Strength is Never a Weakness

Friday, 23 June 2017

A Review of an Androgenic Anabolic Steroid (AAS) Meta – Analysis Paper 1985-2015

This article is a condensed version of a university assignment I submitted (as part of one of my assessments last semester) on Androgenic Anabolic Steroid Usage.

*Disclaimer*

This is not an attempt to bash or throw a dig at someone who uses AAS. This is just a review of a meta analysis, which I am hoping to inform and educate my readers with this blog post.

Just because this is a meta analysis, it does not mean we should take its word for it. We should be critical of how it was made, the potential bias of the researcher(s), and the level of rigor for the methodology (validity and reliability).

Remember I am discussing this in the context of recreational usage of AAS, not in the context of competitive sports (they are two entirely different topics of discussion) and as a competitive athlete and member of UK Anti-Doping I am not in favor of using AAS in a tested sporting environment to gain an unfair and non sportsmanship advantage over one's opponent.

Enjoy reading!

Methodology of Literature Review

A literature search was carried out on Sports Discus, Google Scholar and Science Direct with

using keywords “AAS”, “Anabolic Steroids”, “Muscle Dysmorphia”, “Body Image”, and “Anabolic

Steroids Meta-Analysis”. Through analyzing the literature search, the Meta-Analysis entitled

“The global epidemiology of anabolic-androgenic steroid use: a meta-analysis and meta-regression

analysis” (2014) was found.

Sagoe, D., Molde, H., Andreassen, C.S., Torsheim, T. and Pallesen, S., 2014.
The global epidemiology of anabolic-androgenic steroid use: a meta-analysis
and meta-regression analysis. Annals of epidemiology, 24(5), pp.383-398.

This reviewed 271 papers and was deemed a suitable reference for

analyzing AAS trends over time. To do this, in Appendix 1 the adapted Data Inclusion and

Exclusion Criteria was imposed upon the 271 Journals, 61 of which met the criteria. These papers

were across the following two defined time periods;

1. 1985 – 1999

2. 2000 – 2015

The reason for the two time periods is to compare usage at the turn of the century and then review a

new generation of “AAS users” - 15 years later which may highlight new trends. In addition, the

introduction of certain external factors has made getting AAS easier in the 21st Century. These

time periods are also cross-referenced geographically as follows:

1. United Kingdom

2. North America

3. Rest of World

This is for comparison within each region as different countries have dissimilar laws on accessibility

for AAS. E.g. in the UK it is easier to obtain AAS than in America (Kokkevi, et al, 2008).

Furthermore, data between each geographical area and can be found in Appendices 2 and 3 which

formulated the Flow – Chart 1.0 and 2.0 below.

How has there been such an increase in AAS usage over the last 15 years compared to

1985-1999? There is no one simple answer as there are plenty of contributing multi factorial issues.

If I was to pick three;

• Internet Access: This has to lead to an increase of buying steroids and the most popular place

for internet users is off black market sites and the dark web (DuRant et al., 1993: 923).

• Influence of Social Media: The encouragement of the steroid user has been negatively

influenced by unrealistic images and beliefs circulated on social media. These have massive cult

followings (Instagram) behind them due to their lavish, appealing and large than life lifestyles,
thus encouraging those with already frail perceptions of their masculinity to follow them.
(Field et al, 2005). Again with reference to symbolic violence.

• Job Roles: Police, army, fire service, private security, construction, etc use steroids for their

physical jobs, but there is an increase in other professions such as doctors, coaches and teachers to

use AAS to look and feel powerful and authoritative when dealing with clients or patients

(Kimmel and Mahalik, 2004; Magnolia Pictures & Magnet Releasing, 2008).

