I normally like to publish my recommended readings on Monday, but I got off schedule over the past few weeks. Posting this today will get me back on track:
CSP Business Building Mentorship - By popular demand, my business partner, Pete Dupuis, and I are hosting a business building mentorship. We only have 20 spots in this one-day event, and nine are already taken from an "in-house" announcement to close industry colleagues.
Athletic Groin Pain - This was an excellent, comprehensive article from Chris Hart on everything from differential diagnosis to rehabilitation timelines and protocols.
29 Years, 29 Lessons - Tony Bonvechio shares a collection of things he's learned in training, nutrition, and business.
Top Tweet of the Week
"The medical system is not designed to address a rather complex non homogenous condition like back pain." https://t.co/LyzMIKg0fj
Here's this week's list of recommended strength and conditioning reading:
Sports Rehab Expert Interview - Yesterday, Joe Heiler interviewed me about the new Functional Stability Training of the Lower Body product, although we actually covered a number of topics. The interview is free. Also, if you're interested in checking out FST - Lower, you can do so here.
Elite Training Mentorship - The July update was just posted last week, and (along with an article and two exercise demonstrations), I did a webinar on evaluating scapular positioning to determine if the bench press is contraindicated for your clients, particularly those with a history of shoulder pain.
Groin Injuries in Hockey Players - This was an awesome post from Peter Nelson on Mike Reinold's blog - even if you have no interest whatsoever in hockey. It parallels one of my presentations (Preparing the Adductors for Health and Performance) from the FST - Lower DVD set, and also leads in to some of Mike's material. You'll get a little taste of the Postural Restoration Institute in this article, too.
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In this week's mobility exercise of the week, I've got an excellent drill for reducing stiffness in the hip adductors. I came up with this exercise when I realized that I wanted to be able to do more drills to improve hip abduction range-of-motion, but I didn't always want them to be ground-based. And, just doing lateral lunge variations all the time can get a little boring for athletes. Enter table adductor dips.
I especially like to use this with our throwers because it actually parallels some of the hip angles we see with the pitching delivery, so it makes for a great warm-up and off-season maintenance/improvement exercise. I also like it for them because they can do it out on the field without having to roll around in the grass (which would be the case with a lot of other adductor mobility drills).
In terms of coaching cues, it's important to keep the weight on the support leg's heel and sit back "into" the hip. The majority of the weight should be on the down leg, with minimal pressure put on the leg that's up on the table.
As you go through the exercise, brace the core to ensure that the movement comes through the hips (flexion and abduction) at the bottom position, rather than just allowing the lower back to round. Having the arms out in front as I do in the video above can help as a counterbalance to prevent your butt from tucking under. If you're super stiff, you may want to consider holding a ten-pound plate out at arm's length as an additional counterbalance.
At the top position, be sure to extend the hips all the way to stand tall between each rep. I usually cue folks to activate the glute on the support leg to finish each rep. This will also help guarantee that you're stretching the adductors in both flexion and a neutral position.
We'll typically do sets of eight reps on each side during the warm-up period. This can, however, be held for a longer duration as a static stretch at the end of a training session.
Here's this week's list of recommended strength and conditioning reading:
Groin Strain? Get Manual Therapy - I received an email inquiry this week about training around a groin strain, and it reminded me of this old post of mine.
America's Scariest Fitness Trends - This was a story by Adam Campbell for Yahoo Sports' The Postgame, and I provided a few quotes.
Quantifying the Farmer's Walk- I thought this was an outstanding piece from Shon Grosse, a good friend of mine who is an outstanding physical therapist in Pennsylvania.
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If you've had a groin strain (or adductor strain, for the anatomy geeks like me in the crowd) - or would like to prevent one in the first place - read on.
Those of you who check out this website regularly probably already know that I'm a huge advocate of good manual therapy - especially disciplines like Graston and Active Release. One area where we constantly see athletes really "gritty" is the hip adductors (groin muscles) - and it's one reason why we see so many groin strains in the general population. Note that treatments DON'T have to be this aggressive to yield favorable outcomes; it's just an extreme example of someone with a pale skin tone that makes it even more prominent:
Soccer and hockey players really overuse the adductors during the kicking motion and skating stride, respectively. And, even outside athletic populations, you'll see a lot of people who don't activate the gluteus maximum well as a hip extension - so you have the adductor magnus taking over to help out with this important task. The only problem is that the adductor magnus internally rotates and adducts the hip, whereas the glute max externally rotates and abducts the hip. Movements get altered, one muscle gets overworked and all fibrotic, and the next thing you know you've got a nasty "tweak" just south of the frank and beans (or female equivalent).
