Between the holidays and my "Best of 2016" series, it's been a few weeks since the last installment of this weekly recommended reading/viewing list. With that in mind, I'll throw out some extra recommendations this week:
Understanding Influencer Marketing - My business partner, Pete Dupuis, discusses the value of collaborative marketing efforts between one company or individual and another - using our relationship with New Balance as an example.
Stress is Not Stress - This was an outstanding post from Dave Dellanave; he cuts through all the science and explains why not all stress is created equal for every person.
In today's post, I want to cover three more coaching cues you can use to clean up your training technique. These are ones I use all the time with athletes at Cressey Sports Performance:
1. "Create a gap."
I use this one all the time with both rowing and pressing variations. Athletes love to keep the elbow too close to the side, and it creates an environment of faulty scapular positioning during movement of the upper arm. You can check out examples on my Instagram page, if you're interested (FAULTY vs. CORRECTED).
The answer is very simple: create a gap between the upper arm and torso. I'll usually just put my hand between the two landmarks and wiggle my fingers side to side to create a gap, as depicted by the blue line here:
2. "Don't let this plate fall."
I've written in the past (here) about how much I love bear crawls as everything from a low-level core stability exercise to a great scapular control drill. That said, one thing you'll see as a common mistake from athletes is that they'll allow their lower back and hips drift side to side on each "step." While this is indicative of the need for rotary stability at the core, usually, the problem is still something that can be fixed up pretty quickly with some basic coaching cues, starting with "slow down."
To build on "slow down" with an external focus cue, I'll set a 2.5-pound plate on the athlete's lower back. The more the lumbopelvic shifts, the more likely it is to fall.
3. "Don't break the glass."
One of the biggest mistakes we see with quad dominant athlete who have poor hip hinge patterns is that they'll break the knee forward in lieu of shifting the hips back. You'll see this on everything from lateral lunges to the eccentric (lowering) portion of deadlifts.
Obviously, we can start to address this by coaching at the hip ("push your butt back to try to touch the wall behind you"), but you can also have a positive impact on the movement by coaching the knee with an external focus cue of an imaginary pane of glass running directly up to the ceiling from the toes. Check out this still frame I took from the lowering portion of a sumo deadlift. The knee shouldn't hit the blue line that signifies the imaginary pane of glass:
The image would be more powerful from the side angle, but the plates obscure the lower leg and foot from that perspective, unfortunately. Fortunately, the lateral lunge with overhead reach is a good second shot:
That wraps it up for this edition. Hopefully, you've found these cues useful and easy to apply in your strength and conditioning programs. If you're looking for direction with respect to both programming and coaching cues, be sure to check out The High Performance Handbook, which features more than 200 exercise coaching videos, comprising three hours of footage of the exact cues we use with our athletes.
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Here are this week's nutrition and strength and conditioning tips from Greg Robins. Hopefully, they make your week a little more awesome!
1. Try these tips for a better late night smoothie.
If you’re after increased strength, performance, and muscle mass, you need to conquer two variables. One is eating nutrient dense foods (and plenty of them), and the other is getting quality sleep. Many people turn to a smoothie later in the evening as an easy way to add additional calories to their day. If you’re in this boat, consider using some ingredients that will help you tackle both of the previously mentioned variables. Check out this smoothie, and give it a try!
12-16oz Almond Milk (almonds are high in magnesium, which can help you relax!)
½ -1 Cup Plain Greek Yogurt (yogurt is rich in calcium – which can reduce stress – and contains tryptophan – which can aid in sleeping!)
½-1 Banana (These guys are also high in magnesium, as well as potassium, which will aid in relaxation and stress reduction!)
1 Cup Dark Cherries (cherries are rich in melatonin!)
¼- ½ Cup Raw Oats (oats are also rich in magnesium, potassium, and calcium!)
For additional protein needs, you can throw in a scoop of whey as well!
2. Consider this video for your sumo deadlift technique.
3. Prioritize adherence for nutritional success.
Nutrition is an area that frustrates me. It goes beyond the fact that deep down, I wish ice cream, cereal, and anything engulfed by bread was the pinnacle of healthy eating. My frustration has to do with how we approach nutrition. What I am about to tell you is not revolutionary, nor does it apply solely to nutrition.
If you want to be successful, prioritize adherence.
If I asked a handful of people what the priorities would be in helping someone improve nutrition, they would likely spit out a few things. Eat real food, drop the carbs, and so on. All these ideas are worth considering, but all leaps and bounds away from the top of the priority list.
Nutrition is often limited by the person, not by the information. The information is there; it’s everywhere, although some information is better than others. The reason changes aren’t being made has more to do with the person (or with YOU).
If I were to choose one thing to prioritize in a nutrition plan, it would be adherence. Adherence is your ability to stay the course, or stick to the plan. When you ask yourself “What do I need to know about this person?,” and “What can I do to make sure this person can be successful adhering?,” you will see what needs to be prioritized. The same goes for you. Make changes slowly, and choose things to which you know you can adhere.
