Monday, Fun day! I hope you all had a great weekend. Here's some recommended strength and conditioning reading to kick the week off for you:
4 Tips for Stronger Client Connections- Todd Bumgardner provides some excellent tips for anyone - especially the personal trainer - who is in the business of dealing with people.
I thought I'd use today's post to throw out some thoughts on training the shoulders.
1. In the upper extremity, the assessments are often the solutions, too.
Imagine you're assessing an athlete, and their squat pattern is absolutely brutal. Usually, the last thing you're going to do is go right to a squat as part of their training. In other words, simply coaching it differently usually won't improve the pattern immediately. Rather, you typically need "rebuild" the pattern by working with everything from ankle and hip mobility to core control, ultimately progressing to movements that replicate the squatting pattern.
Interestingly, the upper extremity is usually the opposite in that the assessment might also be the drill you use to correct the movement. For instance, an aberrant shoulder flexion pattern like this...
...might be quickly corrected with some of these three cues on a back to wall shoulder flexion pattern.
This is also true of push-up assessments and shoulder abduction and external rotation tests we do; funky patterns are usually cleaned up quickly with some subtle cueing. This just isn't the case as much in the lower body, though. Why the difference?
My theory is that because we're weight-bearing all day, the lower extremity is potentially less responsive to the addition of good stiffness in the right places. Conversely, a little bit of stiffness in serratus anterior, lower trap, or posterior cuff seems to go a long way in quickly improving upper extremity movement. My experience with the Postural Restoration Institute also leads me to believe that creating a good zone of apposition can have lead to a more pronounced transient movement in the upper extremity than it does in the lower extremity. This is likely because the rib cage is directly involved with the shoulder girdle, whereas the relationship with the lower extremity (ribs --> spine --> pelvis) is less direct.
These differences also seem to at least partially explain why upper extremity posture is much easier to change than lower extremity positioning. It's far more common to see a scapular anterior tilt change markedly than it is to see an anterior pelvic tilt substantially reduced.
Just thinking out loud here, though. Fun stuff.
2. Anterior shoulder pain usually isn't "biceps tendinitis."
First off, true tendinitis is actually quite rare. In this landmark paper, Maffulli et al. went to great lengths to demonstrate that the overwhelming majority of the overuse tendon conditions we see are actually tendinOSIS (degenerative) and not tendinITIS (inflammatory). It may seem like wordplay, but it's actually a very important differentiation to make: if you're dealing with a biceps issue, it's probably tendinosis.
Second, if you speak with any forward thinking orthopedic shoulder specialist or rehabilitation expert, they'll tell you that there are a lot of differential diagnoses for anterior (front) shoulder pain. It could be referred pain from further up (cervical disc issues, tissue density at scalenes/sternocleidomastoid/subclavius/pec minor, or thoracic outlet syndome), rotator cuff injury or tendinopathy, anterior capsule injury, a lat strain or tendinopathy, labral pathology, nerve irritation at the shoulder itself, arthritis, a Bankart lesion, osteolysis of the distal clavicle, AC joint injury, and a host of other factors.
3. Thoracic outlet surgery really isn't a shoulder surgery.
Over the past few years, each time a professional pitcher gets thoracic outlet surgery, you see many news outlets call it "shoulder surgery." Sorry, but that really isn't the case unless you have a very expansive definition of the word "shoulder."
With this intervention, the surgeon is removing the first (top) rib to provide "clearance" for the nerves and vascular structures to pass underneath the clavicle.
Additionally, surgeons usually opt to perform a scalenectomy, where they surgically remove a portion of the anterior scalenes, which may have hypertrophied (grown) due to chronic overuse. Again, this is not a "shoulder" procedure.
Finally, more and more surgeons are also incorporating a pec minor release as part of the surgical intervention. This is because the nerve and vascular structures that may be impinged at the scalenes or first rib can also be impinged at the coracoid process of the scapular if an individual is too anterior-tilted. While the coracobrachialis and short head of the biceps both attach here, the pec minor is likely the biggest player in creating these potential problems.
