This is the second half of my collection of take-home points from reviewing The Complete Shoulder and Hip Blueprint from Tony Gentilcore and Dean Somerset. In case you missed the first half, you can check out Part 1 here. Additionally, I should offer a friendly reminder that the introductory $60 off discount on this great resource ends tonight at midnight; you can learn more here.
6. Shifting low threshold exercises to a high threshold strategy may yield faster results.
Dean goes to great lengths to discuss how proximal (core) stability affects distal (extremity) mobility. In doing so, he cites four examples:
a. Doing front planks may help one to gain hip external rotation.
b. Doing side planks may help one to gain hip internal rotation.
c. Doing dead bugs may help to improve your deep squat.
d. Training active hip flexion (one joint) may help one to to improve a straight leg raise (multiple joints).
With that said, there is a HUGE clarification that must be made: these exercises are all performed with HIGH TENSION. In other words, if you can do eight reps of dead bugs, you aren’t bracing hard enough.
To some degree, this flies in the face of the conventional wisdom that there are high-threshold exercises and low-threshold exercises – and most folks would assume the aforementioned four drills would fall in the low-threshold category. That said, I think a better classification scheme would be high- and low-threshold STRATEGIES. In other words, there is a time to treat a plank or dead bug as a low threshold drill, but also scenarios under which bracing like crazy is appropriate. Trying to create distal mobility is one such example.
That said, don't go and turn everything you do into a high-threshold strategy! This leads me to...
7. Improving mobility is a combination of sympathetic and parasympathetic activity.
I loved this quote from Dean so much that I replayed it a few times so that I could type up this quote:
"If you hold your breath, you're going to limit your mobility. If you breath through the stretch, you're going to access a greater range of motion than you had before. So, it's kind of a dance between parasympathetic and sympathetic and neural activation. You want to be able to use high-threshold sympathetic type stuff to fire up the nervous system and produce that stability, but you want to use parasympathetic stimulation - that long inhale, long exhale - to be able to use that range of motion after you've built the stability."
That's pure gold right there, folks.
8. The term “scapular stability” is a bit of a misnomer.
Nothing about the scapula is meant to be stable. If it were meant to be stable, it would have so many different muscular attachments (17, in fact) with a variety of movement possibilities. A better term would be something originally popularized by physical therapist Sue Falsone: controlled mobility.
9. Don’t assume someone’s "aberrant" posture means an individual will be in pain.
Posture is a complex topic, and the relationship between resting posture and pain measures is surprisingly very poorly established in the research world. We can walk away from this recognition with two considerations:
a. It's important to assess movement quality, and not just resting posture.
b. Use posture as information that guides program design and coaching cues rather than something that tries to explain or predict injuries.
10. Teach movements from the position where relative stiffness principles are challenged the most - but cue high-threshold tension.
During one of his presentations, Dean was coaching a hip flexor stretch in the lunge position, and it immediately got me to thinking about the principle of relative stiffness. In this position, if there isn't adequate anterior core control, lumbar extension will occur instead of hip extension. And, if there isn't solid glute recruitment, there will be a tendency of the head of the femur to glide forward in the socket during the hip extension that does occur.In other words, being able to brace the core and have solid glute activation is key to making sure that the individual is in a good place at this position where movement is challenged the most.
In this instance, Dean cued a high-threshold strategy that allowed him to effectively coach the movement from the most challenging position - which is somewhat counterintuitive to what we've always assumed as coaches ("win the easy battles" first by owning the simple ranges-of-motion). However, if you can get to the appropriate position (adequate passive ROM) and educate a trainee on how to establish a bracing strategy, chances are that you can speed up the learning process.
As I thought about it, this is something we do quite commonly with our end-range rotator cuff strengthening exercises, but I simply haven't applied it nearly as much at the hip as we do at the shoulder. It's definitely something I'll be playing around with more moving forward.
Last, but certainly not least, just a friendly reminder that today is the last day to get the introductory $60 off discount on The Complete Shoulder and Hip Blueprint. As you can probably tell from these posts, I've really enjoyed going through it myself, and would highly recommend it to any fitness professionals and rehabilitation specialists out there. Click here to learn more.
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Today's guest post comes from Cressey Sports Performance coach, Laura Canteri.
From super tight to super loose, people can fall at any point on the laxity continuum. Most women fall under the more hypermobile side of things, but there are a surprising amount of women who are nonetheless unaware of their extreme laxity. As a hypermobile female who learned the hard way, I want to share my knowledge and experiences with you to help improve your training and long-term health in four simple steps. While I'll focus my attention on females in particular, the overwhelming majority of these lessons hold true for hypermobile males as well.
1. Create Self Awareness.
What is Hypermobility?
Each joint has a certain amount of laxity and can be either congenital (you were born with it; thanks, Mom and Dad) or as a consequence of repetitive activities (e.g., swimming). It shouldn't be confused with instability, which would result from an injury that leads to excessive, uncontrolled range-of-motion. With that said, hypermobility is excessive laxity at a joint. If you often feel “tight” and don’t think that this article pertains to you, I encourage you to keep reading.
How Do I Know If I’m Hypermobile?
At Cressey Sports Performance, we like to use the Beighton scale to assess joint laxity and hypermobility. The screen is scored out of nine points in which there are five tests (see below). Unilateral tests should be scored on both sides with each positive test counting as one point. The higher the score, the higher the laxity.
1. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
2. Flex the thumb to contact with the forearm (left and right sides)
3. Elbow hyperextension > 10° (left and right sides)
4. Knee hyperextension > 10° (left and right sides)
5. Toe touch with knees straight, touch the palms flat on the floor
2. Remove Static Stretching From Your Routine.
From youth to college basketball, I had my fair share of injuries - from sprained ankles to dislocated shoulders -but despite having such loose joints, I would always feel “tight.” I couldn’t touch my toes, clasp my hands behind my back, or do any “cool” tricks. So, I incorporated static stretching before and after every game/practice to decrease my risk for injuries. Good news: I was eventually able to touch my toes and clasp my hands behind my back. Bad news: I continued to have even more shoulder instability issues, which resulted in surgery.