4. Try this front squat technique cue.
5. If it’s important, just do it.
Recently, I had a conversation about whether implementing a certain training strategy had value in my programs. Interestingly, the debate wasn’t about whether or not using a certain exercise was worth it; instead, it was about “how” worth it. The exercises in question were ones that have a lot of reward. The problem was whether or not people would take them seriously enough not only to do them correctly, but also to learn from them and keep their lessons in mind throughout the rest of the training day – not to mention the rest of the day in general.
As an example, let’s use breathing drills. We know that breathing drills are important. Challenging someone to change their breathing, and to be aware of it more often, can have incredible transfer in improving a number of different qualities. However, the average person tends to miss the value of their application. While we can debate the quality of coaching, and explanation they are receiving, in relation to its continued practice; the truth is no amount of information is enough to make someone do something they are not willing to practice. If the majority of people aren’t going to do it, is it worthwhile to include it at all?
YES, I think so. With our example, let’s say that adding breathing drills takes two minutes of additional time. Now let’s imagine only 20% of the people who do them actually take the concept to heart. 120 people will come through our facility on a given day. That means 24 people will have picked up a concept that has incredible value. In fact, those 24 people have completely revamped their thought process, and are benefiting from it ten-fold. That may seem like a futile effort, but in the end, the others didn’t receive anything negatively from their inclusion, and the 24 who bought in have received a mighty return.
The take home message is that if something is worth doing, then you need to include it. If people choose not to do it enough, or not do it properly, it’s their loss. If you don’t include something based purely on whether or nor not you think it’s going to hit home with your athletes, it’s like counting them out from the start. Give them a chance to succeed using the best of what you know. Furthermore, as the ones who benefit begin to show improvement, the likelihood that others will follow suit is very high.
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Today marks the fifth installment of a series that looks at the coaching cues we use at Cressey Sports Performance. Here are three more cues we find ourselves using with our athletes all the time.
1. Move the hands in or out to improve your deadlift technique.
When you're learning how to deadlift, understanding hand positioning is really important - but each deadlift variation is unique in terms of what you have to do with your grip. Check out this video to understand why:
2. Squat between your legs instead of over them.
In the past, I've spoken at length about how stance width impacts where the knees go. Move the feet out too wide, and the knees have no place to go but in. Bring them in closer, and it's much easier to get the knees out. Check out this video for more details:
So, for many folks, bringing the feet in can really help - particularly with the deadlift. However, squats can be a bit trickier, as the stance coming in can lead to a lot more forward lean and individuals not positioning the torso correctly. Individuals will squat as if they are trying to touch the belly to the quads. There are, in fact, some accomplished lifters who do this, but their bellies are very big, and the Average Joe isn't fat enough to pull this mechanical advantage off! Most folks wind up turning this approach into a really ugly good morning.
This is why I like the cue of telling folks to squat between the legs instead of over the top of them. Some people grasp it a lot better than "spread the floor" or "knees out." They can also understand positionally if you show them a bad set-up followed by a good set-up, like this classic photo (notice how the knees around outside the torso from the rear view):
Source: DaveDraper.com
3. Pretend your biceps is a rotisserie chicken.
This is, without a doubt, the strangest cue I've given. However, it works.
When we're doing our (shoulder) external rotation variations, we want to make sure the humeral head (ball) is centered in the glenoid fossa (socket), as that is the primary functional of the rotator cuff. This cue gets the job done:
Looking for more detailed coaching tutorials like this? Check out Elite Training Mentorship, an extensive online education program that features my staff in-services, exercise demonstrations, and articles - as well as the contributions of several other accomplished fitness professionals.
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Today marks the third installment of a series that looks at the coaching cues we use to optimize training technique at Cressey Performance. Today, we'll focus specifically on deadlift technique coaching cues. Additionally, if you really want to learn how to deadlift from scratch, I'd encourage you to subscribe to my free newsletter, as you'll receive a video deadlift technique tutorial when you do so.
1. Touch your butt to an imaginary wall a foot behind you.
"Hips back" is a cue that works great for many people when it comes to coaching deadlift variations, box squats, toe touch progressions, and a host of other exercises requiring a good hip hinge. For those with less-than-stellar "movement awareness," I prefer to give a slightly different reference point.
You see, "hips back" is an internal focus coaching cue; it focuses on the athlete moving part of his/her body. The imaginary wall, on the other hand, is an external focus cue; it's just an inanimate object that serves as a reference point for the athlete. With the "touch your butt to an imaginary wall a foot behind you" cue, you give an athlete both internal and external focus options, so it's more likely that one of them will register. Plus, "butt" may register a bit more with folks who can't don't understand how to dissociate the hips from the lower back.
2. Show me the logo on your shirt.
Also on the deadlifting front, many individuals simply don't grasp the concept of "chest up" when they're in the bottom position of a deadlift and want to go hunchback on you. However, I haven't met a lifter yet who doesn't understand what I mean when I stand in front of them and say, "Show me the logo on your shirt." Again, "me" is an external cue that helps to fix things up.
