Q: I was just curious: why would surgeons have waited so long to repair Brady's ACL? It seems that it would be ideal to do the surgery as soon as possible after the injury to give him more time to rehab and come back.
A: It actually has less to do with the anterior cruciate ligament (ACL), and more to do with the associated injuries he (presumably) had. It's widely speculated that he ruptured both the ACL and medial collateral ligament (MCL).
A MCL will heal on its own, in most cases, so they'll give it 4-6 weeks to do so before going in to do the ACL reconstruction. Had he experienced a lateral meniscus tear, though (as is common in traumatic ACL injuries), they'd have gone in pretty quickly. ACL injuries that also include the lateral meniscus are typically much more serious and potentially career-threatening.
With all ACL ruptures, they'll usually have folks wait at least a few days to allow the swelling to go down. In some cases - particularly with really deconditioned individuals, they might opt for a period of physical therapy prior to the surgery to strengthen the surrounding musculature, reduce swelling, and ensure full knee extension ROM to improve post-op outcomes.
If you're interested in learning more about knee function and injuries, Mike Robertson has actually pulled together some great stuff with his Bulletproof Knees Manual. It's definitely worth checking out.
All that said, best wishes to Brady for a speedy recovery. Us Pats fans look forward to seeing him back on the field.
In my newsletter earlier this week, I introduced you to Danny, a Cressey Performance client who had made some awesome progress on theWarpspeed Fat Loss diet over the course of 28 days. In reality, though, there’s quite a bit more to that story.
You see, Danny had actually made a lot more progress than that since December of 2007 when he really committed to kicking a** and taking names. As was the case on Monday, a picture is worth a thousand words; here are the ten-month progress pictures:
In my last newsletter, I told you that this wasn’t just about “Hooray for Danny” or “Horray for Warpspeed Fat Loss” – although both definitely deserve all the credit in the world! Rather, I’m a firm believer that anytime someone is successful, you have to look at what they’ve done right – and these are the three things so important for Danny’s success.
1. Danny got involved with a great training crew. I don’t care who you are: a training crew will always yield better results. Danny actually lifts quite a bit with our staff nowadays. Hell, with all he’s learned, he’d be a great addition to our staff!
Obviously, I firmly believe that our job is to hammer on technique in a coaching-intensive set-up early on when someone trains at CP. However, I think that our longer-term responsibility is to create the most motivating environment possible in which to carry out our programming.
Additionally, Danny had a great “crew” at home in the form of a very supportive wife who helped him on the diet side of things. It always helps to have someone along for the ride at home; I’ve seen a lot of people “sabotaged” by unsupportive family members.
2. Danny’s goal from the get-go was always performance. The physique stuff took care of itself when he just focused on getting stronger with each session and attended to his nutrition. Along the way, he got his first 300-pound bench and deadlifted well into the 400s.
I have said it before and I’ll say it again: train for performance, put the right stuff in your mouth, and you’ll be pleasantly surprised at the physique improvements you see. It’s a theme that resounded in my Maximum Strength book.
3. Danny realized that you can always get a training effect in spite of injuries. When he first came to us, Danny had been dealing with some pretty significant neck spasms. In fact, when we went to work on some bench press technique the first night, he was pretty nervous that 95 pounds on the bar would trigger a spasm. Toss in a testy lower back, shoulder, hamstrings, and adductor strain, and you’d think that Danny would have been on the shelf for months. In reality, he didn’t miss a training session, as he appreciated that there was always something he could do to get better around those issues – and get better he did!
These factors for success are just the tip of the iceberg, and they'll be different for everyone. However, it's important to recognize them early-on and use them to your advantage, as getting leaner, stronger, faster, and healthier isn't always peaches and cream.