So, what gives? I wouldn’t feel “tight” if I was hypermobile, right? Wrong. Let me explain. When other structures aren’t working properly (i.e. your ligaments and tendons) to support a joint, the surrounding muscles work overtime to stabilize and protect it. This mechanism is known as "protective tension" and is the reason why someone who is hypermobile may feel “tight.” Our body creates trigger points as a strategy to create stability where we don't have it. It may feel good to stretch in the moment, but stretching muscles around an already lax joint capsule will only lead to more instability and greater risk for injury. It's like picking a scab; you feel better in the short-term, but wind up with longer term problems.
Long story short, if you're looking for a quick reduction in tightness, get rid of the static stretching and grab yourself a foam roller instead - and then follow that work up with some good stability exercises.
3. Stay Away From End Ranges.
Women who have a lot of joint laxity tend to stand, sit, and train in extreme end ranges (see pictures below). When joints are constantly loaded beyond normal range, the ligaments will continue to become more lax and the joint will experience more wear and tear overtime. Here are a few examples:
Hyperextended Elbows During a Push-up
Hyperflexed Lumbar Spine and Hyperextended Cervical Spine During Sitting
Hyperextended Knees During Standing
Hyperextended Knees and Right Hip Shift During Standing
Whether you are sitting behind a desk at work, attending a yoga class, or lifting weight, it is important to be aware of your body position and stop just short of end range.
4. Improve Motor Control.
Generally speaking, women have greater Q-angles (measured from hip to patella along femur) and a higher predisposition to joint laxity compared to men. Looser joints require more stability and motor control; therefore, learning better movement patterns is critical for improving long-term health and joint integrity.
For example, if you are experiencing discomfort in the front of your shoulder, one exercise you could incorporate is the standing external rotation. This is a great exercise for hypermobile individuals to increase posterior rotator cuff strength, increase shoulder stability, and improve motor control by learning how to keep the ball centered in the socket.
Regardless of what exercise you perform, in order to improve motor control you must:
a. Be present: Eliminate distractions (e.g. texting, Facebook, etc.). If you are not focused, you will naturally fall back to your compensatory movement patterns
b. Maintain a neutral spine: It is common for hypermobile women to overextend their lower back and rely on bony stability; therefore, learning how to execute and maintain a neutral spine is important in every exercise in order to set a foundation for better alignment
c. Slow down: Perform each rep in a controlled manner, and emphasize quality over quantity.
d. Train in non-fatigued state: Be aware of how you feel, as fatigue will negatively affect your ability to learn new movement patterns
My personal experiences have led me to believe that hypermobility, especially for women, is more common than one might think. Creating awareness for yourself or your clients is the first step in the right direction. As Eric always says, “Assess, don’t guess.”
Happy training to all my hypermobile readers out there!
About the Author
Laura Canteri (@LC_Canteri) heads up strength camps (group training) at Cressey Sports Performance – Florida. She completed her master’s degree in exercise physiology at Florida Atlantic University, and also is Precision Nutrition certified. In addition to her work at CSP, Laura works with folks from all walks of life through her distance-based consulting. You can reach her at firstname.lastname@example.org.
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Today's guest post comes from Physical Therapist Chris Leib. Enjoy! -EC
Recently, there has been plenty of discussion regarding the efficacy of the idea of posture and whether attempting to improve it is a useful tactic for decreasing pain. This discussion has been perpetuated by research indicating that there is a surprisingly poor correlation between pain and posture. The evidence seems to be pretty damning on this topic, which raises questions about whether looking at pain as an outcome measure actually makes sense when discussing posture. Moreover, even more basic questions still need to be asked regarding the very definition of posture.
When discussing these inquiries, it’s important to understand that the current research has demonstrated that pain is far more complex than previously thought, and that a single model of physiological stress will not be sufficient to demonstrate why some people experience pain and some do not. A discussion of pain science is too complicated to be brushed over in the present discussion; however, it must be understood:
Just because proper posture hasn’t been highly correlated with pain doesn’t mean it’s not important.
When looking deeper into the studies cited above, it becomes clear that there is not a consensus definition of posture. Instead of looking at the constantly changing nature of posture, many of these studies defined posture by using various markers of static structure. Taking this fact into consideration, one must ask the following question: If no agreement is reached as to what proper posture is, how can it be well studied?
In my experience over the past decade as both a strength and conditioning professional and physical therapist, my own definition of proper posture has evolved considerably. Utilizing these years of clinical experience and the current research, I would like to set forth the following 4 Rules of Posture.
Rule #1: Posture May Not Cause Pain, But Improving Posture Can Help to Decrease Pain.
Although there is poor evidence that various definitions of poor posture are associated with increased pain, it’s obvious through clinical assessment that a change in posture can decrease pain when it is present. Go to any physical therapy clinic and you will find patients in pain getting education regarding postural changes that improve their symptoms on the spot. Pain can be a great indicator of what the body feels is a stable position. Often, immediate positive changes are made just by getting the person into a different position.
A common example is the individual with neck pain who has pain when sitting slouched with his or her head forward. Frequently, a combination of education and ergonomic adjustment can abolish this excruciating pain in shorter order. Now, this isn’t to say that the quick fix always “cures” the problem, but it does gives the person more feelings of control over making change with regard to their pain, which actually goes a long way. This sense of control has been demonstrated to be a positive indicator of recovery from and the ability to cope with chronic pain .
Rule #1 is the only rule in which we’ll discuss pain. As I noted, the research on pain indicates that the science is far too complex to discuss isolated associations. Clinically, pain can be a good feedback indicator of postures and positions that a person’s body finds unsafe. This feedback helps determine the best positions for the person to train in and, with time, adopt.
The subsequent three rules will discuss posture in relation to functional and physical performance-based movement quality.
Rule #2: Support Yourself Actively and Passively.
This rule will illustrate the difference between passive and active postural stability, as well as the appropriate balance that’s needed between the two. Let’s get some definitions out of the way first.