Take note of the New Balance logo on the front of my shirt during this deadlift; is there ever a point during the lift that you don't see it?
This isn't just for singles, either. You'll see the logo on Tony's shirt on every rep on this set of eight reps.
Now, let's compare two heavier lifts - one that was awful on this front, and two that were significantly better. This first one was taken in August of 2007. Notice how the logo disappears, and my spine looks like it's going to explode?
Now, compare that to the deadlifts (1:40 mark through the end) in my mock/impromptu powerlifting meet two weeks ago. You'll notice that you never lose sight of the logo on my shirt.
3. Don't just lift; put force into the ground.
I've found that folks often get so caught up in the moment when they approach heavy weights on the deadlift that they will simply do anything it takes to get the bar up (reference my ugly August 2007 deadlift from above). However, what they fail to realize is that they'll be stronger if they put themselves in the most biomechanically correct position possible.
In the context of the deadlift, this means not allowing the bar to get too far away from the body. If you do, it's like sitting on a seesaw opposite someone, but letting them move further away from the center point; you've made them feel heavier without actually changing the weight. In other words, crushing big weights on the deadlift is about keeping the bar close to the primary axis of movement: the hips. It's why most lifters will be slightly stronger on a trap bar deadlift than a conventional deadlift; the weight is positioned closer to the hips. And, it's also why folks with long femurs usually can lift more weight with sumo deadlifts (and do so more safely).
Regardless of the deadlift variation in question, I've found that more advanced lifters can really benefit from thinking more about just putting force into the ground. This doesn't mean you have to stomp your heels down (I actually used to do that, but don't any longer), but rather just engaging your posterior chain to take tension out of the bar and ensure that the bar starts out in the right path: close to you. Some cues that go hand-in-hand with this are #2 from above (show logo) and "pull back, not up."
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Q: Unfortunately, my gym doesn't have a power rack. I don't want my strength training program to completely fall to pieces without it. Any ideas?
A: First off, in most cases, you have the option of finding a new gym - even if it just means driving a bit further and buying a day pass for the day of the week that you'd need a power rack for one or more of your strength exercises. Of course, all this additional planning can throw you for a loop if you've already got a busy schedule.
This is a common limitation that is surprisingly easy to work around in your training. To be honest, the only components you’ll miss are squatting, barbell overhead pressing (and push presses), and barbell incline pressing (this, of course, assumes that you have a flat bench press set-up).
You might also be surprised to know that we actually have quite a few athletes who we don’t allow to squat because of functional (e.g., poor thoracic spine mobility, short hip flexors) or structural (e.g., rigid ankle anatomy, femoroacetabular impingement) mobility limitations. These athletes rely predominantly on extra deadlifting variations and plenty of extra single-leg work. My personal favorites for replacing squatting variations are barbell lunge and split-squat variations because they provide the benefits of axial loading. If you're strong enough to clean the weight up and get it into position, you can do these for higher reps and get a good training effect.
Unfortunately, without a power rack in place, it's tough to set up for these single-leg variations. Fortunately, you can also use variations where dumbbells are held at the sides and still get appreciable loading. Heavy sled pushes can also provide variety, if you have access to the appropriate equipment; the only downside is that you don't get much of an eccentric stress challenge.
So, a "typical" lower body training session for someone with no power rack might include sumo deadlifts, walking dumbbell lunges, and barbell supine bridges. Even if you aren't squatting, you're still getting a hefty lower body challenge.
With respect to barbell overhead pressing, simply replace it with dumbbell overhead pressing, or have two training partners hand the bar up to you so that you can receive it in the “rack” position. Incline pressing can be replaced with either dumbbell pressing from this position or a flat bench press variation.
There might not be a more obnoxious and stubborn athletic injury than the hamstrings strain. When it is really bad, it can bother you when you're simply walking or sitting on it. Then, when a hamstrings strain finally feels like it's getting better, you build up to near your top speed with sprinting - and it starts barking at you again. In other words, a pulled hamstrings is like a crazy, unpredictable mother-in-law; just when you think you've finally won her over, she brings you back down to Earth and reminds you how much more she liked your wife's old boyfriend.
However, not all hamstrings pain cases are true strains; more commonly, they present as a feeling of "tight hamstrings." If one is going to effective prevent this discomfort, rehabilitate it, or train around it, it's important to realize what is causing the hamstrings tightness in the first place. Here are five reasons:
1. Protective Tension of the Hamstrings
This is readily apparent in someone who has a crazy anterior pelvic tilt, which puts a big stretch on the hamstrings, which posteriorly tilt the pelvis. When someone is extremely anteriorly tilted, the hamstrings are constantly "on" to prevent someone from ending up with extension-based back pain, such as spondylolysis (vertebral fractures), spondylolisthesis (vertebral "slippage"), and lumbar erector tightness/strains. This is a problem most commonly seen in females (greater anterior pelvic tilt than men) and athletes:
Doing a lot of longer duration static stretching for the hamstrings in this population usually isn't a great idea, as you run the risk of making someone more unstable - particularly in the case of females, who have less rigid ligamentous restraints (more congenital laxity) to protect them. To that end, our approach with these folks is to use the warm-ups to foam roll the area, then do some hamstrings mobilizations to transiently reduce stiffness in the hamstrings.
