Proper post-workout nutrition is essential for those interested in increasing lean body mass, losing weight and achieving their fitness goals. For those new to fitness, you may find yourself in a nutritional supplement store surrounded by hundreds of different options that ensure you will become a lean machine. It will empty your bank account at the same time too. Instead of going through all the different supplement options on the market, I will discuss what the current research shows regarding ingesting protein and carbohydrates post-workout for both weightlifters and endurance athletes.

Proteins and carbohydrates serve different purposes when ingested in the body.

When ingested, carbohydrates are transported as glucose molecules by insulin which is utilized as an immediate source of energy by the brain and muscle tissue (1). Insulin is considered an anabolic (muscle building) hormone since it is responsible for transporting carbohydrates and amino acids into muscle cells which initiates protein synthesis and muscle repair (2). Whatever carbohydrate is left over it is stored as glycogen in muscle tissue and the liver (1). It is important to closely regulate the number of carbohydrates ingested because once the optimal levels of muscle and liver glycogen levels are reached the body converts excess carbohydrates to fat through a process called de novo lipogenesis (3). During this process, glucose molecules are converted and stored as fat which can lead to weight gain when consumed in excess.

When more energy is required, glycogen is broken down from their storage sites in the liver and muscle.

It is utilized as the bodies primary fuel source. Fatty acids are also a major fuel source for light to moderate intensity and long duration activities (4). In the absence of glycogen or carbohydrate intake, gluconeogenesis occurs which allows the body to create glucose from non-carbohydrate sources such as amino acids. This is commonly referred to as a protein (5). It allows the body to regulate energy levels in the absence of carbohydrates but can have a negative effect on muscle tissue since it puts it in a catabolic state or muscle breakdown.

For athletes who perform long duration, low-intensity exercise, they can deplete their carbohydrate stores within 90-120 minutes (6).

At this point, the body utilizes a greater percentage of fats and proteins as an energy source which places the body in a catabolic state meaning it breaks down muscle tissue for energy. Therefore, it is essential for endurance athletes to ingest carbohydrate supplementation either during or immediately following their event in order to avoid protein breakdown and muscle loss. It has also been suggested that higher intensity training such as HIIT training can deplete glycogen levels within 20-30 minutes (6). For endurance athletes, there has been evidence suggesting consuming 3-4 grams of carbohydrates for every 1 gram of protein ingested in order to promote glycogen synthesis within the body and prevent protein breakdown.

Typically, people who perform resistance training do not need to ingest an increased amount of carbohydrates post workout(8).

For many years it had been suggested that ingesting a combination of carbohydrates and protein following resistance training was essential for increasing lean muscle tissue and to promote muscle hypertrophy due to the increased insulin response from ingesting carbohydrates. However, several research studies have concluded that the insulin response from amino acids alone is sufficient to promote muscle repair (8). Also, there were no significant changes in strength gains or muscle hypertrophy when comparing individuals who consumed only amino acids post-treatment versus a combination of carbohydrates and protein (9). The research did suggest that additional research in the area is needed to make substantial claims, but the current evidence does not suggest that a combination of carbohydrates and protein ingestion is more effective than protein ingesting alone for people who perform resistance training.

Ingesting carbohydrates and amino acids post-workout is essential for long duration workouts performed by endurance athletes who are training for 90+ minutes at a time to prevent muscle catabolism (protein breakdown) and to effectively replenish their energy stores for their next workout. However, additional carbohydrate supplementation has not been concluded to be beneficial for those completing resistance training alone since the carbohydrate and fat stores are sufficient to fuel the body and prevent muscle breakdown. For those who perform resistance training, ingesting additional protein alone has been shown to be effective in promoting muscle hypertrophy and muscle repair.

Get your move back with Foothills. With locations all around the valley, we have one near you to get started today!



Hamstring strains are a very common injury that can sideline an athlete or put your typical fitness enthusiast out of commission for several weeks. In fact, hamstring strains make up 12-15% of all injuries in professional sports. In this article, I will discuss the pathophysiology of a hamstring strain, mechanism of injury and risk factors, and discuss rehabilitation techniques.

When a hamstring strain occurs, there is a rupture of the musculotendinous junction causing a tear. Once torn, a hematoma forms between the ruptured muscle fibers causing the formation of scar tissue. Initially, performing passive hip range of motion through its pain-free range is recommended. However, absolutely do not stretch an acute hamstring strain; any added stress can reverse healing and slow the recovery process. Lastly, as the recovery enters its final stages, the muscle fibers will begin to regenerate at the muscle-tendon junction. Advanced physical therapy is the quickest and safest way to complete this recovery.