Generally speaking, passive stability is using something other than balanced muscular effort to adopt and maintain a desired position. Passive stability can either be anatomical or external in nature. Anatomical passive stability utilizes one’s passive stability structures such as joint capsules, cartilage, and ligaments to find stability in a position, while external passive stability utilizes an external item for extra support when attempting to maintain a position. When dealing with passive stability of any type, the common denominator is finding a stable position while decreasing relative muscular effort.
Active postural stability, on the other hand, refers to the use of muscles to maintain a desired position. In order to optimize muscle activity during static and dynamic postures, the attachments of the muscles must be positioned so that the muscles contract in a balanced way. In addition, the position should minimize energy expenditure against the pull of gravity.
For clarification on how best to determine optimal positioning based on the above definitions, let’s illustrate a common static and dynamic example.
i. Static postural stability: Sitting in a chair
No matter what, this common static position will never be ideal for postural stability due to the severe muscle imbalances inherent to sitting with your hips and knees in 90 degrees of flexion. However, sitting with the head and shoulders substantially in front of the line of gravity makes a bad situation even worse. The further forward the head and shoulders travel out in front of this line, the more effort the muscles that hold up the head and trunk must exert. More importantly, because the muscles in this case are overstretched and in a poor position to function in a balanced way, less resilient structures such as ligaments and joint capsules/cartilages are forced to pick up the slack.
Thus, the most optimal default position in sitting is the one that minimizes the effort of your muscles and stress to your other more passive structures by allowing the head and shoulders to balance effortlessly in the line of gravity. (Feel free to take this opportunity to observe your own posture. Are your head and shoulders neatly stacked or forward like the pass from the 2000 Music City Miracle?)
ii. Dynamic postural stability: Deadlifting a heavy load from the ground
In this dynamic example, the muscles of the hips, lower back, abdomen, and thorax will be in the most balanced position to lift the load when the pelvis is in a neutral position. That is to say, the lower back should neither be flexed nor extended. In this position, the muscles of the lower back are well balanced with that of the abdomen, and the hip extensors have a better opportunity to contract during the lift.
If the lift were initiated with the lower spine in an extended position, the position can still indeed be stable; however, the stability would come from passive anatomical structures such as the lumbar facet joints and ligaments of the anterior spine. This position increases compressive forces to the lower back and decreases the contractile ability of both the abdominals and hip extensors, as both of these muscle groups are now in an over-lengthened position.
Therefore, the optimal position for the dynamic movement of deadlifting is the one that allows for the hip/trunk flexors and hip/trunk extensors to work in the most balanced fashion (see video below). Moreover, setting up the movement and transitioning the bar in such a way that the load stays as close to the body as possible minimizes the downward pulling effects from gravity much like the head and shoulders staying over the midline of the body in the previous sitting example.
When attempting to understand how best to balance active and passive stability within a specific task, we must take into consideration four factors: (1) the available tissue mobility in order to get into the position required; (2) the external objects manipulated or used for positioning; (3) the duration of the task; (4) the intensity of the task.
Let’s return once again to our two examples:
i. Static postural stability: Sitting in a chair
For static sitting, we must first assess ranges of motion like thoracic extension, shoulder internal/external rotation, and scapular retraction/depression/posterior tilt. In doing so, we’re able to determine whether the desired position can be assumed without pain or excessive compensatory muscle effort. Moreover, we must know the type of seat the client will be utilizing and what activities he or she will be doing while sitting (i.e. typing, driving, etc.).
In terms of duration and intensity, sitting will typically fall under the category of a low intensity activity done for long durations. The longer the duration, the more muscular endurance necessary to maintain a desired position. If any of the above factors are not optimal, external passive support in the form of a lumbar cushion, posture shirt, or corrective tape may be necessary to enable the client to attain a more favorable posture without excessive effort.
(Passively elevating the hips to decrease the effort to maintain an upright torso)
ii. Dynamic postural stability: Deadlifting a heavy load from the ground
With deadlifting, mobility limitations in the hips and trunk can often limit an individual’s ability to adopt and maintain the optimal stable position described above. In addition, the intensity of the load or duration of the set must not exceed the amount of muscular force the individual is able to generate, or else even a solid initial position will be lost.
In cases where mobility restrictions are a limiting factor, passive support can come in the form of apparatuses that decrease the range of motion of the movement (i.e. elevating the load onto blocks or a rack). When approaching maximal loads or durations, passive support may take the form of stability belts and braces in areas most susceptible to positional failure.
3. Posture is the Product of Your Movement Variability.
Posture is often discussed as a single static element that represents one’s lack of mindfulness or genetic misfortune. Clinical experience and the current scientific literature say this belief is not only wrong, but also a harmful notion to the process of making postural change. One shouldn’t feel guilty or unfortunate that he or she is demonstrating an unskillful posture. Instead, there should be an understanding that posture is not a single static entity, but rather task dependent and constantly changing.
The secret to good posture is that you shouldn’t need to work for it when you are at rest. You see, your static postures during sitting, standing, and walking are a product of your cumulative movement throughout the day. Our bodies are built to adapt to the positions and activities we take on most frequently. If any of these positions and activities are done is excess, all our positions and movement can become imbalanced. This imbalance is what is deemed by many as poor posture, but in reality it is just the body doing what it does best: adapting.
In order to prevent postural imbalances, it is unwise to attempt to simply make ergonomic adjustments to the positions we sustain too frequently. Instead, we must consider our whole body of movement throughout the day. If we focus on proper positioning in training, it will inevitably transfer to our static postures. In this way, programming for any strength, conditioning, or fitness routine must involve a strong focus on developing positions that promote muscular balance (active postural stability) and task transference, as opposed to simply task completion.
For example, there are many ways to push yourself up from the ground when doing a push-up, but there are positioning subtleties that can either promote balanced muscular stability or feed habits of chronic positioning that we already practice too frequently throughout the day (see video below). Thus, an individual’s movement practice should be about movement quality and variability as much as about cultivating strength and conditioning.