After this reduction in stiffness, we work to build stability in synergists to the hamstrings in posterior pelvic tilt. In other words, there's a heavy emphasis on glute activation and anterior core recruitment both with a strength training program and postural reeducation for the other 23 hours of the day.
At the end of the training session, with the male athletes, we may do some shorter duration hamstrings stretching just to "dissipate" a little eccentric stress. I like ten seconds in each of these three positions:
The thing to remember is that while you can do everything right with these athletes in training, what they do with their posture during the rest of their lives is of paramount importance. If they continue to stand around in anterior tilt and don't help the new stiffness they've developed "stick," they'll continue to over-rely on their already tight hamstrings.
2. Neural Tension
Just because you feel hamstrings tightness doesn't mean that the hamstrings are actually the source of the problem. In fact, it's not uncommon at all for those with lumbar disc issues to present with radicular pain, tightness, or numbness/tingling into the legs - especially the hamstrings. The symptoms may also come from nerve entrapment (most commonly the sciatic nerve) on soft tissue structures further down the chain. Just aggressively stretching the hamstrings can actually make these symptoms worse, so it's important to see a medical professional to rule out causes further up with the appropriate clinical exams, such as the slump test.
3. Truly Tight Hamstrings
In order for hamstrings to really be short, one would have to spend a lot of time with the knee flexed and hip extended - so just imagine the position you're in at the top of a standing leg curl. That's a hard pose to hold for an extended period of time, much less do so on a regular basis.
That said, some folks do get somewhat close to that on a daily basis in the sitting position, and are therefore the most likely to really have "tight hamstrings." They have to be in posterior pelvic tilt and knee flexion for a considerable chunk of the day - and even then, it's still pretty tough to be truly short, as they are still in hip flexion.
These folks usually can't distinguish hip flexion from lumbar flexion, so if you do a standing hip flexion assessment, rather than maintain the neutral spine we see in this photo, they'll go into lumbar flexion (butt will "tuck under").
The same trend will usually be noticeable with any kind of squat unless they have a tremendous amount of core stiffness to overcome the posterior hip stiffness that's present. If you test these folks on an straight leg raise, it isn't pretty, as the pelvis is already posteriorly tilted. In a pelvis that starts in "neutral" on a straight leg raise, roughly the first 1/3 of movement that you see comes from posterior tilt of the pelvis before the femur ever starts to flex on the acetabulum of the pelvis. These folks are usually already posteriorly tilt, so that 1/3 is already used up; you're really only measuring hip flexion and not hip flexion PLUS posterior pelvic tilt. And, as you can imagine, if someone is truly short in the hamstrings, that straight leg raise isn't going to be pretty. Obviously, these folks usually have a terrible toe touch pattern as well.
This should also educate you on why you can't treat all hamstrings strains the same. In the protective tension example earlier, we needed to work to regain stability to hold a position of a bit more posterior pelvic tilt. We'd cue glute activation, and use exercises that draw folks back into posterior tilt (e.g., reverse crunches). If you have someone has a pulled hamstrings because they are truly short from already being in posterior pelvic tilt, though, some of these cues and exercises would be contraindicated. You'd be feeding the dysfunction.
While manual therapy and stretching for the posterior hip is valuable, again, it must be followed by stabilization work at adjacent joints with the pelvis in a neutral position. These folks can benefit from training hip flexion above 90 degrees as well, as it educates them on how to flex the hip without rounding the lumbar spine. This is one reason why I think a lot of the chop and lift exercises we've learned from Gray Cook are so fantastic; they teach us anti-rotation and anti-extension stability in various positions of hip flexion while the pelvis is in neutral. They make changes "stick" better.
4. Previous Hamstrings Strain
Not to be overlooked in this discussion is the simple fact that the single-best predictor of hamstrings strains is a previous hamstrings injury. One you have an injury, that area may never be the same from a tissue density standpoint - whether it's the surrounding fascia or the muscle or tendon itself. A previous injury can leave athletes feeling "tight" in the region, so regular manual therapy can certainly help in this regard.
Anecdotally, the athletes with the long-term problems seem to be the ones with the pulls up on the gluteal fold, right where the hamstrings tendons attach to the ischial tuberosity. The area gets "gunked up"in a lot of athletes as it is because of all the tissues coming together and exerting force in a small area, but it's especially problematic in those who have a previous injury in the region. Perhaps more problematic, though, is the fact that we sit on our proximal hamstrings attachments - and that isn't exactly good for blood flow and tissue regeneration.
