I have the normal weekly newsletter posted below, but first a quick announcement: Mike Robertson, Bill Hartman, and I just filmed a new DVD set! Those of you who have enjoyed all of our products individually can now see what happens when the three of us collaborate. For more information, check out today's blog post: A Sneak Peak at the New Project.
The Law of Repetitive Motion: Part 2
In last week's newsletter, I talked about the first three component of the law of repetitive motion: "I" (injury/insult), "N" (number of repetitions), and "F" (the force of each repetition, expressed as a percentage of maximal strength).
This week, I'll discuss the "A" and the "R" of this equation. To begin, amplitude, stated simply, is range of motion. If we spend our entire lives in limited ranges of motion, we run into problems.
Obviously, this refers to those who sit too often and too long - particularly in poor postures. I'm a big believer that the best posture is the one that is constantly changing, so I always encourage people to try to get up and move around every 20-30 minutes whenever possible. If not, I love the idea of simply "shuffling" positions at your computer. Complement this constant fluctuation of posture with some good training to open up the hips and thoracic spine, and strengthen the upper back and glutes, and you'll find that being stuck in a job with a small amplitude is a "manageable" problem.
Amplitude can also refer to only doing certain exercises in the gym, particularly those who exercise through a partial range of motion. It might be people who simply press too often and pull too infrequently, or those who perform a lot of bilateral exercises, but nothing unilateral. We aren't just talking about ranges of motion at the joints; we are also talking about the muscles recruited and type of muscle action - concentric, eccentric, isometric - that takes place.
Lastly, working at a specific task for extended periods of time can be a huge issue for some. Just ask musicians, factory line workers, and even baseball pitchers. These issues can all impose huge asymmetries that must be addressed both directly (soft tissue work, flexibility training) and indirectly (training the contralateral side, or just exposing the individual to a broader excursion of movement outside this specific task).
So, all that in mind, improving amplitude is all about increasing range of motion in one's daily life. Of course, this must be specific range of motion. You wouldn't, for instance, want to increase lumbar spine range of motion in most back pain patients, but you would want to optimize hip and thoracic spine mobility.
Rest, the "R" in our equation, is pretty straight-forward: if a tissue is angry, you need to give it time to settle down. However, just stopping all exercise isn't always the best bet.
Often, it's simply a matter of keeping the stress on the tissue below its capacity for loading. As a great example, a lot of manual therapists with whom I've worked actually like people to go out and lightly load tissues that have just been worked in order to teach the tissue to "deform" properly. For instance, I got a little "Graston Loving" on my biceps a while back, and spent the rest of the day lightly loading the tissues and doing some prolonged stretching sets. It worked like a charm.
Taking it a step further, though, much of the time, it's about redistributing stress. For instance, someone with anterior knee pain may not be able to do a more quad-dominant squat, but instructing that same lifter to sit back into the glutes and hamstrings more can markedly take down the stress on the anterior knee. Sure, it changes the muscular recruitment of the exercise, but the lifter derives great benefit and keeps the loading on the affected tissues below capacity. And, in this particular case, he's strengthening the posterior chain muscles that almost always help to prevent anterior knee pain in the first place.
That wraps up our look at the law of repetitive motion. It's certainly not an exhaustive review, but my hope is that it got you thinking just enough to consider how this law applies to the issues you see on a daily basis, as well as those you want to prevent from ever reaching threshold. For more information, check out the Building the Efficient Athlete DVD Set.
As many of you probably already know, I flew out to Indianapolis on Friday night to spend the weekend shooting a new DVD with Bill Hartman and Mike Robertson. Suffice it to say that we are all pleased with how it turned out and excited for the release. Basically, here's what you're looking at...
27 dynamic SELF-assessments (meaning that you can do them yourself - no partner needed)
A Full-on Static Assessment Guide
Approximately 78 corrective exercises for improving mobility and stability - based entirely on the results of the aforementioned assessments. In other words, you assess, and then you are pointed in a specific direction to correct these issues. You'll learn how to integrate some of the exercises from Magnificent Mobility and Inside-Out in comprehensive progressions - plus loads of new drills along the way.
A Written Collection of Warm-ups specific to certain athletic populations
A Complete Guide to Self-Soft Tissue Work - and a rationale for it
A Comprehensive Static Stretching Guide
You know the project is legit because of this picture of Lance, our demonstrator.
