I hope you all had a great weekend and are enjoying these World Series games. You can't beat playoff baseball!
Here are some recommended resources for the week:
10 Daily Habits of Healthy Lifters - I contributed a few paragraphs for this compilation at T-Nation, and the end result included several excellent recommendations.
Bored and Brilliant - I had the long car ride from Massachusetts to Florida last week, and this is one of the audiobooks I covered to pass the time. Manoush Zomorodi took an outstanding look at how technology impacts our lives in negative ways. While it wasn't written from a strength and conditioning perspective, I could totally see how to apply its lessons to the fitness realm.
Today's smart guy isJohn Pallof, a great physical therapist with whom I am lucky to collaborate on a weekly basis.
The message if very clear and simple - and the practice of this lesson yields marked improvements in outcomes: once you've had soft tissue work done, it's imperative to stretch the tissues that have just been worked. Once you have "disrupted" the tissue and created the desired response, the next step is to re-establish proper lengthening of the involved tissues.
We typically encourage athletes to use multiple sets of 60-second holds over the course of the day following the soft tissue work for most beneficial results. So, if an athlete has aggressive soft tissue work on the elbow flexors, he would do this stretch over the course of the rest of the day to re-establish the elbow extension range-of-motion we're trying to attain.
Recommended Viewing: Check out this cool free slideshow about how Graston Technique (R) works:
What the experts are saying about The Truth About Unstable Surface Training…
“Unstable surface training is many times misunderstood and misinterpeted in both the physical therapy and athletic performance fields. The Truth About Unstable Surface Training e-book greatly clarifies where unstable surface training strategically fits into an overall program of injury prevention, warm-up/activation, and increasing whole body strength. If you are a physical therapist, athletic trainer, or strength training professional, The Truth About Unstable Surface Training gives you a massive amount of evidence-based ammunition for your treatment stockpile.”
Shon Grosse PT, ATC, CSCS
Comprehensive Physical Therapy
Colmar, PA
Click here for more information on The Truth About Unstable Surface Training.
Subscriber-Only Q&AQ: I have a question about your 22 More Random Thoughts article from October of 2008 on T-Nation. In the stretch for the hips found above #10, I can't tell is that athlete bridging or are the hips on the ground. Also, can you please explain exactly what is stretched and how a little bit about how it corrects out-toeing of the feet?
A: Sure, no problem. Here's the lying knee-to-knee stretch, for those readers who missed the original article:
First off, it's a stretch for the hip external rotators, and the athlete is not bridging up. However, it's also useful to do the stretch in a more hips-extended position, as a small percentage of athletes will feel it more in that position. To perform this stretch, we'll do the exact same position, but have the athlete set up atop a stability ball (which keeps the femurs in a more extended position).
Poor hip internal rotation range-of-motion is something you'll see quite frequently in soccer players, hockey players, and powerlifters, as all spend a considerable amount of time in hip external rotation. Likewise, I monitor this closely with all my baseball pitchers, as front leg hip internal rotation deficit is a huge problem for pitchers. When the front hip opens up too soon because of these muscular restrictions, the arm lags behind the body (out of the scapular plane). As such, it isn't uncommon for pitchers with elbow and/or shoulder pain to present with a significant hip internal rotation deficit.
There is also a considerable amount of research to suggest that hip rotation deficits - and particularly, hip internal rotation deficits - are highly correlated with low back pain. There was a great guest blog post at Mike Reinold's blog recently that highlights all this research; you can check it out HERE. My personal experience with hundreds of people who have come my way with back pain overwhelmingly supports this "theory" (if you can even call it that). It's my firm belief that this is one of the primary reasons Mike Robertson and I have gotten so much great feedback on our Magnificent Mobility DVD from folks who have seen a reduction (or altogether elmination) in back pain. Teach folks to move at the hips (particularly in rotation) instead of the lumbar spine, and whatever's going on in their low backs calms down.
Our goal is a minimum of 40 degrees of hip internal rotation. This is measured in the seated position (hips flexed to 90 degrees).