I haven't seen any research on it, but I have a feeling that if you looked at this region in a lot athletes with ultrasound (similar to this study with patellar tendons), you'd find a ton of people walking around with substantial degenerative changes that could be diagnosed as tendinosis even though they haven't actually hit a symptomatic threshold. My guess is that it's even worse in the posterior hip region because a) we sit on it, b) the ischial tuberosity is a more "congested" area than the anterior knee), and c) the study I noted above used 14-18 year-old athletes, and degenerative problems will get worse as one gets older (meaning this study likely undercut the true prevalence across the entire population).
Very simply, an athlete with a previous hamstrings strain needs to stay on top of quality manual therapy on the area, and be cognizant of maintaining mobility and stability in the right places. They have less wiggle room with which to work.
5. Acute Hamstrings Strain or Tendinosis
Of course, the fifth reason you hamstrings might be tight is because you might actually have a hamstrings injury! It could be an actual hamstrings strain, or just a tendinosis (overuse issue where tissue loading exceeds tissue tolerance for loading). There is no one perfect recommendation in this regard, as a tendinosis or grade 1 hamstrings strain is going to be much more tolerable than a grade 3 hamstrings strain where you have bruising all along the back of your thigh.
In terms of maintaining a training effect with the less serious ones, here are a few suggestions:
a. When you are ready to deadlift, use trap bar deadlifts instead of conventional or sumo deadlift variations. I explain a bit more about how the positioning of the center of gravity makes this more hamstrings friendly HERE.
b. Shorten up your stride on single-leg exercises. This makes the movement slightly more quad dominant, but allows you to still get the benefits of controlling the frontal and transverse planes with appropriate glute and adductor recruitment at the hip.
c. Go with step-up and reverse sled dragging variations. Eliminating the eccentric component can take a considerably amount of stress off the hamstrings, and both these exercises get the job done well.
d. If you're going to squat, start with front squats at the beginning, and reintegrate back squat and box squat variations later on, as they will be more hamstrings intensive.
e. Understand anatomy. If you are in hip flexion and knee extension, you're going to really be stretching the hamstrings and likely irritating them in the process. Select exercises that don't hit these painful end-ranges, and then gradually reintroduce more dramatic ranges of motion as the issues subside.
f. Do hill sprints before you do regular sprints. Your stride is going to be a bit shorter with hill sprints, and that'll take a considerable amount of stress off the hamstrings at heel strike (pretty good research on uphill vs. downhill sprinting HERE, for those who are interested). Just don't go out and run as hard as you can the first time out; propulsive forces are still quite high.
Of course, this just speaks to how to train around a pulled hamstrings; there is really a lot more to look at if you want to really understand why they occur and how to prevent or address them. In my eyes, this post was necessarily "geeky," as it is important that we don't dumb down complex injuries to "just stretch it out." This recommendation is analogous to a doctor just telling someone to take some NSAIDs for regular headaches; it doesn't get to the root of the problem, and it may actually make things worse.
One of the biggest concerns players have when it comes to in-season strength and conditioning programs is whether or not a particular exercise will make them sore. It's a valid point, when you consider the profound effect soreness can have on a baseball athlete's performance - both physically and mentally. As such, it's important to select exercises that provide a great training effect, but won't necessarily create a lot of soreness for a player.
The first important point to recognize is that strength exercise familiarity will minimize soreness. In other words, if an athlete has already done an exercise in the previous 7-10 days, it shouldn't make him very sore (if at all). This is one reason why I like to introduce new exercises in the week prior to the start of the season; we can "ride out" those exercises through the first 4-6 weeks of the season without worrying about soreness.
Of course, once you get past that initial stage, it's a good idea to change things up so that athletes will continue to progress and not get bored with the strength training program. One way to introduce new strength exercises without creating soreness is to minimize eccentric stress; so, essentially, you're selecting exercises that don't have a big deceleration component. This is tricky, as most athletic injuries occur from poor eccentric control (both acutely and chronically). So, we can't remove them completely, but we can shoot for a 50/50 split. To that end, we'll typically introduce our more intensive lower-body eccentric strength exercises (e.g., Bulgarian Split Squats) on a day when an athlete can afford to be sore (e.g., the day after a pitcher starts) for a few days. If that isn't a luxury, we'll simply go much lighter in that first week.
To that end, here are five "general" strength exercises I like to use in-season with many of our athletes.
1. Step-up Variations - I'm normally not a big fan of step-ups for off-season programs because they don't offer a significant deceleration component, but they can be useful in-season when you're trying to keep soreness out of the equation. Anterior-Loaded Barbell Step-ups are a favorite because they still afford you the benefits of axial loading without squatting an athlete.
2. Deadlift Variations - It goes without saying that I'm a huge fan of the deadlift (check out this tutorial if you need suggestions on How to Deadlift), as deadlift variations afford a host of benefits from strength, power, and postural perspectives. They're also great because there isn't much of an eccentric component unless you're doing stiff-leg deadlift variations. With that in mind, we utilize predominantly trap bar and sumo deadlift variations in-season.
3. Sled Pushing/Dragging - A lot of people view sled training as purely for metabolically conditioning guys, but the truth is that it actually makes for a great concentric-only strength exercise while helping to enhance mobility (assuming you cue an athlete through full hip extension on forward pushing/dragging variations).
