Between the holidays and my "Best of 2016" series, it's been a few weeks since the last installment of this weekly recommended reading/viewing list. With that in mind, I'll throw out some extra recommendations this week:
Understanding Influencer Marketing - My business partner, Pete Dupuis, discusses the value of collaborative marketing efforts between one company or individual and another - using our relationship with New Balance as an example.
Stress is Not Stress - This was an outstanding post from Dave Dellanave; he cuts through all the science and explains why not all stress is created equal for every person.
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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Another week, another Patriots win and fantasy football victory for me! I'll keep talking about it in this weekly blog until the luck wears off!
That said, let's look at some top picks from around the web from the past week:
They Myths of Mental Toughness Training: Part 1 and Part 2 - Doug Kechijian is a super bright physical therapist who also happens to have extensive military experience. So, you could say that this fantastic two-part article comes from excellent perspectives in multiple regards.
Physical Preparation Podcast with Boo Schexnayder - This podcast from Mike Robertson is several months old, but I actually went back and listened to it a second time. There are loads of pearls of wisdom in there for any coach from any discipline.
Podcast Q&A with Dr. Stuart McGill - There was some excellent information on the lower back front in this interview for Dean Somerset's site. The discussion of calcification in the spine of lifters of various proficiency is fascinating, and is around the 18-minute mark.
I hope everyone had a fantastic weekend. I was on the road for the Providence Perform Better Summit this weekend, but luckily, I've got some great content lined up for you from other folks around the 'net. Check them out:
Elite Athletic Development 3.0 - I'm in the process of reviewing this collaborative effort from Mike Robertson and Joe Kenn, and it's excellent (as were the first two installments). These two outstanding coaches have lots of wisdom to share from the private, collegiate, and professional strength and conditioning worlds - and the resource is on sale at an introductory discount this week.
Maybe You Shouldn't Deadlift from the Floor - This article actually serves as a really good follow-up to the guest post Dean Somerset authored for my site a few weeks ago. Some people are better served not deadlifting from the floor, and Dean outlines why, as well as some alternatives.
Today's guest post comes from Dean Somerset, the creator of the excellent resource, Ruthless Mobility, which is on sale for 60% off through the end of the day on Monday, July 4. Dean is a tremendous innovator and one of the brighter minds in the fitness industry today, and this article is a perfect example of his abilities. Enjoy! - EC
Mobility can be described in a number of different ways, depending on who is writing the story: yoga, flexibility, stretching, movement training, dynamic warm-ups, bendy stuff, and in some cases “how the heck do you even do that?” Regardless of what it’s called or who’s doing it, there are some basic rules and physiologic elements to be aware of when it comes to understanding mobility and how to use it in training programs. Today I wanted to outline the "three big rocks" of developing, using, and maximizing mobility in a safe and progressive manner.
1. Structure Determines Function.
It’s easy to say that genetics are a separating feature for those who can gain a lot of muscle and those who have trouble adding a pound. The same can be said of those who are congenitally lax (via something like a higher Beighton hypermobility score or a diagnosis of Ehlers Danlos syndrome), compared to people who move like the tin man. Some of this could be connective tissue related difference in collagen to elastin ratio, but much of it could also be considered by the shape and orientation of the joints themselves.
In terms of the acetabular angle, D’Lima et al (2011) found in a computerized prediction model for prosthesis implantation that:
a. those with more acetabular anteversion (forward placement on the pelvis) had greater flexion range of motion and less extension
b. lateral placement of 45-55 degrees gave the best overall mobility
c. a lateral angle of less than 45 degrees gave more flexion range of motion and more than 45 degrees gave less rotation capability
d. if the femoral neck was thicken by 2 mm in diameter, it significantly reduced the range of motion in all directions, irrespective of placement.
