Here's a video I just filmed that talked about how important appropriate hip extension is to the pitching delivery. While the video is addressed more to pitchers, the general lessons are applicable to all athletes whose sports involve hip extension (particularly if it's hip extension past neutral). Check it out:
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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).
Need some cutting-edge hip mobility strategies? Watch Dean Somerset's presentations in The Complete Shoulder and Hip Blueprint (on sale for $30 off through Monday).
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.
Speaking of learning more, I strongly encourage you to check out Tony and Dean's excellent new resource, The Complete Shoulder and Hip Blueprint. It's on sale for $60 off this week at an introductory discount; click here to learn more.
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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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It's time for the October edition of this sports performance training series. I've been doing a lot of early off-season evaluations for pro guys, so a lot of conversations and assessments on that front are at the top of my mind.
1. Communication can be good and bad.
One of the biggest complaints I hear from professional athletes about their "employing" organizations is that the communication isn't good. They get mixed messages from different coaches and don't know where they stand on a variety of things. More than any of the amenities they could request, they really just want everyone to be on the same page and for the plan of attack to be related to them - and with frequent updates.
Interestingly, though, in the gym, athletes (especially more advanced athletes) usually want you to communicate less. They need clear, concise coaching cues so that you don't overwhelm them or kill the training environment with "nit-picking." Too much communication can actually be just as problematic as too little.
If you look at the typical training session for one of our athletes, I think you'd find that 80% of all the words spoken occur during the arrival, warm-up, and post-training cooldown periods. During the training session, it's time to get after it. Those 20% of words are implemented tactfully.
2. Many athletes don't have "clean" hip extension - and your exercise selection should reflect that.
Around this time last year, I posted this video of an MLB pitcher who was just starting up with us:
After seeing quite a few guys who look like this, it's really made me reconsider whether going directly to a Bulgarian split squat (rear-foot-elevated split squat) in these guys is a good bet in the early stages of the offseason. This exercise requires a lot of not only hip extension range of motion, but also the core stability to make sure that ROM is actually used (the concept of relative stiffness in action). This is something we touched on on in Mike Reinold and my recent release, Functional Stability Training: Optimizing Movement.
With all this in mind, I've been using more regular split squats - which require less hip extension range-of-motion - in the first month of the offseason for even some of our advanced guys as they work to reestablish cleaner lumbopelvic movement strategies in the early off-season. That said, regular split squats can be a little harder on the trailing leg toes than the rear-foot-elevated version, so individualization (as always) is super important.
3. Sometimes, efficient transfer of force - and not joint-specific coaching - delivers the good positions for which you're looking.
I've often written about how we have both specific and general assessments in our training arsenal, but it's actually somewhat of a continuum. Specific assessments would be more along the lines of classic joint range-of-motion measurements. Shoulder abduction or flexion would be slightly more general, as these screens involve multiple joints. Finally, an overhead squat, overhead lunge walk, or push-up would all be very general screens that look at multiple joints and help to evaluate how well an athlete transfers forces.
Interestingly, though, very often, we see coaches and rehabilitation specialists who only have specific correctives even though they utilize a load of general assessments. The goal should be to ultimately get athletes to the point that efficient movement on general tasks delivers the positions you're hoping to safely achieve. As an example, we will use wall slide variations as part of our warm-ups to teach athletes how to get upward rotation of the scapula. A progression would be landmine press variations; usually in half-kneeling or standing:
Eventually, though, athletes are ready to "sync" these movements up in a scenario where transfer of force from the lower body up through the core and to the arm allows that upward rotation to happen.
In short, a good reminder is:
[bctt tweet="As is the case with your assessments, your correctives should range from specific to general."]
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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.
Summary
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.
It's time for the June installment of "Random Thoughts on Sports Performance Training." With the introductory sale on Functional Stability Training: Optimizing Movement ending on Sunday at midnight, I'm going to use this post as an opportunity to highlight one of the key concepts that resounds throughout the product: relative stiffness.
1. All successful coaching hinges on relative stiffness - whether you're aware of it or not.
I first came across the concept of relative stiffness in reading Shirley Sahrmann's work. This principle holds that the stiffness in one region (muscles/tendons, ligaments, or joint) has can have a functional impact on the compensatory motion at an adjacent joint that may have more or less stiffness. You'll also hear it referred to as "regional interdependence" and the "joint-by-joint" approach by the FMS/SFMA and Mike Boyle, respectively.
For those who do best with examples, think of lower back pain in someone who has an immobile thoracic spine and hips. They don't move through these regions (excessive stiffness), so the lumbar spine (insufficient stiffness) just compensate with excessive motion. Likewise, a female soccer player with insufficient "good stiffness" in the hip external rotators and hamstrings might be more likely to suffer an ACL injury, as this deficit allows excessive motion into knee valgus and hyperextension.