Hamstring strains are separated into three different categories. A grade 1 strain is a mild injury that causes minor tearing of the musculotendinous unit and minor loss of strength. A grade 2 injury causes a moderate strain with a partial tear of the muscle-tendon until leading to a significant loss of strength that will result in functional limitations. A grade 3 hamstring strain is categorized as a complete rupture of the unit and is associated with severe functional disability.

The primary cause for a hamstring strain is a high-velocity eccentric contraction during body hip flexion and knee extension occurring simultaneously. Sprinting greatly mimics this body position and is the primary activity that leads to a hamstring strain. The major factors that can increase hamstring strain occurrences are a lack of flexibility, improper warm up, muscle imbalance between the quadriceps and hamstrings, and having a previous hamstring strain that was not properly rehabilitated. Those who have had a previous hamstring strain are at twice the risk of re-injury with 1/3 of hamstring injuries recurring in the first year.

When rehabilitating a hamstring strain, it is vital to avoid immobilization and start isometric contractions to maintain fiber alignment and facilitate myoblast regeneration. You can start isometric contractions on the same day of the injury, but avoid the temptation to stretch the injured hamstring until the muscle fibers have healed.

By day three, submaximal isotonics such as simple flexing and extending of the knee can limit scar formation without accidentally reinjuring muscle fibers. By days 10-14, you can start low-level eccentrics to prevent atrophy during fiber regeneration.

As the hamstring strain continues to heal, it’s vital to progress your exercise program with a variety of lengthened state eccentric exercises. Lengthened state eccentric exercises have been found to be most effective in strengthening the hamstring and effective in reducing the risk of reinjury.

If you believe you have a hamstring strain visit your Foothills Sports Medicine clinic for advanced physical therapy or schedule an appointment online.

Having spent a good deal of time in the gym as a strength and conditioning specialist and physical therapist assistant, I noticed people tend to overlook necessary rotator cuff strengthening exercises in their shoulder workouts. In fact, one of the most commonly overlooked muscle groups targeted in a typical shoulder workout routine is the rotator cuff musculature, which can lead to trouble down the line. In this article, I plan to explain the basic anatomy of the rotator cuff and the importance of incorporating specific exercises into your gym routine to help prevent the onset of shoulder pain.

The rotator cuff consists of four major muscle groups: the supraspinatus, the infraspinatus, the teres minor, and the subscapularis. These four muscles are located beneath the deltoid muscles and originate throughout the shoulder blade, called the scapula, and insert on the front of the shoulder, called the humerus. The major function of this muscle group is to provide a stable junction within the shoulder, the most mobile joint in the body and an unstable ball and socket joint. It is called a ball and socket joint because the head of the humerus, the ball portion of the arm bone, articulates, or connects, to the glenoid fossa, the socket portion of the shoulder blade.

However, in a standard gym routine, most people focus on isolating the deltoid muscles and engaging in deltoid specific shoulder exercises—such as overhead shoulder presses—looking to build larger shoulder muscles. The large deltoid muscles are the ones that turn people’s heads when you are wearing that cut-off shirt at a pool party. Although these muscles are important in shoulder mobility, the rotator cuff musculature is the major muscle group involved in shoulder stability.

Stability within the joint is necessary; it prevents the dislocation of the most unstable joint in the body. The natural instability of the shoulder joint stems from the difference in size between the humerus and the shoulder blade, with the head of the humerus being 2-3 times as large as the socket of the shoulder blade. Picture a golf ball sitting on a golf tee with the golf ball being the head of the humerus and the tee being the socket in the shoulder blade.

Thus, having a weak rotator cuff musculature can significantly increase the incidence of shoulder dislocation due to decreased stability within the joint. When this is combined with an overworked deltoid, it increases the risk of developing a shoulder impingement.

A shoulder impingement occurs when one of the rotator cuff muscle tendons, called the supraspinatus muscle, and its associated lubricating structures become inflamed inside the small space between the collar bone and the shoulder joint, anatomically known as the subacromial space. During a normal overhead shoulder motion, the rotator cuff musculature pulls the head of the humerus into the shoulder socket, maximizing the subacromial space and preventing impingement of the structures. Excessive deltoid activity, on the other hand, elevates the head of the humerus in an upward direction, minimizing the subacromial space, and pinching the soft tissue structures, leading to shoulder pain and potentially a rotator cuff tear.