Mindless prescription of physical activity (i.e. 30-60 minutes of aerobic exercises; 3 sets of 10 of machine based resistance exercise) prioritizes strength and conditioning capacity over movement capability and variability, hoping that by blindly improving one’s quantity of routine movements the quality of movement will also improve. Don’t get me wrong, in moderation, more movement is better than less movement. However, too much of the same movements can create similar problems as too little movement.
4. Counterbalance Your Life.
The idea of increasing movement quality and variability goes way beyond one’s time at the gym. To allow for increased ease of active postural stability, the common patterns of one’s entire day need to be understood so that behavioral change can be implemented. This is not to say that if we sit all day at work then we need to get a new job. That’s just not practical. Nor does it mean that we must be obsessed with maintaining an upright posture or “drawing our abdomens in” all day long. It simply calls for awareness — awareness of the positions that are most frequently adopted and strategies for counterbalancing them.
Guidelines for this awareness are three-fold:
i. Understand the chronic positions you adopt.
Often postural counterbalances are subtle and developing improved body awareness becomes much more important than simply adjusting your position. This improved body education can come in many forms, such as independent reading on anatomy and physiology, advice from a movement professional, or cultivation of a versatile movement practice as discussed above. It’s important to know that ultimately YOU have the best opportunity to understand your own body. It can be a gradual process to refine this body awareness, but once developed, understanding the positions and movements that are healthy versus harmful to your specific body becomes much easier.
ii. Separate times you must be stationary and times you choose to be stationary.
It’s important to have a plan of attack for positioning throughout your day. Practically speaking, if you sit all day at work, acknowledge it, and then minimize the time you sit when in the comfort of your home. Likewise, if you are on your feet all day, don’t be afraid to spend some time vegging out on the couch. One stationary position is not necessarily better than the other (i.e. standing is not better than sitting). It’s the one that you do most frequently that will usually lead to problems.
iii. Expand your positional repertoire.
When attempting to adopt positions different from those in which you are most comfortable, it is important to have other positions at your disposal. For example, sitting in a chair is a completely different mechanical stress than sitting cross-legged on the ground, just as standing stationary on two legs is different than weight shifting effortlessly from one leg to the other. Similar to the idea of developing more movement variability in an exercise practice, it’s important that you’re able to adopt positions besides those you do most frequently. This may be another area where the help of a movement professional is necessary so that you can become comfortable with the mobility and stability necessary to adopt different variations of sitting and standing positions.
See the video playlist below regarding positional variations for sitting (chair and ground) and standing:
In conclusion, there is plenty of disagreement and misunderstanding around the topic of posture. In my experience, this controversy is unnecessary and overblown. Any respectable strength and conditioning professional would agree that proper positioning and technique is vital when undertaking various movements in a strength and conditioning program. Why should the importance of positioning be any different in our movements throughout the day? We must understand that our bodies are constantly changing; therefore, posture should be viewed as a dynamic, ever-changing journey — not a fixed destination. Hopefully the 4 Rules of Posture set forth above allow you to better understand how to embrace this journey!
About the Author
Chris Leib of MovementProfessional.com is a licensed Doctor of Physical Therapy and Certified Strength and Conditioning Specialist with nearly a decade of experience in treating movement dysfunctions and enhancing human performance. He has written for many popular training and rehabilitation websites, and has a versatile movement background with a variety of certifications as both a physical therapist and fitness professional. Chris considers physical activity a vital process to being a complete human being and is passionate about helping others maximize their movement potential. Be sure to follow him on Facebook and YouTube.
1. Grundy, Roberts (1984) Does unequal leg length cause back pain? A case-control study. Lancet. 1984 Aug 4;2(8397):256-8. http://www.ncbi.nlm.nih.gov/pubmed/6146810
2. Pope, M., Bevins, T., Wilder, D., & Frymoyer, J. (1985). The Relationship Between Anthropometric, Postural, Muscular, and Mobility Characteristics of Males Ages 18-55. Spine, 644-648. http://www.ncbi.nlm.nih.gov/pubmed/4071274
3. Grob, D., Frauenfelder, H., & Mannion, A. (2006). The association between cervical spine curvature and neck pain. European Spine Journal Eur Spine J, 669-678. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213543/
4. Nourbakhsh, M., & Arab, A. (2002). Relationship Between Mechanical Factors and Incidence of Low Back Pain. J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy, 447-460. http://www.ncbi.nlm.nih.gov/pubmed/12322811
5. Dieck, G., Kelsey, J., Goel, V., Panjabi, M., Walter, S., & Laprade, M. (1985). An Epidemiologic Study of the Relationship Between Postural Asymmetry in the Teen Years and Subsequent Back and Neck Pain. Spine, 872-877. http://www.ncbi.nlm.nih.gov/pubmed/2938272
6. Franklin, M., & Conner-Kerr, T. (1988). An Analysis of Posture and Back Pain in the First and Third Trimesters of Pregnancy. J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy, 133-138. http://www.ncbi.nlm.nih.gov/pubmed/9742469
7. Lederman, E. (2010). The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork and Movement Therapies, 131-138. http://www.cpdo.net/Lederman_The_fall_of_the_postural-structural-biomechanical_model.pdf
8. Christensen, S., & Hartvigsen, J. (2008). Spinal Curves and Health: A Systematic Critical Review of the Epidemiological Literature Dealing With Associations Between Sagittal Spinal Curves and Health. Journal of Manipulative and Physiological Therapeutics, 690-714. http://www.ncbi.nlm.nih.gov/pubmed/19028253
9. Evidence-Base for Explain Pain, Second Edition. (n.d). Retrieved October 2, 2015. http://www.noigroup.com/documents/noi_explain_pain_2nd_edn_evidence_base_0813.pdf
10. Control, culture and chronic pain. (n.d.). Retrieved October 2, 2015.
11. Garber, C., Blissmer, B., Deschenes, M., Franklin, B., Lamonte, M., Lee, I., Swain, D. (2011). Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults. Medicine & Science in Sports & Exercise, 1334-1359. http://journals.lww.com/acsm-msse/Fulltext/2011/07000/Quantity_and_Quality_of_Exercise_for_Developing.26.aspx
It's time for the May installment of this popular strength and conditioning series.