Higgins et al (2014) even showed there was a large difference in anteversion angles bilaterally in the same individual (potentially lending some validity to PRI concepts of inherent asymmetry), with as much as a 25 degree difference in anteversion angle between left and right hip. This could translate to a difference in flexion range of motion of 25 degrees between your two hips, without any other feature affecting the outcomes. Zalawadia et al (2010) showed there’s a big variance in the femoral anteversion angle (whether the head of the femur pointed more forward or possibly backward) as the femoral neck attaches to the acetabulum, with the majority being between 10-20 degrees.
Additionally, some acetabulums have too large of a center edge angle, where the socket faces more inferiorly than laterally, which makes impingement during abduction more likely compared to a smaller center edge angle.
These structural differences are primarily set and unchanging after puberty when bones don’t deform as easily to external forces as with young kids. Baseball pitchers can undergo deformational changes at the proximal humerus (upper arm) to allow a much greater external rotation range on their throwing arm compared to adults who pick up the sport later in life. Eric showed that with his comparison of presidential first pitches HERE.
With advancing age, joint range of motions tend to reduce further with degenerative changes to the structures involved, either with an increase in concentration of cortical bone at contact areas, a reduction of cartilage thickness, or decreased fluid content of the joint space itself. The end result is a tighter joint that doesn’t move as easily.
Most of these types of changes, barring injury or disease, tend to not be limiting factors in mobility until many decades have passed, so if you’re in your 20s and concerned about your lack of mobility, it’s pretty safe to say that it’s likely not related to degenerative changes just yet. If you’re 50 or 60, it’s much more of a likely scenario.
This Canadian study showed that men lost an average of 5 degrees of shoulder abduction and 6 degrees of hip flexion per decade between 55 and 86 years old, while women lost an average of 6 degrees of shoulder abduction and 7 degrees of hip flexion in the same age range, and that this loss sped up after 70 years old and was actually not linked to self-reported activity levels. Being more active is better for everything as you age, but based on this study, not necessarily for keeping your mobility into your golden years.
What this means is that everyone will be different in terms of how much mobility they have and in which directions or movements. One person may be able to press overhead because they have joints that easily allow it, while another may never get there due to specific limitations, and a third may just not be ready to press yet. They may have the specific ability to do the motion, but don’t have the control or strength at the moment to do it effectively, which is where part 2 comes in.
So how do you determine a structural limitation? The best mechanisms are simply to see what the range of motion looks like in a couple of scenarios:
a. passive – have someone move you through the range while you’re relaxed)
b. supported - pull the joint through a range without using the muscles involved in the action. (Think a hamstring stretch with a towel wrapped around the foot and pulling on it with your arms)
c. in a different position or direction – in looking at hip flexion, compare a squat to a rock-back or Thomas test to look at the same range of motion.
If you consistently get the same joint angles in different motions or positions, it’s reasonable to believe that could be the true limit of your flexibility based on structural aptitudes. There’s always a potential that the limitation could be something else, and if you involve some of the training practices and options used later and notice an improvement, it’s a happy bonus. Short of developing X-ray vision, these are some of the best options for determining structure that everyone has available to them, whether we’re talking about the clinician, trainer or average meathead looking to get all bendy and stuff.
2. Can you actually get there?
Now, let's consider shoulder mobility; imagine that we look at an individual in supine and there’s no limitation standing in the way of going through full shoulder flexion.
However, when this same individual is asked to bring their arms overhead in an upright position, they do some wonky shoulder shrug, low back arch, and their upper lip curls for some reason. In short, they aren’t able to access that flexion movement very well, even though they have the theoretical aptitude to get there on their own.
We’re looking for the image on the right, but wind up getting the image on the left:
Now the great thing about the body is it will usually find a way to get the job done, even if it means making illegal substitutions for range of motion from different joints. In this case, the lack of shoulder motion is made up with motion from the scapula into elevation instead of rotation, and lumbar extension in place of the glenohumeral motion.
