One thing I didn't note in this video is that if you have muscular, capsular, or alignment issues that persist for an extended period of time, you'll eventually develop changes to the joint (bony overgrowth). In a 2013 study, world-renowned hip specialist Marc Phillipon examined how the incidence of femoroacetabular impingment (FAI) - bony overgrowth at the hip - changed across various stages of youth hockey. At the PeeWee (10-12 years old) level, 37% had FAI and 48% had labral tears. These numbers went to 63% and 63% at the Bantam level (ages 13-15), and 93% and 93% at the Midget (ages 16-19) levels, respectively. The longer one played hockey, the messier the hip – and the greater the likelihood that the FAI would “chew up” the labrum.
It's imperative for strength and conditioning coaches to understand these issues. On evaluation, if an athlete already has changes to the joint, we need to create training programs to deliver a training effect while working around these issues. If you squat an entire team of football players even though you know 4-5 of them already have significant FAI and associated pathologies in their hips, you're probably going to be funding some hip surgeon's retirement. Work on deadlifting and single-leg work instead, though, and you'll probably kick the can down the road for those athletes.
Conversely, if your assessment reveals that an athlete is out of alignment and has some tissue density and core control issues that are preventing quality hip flexion and internal rotation, you need to design a program to get to work on those problems before they can develop bony blocks at the hip. As my buddy Mike Reinold often says, "Assess, don't guess."
2. We might be seeing the end of the versatile strength and conditioning coach.
One thing I've noticed in the strength and conditioning field over the past decade is an increased tendency toward specialization among coaches. Over the years, there have some been really bright coaches - Al Vermeil, Mike Boyle, and Bob Alejo come to mind - who've had success across multiple sports at the highest levels. They were few and far between, but it was still something that was feasible if someone was educated and motivated enough. I think that's changing and this versatility will be obsolete very soon.
We're seeing a much bigger focus on analytics in all professional sports; the focus on minute details has never been greater. In college sports, we are seeing more "baseball only" and "hockey only" guys to build on the years of the football strength and conditioning coach typically not working with other teams. At every level, specialization among strength coaches (and rehabilitation specialists, for that matter) is increasing. As a result, if a coach tries to venture out into another sport at a high level, it takes longer to get up to speed.
If a guy leaves basketball to go to baseball, he's got to learn about thoracic outlet syndrome, ulnar collateral ligament injuries, and lat strains; these just don't happen very often in hoops. He won't have to worry much about humeral retroversion in his programming for shooting guards, either - but it has a huge influence on how he manages functional mobility in pitchers.
Likewise, just because I have a solid handle on managing shoulders in overhead athletes doesn't mean that I'm equipped to handle the metabolic demands that swimmers encounter.
Versatility is still important; a well-rounded professional will never go hungry. However, at the higher levels, I just see fewer and fewer professional teams and colleges valuing it highly when the quickest option is to seek out specialists in specific realms.
3. Create context not only to improve coaching, but also to improve adherence.
Recently, I saw a professional pitcher who noted that his team had commented on how limited his extension on each pitch was. For those who aren't familiar, in recent years, teams have started tracking the actual release point of various pitchers. Basically, if two pitchers both throw 95mph, but one releases the ball closer to the plate, the one with more extension is actually releasing the ball closer to the plate, so it "gets on" the hitter faster. All things considered, a higher extension is generally better. You can view it as part of the Statcast panel on each MLB pitchers' page; here's CSP athlete Steve Cishek's, as a frame of reference. Steve's extension is well above MLB average, so the perceived velocity of his pitches are over one mph higher than their actual velocity.
Returning to the pitcher I evaluated recently, he commented that although his fastball velocity is among the best in the minor leagues and he has quite a bit of movement, he doesn't strike a lot of guys out. While there are a lot of reasons for this, one consideration has to be physical limitations that don't allow him to get extension out in front. In his case, on evaluation, we saw a pseudo military posture; his shoulder blades were tugged back into adduction, and he lacked the upward rotation to effectively "get out front."