This, for me, is the only time this becomes somewhat of a "shoulder" surgery - and it's an indirect relationship that doesn't truly involve the joint. We're still nowhere near the glenohumeral (ball-and-socket) joint that most people consider the true shoulder.
All that said, many people consider the "shoulder girdle" a collection of joints that includes the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulations. In this case, though, the media just doesn't have a clue what they're trying to describe. With that in mind, hopefully this turned into somewhat of an educational rant.
4. Medicine ball scoop tosses tend to be a better than shotputs for cranky shoulders.
Rotational medicine ball training is a big part of our baseball workouts, and it's something we try to include as an integral part of retraining throwing patterns even while guys may be rehabilitating shoulder issues. When you compare rotational shotputs with rotational scoop tosses...
...you can see that the scoop toss requires far less shoulder internal rotation and horizontal adduction, and distraction forces on the joint are far lower at ball release. The shotput is much more stressful to the joint, so it's better saved for much later on in the rehab process.
5. Adequate rotator cuff control is about sufficient strength and proper timing - in the right positions.
To have a healthy shoulder, your cuff needs to be strong and "aware" enough to do its job in the position that matters. If you think about the most shoulder problem, there is pain at some extreme: the overhead position of a press, the lay-back phase of throwing, or the bar-on-your back position in squatting. For some reason, though, the overwhelming majority of cuff strength tests take place with the arms at the sides or right at 90 degrees of elevation. Sure, these positions might give us a glimpse at strength without provoking symptoms, but they really don't speak much to functional capacity in the positions that matter.
With that in mind, I love the idea of testing rotator cuff strength and timing in the positions that matter. Here's an example:
Obviously, you can make it even more functional by going into a half-kneeling, split-stance, or standing position. The point is that there are a lot of athletes who can test pretty well in positions that don't matter, but horribly in the postures that do.
6. Pre-operative physical therapy for the shoulder is likely really underutilized.
It's not uncommon to hear about someone with an ACL tear going through a month or so of physical therapy before the surgery actually takes place. Basically, they get a head start on range-of-motion and motor control work while swelling goes down (and, in some cases, some healing of an associated MCL injury may need to occur).
I'm surprised this approach isn't utilized as much with shoulder surgeries. It wouldn't be applicable to every situation, of course, but I think that in some cases, it can be useful to have a pre-operative baseline of range-of-motion. This is particularly true in cases of chronic throwing shoulder injuries where regaining the right amount of external rotation is crucial for return to high level function. Adding in some work on cuff strength/timing, scapular control, and thoracic mobility before hopping in a sling for 4-6 weeks probably wouldn't hurt the case, either. And, as an added bonus, if this was more common, I think we'd find quite a few people who just so happen to become asymptomatic, allowing them to cancel their surgeries. It's probably wishful thinking on my part, but that's what these random thoughts articles are all about.
For more information on approaches to evaluating, coaching, and programming for the shoulder, be sure to check out Sturdy Shoulder Solutions.
Have a great weekend!
Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
We're excited to announce that on August 14, 2016 Greg Robins will be delivering his one-day seminar, “Optimizing the Big 3″ alongside fellow Cressey Sport Performance Coach Tony Bonvechio. This event, which will take place at our Hudson, MA location, is a a great chance for strength and conditioning professionals to learn from the best. And, it's also been very popular with athletes who have an interest in improving the squat, bench press, and deadlift.
“Optimizing the Big 3” is a one-day seminar for towards those looking to improve the squat, bench press, and deadlift.
Split into both a lecture and hands-on format, the event will provide attendees with practical coaching on the technique of the classic power lifts. Additionally, Greg and Tony will cover how to individualize movement preparation, utilize supplementary movements, and organize their training around a central focus: improved strength in these “big three” movements. Furthermore, they'll touch upon the lessons learned in preparation for your first few meets to help you navigate everything from equipment selection to meet-day logistics.
The value in learning from Greg is a matter of perspective. He has a wealth of knowledge, and has experience stemming from various experiences as a coach and lifter. Greg will effectively shed light on how he has applied movement principles, athletic performance modalities, and anecdotal evidence from working with a wide variety of different populations to optimize the technique, health, and improvements in strength of amateur lifters.