First, he's exhausted, which means that there are loads of exercises. Second, he actually ended up with pit stains from the experience, so these aren't just foo-foo exercises; they take things up a notch at the "top" of each progression (particularly if you do them for six hours, as Lance did on Saturday). Third, you just have to love a DVD set that uses a guy with deadlifting bruises on his shins as the model. Talk about attitude!
For more on the weekend, check out Lance's Blog.
Needless to say, we're stoked about this. There isn't a definitive time-table on the product's release, but you can be the first to find out about it by subscribing to my newsletter through the opt-in box on the right sidebar of this page.
Here's this week's list of great reads:
If We Know We Shouldn't, Why Do We Still? - This blog post from Dr. Jason Harris is a fantastic commentary on the overuse of diagnostic imaging - particularly with lower back pain patients - and the negative impacts these diagnostic results can have on patient outcomes and ease of treatment. I learned about Dr. Harris' blog through Mike Reinold and have been a regular reader every since; the information is fantastic (THIS was by far my favorite post; very good info).
The True Role of the Rhomboids - This is an old newsletter from some guy named Cressey. Not sure if he knows his arse from his elbow.
Five Pounds is Gold - I really liked this article from Myles Kantor. It's short, but makes an outstanding point - using world-record deadlifter Andy Bolton as the example.
1. I'm writing this on Thursday night as Bill Hartman, Mike Robertson, and I collaborate across several states (them in IN, and me in MA) to finalize the plan of attack for the DVD we'll be filming out in Indy on Saturday. We're really struggling to decide which of the following two costumes we want Mike to wear.
I supposed we could just dress him up as a viking with tassels and get the best of both worlds. I guess you'll just have to buy the DVD to find out for yourself.
2. I just read this week that researchers here in Boston are going to be looking into why girls hate guys who listen to techno the role of Vitamin D and fish oil in reducing the risk of cancer, heart disease, and strokes.
From the write-up: "Bloom was MVP of the Dual County League Small, posting a 6-0 record with 3 saves, a 0.90 ERA, and 61 strikeouts in 46‚ innings. He finished his career 22-6 with a 1.95 ERA." And, "Quinn was MVP and won the batting title in the Dual County League Large, batting .488 with five home runs. The four-year starter finished his career with a .386 average and 20 home runs." Nice job, fellas!
6. If I get one more email this week from someone trying to sell me a supplement in a pyramiding scheme, I'm going to flip my s**t. If you need a pyramiding scheme to sell something, then it's a crap product in the first place. And, if you have people who know NOTHING about the product they're pushing, then you have an entirely crap business model, too.
Actually, now that I think about it, these supplement pitch emails are amusing. I might start posting them as blogs to discuss the commonalities of cheeseball supplement pimps - as I began to cover in item #13 HERE.
Off to Indy tonight. Hopefully those pleasant, patient Midwestern folks can calm me down. Have a great weekend!
Back in early May, I published a newsletter discussing some alternatives I've used as replacements for traditional interval training. Basically, the goal was to show that one can work to address inefficiencies while still getting some good energy systems development training.
One of the key concepts I briefly outlined in this newsletter - and also thoroughly in Mike Robertson and my Building the Efficient Athlete DVD Set - is the Law of Repetitive Motion. This law is expressed as the equation I=NF/AR. In this equation, injury equals the number of repetitions multiplied by the frequency of those repetitions, divided by the amplitude of each repetition times the rest interval.
Looking at this equation and understanding each of these factors sheds some light not only on how we can prevent injuries, but also address these issues once they reach threshold. Truth be told, as I related in another previous newsletter, I'm a firm believer that we're always just see-sawing back and forth, getting closer to threshold when tissues are loaded in excess of their capacity.
Providing adequate stability, mobility, recruitment patterns, and tissue quality with the appropriate training loads and recovery measures ensures that we stay below this threshold. All of these issues are covered in one way or another by the equation from above.
"I" is the injury, or insult to the tissues. In the active restraints - muscles and tendons - this may present in the form of soft tissue restrictions that can be addressed with manual therapy and foam rolling. In other words, sometimes simply doing some soft tissue work can bring someone back below threshold (one reason why I refuse to refer any athletes or clients to physical therapists who do not put their hands on patients, but that is a whole other newsletter altogether).