Additionally, in the lower extremity, he had significant bilateral muscular/alignment limitations to hip internal rotation. If you don't have sufficient hip internal rotation on your back leg, you aren't going to ride your hip down the mound very far. If you don't have internal rotation on the front hip, you won't be able to accept force on the front leg, so you'll effectively cut off your deceleration arc, also shortening your extension out front. These are usually the guys who "miss" up-and-armside, or cut balls off in an attempt to correct the issue.
If I had just told him he needed to fix these for the sake of fixing them - or even just to prevent injury - it probably wouldn't hold much water. However, by relating these movement inefficiencies back to aspects of his delivery with which he struggles, the buy-in is a lot higher. Striking guys out is a lot "sexier" than avoiding injury or conforming to some range-of-motion norm.
4. This is a great weekend to be an up-and-coming fitness professional or rehabilitation specialist on a limited budget.
Black Friday/Cyber Monday might be annoying if you're in stores and dealing with a bunch of crazy Moms who are fighting over the last Tickle-Me-Elmo, but in an online context, it's pretty darn awesome - especially if you're an aspiring coach looking to get your hands on some quality educational material.
I did my undergraduate education at a smaller Division 3 school in Southern Maine. We didn't have a varsity weight room where I could observe or volunteer, and there weren't tip top internship opportunities right down the road where I could've found opportunities like that. Looking back, I realize that one of the main reasons I got on the right path was that I was willing to search high and low for those learning opportunities. I spent hours reading T-Nation and hard copy books I'd bought, not to mention driving to whatever seminars I could find.
Nowadays, education is much, more more accessible. Instead of driving nine hours to Buffalo or dropping $1,000 on a plane right, hotel, rental car, and seminar registration, you can spend 10% of that amount and get an awesome education - and you can pick and choose what you want to learn. This weekend, you can do it super affordably, too.
Looking to patch up the holes in your college anatomy course by learning about functional anatomy instead? Pick up Building the Efficient Athlete from Mike Robertson and me (20% off this weekend; no coupon code needed).
Interested in taking a peek into the mind of a successful NFL strength and conditioning coach? Soak up Joe Kenn's knowledge in Elite Athletic Development (20% off this weekend; no coupon code needed).
It's an amazing age in strength and conditioning; short of actual hands-on coaching experience, all the information you need to be successful is at your fingertips in a digital medium - and this is the weekend to get it at the best price.
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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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I've spent the past week going through Tony Gentilcore and Dean Somerset's awesome new resource, The Complete Shoulder and Hip Blueprint. With that in mind, Cressey Sports Performance staff member Tim Geromini and I pulled together ten solid takeaway points from the resource that we thought you'd like. Here are the first five, in no particular order...
1. Full scapular range of motion during push-ups often gets overlooked as a great "corrective."
Tony did an excellent job of making this point during the shoulder portion of the seminar. Push-ups (when done properly) take take the scapula from retraction during the eccentric phase of the push-up to protraction and "wrapping around" the rib cage during the concentric phase. It is usually scapula protraction that is omitted, as many people only focus on straightening their arms to finish the push-up. This creates excessive glenohumeral (ball-on-socket) motion and insufficient scapulothoracic (shoulder blade on rib cage) movement.
Learning to "fill up" the upper back and get the shoulder blades to the arm pits can be a game changer for optimizing scapular control.
2. Your hip structure impacts your likelihood of surgical success.
Citing 2015 research from Fabricant et al, Dean noted that patients with retroverted hips had saw less improvement following surgery for femoroacetabular impingement (FAI) than those with anteverted hips.
This shouldn't be surprising if you understand the implications of these hip presentations. Anteverted hips gives rise to more hip flexion and less hip extension, whereas retroverted hips will yield hips that do well with extension, but struggle getting into flexion.
