that “I just don’t have it today” feeling.

The debate on central fatigue is that I mentioned it being a disruption in efferent fibers. Proponents of peripheral fatigue will argue that it is just the opposite, and that it is the afferent fibers that cause a change in the neurotransmitters. Meaning that muscles, by way of the mentioned metabolic processes, are sending sensory information to the brain that then activate the change in the neurotransmitters to stop exercise. But then studies have shown that fatigue doesn’t start in the motor cortex but even further up in cortical regions, as in the prefrontal and cingulate cortex. So what comes first, the chicken or the egg?
No studies have shown a physiological change with no change on perceived fatigue. Actually, just the opposite has been shown.   Perceived fatigue has been expressed with no physiological change. Chronic fatigue syndrome is just that; patients express fatigue at rest when there is no impairment of the metabolic processes that we discussed. . Consider the fact you can produce more force during an eccentric lift than a concentric lift, which would suggest different neural drives. Studies show that at most during maximal voluntary contraction (MVC) one can only recruit 70% of motor units and some suggest that 100% recruitment would tear tendons right off the bone. On the other side perhaps central fatigue takes place as a protective mechanism. By changing neurotransmitter activity your brain will not allow 100% MVC. So what are your muscles actually capable of and what can you do about it?

Whether you believe it is the chicken or the egg that comes first, you can’t argue that they both have a role in fatigue. Metabolic processes do take place and your brain does prevent 100% MVC. So how do decrease the protective threshold? For the sake of this article, we will save the idea of over training for another time and just focus on a single training session. In order to get more out of our athletes, we need to engage their brain. Increase dopamine and acetylcholine. Studies have shown that verbal encouragement during activity will increase the duration of the contraction. Others have shown that yelling during a lift actually can increase force production. Another study showed that when subjects were asked to give maximal effort during a cycling sprint their power output decreased over the reps except it increased on their last rep, indicating a “reserve tank”. Perhaps the brain protects less knowing that it is your last rep. Perhaps this developed during the pre-historic era when our ancestors had to hunt for their food, but maintain a reserve tank of energy in case they became the hunted. Either way, we need to tap into that reserve tank. One way to achieve this is by including open looped activities. Doing 10 reps or sprinting for 1 minute is a closed loop activity because you know when it will stop allowing you to pace yourself. So including an open loop activity is one way to do short maximal effort without pacing yourself, such as having your athlete sprint for an unknown time stopping when you decide to blow the whistle. Challenge yourself to develop ways for the conscious brain to control the unconscious brain. Don’t allow your athletes to pace themselves. Training is not about surviving, it is about DESTROYING.

If a mother is able to lift a car to save her child, find a way for your athlete to lift a bus, because they can.

Keke Lyles is a DPT student at Northeastern University and has worked directly with both the Men’s and Women’s Basketball teams.


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Topics: Strength Training, basketball conference, boston hockey summit, athletic training, boston hockey conference, sports performance, strength coach, mental toughness, sports conference

To Fail or Not to Fail? – That is the Question

Posted by Boston Sports Medicine and Performance Group on Wed, Apr 14, 2010 @ 08:04 AM

“To fail is a natural consequence of trying, to succeed takes time and prolonged effort in the face of unfriendly odds. To think it will be any other way, no matter what you do, is to invite yourself to be hurt and limit your enthusiasm for trying”
-    David Viscott

I remember coming home after failing a fifth grade geography test and showing my parents the results of my effort.  To avoid a long detailed explanation of what happened next let’s just say I wasn’t able to sit down for the rest of the day.  So failure’s bad right? But what about failure in the weight room? Is pushing yourself or your athletes past the discomfort associated with the last few reps a good thing?

I asked Northeastern University’s legendary throwing coach for his insight and the below is a summary of our interaction.

So Joe, is failing good?

Well this depends on several factors such as, how often the event takes place within a general workout or particular exercise.  
If it is a regular occurrence then:
•    it might be symptomatic of a load that is too heavy for the reps,
•    poor technique,
•    poor fitness.
•    It also can be a sign of over training or
•    It can also be a sign of oncoming poor health.

For a particular exercise, failure might be just a random event. (which is why many top lifters use a daily note log) Technique breaks down when the load becomes too heavy for the current capacity of the athlete.

If you constantly push to failure the system adapts to failure as a goal and feeds back into the athlete with more failure.  The technique of the exercise begins to disintegrate. It is a system of negative follow through where the last motor event in the sequence is the goal. Olympic shooters, for instance, are taught to site-hold on the target after the shot is gone ensuring that the pathway stays on target. What you practice is what you will get and I deal with this all the time in throwing. In baseball Ted Williams used to emphasize 'follow through'. Failure done regularly is a form of 'follow through'.