Agenda
8:30-9:00AM: Check-in/Registration
9:00-11:00AM: Maximal Strength Training Theory – The main lecture of the day will be focused on the principles of how to assess where you (or your athletes) are in terms of training history and how that determines what kind of training loads should be used. Furthermore, this lecture will focus on principles of managing stressors and how to assign proper loading parameters for different level lifters. Last will be a discussion of the cornerstones of training vs. planning, as well as a look at the commonalities and differences of different training approaches.
11:00AM-12:00PM: Managing the Strength Athlete: Assessing and Meeting the Demands of the Lifter – Learn what demands a high amount of volume in the classic lifts puts on the body; how to assess for it in others and yourself; and what you can do to manage the stress associated with these demands.
12:00-12:30PM: Group Warm-up
12:30AM-1:15PM: Squat Hands-on Session
1:15-1:30PM: Squat Recap, Programming Considerations, and Video Review
1:30-2:15PM: Lunch (on your own)
2:15-3:00PM: Bench Press Hands-on Session
3:00-3:15PM: Bench Press Recap, Programming Considerations, and Video Review
3:15-4:00PM: Deadlift Hands-on Session
4:00-4:15PM: Deadlift Recap, Programming Considerations, and Video Review
4:15-5:00PM: Final Q&A
Date/Location:
Sunday, August 14, 2016
Cressey Sports Performance
577 Main St.
Suite 310
Hudson, MA 01749
Note: we’ll be capping the number of participants to ensure that there is a lot of presenter/attendee interaction – particularly during the hands-on workshop portion – so be sure to register early, as the previous offerings have both sold out well in advance of the early-bird registration deadline.
On the fence? Here is what previous attendees have to say...
"Greg Robins has constructed one of the most comprehensive seminars that I have ever attended. I’ve had the opportunity to not only attend The Big 3, but host it at my gym as well. I truly believe that every coach and/or individual who's interested in mastering the squat, bench, and deadlift absolutely must attend this workshop. Greg is loaded with knowledge and learning directly from him has greatly impacted my ability to coach my clients and athletes."
-Chris Semick
Co-Owner, War Horse Barbell - Philadelphia, PA
"Attending the Big 3 Workshop with Greg Robins and Tony Bonvechio was the best thing to happen to my barbell training. After taking close to 20+ years off from working with a barbell I decided to attend the Big 3 workshop to receive excellent coaching and guidance in training. In my experience as a healthcare provider (ATC) a strength coach and a kettlebell instructor this course has helped myself and my clients significantly. I was able to relate all the movements to rehabilitation, strength training and kettlebell training I perform with clients and this helps me to give them a better transition back to sport and training. I would happily attend this workshop again to continue to learn and dial in the Big 3 movements. Just one day with these two professionals is not enough time to soak in all the knowledge!"
-Eric Gahan
Co-Owner, Iron Body Studios
"Greg Robins is the epitome of high integrity, an unparalleled work ethic, and a true passion and dedication toward making those around him better. His Optimizing The Big 3 Workshop is no different. After attending this workshop while also being a personal client of Greg's, I've increased numbers in all 3 lifts, and improved my overall strength by leaps and bounds in the process. Greg is the real deal. Don't hesitate - just go."
I hope everyone had a great 4th of July with friends and family. In light of the holiday, we're a day late with this recommended reading collection, but the content is top notch to make up for the delay. Enjoy!
Spark - This book is a few years old, but that doesn't make it out-of-date by any stretch of the imagination. This an absolutely fantastic look at how exercise impacts the brain and our overall health, with respect to everything from learning, to depression, to menstrual symptoms, to ADHD. If you work in the world of health and human performance, it's must-read material.
RTS Coaching: Thorax Rotation - Mike Robertson posted this coaching video, and I love the "laser" cue he utilizes to help athletes differentiate between movement of the thorax and that of the shoulders.
The Cressey Sports Performance Difference: Individualization - Here's a new promotional video we filmed this past offseason for our Elite Baseball Development program.