1. Train OUTSIDE.
One of the things I've noticed over the years - both with sprinting and long tossing - is that athletes seem to "hold back" when they're indoors. They won't run at top speed when there are only 40-50 yards of turf ahead of them because they're already worrying about decelerating before they even really get moving. And, with throwing, there just seems to be more inhibition when an athlete is throwing into a net - as opposed to throwing to a partner who is pretty far away. Maybe it's the quantifiable feedback of actual distance, or maybe it's just less restriction - but the effort is always better.
To that end, it's mid-May and the weather is getting really nice around the country. Now is a perfect chance to get out and sprint in the grass or at the local track. Don't miss this chance, as it'll be snowing again before you know it!
2. When selecting exercises, prioritize upside over avoiding downside.
This will be the "glass is half full/empty" point of the day - and I'll use an example to illustrate it.
Let's take the question of whether or not to prescribe bench presses for baseball players. I, personally, don't prescribe them for this population, but there are still a lot of strength and conditioning coaches out there who do.
Their argument is that they aren't as big a problem as has been proposed. In other words, they're protecting against the downside.
My mindset, by contrast, is to highlight the lack of an upside. In a population where shoulder and elbow issues are astronomically high, does this exercise provide substantial benefit such that it deserves a place in our programs? Does it deliver a better training effect than a push-up variation or landmine press, for instance?
In other words, it's not just a discussion of "good vs. bad;" it's a discussion of "optimal vs. acceptable." Even if some players can "get away with" bench pressing, are we really doing right by these players if our approach to training is to simply try to justify that our exercise selection isn't doing harm?
3. Use fillers to break up power training sets.
Optimal training for power mandates that athletes take ample time between sets to recharge. Unfortunately, a lot of athletes have a tendency to rush through power work because it doesn't create the same kind of acute fatigue that you'd get from a set of higher-rep, loaded work. In other words, you'll want to rest more after a set of five squats than you would after a set of five heidens, even if you were attempting to put maximal force into the ground on each rep with both.
To that end, one thing I commonly do is pair power training exercises with low-key corrective drills. We call these drills "fillers," but that's not to say that they aren't very important. We might pair a rotational medicine ball training drill with a wall slide variation. This helps us get more quality work in with each session, but just as importantly, slows the athletes down to make sure they get the most out of their power training exercises.
4. Coach standing posture.
Static posture assessments are boring; I get it. However, they can still be incredibly telling. Here's an example...
Last weekend, during a two-day seminar I was giving, a trainer approached me and asked about his chronic bilateral knee issues. He described his soft tissue initiatives, mobility work, and strength training modifications in great detail; it was clear he'd put a lot of thought into the issue and was clearly frustrated, especially having been through physical therapy a few times without success. When he was done describing everything, I looked down at his lower body and asked, "Do you stand like that all day?"
He was just "hanging out" in a bunch of knee hyperextension. A follow-up toe touch screen looked pretty similar to this:
The toe touch is obviously a movement fault, but he was in a bad starting position before the movement even started. If you stand in knee hyperextension all day - especially if you're a personal trainer on hard, unforgiving surfaces all day - your knees will hurt. It doesn't matter how much you foam roll or modify your strength program. You have to learn to stand correctly before you learn to move correctly.
With that said, apply this to your athletes. How many of them do this during down-time in practice or games? And, next time you watch a Major League Baseball game, watch how many position players just "hang out" like this between pitches - and wonder why we see more hip and back pain on the right side.
Sometimes, the easiest solutions aren't the most obvious - even when they really are obvious if you know where to start looking!
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Last week, over the course of two days, I made the long drive from Hudson, MA to Jupiter, FL. Suffice it to say that all those hours in the car gave me a newfound appreciation (or distaste?) for just how hard sitting is on the body. As such, it was really timely when my friend Michael Mullin emailed along this guest post on the subject. Enjoy! -EC
In this article, the author describes a fictional scenario in order to demonstrate a point related to the degree of information and misinformation there is in the layman and professional literature. It is in no way an attempt to create alarm that these facts apply to every person and every situation. While this article is not scientifically based, the published references are meant as an example of what some studies have found of the impact prolonged sitting and being in a stressful environment has on the body. Please read this article with the intent with which it was written—to provide concrete tools to use if you have to sit for extended periods of time.
I would like to have you read the scenario below and let me know if you would want this job.
“Congratulations on being selected for the position of top minion here at Do Everything Against Design, Inc. (DEAD). Our company is a prestigious purveyors of thneeds—and a thneed is a thing that everyone needs (5). We pride ourselves on our commitment to being on the cutting edge of business and we use only the best, most up-to-date information possible to dictate how we run our business.”
“Let me start off by saying that this job will provide all kinds of potential benefits. It is up to you to decide how committed you are. The potentials are endless—overuse injury, chronic pain, depression, increased alcohol use, drug or medication use, cancer, increased general mortality, even bullying—that’s right, just like when you were a kid—are all very real possibilities here at DEAD, Inc.”
“So first thing we will do is get you set up with your work area and station. Here is your cubicle which studies have shown are detrimental to not only work life but also your personal life (1). And here is your ergonomically correct chair so that your body doesn’t have to move, because research has shown that sitting 90% of your day, will almost double your risk of developing neck pain (2). We are also well aware of the fact that this increased time sitting will ultimately yield to a higher mortality rate for you (3), and make you feel generally crummy, but we are willing to take your chances. In fact, don’t even bother trying to counter all this sitting with exercise, because it will increase your risk for certain cancers by up to 66% regardless of how active you are when not sitting! (4)”
“However, placing this degree of stress and strain on your body is mainly so that we can reduce the organization’s costs and increase productivity (5), which is what is most important to us. Because ‘business is business and business must grow, regardless of crummies in tummies you know’ (6). And you do want to be a team player, don’t you?”
“In fact if you do end up having any physical problems, there is a greater than 63% chance that it is actually due to work (7). And if it isn’t from sitting too much (8), then it is due to the psychological stress that this position places on you. Heck, it might even be due to me and the stress I place on you! I will give you an 80% chance that our workplace stress will be the most important factor you will have to deal with here (9).”