Can you have a micro-cycle where push to failure is OK?

 Yes you can, but the exercises should be ambiguous in nature and not closely related to the sport movement. In that way the technique can be undisturbed but the work effort to push CNS and increased body load capacity is affected.  Sometimes you need to 'blast' the system to make it more alert to change. It's the motor systems equivalent of a loud yell!

'Push to failure' in weight training must not impede other sport preparation. Sufficient recovery is necessary. Each athlete is different in this and recovery rates vary. This is why 'One workout for All' does not work for 'all'. You start with a general workout then customize based on developmental ability.

On the flip side, should athletes always experience "success" on each set or rep?

If they are, then they are not pushing hard enough. There is a time for high intensity and a time for general development and maintenance. High intensity in the sport event usually requires a reduced load in the wt room but there are anomalies. Some athletes get a psychological boost when training hard and a significant reduction of load or intensity raises their anxiety. What you believe is as important as what really works which is why education in the latter is so important.

When the failure occurs you can;
1. Do nothing and move on to the next set
2. Adjust the rest of the sets (ie: poundage down)
3. Adjust the reps
4. Adjust reps and poundage
5. Correct the technique

In conclusion, I would say push to fail is OK if done when needed, the cycle is short and does not interfere with the sport skill.  It is not the poundage in the weight room that decides whether a workout plan is effective. It is the sport skill result that is the final arbiter. The knowledge we gain is scientific but the application is still art.

Sometimes a good loud yell is what we all need but not in an airport security line!

*Thanks to Joe Donahue (Northeastern University Legendary Throwing Coach) for his thoughts and contribution.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at


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Topics: Strength Training, basketball conference, athletic training conference, boston hockey summit, boston hockey conference, sports performance, strength coach, mental toughness

A Bigger Box

Posted by Boston Sports Medicine and Performance Group on Mon, Apr 5, 2010 @ 09:04 AM

I hate when people say, “You need to think outside the box,” like they’ve just discovered the world was round.

Since when was reading articles or attending conferences “thinking outside the box”?  When did practicing evidence-based medicine or implementing strength programming other than 3 sets of 10 on bench press every Monday become novel thinking?

Some people just need to get a bigger box.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at


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Topics: Strength Training, basketball conference, athletic training conference, boston hockey summit, boston hockey conference, Mike Boyle, barefoot running, mental toughness, northeastern

Seth Godin Squats a Thousand Pounds

Posted by Boston Sports Medicine and Performance Group on Mon, Mar 15, 2010 @ 13:03 PM

I get it.  You’re too busy.  

Right now, in your athletic department, in your sports medicine department or in your strength and conditioning department there is a million and one things to get done, and they were all due yesterday.  Whether it's preparing summer conditioning programs, Christmas break rehabilitation plans or putting the finishing touches on your policy and procedure manual, there’s no time to take on another task, let alone put time aside to develop your skills or trade.

So if you’re too busy, it’s safe to say you won’t be attending a conference this weekend or snuggling up with an anatomy text book tonight in order to better your skills.  And if you’re too busy to improve your particular trade or skill then perhaps you’ll also be too busy to notice the young kid two cubicles down accept your dream job at the college across town or maybe you’re too busy to look up and notice your customers, (ya, customers – I know in most athletic departments they’re called athletes or even student-athletes) have stopped buying what you’ve been selling.

So if you’re too busy and can’t find five minutes to breathe, can I suggest finding two minutes and to read and learn from one of the nation’s top thought leaders?  Seth Godin isn’t a world renowned surgeon, he’s never taped an ankle and he probably can’t even bench his body weight.   But what Seth Godin can do, he does better than anyone else – he’ll stop you dead in your tracks.  Seth Godin will make you think… think about everything you do today and everything you’ll do tomorrow.  He will not make your athletes run faster or return your athlete from ACL surgery quicker – but he will challenge you to find five more minutes in your day to simply get better.

And if Seth Godin were in athletics? Well, Seth Godin would squat a thousand pounds.

Two of my favorite blog posts from Seth Godin:

The least I could do
One way to think about running a successful business is to figure out what the least you can do is, and do that. That's actually what they spent most of my time at business school teaching me.

No sense putting more on that pizza, sending more staff to that event, answering the phone in fewer rings... what's the point? No sense being kind, looking people in the eye, being open or welcoming or grateful. Doing the least acceptable amount is the way to maximize short term profit.

Of course, there's a different strategy, a crazy alternative that seems to work: do the most you can do instead of the least.

Radically overdeliver.

Turns out that this is a cheap and effective marketing technique.

We can do it
Too often, it seems, this attitude is missing from teams, organizations or the community.