In addition to the classes of athletes I mentioned earlier, we also need to watch out for hip internal rotation deficit (HIRD) in the general population because of what happens further down the kinetic chain. We all know that overpronation at the subtalar join is a big problem for a lot of folks. This can occur because of a collection of factors, from poor footwear (too much heel lift), to muscular weakness (more on this in a second), to mobility deficits (particularly at the ankle), to congenital factors (flat feet). To understand how pronation affects the hip external rotators, you'll need to listen to a brief synopsis of subtalar joint function...
During the gait cycle, the subtalar joint pronates, to aid in deceleration. Basically, the foot flattens out to give us a bigger base of support from which to cushion impact, and from there, we switch back over to supination to get a rigid foot from which to propel. The picture below shows what our foot looks like when we have too much pronation.
Here's where our hip gets involved. Physical therapist John Pallof once called the subtalar joint a "torque converter," and it really stuck with me. What that means is that while the subtalar joint allows motion in three planes for pronation/supination, it converts this motion into transverse plan motion where it interacts with the tibia. And, as you can imagine based on the picture above, when you pronate, you increase tibial internal rotation. This, in turn, increased femoral internal rotation. Taken all together, we realize that increasing pronation means that there is more tibial and femoral internal rotation to decelerate with each step, stride, or jump landing.
The hip external rotators are strong muscles with a big cross sectional area, so they can take on this burden. However, over time, they can get balled up from overuse. As a result, the hip will sit in a more externally rotated position all the time - and the feet simply come along for the ride. That said, as I wrote HERE, it isn't the only cause of this foot position, so be sure to assess thoroughly and individualize your recommendations.
Also, a quick side note, be careful using this stretch with individuals who have previously experienced medial knee injuries, as the valgus stress can be a bit too much for some folks.
New Blog ContentRandom Friday ThoughtsFor High School Pitchers, No Grace PeriodDoga? Seriously?CP Athlete Featured at Precision Nutrition
I encourage you to check out this Precision Nutrition Athlete Profile on Cressey Performance athlete and Oakland A's minor league pitcher Shawn Haviland. Shawn completely changed his body this off-season and had a nice velocity jump from 87-89 to 91-93mph - and he's off to a good start for the Kane County Cougars. A lot of this can be attributed to him making huge strides with improving his nutrition.
Have a great week!
EC
I got to talking with an athletic trainer at a recent seminar, and we were discussing how people really don't understand how the rhomboids work.
You see, the rhomboids typically get lumped right in with the trapezius complex as scapular retractors - and that's correct, but not exhaustive enough to illustrate my point. What you want to observe is the line of pull of the rhomboids:
What you'll see if that this line of pull is quite similar to that of the upper trapezius and levator scapulae muscles, both of which "hike" the scapula up. In reality, the goal with any rowing exercise should be to get the lower trapezius firing as much as possible, as its line of pull depresses the scapula as it retracts - and the muscle is involved upward rotation, which is essential for safe overhead movements.
Note how the line of pull of the trapezius changes as you go superior (top) to inferior (bottom).
As such, you want to make sure that you get your shoulder blades back and down as you do your rowing movements. Here's an example of what a bad seated cable row, where the scapulae are retracted, but ride up, leading to upper trap, levator scapulae, and rhomboid recruitment.
Much of this comes because of the backward lean, but it's also possible to have it when in the right torso position.
If you are someone with shoulder issues, you'll be surprised at what some general massage work on the rhomboids will do to alleviate your discomfort. We know that working on pectoralis minor and levator scapulae will quickly yield results, but rhomboids falls into the same category, as (like these two muscles) they're involved in downwardly rotating the scapulae.
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I’m a nice guy. I pay my taxes, get all giddy when I see new pictures of my baby niece, and never rip the tags off my mattresses. However, when it comes to fitness and health care professionals, I’m a cynical bastard. I read a ton and am always looking for ways to get better, so I guess you could say that I’m less than tolerant when it comes to people in this industry who are lazy and afraid to question the status quo. This is probably why John Pallof and I get along so well (well, that and the fact that we’re both Irish, went to school at UCONN, and cheer for the Red Sox).
John is without a doubt one of the brightest therapists I know. He’s our go-to guy in Massachusetts, and has already been out to our facility to offer one more set of eyes to our most complex cases and highest-caliber athletes. I just had to interview a guy who “gets it” so well.