Future Research Recommendations and Summary

In order to raise awareness and to help those suffering with BI, MD or perhaps an addiction to AAS,
the Image and Performance Enhancing Drugs (IPEDs) publish literature reviews and steroid
awareness guides within the UK to educate and inform users or potential users as part of the

Lifeline Project (Lifeline, 2017). Another example of a successful scheme is Drugs in
Sport Clinic and User Support (DISCUS) in Durham (Frank, 2016). It ran for fifteen years educating
the public on how to train, eat correctly, use AAS safely and the potential negative side effects of
using AAS, but its funding was cut. This is an issue when one of the local towns (Middlesbrough)
which was named the UK capital for steroid usage (GazetteLive, 2016).

Across the pond, the Adolescents Training and Learning to Avoid Steroids (ATLAS) study in

America (1996) was created to reduce the increase in steroid usage at school level. At the end of

the program, students reported better understanding of the effects (positive and negative) and

also encouraged better lifestyle (diet and training) habits (Goldberg et al, 1996). Regrettably, a

year after the ATLAS program, the American Paediatrician Association stated “to our knowledge,

no study has identified an adolescent population without the temptation and risks of anabolic steroid

use. Furthermore, no study has been published showing a decrease in the prevalence of anabolic

steroid use over time” (Miller et al 2002). This can be evidenced with the data shown in Flow -

Chart 1.0 and 2.0.

What is required is a data analysis on a large scale to determine behavioral tendencies of the 21st

century AAS user. The government needs to recognize this matter and its ultimate effect it will have
on the NHS if unchecked. That way, new intervention programmes can be put into immediate effect
at hospitals and drug/alcohol clinics. This should minimize any increase in ujnderground AAS usage,
eventually reducing it over time whilst decreasing MD and related issues. However, this is easier said
than done as getting access to this data requires having trust within the gym and fitness sub-cultures
to open up about the stigma that surrounds MD and AAS usage and acquisition.

Appendices

Appendix 1: Data Collection Inclusion and Exclusion Criteria to formulate argument:

61 studies were included in this review. Inclusion of these studies was due to them meeting the

following;

I) Male and female included in data collection within respective journals.

II) N sample size value shown (showing both male and female breakdown).

III) % breakdown of AAS used by males and females.

IV) Paper had to contain either one or more of the following keywords; High School/School/

Adolescents/Gym/General/Prison/Ex Prisoner/Prisoner/Drug User/Athlete/Athletics/NFL/Sports.

V) Studies must be within 1985 – 2015.

VI) Studies must show survey response rates.

210 Studies were excluded from the data analysis if they did not meet the following;

I) Studies did not show AAS prevalence rates

II) Studies did not show survey response rates

III) Studies did not show any gender breakdown of sample population

IV) Studies did not show sample sizes

Appendix 2.0 Limitations of the Literature and Data

Within any study or methodology there are some limitations to the data collection which are

identified as follows: regarding questionnaires, it is to be assumed people can lie and that they are

limited to what they can answer (Beiske, 2002) due to the questions that are set. Each studies’

questions will be different to some degree bar a few standardised statements requiring answers.

The can be duplicated if subjects are used more than once, however this is unknown as

participants’ are left out in accordance with the Data Protection Act (Act, 1998). There is

more research being done in the 21^st Century on AAS than in previous years.

This can be shown in the papers

This is due to the popularity of AAS being used and studied at an academic level. Regrettably

this places bias and an unfavorable slant to presenting any case. The data gathered is from

multiple populations so one cannot assume that all AAS users are all athletes, teenagers, males or

females etc. The main purpose was to identify the difference in usage over time. Considering

some of the studies, a few had very poor replies to their questionnaires whereas others were

excellent. These ranged from a 2.7% response to up to 100%.

This no doubt effects the reliability of the study. Adding to that, some studies had very small

sample sizes thus also presenting potentially unrealistic or misleading data (Beiske, 2002). A

significant majority of the studies analysed did not meet the criteria. If they did, the data may

have changed significantly (in favour of an increase usage of AAS). Finally, as previously

mentioned, different countries have different laws on steroid availability and accessibility

(Anabolics.com Advanced Science of Muscle Building, 2017 and Sted-Ed Steroid Education,

2017) which may also affect recruitment numbers for data collection.