It's missing because people are quick to opt out of the 'we' part. "What do you mean, we?" they ask. It's so easy to not be part of we, so easy to make it someone else's problem, so easy to not to take responsibility as a member of whatever tribe you're part of.

Sometimes it's missing because people disagree about what 'it' is. If you don't know what you're after, it's unlikely you're going to find it.

And it's missing because people confuse cynicism with realism, and are afraid to say "can". They'd rather say 'might' or even 'probably won't'.

Just about everything worth doing is worth doing because it's important and because the odds are against you. If they weren't, then anyone could do it, so don't bother.

Product launches, innovations and initiatives by any organization work better when the key people agree on the goal, believe that they can achieve it and that the plan will work.

Do we have a cynicism shortage? Unlikely.

Successful people rarely confuse a can-do attitude with a smart plan. But they realize that one without the other is unlikely to get you very far.

Count me in. Let's go.

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at

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Topics: basketball conference, athletic training conference, boston hockey summit, boston hockey conference, Seth Godin, sports performance, strength coach, mental toughness

Who Wins - Mental Toughness or Daily Discipline?

Posted by Boston Sports Medicine and Performance Group on Thu, Mar 11, 2010 @ 20:03 PM

    When I hear strength coaches talk about discipline, I often think about an example that Jim Collins gives from his book, Good to Great, where he describes the “rinsing your cottage cheese factor.”

    He writes, “The analogy comes from a disciplined world-class athlete named Dave Scott, who won the Hawaii Ironman Triathlon six times. In training, Scott would ride his bike 75 miles, swim 20,000 meters, and run 17 miles - on average, every single day.  Dave Scott did not have a weight problem! Yet he believed that a low-fat, high-carbohydrate diet would give him an extra edge. So, Dave Scott - a man who burned at least 5,000 calories a day in training - would literally rinse his cottage cheese to get the extra fat off. Now, there is no evidence that he absolutely needed to rinse his cottage cheese to win the Ironman; that’s not the point of the story.  The point is that rinsing his cottage cheese was simply one more small step that he believed would make him just that much better, one more small step added to all the other small steps to create a consistent program of superdiscipline."

    I’ve often thought that discipline is the one virtue which set the very best athletes apart from those that were merely average.  However, much has been made recently of developing mental toughness in our athletes in order to better prepare them for “when the going gets tough”.  My friend, Brijesh Patel, Head Strength and Conditioning at Quinnipiac, has done a terrific job writing and presenting on this exact topic and has convinced me and a number of other coaches to integrate some of his strategies into our own programming.  Whether it’s a grueling finishing exercise, an ungodly number of sprints, or work-capacity circuits that the Geneva Conventions would call abusive, the goal remains the same; push the athlete to a limit they are uncomfortable with so when the same uncomfortable situation arises in competition they are ‘mentally tough’ enough to persevere.

    I remember the exact moment I asked Mike Boyle about training athletes in order to develop mental toughness. His response: “Being tough is showing up on time, every time.  It’s about doing the little things all the time.  That’s tough.”  From that moment forward I became conflicted on whether these mental toughness programs/exercises were simply making my athletes tired (I mean, anyone can make a kid sweat, tired and cramp) or if I was in fact instilling an inner warrior mentality that would be unleashed at the time of competition?

    I think we all understand the mental toughness part, but instilling a culture of “superdiscipline” as described by Collins means demanding and having our athletes touch the baseline each and every time during conditioning drills, closing out under control on a three-point shooter with hands up instead of  “fly-by” which basically takes you out of the play pending a missed shot, “Walling Up” on your man with arms straight up and staying down instead of leaving your feet during a fake shot attempt, defending for the entire 35 second shot clock, showing up on time for a 2:00pm lift (that’s not walking in the door at 2:00 pm but rather being prepared and ready at 2:00pm), being the first on the floor at practice to get extra shots up AND having purpose to your shooting drills (putting up 300 shots vs. putting up 300 total shots with the goal of making 70 percent from the left elbow after a cross-over dribble), coming to the weight room 10 min early to address mobility and stretching needs outside the scope of training that day, waking up 15 minutes early so you can eat breakfast rather than show up for 6am lift on an empty stomach, or disciplined enough to pack snacks and plan your meals for the next day so you don’t begin afternoon practice on an empty stomach. Now THAT’S being “superdisiplined”.

    So when the game is on the line, when you must get a defensive stop to seal a win, or when you have to stretch a ball screen all the way, was your success or failure due to your athlete’s mental toughness or a lifestyle of “rinsing the cottage cheese”?

Art Horne is the Coordinator of Care and Strength & Conditioning Coach for the Men’s Basketball Team at Northeastern University, Boston MA.  He can be reached at

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Topics: basketball conference, boston hockey summit, training, Good to Great, discipline, Mike Boyle, sports performance, mental toughness, superdiscipline