This by itself isn’t a problem, but rather a solution. It’s not bad to have something like this happen by itself, but it does alter the specific benefits of an exercise when the segments you’re looking to have do the work aren’t actually contributing, and you’re getting the work from somewhere else. There’s also the risk of injury from poor mechanical loading and improper positioning that increases the relative strain on some areas that aren’t meant to be prime movers for the specific exercises.
Now, the big question is whether someone is willing to not do an exercise because they’re demonstrating that they’re not ready for at the moment. If a client wants to squat in a powerlifting competition, but his hip range of motion makes it very difficult to get below parallel to earn white lights without losing lumbar positioning or grinding the hip joints to pieces, how willing would he be to adjust his training or eliminate that possibility to save a lot of hassles? Some people identify themselves by their sport, so telling them not to do what they love isn’t an option. I’ve worked with a lot of runners, and saying “don’t run” tends to go in one ear and out the other.
Back to the overhead example, maybe going right overhead isn’t possible at the moment, but a high incline press can be done easily. This is working in what Mike Reinold calls on Functional Stability Training: Optimizing Movement “Green Zone vs Red Zone training.” Overhead at the moment is a red zone movement as they can’t get there easily and on their own. Green zone would be a landmine press, where they’re still working on flexion, but not moving into a range they can’t easily access.
One manner that could help an individual access this range of motion if they have shown an ability to get there passively is through what Dr. Andreo Spina calls eccentric neural grooving of the motion. Use either a support or pulley to get into the terminal range of motion, release the support or pulley and try to maintain the terminal position while slowly moving out of the end range as controlled as possible. Here’s Dr. Spina doing ENG work on the ankle and anterior shin for some dorsiflexion work.
Here’s another version with yours truly working on a similar variation via controlled hip abduction:
You could do this for the shoulder easily enough as well by grabbing a rope, pulling the shoulder into flexion, releasing the rope, and trying to maintain the position before slowly lowering the arm out of terminal flexion. Just make sure you’re not letting your low back arch or shrug up your shoulder blades in to your neck.
3. Can you use it with force when needed?
So now you’ve shown you have the joints to do stuff, you can get there on your own without assistance, and you want to train the heck out of it to look like your favorite Instagram bendy people.
One thing to consider when exploring these ranges of motion is that force production tends to be greatest in mid-range positions, likely due to the greatest torque development required to overcome natural leverage elements and also due to spending less time in the end ranges. There’s also the reduction of cross bridge linkages in these positions, limiting sarcomeric action when you’re gunning your biceps in peak flex.
Controlling these end ranges (even if the goal may not be to develop maximal force in them for moving the biggest weight from point A to B) can help expand the usable range of motion where peak torque development occurs, as well as provide the potential for expanding sub-maximal torque percentage ranges of motion. These movements aren’t easy and tend to take a lot of mental energy coupled with physical effort, but if getting awesome was easy, everyone would already be there.
To round things out, understanding and developing mobility comes down to:
a) having the structure to produce the range of motion
b) being able to get into position to effectively use that range of motion
c) building strength and conditioning within that range of motion to keep the ability to use those ranges for a long time, and through as many positions and directions of movement as possible.
Some specific movements or positions may not be possible due to your own unique structure and abilities, but work hard at using everything you do have, build strength throughout the entire range of motion, and enjoy the process as much as the outcomes.
Note from EC: If you're looking for more mobility tips and tricks - and the rationale for their inclusion in a program - I'd encourage you to check out Dean's fantastic resource, Ruthless Mobility. Your purchase includes lifetime updates and continuing education credits. Perhaps best of all, it's on sale for 60% off through this Monday (7/4) at midnight.
Scaling Up Excellence - I finished up this excellent book by Robert Sutton on my drive back to Massachusetts last weekend. It's targeted toward managing growth of businesses, but has a ton of invaluable messages for coaches, too.
I've also decided to start including my top Tweet and Instagram posts of the week in this weekly feature. Here they are:
In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.
As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,
“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”
As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:
Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:
You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.
For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”
How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.
To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.
Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.
Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).
Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:
Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.
A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.
This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.
With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.
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