"N" is the number of repetitions imposed on the tissues. This may be working on a factory line doing the same motion over and over again. It may also be simply sitting with poor posture, which is the equivalent of a high number of reps (constant activation). Or, it could come from doing as many chin-ups as possible simply because your business partner told you that he didn't think you could do it - and the Mudvayne in the background motivated you to action (but I wouldn't know anything about that).
With respect to "N," the general assumption is that simply reducing the number of repetitions is what it takes to reduce insult to the tissues. That's absolutely true, but not exhaustively true.
Take someone who bench presses with the elbows flared, and teach them to tuck the elbows and activate the upper back and scapular stabilizers. You may instantly relieve their pain without altering the number of repetitions; you're just redistributing the load.
The same is true of someone with anterior knee pain who has pain with forward lunging, but not with reverse lunges. So, the lesson to be learned isn't just to modify the number of repetitions, but also the manner in which those repetitions are performed.
"F" is the force of each repetition, and it's important to remember that this force is expressed as a function of maximum muscular strength. So, in other words, the "F" figure will be higher - and more injurious - on a weak tissue. This is one reason why resistance training is a big portion of modern physical therapy - including physical therapy that the brighter minds in the PT community wouldn't consider "comprehensive" or "good."
Here's an example. Average Joe gets anterior knee pain and, of course, he gets diagnosed with patellar tendinitis when it's really more of a tendinosis (but I won't digress on that). He spends six weeks in PT to really "build up his quads." It's obvious that the patellar tendon was just weak and inflamed, so strengthening it and knocking back NSAIDs like candy will fix everything. Riiiiight.
Chances are that the patellar tendon was just overused because Joe had no hamstrings or glutes. Getting the quads strong just reduces the "F" figure in the equation above. They push him away from threshold, but not as far as he'd have gone if they'd also worked on recruiting glutes and hamstrings better, optimizing hip and ankle mobility, or performing soft tissue work. Or, maybe he just got better because they reduced the "N" we discussed above by resting the knee. Regardless, Joe's not in the clear and very well might be back in PT in a few months if he doesn't address the other issues in the equation.
And, with that in mind, I'll get to the final two components of the Law of Repetitive Motion in my next newsletter. In the meantime, check out the Building the Efficient Athlete DVD Set for more details.
CP intern Roger Lawson is perhaps best known for his fish-flop into the net at the end of a intern hazing medley, but it turns out, he is also a world-class Rock, Paper, Scissors competitor. Check him out dominating at the World Championships (he is the one in the red shirt and American flag bandana). It's no wonder that all the ladies throw themselves at Roger...
I got this question the other day and thought I'd share my response:
Q: When significant improvements in flexibility are either desired or needed, do you have any general suggestions with regard to what method(s) and type of schedule set-up (frequency, duration of session, etc.) would help accomplish this in the most timely and efficient manner possible?
A: As always, my answer would be "it depends." And, more specifically, it depends on whether you are talking about short or stiff tissue.
If a tissue is legitimately short - meaning that it has lost sarcomeres due to chronic immobilization - longer duration holds are ideal. Bill Hartman and Mike Robertson go into great detail in covering this in the Indianapolis Performance Enhancement DVD Set, as I noted HERE.
If you are dealing with someone with capsular issues (outside the scope of practice of the personal trainers and strength coaches out there, in most cases), then you might just leave them alone with 15 minutes of low-load passive stretching (e.g., theraband wrapped around a DB to hold the shoulder in external rotation after a period in a sling). Going back to our "loss of sarcomeres" scenario, if you're dealing with something more muscular-only issues, the least you'll want is five 30s holds throughout the day, in my experience. Or, if feeling bold, you can have people set up for 3x5min holds or 1x15min hold. In both cases, total duration over the course of the day is likely more important than duration per stretch.
If it's stiff, in order to get it to relax, you likely need to train an adjacent tissue that acts as a synergist. A good example would be strengthening the lower traps to take the stress off chronically overused upper traps and the stiff neck that follows. Or, we have activating the glutes to take the stress off the lumbar erectors and/or hamstrings and adductor magnus. Here is a great blog post from Bill Hartman that closely illustrates the point that you don't necessarily have to stretch a muscle to reduce its stiffness.
Of course, you can never go wrong with integrating a good dynamic warm-up program prior to exercise, as this option challenges both range-of-motion and stability to provide a comprehensive training effect in a matter of minutes.