To see the breakdown of the papers and the stats they are at the bottom of the page. There is a

big break in the text as the tables extend across the page. Do allow the table to be fully seen

we have had to knock them way down so no adverts down the side will interfere with

them. Apologies for this presentation error bu eblogger does not support formatting tables.

Once both my final Master projects are completed I will write them up on this as it goes
more into detail into AAS culture, gym culture, negatives of social media.

Appendix 3 Table 2.0 Data of all AAS and Non AAS users across 21 Studies over a 15 year period.

1985 - 1999 Timeline of AAS Studies
Geographical area of Investigation	Studies	AAS Usage % (Combined)	Male AAS Usage %	Female AAS Usage %	Sample (N) Size (Combined)	Sample Size Male	Sample Size Female	Sample Size of AAS Users (Combined)	Sample Size of Males who use AAS	Sample Size of Females who use AAS	Study Response Rate %
United Kingdom	4	3.50	3.90	1.80	3576	2870	706	125	112	13	59.50
North America	11	2.80	3.50	2.00	34321	15529	15792	973	650	323	75.20
Rest of World	6	5.88	5.28	1.20	17188	9285	8503	487	386	101	81.50
Combined	21	2.88	4.15	1.77	55085	27684	25001	1585	1148	437	72.00

Appendix 4 Table 3.0 Data of all AAS and Non AAS users across 40 Studies over a 15 year period.

2000 - 2015 Timeline of AAS Studies
Geographical area of Investigation	Studies	AAS Usage % (Combined)	Male AAS Usage %	Female AAS Usage %	Sample (N) Size (Combined)	Sample Size Male	Sample Size Female	Sample Size of AAS Users (Combined)	Sample Size of Males who use AAS	Sample Size of Females who use AAS	Study Response Rate %
United Kingdom	4	41	41.06	0.00....	1408	1383	25	578	576	2	54.40
North America	8	4.04	4.12	3.97	39910	17,308	22,602	1612	713	899	85.40
Rest of World	28	4.79	5.60	3.73	101233	57996	43237	4859	3248	1611	80.62
Combined	40	4.94	5.91	3.81	142,551	76687	65864	7049	4537	2512	73.47

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University.

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019.

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications:

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning.

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering.

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness.

I had my own business for providing training plans for teams and athletes.

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships,

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge.

Contact details below;

Facebook: Andrew Richardson (search for)

Facebook Page: @StrengthisNeveraWeakness

Twitter: @arichie17

Instagram: @arichiepowerlifting

Snapchat: @andypowerlifter

Email: a.s.richardson@tees.ac.uk

Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278

Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7

Thursday, 13 April 2017

The Squat: Can you Coach it to Everyone?

The Squat: Can you Coach it to Everyone?

By Andrew Richardson (BSc), Owner of Richardson’s Strength and Conditioning, Head Coach of the Teesside Barbarians and Level 2 IPF Powerlifting Coach and current MSc Student

It may seem like an obvious answer however, most trainers, coaches and PT’s struggle to coach the squat. They just see it as another exercise, not a complex movement which so many factors play a key role in ensuring the squat is performed correctly and safely for any individual. A lot of the times the information they have read leads trainers to be misinformed. This I will help to eliminate and to help those in some squatting tips. As a forewarning, this is how I was taught and how I have learned to teach the squat (in all its variations). By all means please try them out but be open to other coach’s interpretations and methods of teaching.

The article was made based off my lecture noes to Undergraduates at Teesside University (2017). Lectured notes tailored to students whom are new to coaching and fitness.

Let’s get into it!