The Truth About Unstable Surface Training: An Athletic Trainer's Perspective
“As someone who has both rehabbed injured athletes and trained healthy people for over 18 years, I can honestly say that Eric Cressey’s The Truth about Unstable Surface Training is a breath of fresh air."Being a certified athletic trainer and a strength and conditioning coach has afforded me a unique perspective in the training world. I have watched personal trainers, strength coaches, athletic trainers and physical therapists use and abuse unstable surface training.
"Eric has combined his in-the-trenches experience with research to uncover the truth behind unstable surface training. This book is a must-read for anyone that trains, rehabs, or coaches, people in anyway. Yes, that means Physical Therapists, Athletic Trainers, Personal Trainers, and Strength Coaches.
"I hope that this book will help to 'stop the madness' of a training fad that has gotten out of control and help to support the proper uses of unstable surface training.
"I know I will be referring this work to my network of athletic trainers, strength coaches, physical therapists and personal trainers.”
Keith Scott, MS, CSCS, ATC
Certified Athletic Trainer, and Strength and Conditioning Coach
www.BackToFormFitness.com
Roughly 10-15 times per week, I get emails from folks who claim that they have "shoulder impingement.” Honestly, I roll my eyes the second I read these emails.
Don’t get me wrong: I’m not making light of their pain. It’s just that it drives me crazy when doctors throw this blanket statement out there. I will be completely and 100% clear with the following statement:
Shoulder impingement is a physiological norm. Everyone – regardless of age, activity level, sport of choice, acromion type, gender, you name it – has it.
Don’t reach up to touch that mouse on your computer; you’ll aggravate your impingement and your supraspinatus will explode!
And, don’t scratch that itch on the back of your neck; your impingement will go crazy and your labrum will disintegrate!
So, the next logical question is: why do some people have pain with impingement while others don’t?
In reality, there are several factors that dictate whether or not someone is in pain, including:
1. Tissue quality – the most “impinged” structures are more likely to break down in older age than they are in earlier years. Younger individuals can regenerate faster even when overall stress on the tissues is held constant, so how you handle a 50-year-old with "impingement" is going to be somewhat different from how you handle a 15-year-old with "impingement."
2. Degree of elevation – the more one abducts or flexes the humerus, the greater the degree of impingement. This is why folks need to start in a more adducted (arm at side) position early on in rehab. Those that impinge early in their arc tend to be dealing with subacromial impingement, whereas those who hit it at the absolute top tend to be more AC joint impingement.
3. Acromion type – flat acromions have significantly less contact area with the rotator cuff tendons than hooked or beaked acromions. These structures may change over time due to…
4. Bone Spurs – bone spurs on the underside of the acromion will increase the amount of impingement.
5. Strength of the rotator cuff – the stronger the cuff, the better its ability to depress the humeral head and minimize this impingement
6. Scapular stability – the more stable the scapula, the more likely it is to posteriorly tilt and upwardly rotate effectively when the humerus is raised into the zones of greater impingement. This scapular stability includes adequate length of the downward rotators (pec minor, levator scapulae, and rhomboids) with adequate strength of the upward rotators (lower traps, serratus anterior, upper traps).
7. Thoracic spine mobility – the posture of the thoracic spine dictates the position of the scapulae, which in turn affects impingement as noted in #6. Assess and Correctis an awesome product for improving thoracic spine mobility - and you can also find some good drills in my recent post, Shoulder Hurts? Start Here.
8. Increased internal rotation – Certain movements that lock the humeral head in internal rotation increase the degree of impingement during dynamic activities. It’s why some people can’t bench press early-on in their rehabilitation programs, yet they can do dumbbell bench presses with a neutral grip pain-free. It’s also the reason why upright rows are a stupid exercise, in my opinion.
9. Breathing patterns – think about what happens when someone has poor diaphragmatic function and becomes a “chest breather:” the shoulders shrug up, and you get extra tightness in the levator scapulae, scalenes, pec minor, and sternocleidomastoid (among other supplemental respiratory muscles). In the process, the degree of impingement can increase.