Just make sure to keep the load heavy and distance short.
4.1-leg Hip Thrusts off Bench - This is a great "halfway" exercise with respect to eccentric stress. For some reason, even if you lower under a ton of control and with additional load (we drape chains over the hips), this exercise still won't make your posterior chain sore. A big shout-out goes out to Bret Contreras for bringing it to the forefront!
5. 1-arm DB Bulgarian Split Squats from Deficit - The asymmetrical load to this already asymmetrical (unilateral) exercise allows you to get a training effect without a ton of resistance (especially with the increased range of motion provided by the deficit). It'll still create some soreness, but it's another one of those "halfway" exercises where the soreness isn't as bad as you'd expect, especially if you phase it in a bit lighter in week 1 of the new strength training program.
These are just five of my favorites, but a good start, for sure. Of course, we still need to do a better job of educating "the masses" about how important it is to even do an in-season strength training program!
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Today, we have a guest blog from former Cressey Performance intern Eric Oetter, who is well on his way to a great career in physical therapy. Eric is an extremely bright up-and-comer from whom you'll be hearing a lot in the years to come. Here's a little sampling.
As part of the “pre-launch” phase for his new collaborative project, Elite Training Mentorship, Eric posted an outstanding video covering the lower-extremity assessment protocol he uses at Cressey Performance. For those who haven’t yet seen it, follow the link here; you won’t regret it.
In the video, Eric mentions three different factors that can contribute to mobility deficits at the hip: muscular restrictions, capsular restrictions, and bony restrictions. While the first two – muscular and capsular – can be relatively easy to decipher based on the test position of the hip, identifying bony restrictions can be tricky unless you’ve got access to a client’s radiological imaging. For this reason, it’s important to appreciate any structural variations in the skeletal system that can underlie joint malalignment at the hip.
The focus of this piece is a structural variation called hip anteversion. We’ll be covering the joint morphology associated with anteversion, along with a quick orthopedic test and some implications for programming.
What is hip anteversion?
Excerpted from the 2002 text Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann describes hip anteversion as the following:
“ … the angle of the head and neck of the femur is rotated anteriorly, beyond that of the normal torsion with respect to the shaft. The result is a range of medial hip rotation that appears to be excessive, whereas the lateral rotation range appears to be limited.”
Essentially, clients who present with this structural abnormality were born with, or have acquired, a more internally oriented neutral position for their femurs as they sit in the acetabulum (or hip socket). To be classified as anteverted, the femoral head and neck must be rotated more than 15° anteriorly with respect to the plane of the femoral condyles (Sahrmann 2002). (Conversely, a posterior rotation of the femoral head and neck would constitute a retroverted hip.)
When observed standing, clients with hip anteversion will often present with femoral adduction and genu valgum – the classic “knock-kneed” posture. As kids, these clients likely eschewed “indian-style” for W-sitting – a position much more congruent with their natural femoral alignment.
While some might also classify “pigeon-toes” as an indicator for anteverted hips, this is not always the case. In the presence of anteversion, some clients – especially athletes – will develop a tibial torsion as a result of the applied stresses to the lower extremities. This adaptation allows for a neutrally aligned sub-talar joint in the face of morphological changes up the kinetic chain.
The largest implication of hip anteversion or retroversion is a significant discrepancy between hip internal and external rotation. As described in the Sahrmann quotation above, hip anteversion creates an apparently large amount of internal rotation (IR) with a reciprocal loss of external rotation (ER).
I liken these morphological changes to those seen in the retroverted shoulder of an overhead throwing athlete. The total hip range of motion (IR + ER) can present at around 90°, or “normal”, but these measures are drastically skewed in one direction of rotation.
Whereas a retroverted shoulder presents a favorable adaptation in baseball, the same cannot always be said for the athlete with anteverted hips.
If undiagnosed or mismanaged, hip anteversion can create pathology. Expect issues like knee pain, back pain, and hip instability (Sahrmann 2002). For this reason, it’s imperative to recognize anteversion when it presents and apply the programming modifications necessary to accommodate this structural abnormality.
So how can I test for it?
Although checking IR and ER in both supine and prone can highlight limitations in the capsule or surrounding hip musculature, you’ll need an extra orthopedic test at your disposal to clear the skeletal system. For this purpose, we’ll use the Craigs’s test.
Assuming you’re following the assessment outlined in Eric’s video, the best time to perform a Craig’s test is immediately after you’ve assessed a client’s hip rotation in prone, especially if you detect a glaring asymmetry between IR and ER.
Note the client in the photos below – here, we see an excessive amount of IR (~50°) met with limited ER (only ~20°). With a rotational deficit of ≥30°, this client may have some torsional issue at play; thus, a Craig’s test indicated.
With the client remaining in prone the knee held in flexion, the Craig’s test is performed by first palpating the same side greater trochanter, a landmark on the femur that protrudes laterally about 5 inches below the iliac crest. Make sure to apply flat-hand contact with the pads of the fingers – this posture allows for greater sensory feedback and precision. Once this position is assumed, begin internally and externally rotating the femur through its full range of motion.