Escamilla et al (2000) cited the squat as the best exercise, as it can make athletes quicker or add muscle mass. Due to its array of applications, the squat is one of the most recorded movements within the Sports Science and Strength and Conditioning literature (Brown 1988, Chiu et al 2009, Chiu & Burkhardt 2011 and Cissik 2000). It has been named the gold standard of leg strength assessment (Escamilla et al 2001a and Escamilla et al 2000b). Additionally, the squat is a great assessment tool for many components of fitness, such as motor unit recruitment, maximal strength, balance and flexibility (Bell et al 2008, Clark and Lucett, 2007 and Escamilla et al 2001). Hartmann, Wirth and Klusemann (2013) stated in their paper "provided that technique is learned accurately under expert supervision and with progressive training loads, the deep squat presents an effective training exercise for protection against injuries and strengthening of the lower extremity."

We know it is a well referenced and popular exercise amongst the literature but, what muscles are being used and how? Table 1 and Table 2 give a detailed overview on how the anatomy of the human body works in relation to performing a squat;

Table 1.0 The Role of the Muscles in the Back Squat (Clark & Lucett, 2007).

Type of Muscle Function of the Muscle What Muscles are Used

Agonist Prime Mover Gluteus Maximus

Quadriceps

Synergist Assists Prime Mover Hamstrings

Stabilizer Stabilise while Prime Mover & Synergist Work Transversusabdominis

Antagonist Oppose Prime Mover Psoas

Table 2.0 The Barbell Back Squat (Yule, 2007)

Muscle Function

Quadriceps Extend the Knee

Gluteus Extend the Hips

Gluteus Med Extending of the Hip and Lateral Hip rotation

Hamstrings Extend the Hip

Erector Spinae Stabiliser of the Spine and Pelvis

Latissimusdorsi Stabiliser of the Spine and Pelvis

Adductors Contribute to the extension of the hips and stabilising of it.
(Magnus, Longus,
Brevis & Minimus)

Abdominals Stabiliser of the Spine and Pelvis

When coaching the back squat think of it as a balance drill. Imagine this in your head as your reading this; The distance between the subjects’ feet when squatting is known as the base of support (BOS). When using weight (external load), it will have an effect on the subject’s centre of mass (COM). This external load can be referred to as the perceived centre of mass (PCOM). If the PCOM moves outside the BOS (barbell moves away from the midfoot), then the squat will become more challenging (Cleather, 2012). From image below we can clearly see this affecting the individual below when the barbell moves away from the mid foot.

Figure 1.0 Correct Positioning for the Back Squat (Khan, 2016)

Credit: http://smartlifting.org/2015/08/com-delle-mie-brame/

To far back and you will fall backwards, too far forward and you will fall forward with the bar hitting your head. To summarise the first section, we have looked out the usefulness of the back squat, its anatomical and biomechanical abilities and how the squat is a balance skill when being coached.

When we squat depending on the individual we will open up our hips at different angles based upon our femur, tibia/fibia lengths and ankle, knee, hip joint designs.

The next section of the article has me answering some of the most common questions I get as a coach when being asked about the squat. This makes it easier for you as readers (whom I writing this for coaches and trainers) as you will get asked similar questions.

1. Question: What coaching points would you give when coaching a novice the bodyweight squat?

(This is assuming they have no injuries and have full mobility)

My main coaching points for the bodyweight squat (a lot of these cues can be applied to weighted versions of the squat as well);

• Get feet in correct stance based on individuals biomechanics (we will expand on this later).

• Head neutral (this just means head straight not forward or back).

• Eyes up (look up few inches above where you are looking forward).

• Shoulder blades retracted and flex the lat muscles (this creates a strong and tight upper back). This also replaces the chest up cue as many new lifters will just arch their upper backs causing an exaggerated extension of the back. This will lead to injury if not corrected.

• Brace core (small amount of air breathed in and in combination with this flex your abdominal muscles. Hold this tension when squatting).

• Break at the hips (push your hips back first when squatting not bending at the knees).

• Knees track over toes (within one’s ankle dorsi flexion ability).

• Feet stay on the ground (don’t roll inwards).

• Keep yourself braced and looking up during descent (simply put don’t collapse your form when coming in and out of the hole).

• Once below parallel (or whatever depth the person can achieve) then come back up and stand tall.