FAI is a flexion-based pathology; bony overgrowth occurs because the femoral head (ball) bangs repeatedly into the acetabular rim (socket). It makes sense that a hip structure more conducive to allowing flexion would be less likely to re-develop these negative structural changes after a surgical intervention.
That said, the big takeaway from this is that the more retroverted a hip is, the more conservative the rehabilitation ought to be - and the less aggressive that "patient" ought to be with squatting, etc. in the years that follow.
3. Don't let a lack of a partner prevent you from doing rhythmic stabilization work.
The main function of the rotator cuff is to center the humeral head (ball) on the glenoid fossa (socket). Partner assisted rhythmic stabilization drills are fantastic in training this quality. Here's an example:
However, if you don’t have a partner available to help, a nice substitute would be this simple exercise you can do with a band.
The pushing and pulling on the band with your free hand serves as form of distraction that will force the rotator cuff to resist. Of course, things like the Body Blade and Shoulder Tube can be options as well. Rhythmic stabilizations will always be the best option because they are less predictable, though.
4. Full exhalations can quickly enhance mobility - but only if you FORCEFULLY exhale.
A commonly overlooked limitation to mobility is alignment issues. As an example, if the pelvis is stuck in anterior tilt, the hip will be limited in internal rotation and flexion. As such, adding core stability (in this case, the ability to hold the pelvis in posterior tilt) can often quickly make changes to hip range of motion.
A great way to do this, as Dean notes, is to perform course stability exercises with full exhalations. When you exhale fully, the anterior core is engaged, as the rectus abdominis and external obliques, in particular, help to get air out. You can do this in various positions, but the most well-known are definitely prone and side plank positions with full exhale. It can't just be a light exhale, though. You have to work very hard and blow out every last bit of air to get that cord engagement in order to really assess that positioning will change the range of motion.
We've used these strategies a lot in the past, but this video was a good reminder that we have to really push folks to get all that air out, especially if it's the first time we're cueing them to do so.
5. Make sure you're getting motion in the right places during your thoracic spine extension work.
Improving thoracic spine extension in some people is an important part of improving overhead mobility. It’s not uncommon for many to grab a foam roller and haphazardly start leaning back in an attempt to do so. Unfortunately, many individuals perform their reps with incorrect technique; check out this video to learn more.
Today's guest post comes from Dean Somerset, the co-creator of the excellent new resource, Complete Hip and Shoulder Blueprint. It's on sale at a $60 off introductory discount. I really enjoyed going through the product and highly recommend it. In the meantime, without further ado, I'll turn this over to Dean. -EC
I’ve been fortunate enough to work with a broad array of people and hips, ranging from post-total hip replacement to pro hockey players and Olympic athletes in multiple sports. I’ve seen general fitness folks with normal aches and pains, and even people missing the odd hip here and there.
The good thing about training a broad range of clients is that you get to see what happens when a population isn’t homogenous. Imagine if I only trained total hip replacement clients. I would have zero idea of how a hip worked if it wasn’t made of titanium and ceramic. I would also never move through internal rotation and flexion without fear or popping that hip out of its socket. If I only ever trained hockey players, I’d never know life without groin pulls or femoroacetabular impingement (FAI).
This also helps me to see what kinds of things work really well across different populations without issue, as well as the concepts that seem to stick well through all phases of training, while also seeing what stuff falls completely apart across different outcomes and inputs.
While there are a lot of potential variables and details to consider with each of the specific and non-specific populations I outlined above, there are also some simple and consistent things that you can take away from them all that makes my life as a trainer much easier. These things also help to deliver better results all around, and I wanted to share some of my failures and realizations to help your training as a result.
#1: Don’t assume symmetry.
When I started training, every text or manual said to have feet pointing in the same direction to prevent “imbalances.” The belief was if you do anything different between left and right sides, you’re going to develop these nefarious things that will limit your progress and ruin your life, so to speak.
While preventing poor performance or development is entirely admirable and a massive goal of any training program, it’s somewhat inaccurate to say standing in a symmetric stance prevents asymmetry. This is especially true if there’s a degree of asymmetry in the structure of the hips, knees, or feet.