This is why a knowledge of functional anatomy is so key for strength and conditioning coaches. Every cue you use is an attempt to either increase or decrease stiffness. When you hear Dr. Stuart McGill say, "lock the ribs to the pelvis," he's encouraging more (anterior) core stiffness. When you hear "double chin," it's to increase stiffness of the deep neck flexors. When you ask an athlete to take the arms overhead during a mobility drill, you're looking to decrease stiffness through the lats, thoracic spine, pec minor, etc. - and increase stiffness through the scapular upward rotators, anterior core, deep neck flexors, etc.
In short, absolutely everything we do in training and in life is impacted by this relative stiffness.
2. Remember that elbow hyperextension doesn't only occur because of joint hypermobility.
I've written frequently about how elbow hyperextension at the top of push-ups is a big problem, especially in hypermobile athletes who may be more predisposed to the issue. Typically, this is simply a technique issue; you tell athletes to stop doing it, and they do.
However, this doesn't mean that they'll automatically correct the tendency on other movements - like catching a snatch overhead, or throwing a baseball. It's when we look at the problem through a larger lens that we realize there is a big relationship to a lack of scapular motion. If you don't have enough good stiffness in serratus anterior to get the scapula to "wrap" around the rib cage and upwardly rotate, you'll have to go elsewhere to find this motion (elbow hypermobility). This is why I'm a huge stickler for getting good scapular movement on the rib cage - and the yoga push-up is a great way to train it. Think "more scap, less elbow."
3. If you want job security, become a hip surgeon.
The other day, I was speaking with a good friend who works with a lot of strength competitors - powerlifting, Olympic lifting, and Crossfit - and he made a comment that really stood out to me: "I'm seeing uglier hips than ever - even with females."
This has some pretty crazy clinical implications. Most females of "strength sport competitor age" have quite a bit of natural joint hypermobility, so they typically present with excellent hip range-of-motion prior to the age of 40. Even females who sit at computers all day rarely present with brutal hip ROM before they're middle-aged. What does this tell us? We have a lot of females who are developing reactive changes (bony overgrowth = bad stiffness) in their hips well too early, and when they later add increased ligamentous stiffness and a greater tendency toward degenerative changes (both normal with aging), we are going to see some really bad clinical hip presentations.
As an aside, it’s widely debated whether those with femoracetabular impingement (FAI) are born with it, or whether it becomes part of “normal” development in some individuals. World-renowned hip specialist Marc Phillipon put that debate to rest with a 2013 study that examined how the incidence of FAI 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.
Source: Lavigne et al.: http://www.ncbi.nlm.nih.gov/pubmed/15043094
So, whether it's strength sport athletes, hockey players, or some other kind of athlete, if you want job security, become a hip surgeon - and expect to do a lot of hip replacements in 2040 and beyond. There's a good chance these folks will need multiple replacements over the course of their life, too, if the longevity of the hardware doesn't improve before then. The same can probably be said for shoulders, too.
How does it relate to relative stiffness? Once you've used up all the "bad" stiffness you can acquire - muscles, tendons, ligaments, and joint - there's a good chance that you'll have beaten at least some structure up enough to warrant a surgery.
Wrap-up
I could go on and on with other examples of relative stiffness in action, but the truth is that they are countless - and that's why it's so important to appreciate this concept. To that end, I'd highly recommend you check out Mike Reinold and my new resource, Functional Stability Training: Optimizing Movement. It's on sale at an introductory $30 off discount through this Sunday at midnight.
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It goes without saying that some athletes pick up new movements faster than others. Usually, this occurs because they have context from which to draw.
As an example, an athlete might have a great hip hinge because they've done it previously while playing defense in basketball. Having that hip hinge proficiency helps the individual to efficiently learn a deadlift pattern (among many other athletic movements).
Establishing context is just one of many reasons that children should be exposed to a wide variety of free play and athletic endeavors. The more movement variability we have at younger ages, the broader the foundation we build. The wider the base, the more we can stack specific skills on top of it once the time is right.
It's foolish to think, however, that every individual we encounter in personal training, strength and conditioning, or rehabilitation settings will have this broad foundation of context from which to draw. This is where appropriate training progressions become so important. You select exercises with which individuals can be successful not only to build confidence and achieve a training effect, but also to establish context for further progressions.
As an example, if you want to be able to do a quality lateral lunge with overhead reach as part of your warm-up, you've got to be able to string together several movement proficiencies: full shoulder flexion range-of-motion; sufficient thoracic extension and scapular posterior tilt/upward rotation; hip adductor range of motion; hip hinge proficiency; and good stiffness in your anterior core and deep neck flexors to prevent low back arching and forward head posture, respectively.
When I'm teaching this pattern for the first time, I'll always say, "It's just like your back-to-wall shoulder flexion, but with a long lunge to the side."