Really, that's not the issue, though. Nobody is denying that groin strains occur - but there are different treatment approaches to dealing with this issue on the rehabilitation side of things. Some professionals use manual therapy during their treatments, while others don't. Can you guess which school of thought gets my backing?
Well, it turns out that the "include manual therapy" side of the argument gets the backing of Weir et al in light of some new research they just published. These researchers found that athletes with groin strains returned to sports 4.5 weeks sooner when they received manual therapy plus stretching and a return to running program as compared to an exercise therapy and return to running program only. It took the average time lost down from 17.3 weeks to 12.8 weeks in those with good long-term outcomes! For a bit more information on the manual therapy discipline utilized in this particular study, check out this abstract.
Need a quick tutorial on how to come back from a groin strain?
1. Find a good physical therapist who does manual therapy.
2. Listen to and do everything he/she says.
3. If anything hurts in the gym, don't do it. In most cases, deadlifting variations are okay, but single-leg work will really exacerbate the pain. Squatting is usually a problem at first, and then gets better over time. It really depends on which of the adductors you strained.
4. When you are cleared for return to full function, keep hammering on glute activation and hip mobility as outlined in Assess & Correct.
5. Make sure you're continuing to foam roll the area and getting the occasional treatment on them with that same manual therapy you had during your rehabilitation. Here's a great self myofascial release option with the foam roller:
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1. It's going to be a quick one this week, as I'm doing some last minute preparations for this weekend's Perform Better Summit in Providence, RI. To all the poor abandoned souls who count on my blog for companionship each Friday, I apologize for not giving our relationship the tender romance it deserves this week.
2. Congratulations to Cressey Performance athlete and Auburn High pitcher Tyler Beede, who threw a no-hitter on Wednesday. Tyler struck out 15 in his complete game performance.
3. I contributed on the fourth installment of Mythbusters at T-Nation this week. It also includes contributions from Chad Waterbury, Tony Gentilcore, and Christian Thibaudeau. Noticeably absent from this esteemed crew of contributors is Mr. Celery - so I thought I'd give him some love.
4. For the foam rolling aficionados in the crowd, here's a great variation to use for those hard-to-reach grundle adductor region. Thanks to Tony Gentilcore for the video:
This is a really important one for those of you in the crowd with a history of groin strains and sports hernias. Hockey players, soccer players, and powerlifters should commit this one to memory.
5. It's official: Mike Robertson, Bill Hartman, and I are filming a new DVD on June 7th. Lots to prepare before then!
Hip pain - particularly of the anterior (front of the hip) variety - is a very common problem in the weight training population.
In her book, Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann discusses Femoral Anterior Glide Syndrome in excellent detail. And, while it may seem like an obscure diagnosis, it's actually a really common inefficiency we see in a weight training population.
In order to understand this syndrome, you have to appreciate the attachment points and functions of the hamstrings and gluteus maximus. With the hamstrings, you'll notice that they attach to the ischial tuberosity of the pelvis (with the exception of the short head of the biceps femoris, which attaches on the femur), and then run down to a point inferior to (below) the knee. In other words, they are a two-joint muscle group. All of the hamstrings aid in knee flexion, and all but the short head of the biceps femoris also aid in hip extension.
Conversely, the glutes attach on the pelvis and the femur; they're a one-joint muscle - and this is why they can so directly impact hip health.
You see, when the hamstrings extend the hip (imagine the hip motion that happens when one comes out of the bottom of a squat), they do so in a "gross" fashion. In other words, the entire leg extends. In the process, there is little control over the movement of the femoral head ("ball" in the "ball-and-socket" hip joint) - and it tends to migrate forward during hip extension, giving you a femoral anterior glide syndrome. In the process, it can irritate the anterior joint capsule, and this irritation can give a sensation of tightness in the front of the hip.