For video demonstration please refer to:

• Bodyweight squat coaching video https://www.youtube.com/watch?v=3etB0RavVuw

• Coaching the back squat https://www.youtube.com/watch?v=iZlcBUnkdp8

2. Question: If someone cannot do a bodyweight squat (for whatever reason) what can they do instead?

• Isometric corner squats (hold a corner of a squat rack for few sets of 10-15 seconds, fires up the quads and keeps good form).

• Paused bodyweight squats (again maintains good techqniue and pauses can be done at a variety of heights based on the individuals needs).

• Squatting to a Box or chair. The height of the box/chair can be reduced over time (depending on the client this is quite good if someone has tendonitis or some other knee injury, as the weight is shifted to the hips/hamstrings/glutes more rather than the quadriceps.

• Leg Curl Machine (works the hamstrings).

• Leg Extension Machine (works the quadriceps).

• Leg Press Machine (works the quadriceps, hamstrings, glutes and calves).

• Trap Bar Deadlift. This is a great tool for clients who are very tall, lack hip or shoulder mobility and finally may have weak quads. Clients can grab the bar as the handles are raised, similar mechanics to a squat and a nice stepping stone to doing a squat.

These are just a suggestion (I will do an article on the deadlift separately to cover it as well).

3. Question: What should I look for when coaching a client who has different limb lengths or impairments?

(This won’t cover everything as some injuries can make up their own articles this is a brief summary for trainers and coaches out there).

Here are some key points about building the squat for an individual;

• Look at their leg length in relation to their torso. If their legs are longer than their torso then they will naturally have a wider stance squat (depending on their hip mobility).

• If they have a very long back this will limit their ROM (range of motion) when squatting down. Linked in with tight hips and tight lower back. Have a tendency to collapse forward when squatting (this can be affected even more with tight ankles and shoulders).

• Students, office based jobs will have poor ankle, knee, hip mobility as they sit down all the time so depth and degrees of freedom around a joint will be limited.

• What is their ankle mobility like? Are they wearing the appropriate shoes? Do they wear insoles?

• What is their injury list? Can they physically do a squat? Can they stand up or sit down without pain?

• What is their end goal? Do they want to get stronger or faster or bigger legs?

• What is their sport? Is it explosive or endurance?

As you can see this is just a snapshot of what you may see when working with an array of clients so be prepared to adapt movements around your client needs.

4. Question: I have a good grasp of the bodyweight squat. What can I do next?

The following exercises are suitable to use as progressions (in no particular order);

• High bar back squat (barbell rests on an individual’s traps).

• Barbell Paused squat (same as the above but pausing it).

• Lunge done statically without weight (single leg work is a great way to bring up strength).

• Goblet squat (nice exercise keeping the spine neutral can use a kettlebell or dumbbell).

• Overhead squat with bands (great for mobility and progressing to doing an overhead squat).

• Front Squat (with kettlebells is a great way to strengthen the quads and core muscles).

Not everyone you meet will be able to do every exercise I have listed (and there is more I haven’t listed). It is your job as coaches to make the call and assess what they can and cannot do. This will require some time to eliminate out what your client is physically able to do whilst still achieving their goals.

5. Question: From the exercises suggested as regressions and progressions. What kind of variations can I do?

Variations which can be applied to exercises I have mentioned;

• Tempo of the movement (Time under Tension training for hypertrophy).

• Pauses at different points of a movement to create for tension (again for hypertrophy or to build strength at a specific point of a movement).

• Weight used as in percentage of one rep max (1RM).

• Drop Sets/Super Sets/Pyramid Sets for lactic acid training, hypertrophy training or strength endurance and much more.

• Bands around the knees to create more tension when externally rotating the femur away from the body (gets the glute muscles more engaged).

• Stance Width when doing a squat (wider stance more glutes and hamstrings, close stance more quadriceps).

• Speed/Velocity of the barbell is referring to how fast or slow one is lifting the bar. This is dependent on the sport or goal of an individual.