So, in the end, it's different strokes for different folks - at different times, with different issues. Keep an eye out for an upcoming project from Bill, Mike, and I that really delves into this in great detail. It'll be the most comprehensive resource out there for self-assessment and corrective exercise.
Just a quick blog announcement today for those of you who are in New England - or are motivated enough to travel to watch some good boxing.
CP athlete Danny O'Connor looks to take his professional record to 7-0 this Saturday night at The Roxy in Boston when he fights on a great card. There will be loads of CP athletes in attendance, and I'd encourage you to check it out and show Danny some love. For more information, check out Cappiello Promotions.
It's been a while since my last dose of Friday Randomness, but when you're got so much intern hazing going on, it's hard to even imagine topping that kind of content!
1. I recently contributed to another T-Muscle feature; check out Advice You Don't Want to Hear: Volume 2 for a little dose of tough love. I'm the last one down.
2. I have to say, I'm pretty proud of myself. My fiancee's been out of town since Monday morning, and while the fridge is just about empty and I'm down to one pair of clean underwear, the place didn't burn down, and I didn't put an eye out.
3. Here's a quick takeaway from a great Elbow Biomechanics talk by Mike Reinold earlier this week...
Obviously, in dealing with loads of baseball guys, I see a lot of elbow issues come through my door. The overwhelming majority of those folks are medial elbow pain, but we also see a fair amount of lateral elbow pain - even though we program for these individuals very similarly, as their inefficiencies are pretty much identical. I've seen it in practice, but never actually gotten the numbers on the forces involved.
The same medial tensile force that can wreak havoc with an ulnar collateral ligament or ulnar nerve also applies approximately 500N on the radioulnar joint during the late cocking (maximum external rotation) phase of throwing; that's about one-third of the total stress on the elbow. This lateral area also takes on about 800N of force at the moment arm deceleration begins (elbow extended out in front). As always, a picture is worth a thousand words:
I always knew it was going on, and always worked to prevent problems in the area, but suffice it to say that it was nice to get some numbers on this. If you see these issues, you've obviously got to look at mechanics, but more importantly, tissue quality, all the common flexibility deficits we see in pitchers, and overall strength of the rotator cuff, scapular stabilizers, core, lower body, and muscles acting at the elbow to provide valgus stability. For more information, I highly recommend you check out the 2008 Ultimate Pitching Coaches Boot Camp DVD set.
4. Bill, Mike, and I film our new DVD next weekend out in Indianapolis, so I'm going to end this one here and get to work on finishing up the script. Stay tuned on this front; we are excited about how thorough this is.
Have a great weekend!
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used by Cressey Performance Pitchers after they Throw!
As many of you know, earlier this week, I spent three days at a huge sports medicine conference organized by Mass General Hospital in conjunction with the Harvard University Medical School. It was a great event geared toward sports orthopedists, radiologists, physical therapists, and athletic trainers; I was very humbled to have been invited to present alongside some of the brightest minds in the sports medicine world. The discussions on surgical technique, physical examinations, etiology of injuries, biomechanics, rehabilitation, and return-to-play guidelines were absolutely fantastic. The stuff that caught my attention the most, though, actually came in the discussion of imaging - MRIs, MRAs, and x-rays - by some of the best radiologists in the world.
Several of these brilliant radiologists made specific points of commenting on how not every abnormality you see on diagnostic imaging constitutes a symptom-causing issues. A perfect example would be a SLAP 1 (superior labrum fraying) in a baseball pitcher, which is completely normal for 79% of major league pitchers. Just because the labrum is fraying doesn't mean that the pitcher is going to be in pain; it's a passive stabilizer, and the active restraints (rotator cuff, scapular stabilizers) can get stronger to pick up the slack. Likewise, just because a player is having shoulder pain and he has a SLAP 1 lesion on imaging doesn't mean that the frayed labrum is the cause. It could be coming from the biceps tendon or rotator cuff, for instance, and the labral issue is just "there."
So what does that mean for strength and conditioning professionals? Well, as I wrote in Inefficiency vs. Pathology, there isn't a whole lot we can do to effect favorable changes in what diagnostic imaging looks like, but we can go out of our way to ensure that clients and athletes move efficiently and have adequate muscular strength, stability, and tissue quality.