Fortunately, the glutes can help prevent the problem. Thanks to their point of attachment on the superior aspect of the femur (closer to the hip), they have more direct control over the femur as it extends on the hip. As a result, they can posteriorly pull the femoral head during hip extension. So, in an ideal world, you get effective co-contraction of the hamstrings and glutes as one extends the hip; they are a system of checks and balances on one another. If you use the hamstrings too much in hip extension, you're just waiting to develop not only femoral anterior glide syndrome, but also hamstrings and adductor magnus (groin) strains and extension-based back pain.
As an aside, this hamstrings/glutes relationship is somewhat analogous to what you see at the shoulder with the subscapularis posteriorly pulling the humeral head as the infraspinatus and teres minor allow it to drift forward. That's another newsletter altogether, though!
Once the femoral anterior glide issue is in place, the first course of action is to stop aggressively stretching the hip flexors. While the issue gives a sensation of hip flexor "tightness," in reality, stretching the area only exacerbates the anterior hip pain. A better bet is to just ditch the stretching for a few days, and instead incorporate extra glute activation work, as detailed in Assess and Correct. Eventually, though, one can reintegrate both static and dynamic hip flexor stretches.
Just as importantly, it's important to identify the causes. We'll see this issue in runners who have no glute function, but more commonly, I'll see it in a weight training population that doesn't understand how to complete hip extension. Here's what a hamstrings-dominant hip extension pattern would look like with squatting.
The final portion of hip extension is when the glutes are most active, so it's important to "pop the hips through" at lockout of deadlifts, squats, pull-throughs, and other exercises like these. In the same squat example, it's really just as simple as standing tall:
Of course, this is just the tip of the iceberg when it comes to hip issues in athletes, but it's definitely something we see quite a bit.
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Cressey Performance was lucky to have Kevin Neeld around the facility last summer, and all our coaches were much better off thanks to this experience. Kevin always makes some great points and is never afraid to question the norm - and do a ton of research. Kevin's specialty is hockey, and he recently introduced an Off-Ice Performance Training E-Manual for hockey players and coaches that is absolutely fantastic. I was fortunate enough to get an advanced copy, and it was so good that I couldn't wait to get an interview with him up here at EricCressey.com. So, without further ado, here it is.
EC: I'll be the first to admit that if I see another seminar presentation or article on "core training," I'm going to lose my lunch. Interestingly, though (and to be blunt), yours in this product doesn't suck. In other words, there is a lot to be learned both specific to hockey and in a general sense. Can you explain for my readers in a bit of detail?
KN: Sure thing. In my experience, the reason core training is so poorly practiced is because people don't understand what muscles are involved in the core and what their collective function is. Beyond the rectus abdominis ("6-pack" muscles) and the external and internal obliques, the core encompasses over a dozen other muscles that attach to the hips, rib cage, and spine. Collectively, these muscles serves a few major, inter-related functions: 1) Control movement of the hips; 2) provide a stable base for leg and arm movement; and 3) create stiffness for efficient force transfer between the upper and lower body.
My approach to core training is pretty straight forward: 1) Teach athletes awareness-what core stability is and feels like; 2) Train for core stability; 3) Progress to dynamic stability (stability challenged by internal or external forces); 4) Progress to training core stiffness and force transfer; 5) Combine force transfer and dynamic stability into one exercise.
The progressions are explained in more detail in the course, but to give you an idea of what that looks like:
1) Abdominal draw-ins (for awareness, NOT transversus abdominis isolation...which is a stupid concept), and simply having the athlete put their hands over their stomach, fill their belly up with air, squeeze their core and continue to breathe.
2) Planks and bridges
3) Planks and bridges with partner perturbations
4) Medicine ball throws, tosses, and slams
5) Combined med ball exercises with holds in various positions challenged by a partner perturbation
I hope that all makes sense. The course doesn't go into full detail on medicine ball exercises because I really wanted to make the exercises and progressions realistic for a team setting, and typically there isn't a lot of equipment available.
EC: Along these same lines, what are the specific injury issues that you prioritize in this e-manual?