Zalawadia et al (2010) showed that the angle of anteversion or retroversion of the femur could be significantly different from left to right, sometimes more than 20 degrees worth of difference!
What this means is your left or right leg might point in a different direction simply due to the angle differences between the two structures. Moreover, it means putting them both into a symmetric stance would actually push one into a different alignment with the hip socket or femoral neck angle relative to the pelvis, which would actually CREATE imbalanced tension through both sides of the hip.
This means if someone is standing in a symmetric stance and doing something like a squat, but feel one hip doing something funky, it could be because they have some structural issues (or maybe they have some other soft tissue stuff), but it’s not working in symmetric stance. If turning one foot out into a new position makes them feel awesome and helps them get stronger and more stable, it might be worth chasing that rabbit down the hole.
#2: Stretching isn’t always the answer.
Piggybacking on the concept of structure, there’s a lot of range of motion limitation that could be attributed to bone-to-bone contact compared to a muscles ability to stretch through a specific length.
D’Lima et al (2000) found that hip flexion ROM could be as low as 75 degrees with 0 degrees of both acetabular anteversion (whether the hip socket points forward) or femoral anteversion (when the neck of the thigh bone points either forward or backwards), but as high as 155 degrees, with 30 degrees of both acetabular anteversion or femoral anteversion. An increase in femoral neck diameter of as little as 2mm was able to reduce hip flexion range by 1.5 – 8.5 degrees, depending on the direction of motion.
These ROMs are pretty much the absolute limit of ability in these individuals, because accessing a range beyond this bone-to-bone contact is like me trying to find more space in my bedroom by pushing my face through a wall. Sure, I could technically do it, but something bad will likely happen by trying. Another way to achieve the range would be by moving from an adjoining segment once the first one is used up. If I go to tie my shoes, but run out of hip range of motion somewhere around my knees, I’ll round my back to get the job done.
For many of the people I was working with in our Complete Shoulder and Hip Blueprint resource, as we were trying to improve their mobility to help them do stuff like squat deeper or tie their shoes, they would hit a physical wall and not be able to get through that regardless of what soft tissue modality or active smashing we could do to the area. It also didn’t matter how much time we spent working on static or active stretch modalities. I can swing my face around the room in the earlier example all day long, until I get to a wall. I can’t swing my face through that wall all that easily.
The big question then comes to how much of that free space between their bones ramming into each other can they access and use. If you can get your knee to your chest when on your back, but squat looking like a new-born deer with legs going everywhere and looking like you’re going to fall over at any moment, there’s a mismatch. And, we need to help you access that range a lot more effectively. This can also be position and direction specific.
Often active range of motion will be more beneficial in creating a usable ROM that’s within that individual’s aptitude of control versus static stretching, which will help people make muscles longer, but may not help them use them in a specific position or direction.
#3: Don't forget that vertical and horizontal force vectors are similar, but different – and both make you better.
Let’s say I’m training a 16 year-old basketball player and a 65 year-old grandmother who has some hip arthritis. Both of them would require some training in how to perform a hip hinge in one way or another, but they would occasionally do the movement in the same way. They would start the movement by rounding their low back and essentially think of getting their chest closer to the floor versus sitting their hips back without initiating through the low back. They have completely different morphologies and training histories, but they access the movement the same. In other words, they could benefit from a different type of training environment to see the development of that hinge, especially if I’m looking to load it up without smashing out their spines.
In many ways, the deadlift is the same as a hip thrust or glute bridge in that the movement is supposed to be initiated from the hips with stable feet and minimal movement from the lumbar spine. The big difference between the two is the direction of force application through the spine and hips, as well as the volume of torque development at the initiation and conclusion of the rep movement. A deadlift produces the greatest torque at the bottom of the movement when the hip is flexed and the least at the top when standing tall, whereas a hip bridge produces the max torque at the end of the extension. There’s also more shear force through the spine at the start of the movement versus throughout the movement on the hip thrust due to the placement of load and length of lever arm.