6. Question: What technical issues should I be aware of when coaching my clients when they are squatting?

These are things you may see clients do which will affect their technical proficiency in this exercise;

• Fall backward (see image below). This is usually due to being off balance and putting the weight too much on the back foot when sitting into the hole or when coming out of the hole they push back and don’t slow down.

Figure 2.0 Incorrect Positioning for the Back Squat

Credit: http://smartlifting.org/2015/08/com-delle-mie-brame/

• Fall forward (see Image above). Can be due to losing balance or lack of mobility at the ankles to go down low. To compensate the chest is pushed forward which gives the impression (to the lifter) he/she is going lower where in fact they are just going forward not lower.

• Knees caving inwards (this is known as Knee Valgus Collapse). Can be due to tight hip flexors, tight glutes or lack of stability of the knee joint during the lift itself.

• Ankles rolling inward. Lack of mobility or due to having high arches, this is because the feet will collapse inwards (due to the increase in weight). This causes a knock on effect, knees come in then hips come inward. If a lifter has high arches insoles are recommended. If possible have a client’s gait assessed as if their squatting is being affected their walking is probably affected as well.

• Elbows flaring back. This is a lack of lat tightness or not enough shoulder mobility under the bar. Try and get your clients to pull the barbell into their traps as if they are doing a lat pulldown

movement. Once pulled down, then crush their lats together with their elbows (mobility permitting). If struggling widen their grip and do the above again.

• Rounded back is due to not doing the above and or a combination of no upper back tightness and not bracing.

• Dive bombing (rapid speed of descent). This is squatting which maximum effort down without control. Only thing one will gain with this getting themselves injured. Leave the ego at the door and slow down the movement.

Reference List

1. Bell, D. R., Padua, D. A. & Clark, M. A. (2008). Muscle Strength and Flexibility Characteristics of people displaying excessive Knee Displacement. Arch Phys Med Rehabil. 89: pp.1323-1328.

2. Brown, L. (1998) Which way to do the Squat Exercise? Strength and Conditioning, 20, pp. 65-66

3. Chiu, L.Z.F. and Burkhardt, E. (2011). A Teaching Progression for Squatting Exercises. Strength and Conditioning Journal, 33, pp. 46-54.

4. Chiu, L.z.f. et al. (2009) Sitting back in the Squat. Strength and Conditioning Journal, 31, pp. 25-27.

5. Cissik, J. (2000) Coaching the Front Squat. Strength and Conditioning Journal, 22, pp. 7-12.

6. Clark, M. A. and Lucett, S. C. (2007). NASM Essentials of Personal Fitness Training. Lippincott Williams & Wilkins.

7. Dan Cleather. (2012). Squatting is a balance skill: An alternative technical model. In: Ian Jeffreys Professional Strength and Conditioning. Lancashire: UKSCA. pp. 17-21.

8. Escamilla, R. F. (2001a). Knee Biomechanics of the dynamic squat exercise. Medicine & Science in Sports & Exercise, 33(1), pp. 127-141.

9. Escamilla, R. F., Fleisig, G. S., Zheng, N., Lander, J. E., Barrentire, S. W., Andrews, J. R., Bergeman, B. W. and Moorman, C. T. (2001). Effects of technique variation on knee biomechanics during the squat and leg press. Medicine & Science in Sports & Exercise Science, 33: pp. 1552-1566.

10. Escamilla, R.F., Fleisig, G.S., Lowry, T.M., Barrentine, S.W. and Andrews, J.R., 2001. A three-dimensional biomechanical analysis of the squat during varying stance widths. Medicine and science in sports and exercise, 33(6), pp.984-998.

11. Hartmann, H., Wirth, K. and Klusemann, M. (2013). Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports Medicine, 43(10), pp.993-1008.

12. Yasha Khan. (2016). Check Your Balance. Available: http://yashathoughts.com/check-your-balance/. [Accessed 20th March 2016].

13. Yule, S. (2007). The Back Squat. Professional Strength and Conditioning, 8, pp. 20-23.