KN: Hockey players are plagued by hip and lower abdominal injuries. What's scary is that the true causes and predisposing risk factors to these injuries are only starting to be explored in the research community. Usually, creating an appropriate balance within and between the hip and core musculature can prevent these injuries. For example, if you have a strength imbalance between the muscles on the outside and inside of your hip, your risk of adductor (commonly referred to as the "groin") strain increases. If you have a strength imbalance between your adductors and your anterior abdominal musculature, your risk of lower abdominal injury increases. As with most injuries, the key is creating a balance.
As a quick note, creating balance often means utilizing unbalanced training. Your readers may know this already since you talk about the same things with your baseball guys. Hockey players take several dozens shots every week. These shots usually involve forceful rotation in the same direction. The best way to create balance would be to use an unbalanced training program with more rotation or anti-rotation exercises in the direction OPPOSITE to that in which they shoot. This is where sport-specific training really threw people off. Training "sport-specific" patterns again and again off the ice is likely to increase injury risk, not performance.
Getting back to hip and lower abdominal injuries...Typically these injuries are a result of under-preparation or overuse, both of which can be addressed with similar training methods. I first implemented some of the dynamic warm-up and core training exercises outlined in the course with the University of Delaware Men's Ice Hockey Team in 2006. We had ZERO pre-season hip flexor or "groin" injuries. Not a single player missed a single practice or game. I've refined a lot of things since then, but a lot of the concepts are still the same. Warm-up appropriately by improving range of motion around the right joints and activating the right muscles, and train the core for its true function, and you'll likely avoid these injuries.
EC: Hockey players, like all athletes, have loads of competing demands - from on-ice technical work, to energy systems training, to resistance training, to flexibility training. This manual does a great job of integrating all these features. Where do you feel that most people make the biggest mistakes in this regard?
KN: It really depends on the team, but the three things that seem to come up most often are:
1) The training of most youth programs involves a couple laps around the rink, a long stretch, maybe some jumping, push-ups and sit-ups. These programs leave out a lot of important forms of training (e.g. dynamic flexibility, core stability, reactive agility, acceleration/deceleration, etc.).
2) Conditioning is still horribly misunderstood. The idea that hockey players need to train for a well-developed "aerobic system" by going for long runs is pretty ridiculous. We're talking about a sport that typically involves 30-45 second shifts, followed by several minutes of rest. Within each shift, there are typically a few bouts of 3-5 second all out efforts, followed by periods of gliding, and usually a stoppage or two. This breaks down into something like 20 seconds of high intensity effort every five minutes. Repeated 20-minute jogs around the rink will make you well-conditioned for the wrong sport.
3) The largest problem I see in team settings is a complete disregard for the QUALITY of movement. Hockey players and coaches are very driven, which usually means they want more, not better. The first thing I do when working with a new team is sit them all down and tell them that focus will be placed on quality of movement before intensity or quantity of movement. Moving the wrong way, at a high intensity or volume, will only make bad patterns worse. I made a strong effort in the course to emphasize proper movement and technique and provide simple coaching cues so that people without a background in sport biomechanics can still move the right way.
EC: A large percentage of the folks reading this resource are going to be high school athletes and coaches - many of whom play multiple sports. What pieces of advice do you have for these folks? How can they make the most of this training when they've got other sports on top of the competing demands we discussed above?
KN: My advice: Keep playing multiple sports. Early specialization (only playing hockey from a young age) will have detrimental effects on your development and movement quality as you get older. Typically these are the players that dominate when they're 12-14, then drop off the map or are plagued by injuries at 20.
To get to the heart of your question, good training is good training. The course outlines quality training in the context of hockey, but the principles are mostly the same for all sports. A strong, functional core will improve performance in all sports. Training to improve acceleration, and your ability to rapidly decelerate and change direction explosively will improve performance in all sports. I use many of the same dynamic warm-up progressions for hockey players as I do for athletes in all other sports (rowing, soccer, football, basketball, lacrosse, etc.). All team-sport athletes need to be mobile, stable, strong, explosive, and quick. I honestly can't think of a sport that wouldn't benefit from the training outlined in the course, which details how to alter the intensity and volume of your training in preparation for more important games (which becomes an increasingly important concept for athletes playing multiple sports at the same time).
EC: Thanks for taking the time, Kevin. Great points - and definitely a great resource, too.
For more information on Kevin's Off-Ice Performance Training Course, head over to HockeyTrainingU.com.
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