EC: Hey John, thanks for taking the time to talk shop. As hackneyed a first question as it might be in the world of fitness interviews, could you please tell our readers a bit about yourself?
JP: I am a physical therapist first, specializing in treating athletes of all ages and levels. I have worked hard to develop skills in both the PT and performance enhancement arenas, as I do actively train athletes anywhere from four to ten hours a week on top of my “normal” PT job at South County Physical Therapy in Auburn, MA. As for the physical therapy side of things, I pride myself on my manual therapy skills, biomechanical assessment perspectives, and a very solid therex background, largely developed from my interactions with numerous professionals in the strength and conditioning field.
EC: I can’t believe you’re not even going to list “off color humor” as one of your finest qualities! But anyway…one of the main reasons you’re our go-to guy in terms of physical therapy is that you think outside the box and really have an understanding of what it is performance enhancement coaches do. How did you gather that perspective?
JP: I have had the great fortune to spend the past four years working with the two coaches I view as the standard to whom all other strength and conditioning coaches should be compared: Jeff Oliver and Brijesh Patel, from the College of the Holy Cross, in Worcester MA. My career would not be where it is if not for them. I have spent countless hours with these guys on a weekly basis, and they’re two of the brightest guys I know, in any field. Above all, I have learned the value of generosity (in time, knowledge, and opportunity) and how to be a true professional from “Ollie.” I have accepted the fact that we will probably all be working for Brijesh someday, as he is the most disgustingly organized, and hardest working person I know. A woman at HC actually mistook me for B once – not sure if she had her glasses on!
As far as gaining perspective on performance enhancement, the only way to learn it is to do it – do the training yourself, and coach, coach, coach – and then coach some more. Plus, there is an abundance of good seminars and reading materials out there, so there is no excuse to slack off on learning.
EC: Along those same lines, why is it that most physical therapists aren’t able to see things like you are? Where is the profession as a whole missing the boat?
JP: Some of the blame falls at the feet of the academic world, and thus the American Physical Therapy Association, who designs the standardized academic criteria for accreditation. This can be a very long conversation, but in a nutshell…more emphasis needs to be placed on teaching students clinical reasoning skills – learning how to think critically – as opposed to dogmatic memorization of theories which are just that: theories. Not to be overlooked as well, the therapeutic exercise component of the education process is pretty bad. Most, if not all PTs have no idea how to teach a squat, much less an Olympic lift. I was lucky enough to have Dave Tiberio and Mike Zito (among others) as role models while at UCONN, so I learned that it’s not really about memorizing crap; it’s about learning how to think and problem solve.
EC: You and I had a great discussion recently about lumbar stabilization, and I know our readers would love to hear some of the stuff you shared with me. Care to fill them in a bit?
JP: I view abdominal musculature in two categories: global stabilizers and local stabilizers. Local stabilizers function to give segmental stability – control what happens between individual vertebrae – primarily shearing and compressive forces. They give your spine integrity and prevent buckling when you flex/twist. Examples include the transversus abdominus, multifidus, psoas, and to some degree the internal oblique due to its insertions into the thoracolumbar fascia. Global stabilizers are your larger muscles that contribute to overall stability and help generate force – think rectus abdominus, quadratus lumborum, and external oblique, amongst others. Paul Hodges and others helped develop these classifications, and are extremely bright therapists.
EC: Any helpful tips for training within these classifications?
JP: First, make sure you have good local stabilizer function, especially if the client has had LBP in the past. Second, focus on isometric endurance (these are postural muscles remember). Then, progress to force production and movement: just my two cents. Remember – pain shuts these local stabilizers down – so athletes with a history of pain may need to work extra on these guys.
EC: How about a few examples in this regard? Any particular exercises you’re using frequently to retrain local stabilizers following injuries?
JP: Well, there are two main ones that I find myself using frequently – cable column (or stretch band) pushes and quadruped multifidus lifts. CC pushes – standing in an athletic position (good lordosis, butt back, chest up/scaps back, feet beneath hips), the cable is parallel to your body – holding the handle with both hands in front of your belly button. Without allowing trunk movement and maintaining good positioning, you slowly extend your arms to full extension (at stomach height), than slowly return. Can do for reps or holds. You are basically resisting a rotational force.