“We have also found that this job can also really give you a great chance on becoming an alcoholic or binge drinker (10), so you have that going for you as well.”
“If stress does become greater than you can learn how to cope with, which is apparently one important part of your employment here (11), then rest assured that we don’t really have a plan in place, because 80% of facilities do not have formal programs in place to deal with workplace stress, and of those that do, only about 14% say it is effective (12). Since that’s what the research suggests, then I mean, how important can establishing a plan be?”
“The single greatest thing about this whole situation is that I will actually pay you to let me break you down, little by little, bit by bit, until you feel beaten and broken. Don’t you see? It’s a win-win situation for both of us here at DEAD, Inc!”
I decided to title this article differently from my original title, “Your Employer Is Trying to Kill You” because I thought it might be a little less inflammatory. But, if you think about it, if data were used to truly guide what we should be doing, than many jobs where employees have to sit the better part of the day are truly a form of abuse. OSHA should be having a field day with these kinds of stats!
This is not about trying to bash many of the companies that have these incredibly sedentary work environments, though. Moreover, it's also not about the fact that I disagree with how our ergonomic evaluations and standards currently are. This is more about trying to create a "Movement/Movement."
Our bodies are designed for movement. Period. Our brains are designed for processing and trying to create efficiency so that we can process more. Now that’s pretty smart, however, highly detrimental when it comes to the importance of movement. Because if we continue to listen to what our brain is telling many of us, then it will constantly suggest that we just continue to sit to conserve energy.
So what to do for those of us who have to sit regularly during the day?
Get up regularly, even if it means setting a timer at your desk to walk down the hall a couple of times. Not only good for the body, but also good for the brain.
Stand every time the phone rings in your office, even if it means you have to sit back down to do something at your computer for the call.
Every hour, independent of getting up for regular walks:
Sit at the front edge of the chair, hands resting on thighs and body in a relaxed position—not too slouched or sitting up too straight. Take a slow breath in through your nose, feeling your ribs expand circumferentially. Then slowly, fully exhale as if you are sighing out and exhale more than you typically would, without forcing or straining. Inhale on a 3-4 count, exhale on a 6-8 count, then pause for a couple of seconds. Re-inhale and repeat for 4-5 breaths.
Staying in this position at the front edge of the chair, reach one arm forward, alternating between sides, allowing your trunk and torso to rotate as well. Your hips and pelvis should also shift such that your thighs are alternately sliding forward and back. Perform 10 times on each side, slowly and deliberately and while taking slow, full breaths.
Consider using your chair differently, depending on the task:
When doing work on the computer, sit with the lowest part of your low back (i.e. sacrum) against the seat back, but don’t lean your upper body back. This will give the base of your spine some support, but also allow for good trunk muscle activity as well as proper thoracic circumferential breathing.
When doing general work such as going through papers, moving things around your desk, filing, etc., sit forward on your chair so that you are more at the edge of the chair. This will allow your legs to take more load and your trunk muscles better able to aid in support, reaching and rotating tasks.
When reading items or reviewing paperwork, recline back with full back contact to give your muscles, joints and discs a rest. Make sure to hold the items up at roughly shoulder height—even if you support your arms on armrests or desk.
Remember, chairs and sitting is something that WE as humans created and the current norm is in no way optimal. We were not put on this planet to sit on chairs, and in particular not ones which shut our system off and limit our movement and ability to breathe normally. Until organizations and the general mindset changes to balance work requirements, work efficiency and human health, then we will be constantly be dealing with companies such as DEAD, Inc.
Note: the references to this article are posted as the first comment below.
About the Author
Michael J. Mullin, ATC, PTA, PRC: Michael is a rehabilitation specialist with almost 25 years of experience in the assessment and treatment of orthopaedic injuries. He has published and lectured extensively on topics related to prevention and rehabilitation of athletic injuries, biomechanics and integrating Postural Restoration Institute® (PRI) principles into rehabilitation and training. He has a strong interest in system asymmetry, movement, rehabilitation and respiratory influences on training and their effect on athletics. He has extensive experience with dancers, skiers, and professional and recreational athletes of all interests. You can find him on Twitter: @MJMATC
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Earlier this week, I posted a video on different ways to look at upper body pressing. In light of the great feedback I received, I have another one for you. Today, I’m going to talk about breathing, a topic that has taken the fitness industry by storm in recent years.
We can use breathing to help with relaxation (yoga, meditation), but also with bracing the core to lift heavy weights. If you have something that can help with two extremes like this, you know it can be “clutch” when it comes to making or breaking your fitness progress. And, that’s why today’s video will be so beneficial to you:
This video today focuses on some of the breathing strategies I uses in terms of exercise selection and coaching cues with our athletes at Cressey Performance. These drills are awesome for enhancing core stability and correcting bad posture. Fortunately, you can have the same great results if you just pay close attention to the cues I outline and put them into action. And, be sure to keep an eye out for the release of The High Performance Handbook next week!
It's time for round 2 of my series on things you might overlook when assessing a new client or athlete. Here are three news things to which you should pay attention:
1. Nervous Tick/Anxiety
When I see someone who is constantly "on" - foot tapping, cracking knuckles, fidgeting while standing/sitting, or any of a number of other displays of nervous energy - I'm obviously wondering if this is someone who is so wired that stress outside of training could be a serious problem. These folks often have poor sleep quality and don't recover well.
However, it may extend beyond that. If you check out Clinical Applications of Neuromuscular Techniques, Lean Chaitow and Judith DeLany reflect on how congenital laxity (loose joints) is correlated with anxiety disorders and panic attacks. So, even in my first dealings with people, if they're really on edge, I'm wondering we're going to need to do a lot more stabilization work, as opposed to actually created new range of motion.
2. How They Carry Their Bags
A lot of people really don't understand how their daily habits impact their long-term movement quality or the presence or absence of pain. Along these lines, it always surprises me to see people with low right shoulders who always carry their backpacks or purses over the right shoulder, just feeding into this excessive asymmetry with constant scapular depression. An initial evaluation is the perfect time to pick up on these things and counsel clients and athletes on how to prevent activities of daily living from interfering with fitness progress.