10. Other issues further down the kinetic chain – I could go on and on about a variety of issues in this regard, but it’s impossible to be exhaustive – so I’ll just give an example. If someone has poor core stability in the sagittal plane that is manifested in an inability to resist the effects of gravity during a push-up, the hips will “sag” to the floor. As this happens, and the upper body remains strong, the scapulae are shifted into an anterior tilt –which increases the amount of impingement on the rotator cuff. So, weakness and/or immobility in other areas can certainly predispose an individual to shoulder problems.
This can also be carried forward to pitchers. We know that shoulder problems are more likely to occur in throwers who have poor lead leg hip internal rotation, as it causes the stride leg to open up early, leaving the arm “trailing behind” where it should be.
Speaking of pitchers, a phrase that has been coined with respect to the “unique” kind of impingement you see in them is “internal impingement.” In next week’s newsletter, I’ll discuss the different kinds of impingement – and why it’s still a cop-out diagnosis for any health care professional to just say you have one or the other rather than tell you explicitly what dysfunctions need to be addressed.
Click here to purchase the most comprehensive shoulder resource available today: Sturdy Shoulder Solutions
Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!
Going in to Monday night's game, I was trailing by 16 points with only my QB, Kurt Warner, still to go. He didn't disappoint, putting 25 points on the board with 328 yards passing and three touchdowns. After this, he had this to say about being a part of my fantasy football team (he refers to it as the "franchise" and the "organization"):
With Warner and God on my side, there's no stopping me. It doesn't quite explain my 5-5 record, but even deities have bye weeks.
And, for those who missed it, check out this week's newsletter. The follow-up on Thursday is going to be just as good.
I've gotten several emails over the past week from folks who read the following article in the New York Times:
Stretching: The Truth
You know what the questions were? I'll tell you (paraphrased):
"Didn't you already talk about this in your Magnificent Mobility DVD?"
Yes, as a matter of fact; we did. And, the MM DVD was filmed in November of 2005.
You know what else? With just a cursory glance at our references from peer-reviewed journals for MM, I found two separate studies supporting these facts from - believe it or not - 1999.
Sorry, folks; the New York Times is far from revolutionary. This news is at least nine years old - and even older when you consider that there were guys in the trenches experimenting with dynamic flexibility for decades before the research even came to fruition.
This same "delay" kicked in about a year ago when everyone went crazy when we finally "discovered" in the mainstream media that lactic acid was not the cause of muscular fatigue. I actually first heard this in 2004 back in a Muscle Physiology class in graduate school at the University of Connecticut. This review by Robergs et al. at the University of New Mexico was what opened a lot of people's eyes.
1. I'm driving down to Connecticut today, and then going the rest of the way to Long Island for the Major League Strength Coaches Clinic this weekend. I'm excited to present, talk shop, see some old friends, and make excessive use of the phrases:
a. "You have to train ass to throw gas."
b. "You can't steal second with your foot on first."
c. "Is this thing on? Oops! Did I say that out loud?"
If you couldn't make the event, you're still in luck; you can pre-order the DVD of the seminar HERE.
2. Last weekend, my girlfriend and I moved all our tupperware to a new cabinet. I have to say: it's changed my life. There's no more cramming containers and lids into a small drawer - and there's no more searching for the long-lost-lid for the weird shaped container that doesn't seem to match.
I haven't felt this free, yet organized, since I switched from boxers to boxer-briefs. And, for the record, yes, I just became the first person in history to liken tupperware to male reproductive anatomy. If you ever need a reminder that this blog is all about trendsetting, just bookmark this post.
3. I had a pleasant experience voting on Tuesday - right up until the point at which I went to leave, and I was accosted by a 70-something-year-old women at the door insisting that I take an "I Voted" sticker. It got me to thinking on my walk home from the polls...
If 122.3 million people voted in 2004, and they expected 2008 to be even better, we'll assume 130 million people voted. I'm writing this three days early, so the final numbers will surely be slightly different - but being exact isn't important for my point.