What this means is that if you’re looking to train hip extension – but deadlifts are problematic for the rounding of the spine or shear force on the spine (especially for someone with any potential discogenic issues or spinal pathology) – a deadlift may not be an ideal option compared to a hip thrust. If someone can’t or shouldn’t do a deadlift with vertical force development or tolerance, but they can hip thrust without issue, we’re going to hip thrust until their face explodes and glutes shred their denim. The shorter lever length working on the spine means they can expose the hips to more load with less force on the spine, and, in turn, generate a training effect without potential limitations of vertical loading. For the two hypothetical clients above, the ability to pull the weight from the floor isn’t as important as developing a training effect while minimizing injury risk.
#4: Don't focus too much on posterior chain and forget hip flexion movements.
Some of the most common exercises – squats, deadlifts, lunges – tend to focus on forms of hip extension, but very few programs involve some form of hip flexion work. While it’s difficult to access the end ranges and create some high force like you can with some stupid heavy deadlifts, you can still work on training the ability to access that range with some degree of control.
A word of warning: these absolutely suck to do, but you should still do them.
Rapid and high force hip flexion is a massively beneficial movement for any athlete who requires running or change of direction movements, and also for anyone who has to preload before performing rapid hip extension, which means pretty much everything. It’s not something that should take the place of any extension-based exercise, but using it to help create some balance between front and back can give a lot of benefits. You don’t need to go 50/50 with posterior and anterior exercises, but throwing the odd one in every now and then can pay big dividends. Think one set for every five sets of posterior chain work in a week.
#5: Don't forget that only two people NEED to deadlift from the floor.
The pre-set bar height for a deadlift is the radius of the plates, which means you have to grab that 1-1/8” bar sitting 8.75 inches from the flat ground. This is fine for someone if they’re 5-feet-tall and have the mobility to do anything they want, and even for the limber 6-foot-tall individuals out there who can get their knees to their chest without problem. But what about the guy who is 6’8” with a long torso, or the girl who is 5’8” and has a retroverted acetabulum? Both can’t grab that bar without running out of hip flexion range of motion about a hands length above the bar, meaning to get there they now have to flex their spine. This typically shouldn’t be a problem, but any forced flexion with uncontrolled motion under load could be disastrous.
We can see people who use this lumbar flexion mode to make up for a hip limitation by looking at their low back when they’re flexed. If they’re using their low back to initiate the movement, you’ll see a distinct arching out of their low back at the segment that’s moving, as well as some significant hypertrophy of their erector spinae at that group compared to the rest of their spine.
If I’m worried about keeping someone’s low back happy, having them pull from the floor and seeing them initiate the movement with their lumbar spine versus from their hips could be a starting point of failure. This could be via in limiting performance by using tonic versus phasic muscles, or via increasing the relative strain on a sensitive spinal segment that eventually becomes irritated.
[bctt tweet="Only competitive powerlifters and Olympic lifters are REQUIRED to deadlift from the floor."]
Everyone else isn’t required to do this, except on the internet where random rules are made up to test people’s manhood/womanhood all the time.
For most lifters, using a slightly higher surface to pull from (either a rack pull or elevating the weights with some mats or onto other plates) can make the difference between lifting with discomfort from the floor or feeling absolutely flawless and strong with no pain or problems. When training people who don’t make their livelihoods on a powerlifting or Olympic lifting platform, that’s a big win.
These are all concepts covered in the new video resource from Dean and Tony Gentilcore, Complete Shoulder & Hip Blueprint. This video series contains 11 hours of HD video, offers NSCA continuing education credits, and can help trainers, therapists and exercise enthusiasts alike take their training knowledge to the next level. To sweeten the deal, the product is on sale for $60 off the regular price as an introductory special through this Saturday at midnight. Click here for more information; you'll really enjoy checking it out (because I sure did!).
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