3. Clavicular Angle
The clavicle is like the bastard child of the upper body; it never gets any love. In fact, there are a lot of people who don't even know what a clavicle is unless you call it by its common name, the collarbone. It's actually a tremendously important bone, as it is the link between two very important joints of the shoulder girdle: the acromioclavicular (scapula with clavicle) and sternoclavicular (sterum with clavicle) joints.
A normal resting posture of the clavicle is about a 6-20° upslope (medial to lateral). What you'll often see with folks with faulty upper extremity posture is a horizontal or even downsloped collarbone. Check out this right-handed pitcher (left side is more normal, right is really "stuck down"):
Just like a scapula needs to upwardly rotate for optimal function in overhead activies, a clavicle needs to upwardly rotate, too. From 0-90° abduction, you only need 5-10° of clavicular upward rotation. From 90-180° of abduction, you need 20-25° of clavicular upward rotation. This clavicular movement can be affected by the muscles that attach directly to it (pectoralis major) or by those that indirectly impact it (muscles attaching to the scapula and/or humerus), as well as the positioning of the thoracic spine.
Keep in mind that where most people with acromioclavicular joint pain wind up with symptoms during abduction: the final 30° of overhead reaching. Any surprise that the symptoms occur at the point where the most amount of clavicular upward rotation is needed? Nope!
If that clavicle starts as too horizontal (downwardly rotated), it's like starting a race from a few yards behind the starting line. Getting resting posture where it needs to be helps to ensure that the subsequent movements that take place will be free, easy, and pain-free.
Thanks to Greg Robins, here are five tips for the week, with a focus on postural awareness.
1. Monitor head positioning during supine bridge and hip thrust variations.
2. Consider this routine to taking your breath before lifts.
Breathing is a big part of postural awareness. Check out this video for ensuring that you're locking things in correctly before big lifts:
3-5. Avoid parafunctional habits.
The following three points will be based on a common theme: “Parafunctional Habits.”
A parafunctional habit is a habitual movement, or positioning that differs from the most common, or ideal movement and / or positioning of the body. It can also be a habitual positioning or movement of the body that’s continuous exposure (repetitive practice of) leads to certain asymmetries or dysfunctions.
When I think about how to attack posture changes both with my clients and myself, I look for the most efficient ways to change daily habits. In other words, I look at how we can disrupt parafunctional habits.
“Posture is a composite of the positions of the positions of all the joints of the body at any given moment. If a position is habitual, there will be a correlation between alignment and muscle test findings.” – Florence Kendall (Adapted from PRI’s Postural Respiration)
Many of us tend to default to the same habitual movements and positions. Here are three examples, and three quick fixes. Making a point to apply these corrections will have a tremendously positive outcome in helping you "feel and move better.”
3. Don’t stand on the same leg all the time.
For a variety of reasons, many of us will tend to shift onto one leg when standing in place for a period of time. Our body is always looking for the most efficient way to “survive.” Shifting onto one leg is any easy way to gain passive stability, via our positioning.
Many of us will tend to shift onto the right leg. Why? In short, it’s easier for us to pull air into our left side, in light of the normal structural asymmetries you see with human anatomy. Breathing is kind of important. It’s also not fun to rob ourselves of air. Enter the “right stance," an aberrant posture you'll see all too often.
Start paying attention to how you stand at rest. Additionally, look around and notice how others stand at rest. I bet it looks a lot like the picture above. This is something we see on extreme levels in some of our right-handed throwing athletes; they're right handed people, in a unilateral sport, in a right-handed world!
Now, let’s make a change. For now on, use the picture below as a guide for how to stand when you shift onto one leg. Place the right leg in front of the left, and shift your weight into the left hip. If you are doing it correctly, your left hip will sit just below the right. Give it a try!
4. Cross your right leg over the left, and cross your right arm over your left.
In a similar fashion to your default standing position, those who tend to cross their legs will generally go left over right. Why? Same reason: it’s easier to sit into the right hip, and breathe into the left side. Instead, start doing the opposite. From now on cross the right over the left, and feel the left hip dig into your seat.
Do the same with your arms. Instead of crossing left over right, cross right over left. Close down the left side, and open up the right.
5. Change the way you sit while driving.
Driving is a GREAT place to work on positioning. Notice that your default is to slump over to the right side, opening the left leg and possibly resting it against the door. Instead, try this:
As you sit reading this, pretend like you’re in your car. First, even up your thighs and feet. Keep a space about the size of your fist between your two knees. At this point, your knees and feet should be even, or you might find the right slightly behind the left. Move the right foot into a position as if it was working the gas and brake pedal. You should look like this:
Now, pull your left hip back and push your right hip forward. This will leave the left knee behind the right.
You will notice the upper, inner thigh of your left leg “turning on.” Reach for the steering wheel with both hands. Consider this your new driving position. If you tend to drive with one arm, start making it your right arm. Leave the left arm hanging down to the side, causing a slight side bend to the left.
All of these positions will seem uncomfortable at first. That’s okay! Use them as much as possible, but allow yourself to just “chill” sometimes. Making these small changes is a fantastic way to better your posture and change your habits. Working on them will pay off in the long run, and you may even find your nagging aches and pains disappearing.
Sitting has been blamed for a lot of the "modern" musculoskeletal conditions and poor posture we see in today's society, and rightfully so: having this posture all day is an absolutely terrible way to treat your body.
Fortunately, by teaching folks to get up and move around during the day, we can break the "creep" that sets in over the course of time. Additionally, we can implement ergonomic adjustments (e.g., standing desks) and mobility and strength training programs that favorably impact posture to prevent these issues from becoming a serious problem long-term.
Unfortunately, though, in the process of focusing our heavy attention on those who sit all day, we've forgotten to show some love to the individuals who have to spend the entire day on their feet. And, this is actually a large segment of the population, encompassing the majority of young athletes, manual laborers, and - you guessed it - fitness professionals and coaches.