It is vital to incorporate rotator cuff isolation exercises into your shoulder routine to reduce the incidence of shoulder injuries or pain that can take several months and even up to a year to rehabilitate.

I have included examples of four different rotator cuff strengthening exercises you can incorporate into your gym routine to maximize your shoulder strength without sacrificing shoulder stability. You can complete 3 sets of 10 repetitions of each exercise applying resistance that results in muscle fatigue.

Exercise 1.

Exercise 2.

Exercise 3.
Shoulder ExercisesShoulder Exercises |Foothills Sports Medicine

Exercise 4.
Shoulder Exercise With Foothills Sports MedicineShoulder Exercises With Foothills Sports Medicine Physical Therapy





Foothills is a group of locally-owned Phoenix physical therapy clinics that provide healthcare services to patients across the Valley. Our mission is to provide every patient with hands-on, individualized care to ensure they receive the greatest possible benefit from treatment. To schedule a free assessment with one of our therapists, simply go online here today. For more information about Phoenix physical therapy, follow our blog!

Steven Seibel, PTA and Certified Strength and Conditioning Specialist, has been a valued member of the Foothills staff for years. His experiences as an athlete, trainer, and therapist have allowed him to work with a wide variety of patients, including those undergoing total knee replacement surgery. He explains why patients should reach out to a therapist before their knee surgeries, and how it will benefit them.

Dr. Richard Snow at OhioHealth reports that in 2014 there were over 700,000 total knee replacement (TKA) surgeries performed in the United States, and the number of TKA procedures is predicted to increase anywhere from 1.7 to 6.7 times by 2030. Due to the rising number of TKAs in the US, patients should prepare for more than just post-operative rehabilitation. Research has demonstrated that performing a prehabilitation program prior to the TKA procedure provides several benefits to the patient, and enhances their overall recovery.

Generally, patients who require a TKA have developed severe osteoarthritis and have been living with discomfort for a long time. In order to cope with these symptoms, patients tend to develop compensatory movements. This can lead to strength and flexibility restrictions in the affected lower limbs, in addition to low back and hip pain. Foothills Sports Medicine’s physical therapists can address these impairments prior to surgery.

According to recent report in The Journal of Strength and Conditioning Research, one study showed that patients who participated in a prehabilitation program 4 to 8 weeks prior to surgery increased their knee extension strength by 10%, and participants who did not complete prehabilitation actually lost knee extension strength leading up to surgery. In addition to increases in lower extremity strength and function, completing prehab can translate to major savings in healthcare costs.

An analysis of Medicare claims reported that performing a prehabilitation program 6 weeks prior to the scheduled surgery reduced health care costs by 29%, which translates to a savings of $1,215 per patient. With nearly 700,000 TKAs per year, this could lead to significant savings for both the patient and health insurance companies. Another study showed that prehabilitation could reduce the need for acute care rehabilitation. It showed that 80% of patients required acute care rehab following surgery if they did not complete prehabilitation, while only 54% of patients required acute rehab if they did complete prehabilitaion. Therefore, it is clear that completing a comprehensive prehabilitation program can save healthcare dollars by reducing total time needed for rehab and less time in an acute rehab facility.

An example of a sample prehabilitation program that I tend to use with my patients consists of the following exercises: quadriceps sets, hamstring sets, mini squats, standing hip abduction and standing hip extension, stationary bicycle, heel slides, heel props, hamstring stretch, and leg press. These exercises concentrate on improving lower extremity strength, knee range of motion, and lower extremity flexibility. I tend to have patients start with two sets of ten reps (2×10) for the exercises, and then I progress repetitions to 3×10, then 3×15, while simultaneously increasing resistance. For stretching, they perform 3 sets of 30-second holds to improve flexibility. All exercises should be completed to tolerance with no increase in discomfort noted.

Make sure to schedule an appointment with one of Foothills’ Phoenix physical therapy clinics 6 to 8 weeks prior to your TKA to improve knee strength and reduce your post-operative recovery time and healthcare expenses. If your insurance does not cover both prehab and rehab treatment visits, we can provide a home exercise program consisting of beneficial exercises to provide an optimal recovery.