EC: They’re called Pallof Presses, dude! Tell the world!
JP: Quadriped multifidus lifts – quadruped, with one knee on airex pad (knees beneath hips, hands beneath shoulders). Slowly lift the down femur vertically by rotating your pelvis to level – no actual hip movement, more pelvis on spine motion. Again, for reps, then progressing to holds for isometric endurance.
EC: I know you’ve seen a lot of really bright physical therapists and coaches speak; who do you feel would be the best for trainers and ordinary weekend warriors to see?
JP: Mike Boyle; some of the Australian therapists (e.g., Mark Comerford) who are starting to make the rounds; and Brijesh Patel. For PTs, any of the Maitland manual therapy seminars or Mulligan courses. There are a ton of people who I have not seen but would like to in the years to come.
EC: How about resources? What five books, DVDs, manuals, CD-ROMS, etc. have impressed you?
JP: In no particular order:
1. Theory and Applications of Modern Strength and Power Methods, by Christian Thibaudeau
2. Nutrient Timing, by John Ivy and Robert Portman
3. Atlas of Human Anatomy, by Frank Netter – by far the best and most accurate anatomy book, bar none.
4. Freakonomics, by Stephen Levitt – excellent book, examining how the “conventional wisdom” of anything is often wrong, when looked at objectively in the right context.
5. Spinal Mobilization Made Simple: A Manual of Soft Tissue Techniques, by Jeffrey Maitland – more of a reference – the Maitland manual therapy/clinical reasoning seminars are the best continuing education series out there – rock solid, phenomenal results, bulletproof reasoning methods. Check out www.ozpt.com. Lots of great research backing up the superior efficacy of manual therapy combined with corrective exercise.
6. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain, by Paul Hodges and Carolyn Richardson. Once again, those damn Aussies are ahead of the game when it comes to rock solid science. Not “I think,” but “research shows” – and they don’t just talk about it, they apply it.
Oops – that was six – had to include the anatomy book, because most people have no idea about something as basic as origins and insertions.
EC: Thoughts on Stuart McGill’s stuff?
JP: I like most of his concepts – very practical, and they make sense. I have not seen him speak first-hand, but I’ve heard nothing but positive reviews. I’m not sure that I agree with avoiding rotational movements in the spine – you can twist all you want, but you’re not going to get a lot of rotation in the lumbar spine due to the orientation of the facets – primarily compressive forces between opposing joint surfaces. However, I completely agree with shearing forces, not so much compressive forces, being damaging to the spinal column. The idea of isometric endurance rather than force production when training the core also makes tons of sense.
EC: Randomly throw some idea out there that will really make our readers say “Oh, crap, that really makes sense!”
JP:
1. A muscle that often gets overlooked with shoulder impingement type problems – like the plain looking girl at the dance – the serratus anterior. It’s very important for a few reasons: helps rotate and protract the scapula/acromion up and out of the way of the humeral head, and is also important for force coupling with the rhomboids/lower and middle trapezius.
2. Many “hamstring pulls” – especially chronic ones – are actually symptoms of a mild nerve irritation – neural tension dysfunction. Just like a brake cable on a bike, your nerves need to glide through the tissue they travel through. If they get hung up, they will become symptomatic to varying degrees. Picture a brake cable on a bicycle – the metal cable glides through the plastic casing. Your nerves need to be able to glide through the structures and tissues they travel through – as much as 7 to 10 mm in some areas!
3. A topic of contention – the elephant in the room – the psoas. While there are many theories out there, I believe the psoas acts along with the TVA/multifidus/internal oblique as a local/segmental stabilizer of the spine. Think about the origins on the anterior surface of the transverse processes of the lumbar spine. Why the hell would it attach so intricately if all it did was flex the hip? The psoas atrophies in a fashion similar to the multifidus with back pain. The multifidus and the psoas form a force couple/agonist-antagonist relationship, giving stability of one vertebrae on the other.
EC: Very cool stuff, John; thanks again for taking the time.