My name is Eric, and I have a problem: standing 8-10 hours per day.
It's important to appreciate that "good posture" is different for everyone. If I sit all day, I'll probably wind up in posterior pelvic tilt. Conversely, when you see folks who stand all day, it's generally greater lordosis and anterior pelvic tilt):
Of course, I should reiterate that this is a generalization. There are folks who sit all day who do so in anterior tilt, and those who stand all day in posterior tilt. As such, you have to be careful to assess and not assume.
With all that aside, let's talk about my top six tips for those who stand all day.
1. Stand differently.
This is clearly the most obvious of the bunch, but it never ceases to amaze me that folks will ask for all the best exercises to correct X posture or Y condition, yet they won't pay attention to modifying their daily postural habits to get the ball rolling.
If you're on your feet and stuck in extension all day, engage the anterior core and activate the glutes to get yourself into a bit more posterior pelvic tilt. Doing so can take you to a position of discomfort to one of complete relief in a matter of seconds.
Remember that these adjustments have to be conscious before they can become subconscious. In other words, be consistent with these basic adjustments and eventually you'll find yourself establishing a better resting posture.
Also, if your posture looks like this...
...make sure you check out this great post from Greg Robins to change your "standing strategy."
2. Learn to exhale fully.
The rectus abdominus and external obliques are two prominent muscles responsible for exhalation. Both of them also posteriorly tilt the pelvis. As such, when you learn to exhale fully, the pelvis posteriorly tilts and the ribs come down, taking you out of excessive lordosis and relieving some of the annoying lower back tightness you may be experiencing. One of my favorite drills for this was inspired by the Postural Restoration Institute. Deep squat belly breathing gets you some length of the latissimus dorsi (a gross extensor) and flexes the spine back toward neutral. During inhalation, the belly pushes out against the quads to make sure that the individual isn't breathing into the supplemental respiratory muscles (e.g., sternocleidomastoid, scalenes, pec minor) we don't want to use. Then, we just try to get all the air out on each exhale.
Of course, there are several other options you can use on this front as long as you understand the positions you're trying to achieve and the cues you want to integrate.
3. Break your day up with "relief" postures.
I always tell our clients that the best posture is the one that is constantly changing. It's healthy to be a good "fidgeter." This also applies to the way you stand - or your avoidance of excessive standing. You simply have to break up the day. Maybe you try to find time to sit, lay on your back for a bit, or go into a half-kneeling (lunge) position. These are great benefits of being a fitness professional; you're constantly going from one position to the next for the sake of demonstrating or coaching an exercise.
If rolling around on the ground isn't an option, look to integrate a split-stance position while standing. It's much more difficult to hang out in excessive lordosis and anterior pelvic tilt if you're in a split-stance position than if your feet are side-by-side. It's also one reason why we teach all of our wall slide variations with one leg forward (usually the right leg).
4. Work in low-level anti-extension drills throughout the day.
If you do have the freedom in your schedule and responsibilities to incorporate some different mobility drills during the day, here are some quick and easy ones you can apply without any equipment.
5. Avoid feeding into your resting postural dysfunction with flawed training approaches.
People who stand in extension can usually "get away with it" if they train well. When they stand in extension all day and then feed into this dysfunction in their training programs, things can get worse sooner than later. In other words, if you're standing all day and then you crush hyperextensions in all your workout routines, expect to have a really tight lower back.
However, it's not just hyperextensions that would be a problem. Rather, doing a ton of arching on the bench press and squat could make things worse as well. You may not be a candidate for an aggressive powerlifting-style bench press with a big arch, as an example. However, a more moderate set-up should be fine.
As important as what not to do is what you should do - and you should definitely work on glute activation/posterior chain strength...
...as well as anterior core stability with prone bridges, reverse crunches, and rollout/fallout variations.
Take all together, I'm basically saying that if you have an extension bias in your daily life, you probably need a flexion bias in your training. Likewise, if you have a flexion bias in your daily life, you probably need an extension bias in your training.
6. Play around with footwear.
Not all feet are created equal, and I'm a perfect example: I have super high arches. Heavy supinators like me typically don't do well on hard surfaces for extended periods of time, as we're built more for propulsion than deceleration (probably one more reason that I'm a powerlifter and not a distance runner). So, you can imagine what walking around on these floors for 8-10 hours per day does to my knees and lower back.
I'm able to minimize the stress by putting some cushioned insoles in my sneakers and changing them every 6-8 weeks. The insoles don't change the contour of the shoe; they just offer some padding. Conversely, heavy pronators may do better for extended periods of times on their feet by wearing firmer shoes, or trying out some orthotics. The answer is different for everyone, but at the end of the day, the take-home message is the same: if you're going to be on your feet all day, you better find the right footwear for you.
If you've read this entire article, chances are that you feel my pain - literally and figuratively - and realize the standing all day can be just as problematic as sitting all day. Fortunately, I can promise you that these strategies do work, as I employ them every day myself. Give them a shot and you'll find that "standing around" is much more tolerable.
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In continuing with our “Best of 2012″ theme to wrap up the year, today, I’ve got the top EricCressey.com videos of the year.
1. Four Must-Try Mobility Drills - This video was part of an article I had published at Schwarzenegger.com. You can check it out here.
2. Cleaning Up Your Chin-up Technique - It's one of the most popular exercises on the planet, but its technique is commonly butchered. Learn how to avoid the most common mistakes.
3. 8 Ways to Screw Up a Row - Rowing exercises are tremendously valuable for correcting bad posture and preventing injury, but only if they're performed correctly.
4. My Mock/Impromptu Powerlifting Meet - After being away from competitions for a while, I decided to stage my own "mock" powerlifting meet just to see where my progress stood. I wound up totaling elite (1435 at a body weight of 180.6) in about two hours.
5. Cressey Performance Facility Tour - We moved to a new space within our building back in August, and this was the tour I gave just prior to the doors opening.
Those were my top five videos of the year, but there were definitely plenty more you may have missed. Luckily, you can check them out on my YouTube Channel.
I’ll be back tomorrow with another “Best of 2011″ feature.
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