As you rotate the leg, you’ll notice the greater trochanter tracking against your fingertips, becoming more or less prominent depending on the direction of rotation. Start shortening your oscillations until you determine the position at which the trochanter is most prominent laterally and pause once you locate it. At this range of rotation, the femoral head is optimally situated within the acetabulum.
We get a positive Craig’s test when the hip rotation at the point of ideal femoral alignment is ≥15° into IR. Also, we can now classify the hip as anteverted, providing useful insight for the dexterous coach.
Check out the video below to see a Craig’s test performed on our client from above.
One thing worth noting – a 1992 study by Ruwe et al. showed the Craig’s test to be more reliable than radiological techniques in the assessment of femoral torsion. So, even if you have client X-rays available, a Craig’s test is still worth administering.
If the Craig’s test is positive, how should I alter programming?
Now that we’ve performed a Craig’s test and determined whether or not any torsional qualities exist, it’s time to write an effective program that respects our findings. Here are a few do’s and don’ts to consider when programming:
• DON’T stretch the hip into external rotation – this only creates impingement. We wouldn’t force the retroverted shoulder of a pitcher into an end-range sleeper stretch, so we need to take the same approach with an anteverted hip. Even though the hip is a much more durable joint, there’s no reason to drive motion that a client simply doesn’t have, as this only serves to jam the femoral head against the acetabulum.
• DO increase the amount of core work in clients with femoral torsion. When someone is stuck in internal rotation at the hip, the kinematics of the lower-extremities become predisposed towards a pronation pattern (sub-talar pronation, tibial/femoral IR, and anterior pelvic tilt).
The hip external rotators often become excessively stiff and overused, as they are constantly checking motion into adduction, internal rotation, and flexion. While increasing external rotator strength will improve the first two, we can employ the posterior fibers of external oblique and rectus abdominis to aid in flexion control, creating a more stable pelvis. By doing so, we’re also increasing stiffness at the lumbar spine, fighting any compensatory motion created by the hip external rotation deficit.
As far as exercise selection goes, focus on half-kneeling chops/lifts and anti-extension – both integrate the hips and core simultaneously to check hip flexion ROM. I especially like rollout variations for clients with hip anteversion, which are highlighted in Eric’s video below.
• DON’T introduce quad-dominant lifts until the client shows dramatic improvements in hip stability. The pronation pattern I described above is essentially a cookbook for ACL and MCL injuries. In a population that is likely anteriorly tilted at the pelvis and anterior weight bearing, the last thing we want to do is make them even more reliant on their quads. An adroit posterior chain should precede any anterior chain-focused movement.
• DO hammer the posterior chain as if your life depended on it. While this statement could serve as a mantra for most general population programming, it is even more important when dealing with anteversion of the hip. These clients sometimes present with femoral control so poor, our first goal is to simply get them to baseline.
Mastering stability in the sagittal plane takes precedence. Start bilateral with deadlift and box squat variations and increase stability demands as the client advances. Great second tier progressions include single-leg RDLs, single-leg hip thrusts, and bowler squats, all of which introduce frontal and transverse plane stability.
Lastly, exercises that force the femur into an abducted and externally rotated state are contraindicated – sumo deadlifts provide a great example. Even though pulling sumo is a fantastic variation for hip strength, it can create malalignment in the acetabulum if the hip is anteverted. In this case, it’s safer to stick with either trap bar deadlift or conventional deadlift variations.
Conclusion
Hip anteversion isn’t something you’ll likely see in every client. Johns Hopkins Medical School reports the prevalence to be ~8-10%, but that number varies based upon cultural norms and neurodevelopmental patterns, which can alter skeletal growth.
Regardless, it is an important structural variation to recognize and program for, especially in an athletic population. Taken as supplement to Eric’s lower-extremity video, I hope this article provides you another piece towards building a better assessment.
About the Author
Eric is currently a senior at the University of Georgia majoring in Exercise and Sport Science, with plans to pursue a Doctorate of Physical Therapy. After concluding a Division-1 football career at the Georgia Institute of Technology, Eric has ardently pursued his passion for coaching, garnering experience with clients of all ages and ability levels through internships at both Indianapolis Fitness & Sports Training and Cressey Performance. His articles can be found on EricCressey.com, 8weeksout.com, and in Fighting Fit magazine. You can follow him on Twitter or reach him via email at ecoetter@gmail.com.
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I know we have a lot of "rising stars" in the fitness and strength and conditioning communities reading this blog, so I thought I'd throw out some of my top coaching suggestions along these lines.
1. Always coach at 90-degree angles.
You'll never see everything you want to see from a 45-degree angle, so you're better off directly in front and/or to the side of the one performing the exercise. Imagine what happens when you are coaching deadlift technique, for instance.
From the side, you can observe neutral lumbar-through-cervical spine, whether the athlete is pushing through the heels or toes, and whether the movement is turning into too much of a squat.