Let's assume that each one of those stickers costs American taxpayers a penny. That's $1.3 million in stickers! Assuming a salary of $35,000 per teacher, you could hire over 37 teachers nationwide with that money. And, I'm guessing that those 37 teachers would do more good than 130 million stickers that likely went directly to the trash.
That said, by the time the 2012 election rolls around, I may very well be on the presidential ticket with the campaign slogan, "Stickers are SO 2008."
4. Twitter seems to be the new rage these days. I'll be honest: I don't know what it is, and the word "Twitter" really evokes the same kind of emotions from me as the "anal leakage" warnings on the old Olestra packages. Plus, I have to say that the minute-by-minute Twitter updates some people give are flat-out stupid:
Fred is twittering. He's going to get a drink of water.
Fred is twittering. The water wasn't cold, so he got some ice from the freezer.
Fred is twittering. The freezer made his nipples hard, and he's strangly aroused.
Fred is twittering. Is thirst a more important sensation than his nipple arousal?
Fred is twittering. Maybe if he spent less time on the internet, he might kiss a girl sometime before he dies.
Seriously, Fred; nobody cares. If you can twitter that much, you really aren't important enough for any of us to give a s**t.
5. I got so busy this week that I literally forgot what day it was - and got a parking ticket (street sweeping) at 12:30AM on Wednesday morning. And, just when you thought I couldn't get any more confused, Bill Gates decided to reformat the Hotmail set-up to make me feel hopelessly inadequate once again. Seriously, Bill - was it really that important?
For those of you who are visual learners, the following two photos should sum up my Wednesday. Please note that in both photos, I would be considered the "kickee" and not the "kicker."
6. It's nice to see that researchers and pediatricians have finally upped their recommended daily Vitamin D intake to 1,000IU+, particularly for those in northern climates during the winter months.
7. Speaking of Vitamin D and sunlight, want to know the easiest way to recognize a pro baseball player in New England in November? The tan line!
8. As I'm sure you noticed, there was very little to do with fitness in this week's blog. Fortunately, I can assure you that you burned at least two calories while reading it. Nice job, skinny.
Have a good weekend.
“As someone who has both rehabbed injured athletes and trained healthy people for over 18 years, I can honestly say that Eric Cressey’s The Truth about Unstable Surface Training is a breath of fresh air.
"Being a certified athletic trainer and a strength and conditioning coach has afforded me a unique perspective in the training world. I have watched personal trainers, strength coaches, athletic trainers and physical therapists use and abuse unstable surface training.
"Eric has combined his in-the-trenches experience with research to uncover the truth behind unstable surface training. This book is a must-read for anyone that trains, rehabs, or coaches, people in anyway. Yes, that means Physical Therapists, Athletic Trainers, Personal Trainers, and Strength Coaches.
"I hope that this book will help to “Stop the madness” of a training fad that has gotten out of control and help to support the proper uses of unstable surface training.
"I know I will be referring this work to my network of athletic trainers, strength coaches, physical therapists and personal trainers.”
Keith Scott, MS, CSCS, ATC
Certified Athletic Trainer, and Strength and Conditioning Coach
www.BackToFormFitness.com
Click here to get your copy of The Truth About Unstable Surface Training.
Q: I have rigid supinated feet that seem to aggravate my Achilles which keeps me from performing my HIIT on a treadmill.
What can I do to overcome this? (I am expecting you to tell me to run on a track)
By the way, I bought your Maximum Strength book and I am working my way through it. I wish I had you for a strength coach when I was in high school as I know I could have landed a full ride scholarship at a 1A school. I worked my beach muscles my whole life and now I have serious imbalances that I am working on with your help. You have really made a big difference in my life and I look forward to training since discovering you, your articles, books, etc.
A: First off, thanks for your kind words! I’m glad you enjoyed Maximum Strength.