Back-to-wall shoulder flexion is big-time "context creator" for me because I can teach it to just about anyone really quickly. In fact, I've taught it to seminars with 100+ people without many challenges. More importantly, it creates quality movement from the core all the way up (five of the seven movement prerequisites I noted earlier) - and that has big payoffs later on when one wants to teach anything from a push-up, to a landmine press, to a snatch, to an overhead medicine ball variation.
A lot of folks will read this article and think, "But these is just common sense progressions." I'd agree. However, as we've learned in recent years, in the world of larger group training without individualized programming, common sense isn't so common anymore - and as a result, folks wind up skipping steps and advancing to exercise for which they aren't ready.
Perhaps more importantly, though, being able to effectively sequence coaching progressions will, in my opinion, become even more important in the years ahead. With the trend of early sports specialization, we're getting "less athletic athletes;" they don't have as much context in place, and wind up having to back-track. Additionally, we have an increasingly sedentary society, which certainly robs individuals of context.
All that said, just remember that if you want to have an exercise in your program, you have to think about how you're going to coach it with all the individuals that may come your way. And, that coaching might involve devising some exercise regressions that build context from which to draw.
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Lately, I've been posting more training pictures and videos on my Instagram page. The other day, I posted this video, and it led to some good discussion points that I think warrant further explanation:
You had an Instagram post the other day about an athlete not being able to differentiate between hip and lower back extension. I have a client with what seems to be a similar problem and just wondered how you generally go about teaching them the difference.
The answer to this question really just rests with having a solid set of assessments that help you to understand relative stiffness. I was first introduced to this concept through physical therapist Shirley Sahrmann's work. Relative stiffness refers to the idea that the presence or lack of stiffness at one joint has a significant impact on what happens at adjacent joints, which may have more or less stiffness. Without a doubt, if you've read EricCressey.com for any length of time, the most prevalent example of this is a shoulder flexion substitution pattern.
In this pattern, the "bad" stiffness of the lats (among other muscles) overpowers the lack of "good" stiffness in the anterior core and deep neck flexors - so we get lumbar extension (arched lower back) and forward head posture instead of the true shoulder flexion we desire. Truth be told, you can apply these principles to absolutely every single exercise you coach, whether it's an 800-pound squat or low-level rotator cuff exercise.
As an example, when you cue a wall hip flexor mobilization, you're working to reduce bad stiffness in the anterior hip while cueing an athlete to brace the core and activate the trailing leg glute. That little bit of good stiffness in the anterior core prevents the athlete from substituting lumbar extension (low back movement) for hip extension, and the glute activation creates good stiffness that impacts the arthrokinematics of the hip joint (head of the femur won't glide forward to irritate the anterior hip during the stretch).
In the upper extremity, just use this back-to-wall shoulder flexion tutorial as an example.The "reach" would add good stiffness in the serratus anterior. The shrug would add good stiffness in the upper traps. The "tip back" would add good stiffness in the lower traps. The double chin would add good stiffness in the deep neck flexors. The flat low back position would add good stiffness in the anterior core. Regardless of which of these cues needs the most emphasis, the good stiffness that's created in one way or another "competes" against the bad stiffness - whether it's muscular, capsular, bony, or something else - that limits overhead reaching.
Returning to our prone hip extension video from above, if we want to get more hip extension (particularly end-range hip extension) and less lumbar extension, from a purely muscular standpoint, we need more "good stiffness" in rectus abdominus, external obliques, and glutes - and less stiffness in lumbar extensors, lats, and hip flexors. As the question received in response to the video demonstrates, though, this can be easier said than done, as different clients will struggle for different reasons.
Sometimes, it's as simple as slowing things down. Many athletes can perform movements at slow speeds, but struggle when the pace is picked up - including when they're actually competing.
Sometimes, you can touch the muscle you want to work (tactile facilitation). Spine expert Dr. Stuart McGill has spoken in the past about "raking" the obliques to help create multidirectional spinal stability. I've used that cue before with this exercise, and I've also lightly punched the glutes (male athletes only) to make sure athletes are getting movement in the right places.
Sometimes, a quick positional change may be all that's needed. As an example, you can put a pad under the stomach to put the lumbar extensors in a more lengthened position. In fact, doing this drill off a training table (as demonstrated above) was actually a positional change (regression) in the first place; we'd ideally like to see an athlete do this in a more lengthened position where he can challenge a position of greater hip extension. Here are both options:
Sometimes, a little foam rolling in the right places can get some of the bad stiffness to calm down a bit. Or, you might need to refer out to a qualified manual therapist to get rid of some "tone" to make your coaching easier. I do this every single day, as I have great massage therapists on staff at both our Florida and Massachusetts Cressey Sports Performance facilities.
Sometimes, a little positional breathing can change the game for these athletes, as it helps them to find and "own" a position of posterior pelvic tilt while shutting off the lats.
The take-home point here is that there are a lot of different ways to create the movement you want; coaching experience and a working knowledge of functional anatomy and relative stiffness just help you get to the solutions faster and safer.
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