From the front, you can watch for hip shifts, knock-knees, turning-out of the toes, and grip width (in the case of the conventional deadlift and sumo deadlift).
From a 45-degree angle, you can see some stuff - but never with as "unobscured" a view as you'd prefer.
2. Never cross your arms.
This is the single-best way to say "Don't talk to me; I'm in a bad mood." The problem is that you might not even be in a bad mood, but that's the way clients and athletes perceive it. "Open arms" equals "open to interaction."
3. Don't sit down.
How athletic is this posture?
The only way you could make yourself any more unappealing as a strength coach or personal trainer is to rock a turtleneck like the one the guy in the photo has. Standing up gives you a better view of the training room and makes you more approachable.
That said, a lot of coaches and trainers may get cranky knees and lower backs from standing on hard training surfaces for hours and hours on-end. If this is the case, you've got a few ways to break the wear and tear:
a) Demonstrate more exercises - simply getting moving will help things out, especially if you are doing a lot of ground-to-standing transitions
b) Put a foot up on a bench or weight rack here and there - going to single-leg stance can redistribute your weight and give you breaks in the action (while keeping you standing)
c) Play around with footwear and training surface - In a given day, I might coach in two different pairs of shoes and even go barefoot for a bit. I think our lower extremities like the variety (and I generally feel best in my minimalist footwear or barefoot). It's also helped me to bounce back and forth between the harder rubber training surface and the softer turf we have at Cressey Sports Performance.
4. Find out whether clients/athletes like "demonstrate" or "describe."
Some people are visual learners; you need to show them what you are asking them to do. This is especially true among beginners, and those who don't have strong athletic backgrounds (as well as those who are very forgetful).
Other people just need to hear the "what" and a few coaching cues, and they'll go right to it and be successful. They'll actually be annoyed with you if you slow things down too much and get in their way when they are ready to train. These are generally the more experienced exercisers who may have already mastered some derivative of the exercise in question (for instance, learning a 1-arm DB Bulgarian Split Squat from Deficit after they've already learned a regular Bulgarian Split Squat).
As an interesting anecdotal aside to this, last year, we had a professional baseball player come to us who had previously trained at a large facility in a group with more than a dozen other players who were all doing the same program off the same dry erase board. He spent much of his first day with us bad-mouthing the other facility, saying that all they did was "grab-ass" and "stand around," never getting anything done. After his first session, he made a point of saying how much better he liked our business and training model. The reason was very apparent: he was a "describe" learner in light of his previous training experience, but he'd been plugged into a "demonstrate" model with a lot of less experienced athletes. All they did was get in his way.
It's important to identify what kind of learner people are early on in their training with you - but also to appreciate that their learning style may change when they're presented with unfamiliar exercises.
5. Find different ways to demonstrate energy.
Many up-and-coming coaches worry that they aren't "Rah Rah" enough to be successful in this field. They seem to think that the only way to win people over is to be over-the-top excited all the time. The truth is, though, that the majority of the most successful people in the industry aren't in-your-face yellers, non-stop clappers, or bouncing-off-the-wall coaches. Guys like Todd Durkin and Dave Jack who have seemingly endless energy and great coaching ability are actually rare exceptions in our field (and I learn a lot about coaching each time I watch those two).
In reality, a lot of the other high-energy guys I've encountered use that enthusiasm to cover up for a lack of knowledge, and athletes eventually see through it. Plus, it's impossible to be high-energy all the time, so when these individuals are having rough days, they often lose their #1 coaching asset. You simply can't have bad days as a coach or trainer.
That said, there are a lot of ways to show enthusiasm without yelling all the time. Having a spring in your step is an extremely valuable asset in a trainer or coach's toolbox. If you were to watch me at Cressey Sports Performance, I never "amble" around; I always have spring in my step and am getting from Point A to Point B quickly, as it allows me to do more coaching (and interact with more people) in a given hour.
Being excited about what you're coaching is also paramount; tell athletes/clients what it's doing for them and why that's important.
Creating relationships should be a means of building excitement as well. Ask clients about their backgrounds, how they're doing, and what their goals are. People get excited and motivated when they find out that you are interested in them.
There are countless other ways to demonstrate energy on a daily basis: picking the right music, clapping your hands, creating competition among athletes, sending emails/Facebook posts/Tweets to athletes before they come in to train, or pairing up certain clients who you know will push each other. The only limitation is your creativity - and you'll find that it's easier to create energy once you know clients well, as you'll know exactly which buttons to push to get the reaction you seek.
These are just five coaching tips that immediately came to mind when I sat down to write this post this morning, but there are surely hundreds more that warrant attention. If you're an up-and-coming strength and conditioning coach or personal trainer, above all else, I'd encourage you to get out and observe coaches in the industry. Don't just watch their programming or exercise selection; rather, pay attention to their mannerisms, the flow of the facility, and how their staff carries themselves. You'll realize quickly that there is a lot more to successful coaching than just X and Os.
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