With respect to your feet, believe it or not, one of the best things you can do is just pick up a pair of cushioned insoles. They shouldn't change the contour of the shoe; they should just offer added padding. I actually wrote about it in The Prehab Deload (toward the end).
On a related note, to be honest, I’m not a fan of HIIT on a treadmill (or much of anything on a treadmill). It just doesn’t afford the same benefits of running outside, although I do understand that weather gets in the way in the winter in many areas. At these times of year, I prefer to have clients gravitate toward rowing, cycling, and jumping rope.
....Greg Olsen of the Chicago Bears as the newest representative of the "Eric Cressey's Tight Ends Can't Score Points Club." I lost 73-72 this week and he scored me a whopping one point.
The only thing more pathetic than losing to someone who puts just 73 points on the board is delayed-onset muscle soreness from bowling. And, yes, that happened to me this week as well. I hadn't bowled in about five years, and we went on Sunday night. Sure enough, Monday morning, the DOMS had kicked in. How is it that I trap bar deadlifted 625 pounds last week and had zero soreness, yet rolling a ball could actually do that? I know non-familiarity is a part of the equation, but it's still absurd.
Oh yeah, I bowl like an uncoordinated chimp. Let's just say that I barely outscored my fantasy football team.
As with the past few weeks, if you don't like fantasy football (or bowling, for that matter), check out this week's newsletter. I go into some detail on the types of shoulder impingement and how each needs to be managed differently.
Q: Mr. Cressey,I was given your name and website from my massage therapist, who is a big fan of yours. I was wondering what your opinion is about when a child should start muscle strength training (not weight training) for baseball? I have a 10-year old son who pitches and I always worry about his shoulder since I have had to have surgery on both of mine. He is playing up in age so he is pitching from 50 feet and pitches a consistent 48 mph. I always ice him down after for 30 minutes, but what do you recommend him to do to prevent injuries?
A: This is a great question, and the timing is actually perfect (as I'll explain in the last paragraph). In a nutshell, assuming good supervision, I'd start as early as possible.
While most of our work is with athletes in the 13+ age range, we run a group of 9-12 year olds every Saturday morning at Cressey Performance. There is a lot you can to with kids at that age to foster future success - but, more importantly, have fun.
It was actually started by popular demand of some of the kids who had older brothers in our program; they wanted to jump in on the fun. Now, we look at it as a feeder program of sorts; by teaching things effectively early-on and exposing them to a wide variety of movements, it makes it easier for them to become athletes down the road.
We work on squat technique and/or deadlift technique, with the majority of the time aimed at just keep them moving by performing various circuits that include things like jumping jacks, med ball throws, lunges, and wheelbarrow medleys, etc. We also have tug-o-war battles and SUMO wrestling where we have them grab onto a SWISS ball and try to maneuver each other outside of a circle. All in all, we have fun while at the same time improving their motor skills. That is what's most important. I don't want the kids to dread coming to the gym, which is what I think happens when trainers and parents start taking it too seriously. There's going to come a time when things will get more specialized, but ages 9-12 isn't that time.
Truth be told, kids nowadays are more untrained and unprepared than ever - yet they have more opportunities that ever to participate in spite of the fact that they are preparing less. It's one of several reasons that youth sports injuries are at astronomical rates. As perhaps the best example, you can now see glenohumeral internal rotation deficit (GIRD) in little leaguers, as this study shows. The GIRD isn’t the problem; that’s a natural by-product of throwing. The problem is that kids throw enough to acquire this structural and flexibility anomaly, but have no idea how to manage it to stay healthy.
So, in a nutshell, find someone who understands kids both developmentally and psychologically - and make it fun for him. Looking for someone affiliated with the IYCA (www.iyca.org) would be a good start.
Also, among the products out there, Paul Reddick's stuff is a great start if you're looking for things to do with up-and-coming baseball players.