Top Tweet of the Week: My Twitter game was lame over the past week, so I'll just plug in a friendly reminder that I'm now on Snapchat.
Today's guest post comes from Dean Somerset, the creator of the excellent resource, Ruthless Mobility, which is on sale for 60% off through the end of the day on Monday, July 4. Dean is a tremendous innovator and one of the brighter minds in the fitness industry today, and this article is a perfect example of his abilities. Enjoy! - EC
Mobility can be described in a number of different ways, depending on who is writing the story: yoga, flexibility, stretching, movement training, dynamic warm-ups, bendy stuff, and in some cases “how the heck do you even do that?” Regardless of what it’s called or who’s doing it, there are some basic rules and physiologic elements to be aware of when it comes to understanding mobility and how to use it in training programs. Today I wanted to outline the "three big rocks" of developing, using, and maximizing mobility in a safe and progressive manner.
1. Structure Determines Function.
It’s easy to say that genetics are a separating feature for those who can gain a lot of muscle and those who have trouble adding a pound. The same can be said of those who are congenitally lax (via something like a higher Beighton hypermobility score or a diagnosis of Ehlers Danlos syndrome), compared to people who move like the tin man. Some of this could be connective tissue related difference in collagen to elastin ratio, but much of it could also be considered by the shape and orientation of the joints themselves.
In terms of the acetabular angle, D’Lima et al (2011) found in a computerized prediction model for prosthesis implantation that:
a. those with more acetabular anteversion (forward placement on the pelvis) had greater flexion range of motion and less extension
b. lateral placement of 45-55 degrees gave the best overall mobility
c. a lateral angle of less than 45 degrees gave more flexion range of motion and more than 45 degrees gave less rotation capability
d. if the femoral neck was thicken by 2 mm in diameter, it significantly reduced the range of motion in all directions, irrespective of placement.
Higgins et al (2014) even showed there was a large difference in anteversion angles bilaterally in the same individual (potentially lending some validity to PRI concepts of inherent asymmetry), with as much as a 25 degree difference in anteversion angle between left and right hip. This could translate to a difference in flexion range of motion of 25 degrees between your two hips, without any other feature affecting the outcomes. Zalawadia et al (2010) showed there’s a big variance in the femoral anteversion angle (whether the head of the femur pointed more forward or possibly backward) as the femoral neck attaches to the acetabulum, with the majority being between 10-20 degrees.
Additionally, some acetabulums have too large of a center edge angle, where the socket faces more inferiorly than laterally, which makes impingement during abduction more likely compared to a smaller center edge angle.
These structural differences are primarily set and unchanging after puberty when bones don’t deform as easily to external forces as with young kids. Baseball pitchers can undergo deformational changes at the proximal humerus (upper arm) to allow a much greater external rotation range on their throwing arm compared to adults who pick up the sport later in life. Eric showed that with his comparison of presidential first pitches HERE.
With advancing age, joint range of motions tend to reduce further with degenerative changes to the structures involved, either with an increase in concentration of cortical bone at contact areas, a reduction of cartilage thickness, or decreased fluid content of the joint space itself. The end result is a tighter joint that doesn’t move as easily.
Most of these types of changes, barring injury or disease, tend to not be limiting factors in mobility until many decades have passed, so if you’re in your 20s and concerned about your lack of mobility, it’s pretty safe to say that it’s likely not related to degenerative changes just yet. If you’re 50 or 60, it’s much more of a likely scenario.
This Canadian study showed that men lost an average of 5 degrees of shoulder abduction and 6 degrees of hip flexion per decade between 55 and 86 years old, while women lost an average of 6 degrees of shoulder abduction and 7 degrees of hip flexion in the same age range, and that this loss sped up after 70 years old and was actually not linked to self-reported activity levels. Being more active is better for everything as you age, but based on this study, not necessarily for keeping your mobility into your golden years.
What this means is that everyone will be different in terms of how much mobility they have and in which directions or movements. One person may be able to press overhead because they have joints that easily allow it, while another may never get there due to specific limitations, and a third may just not be ready to press yet. They may have the specific ability to do the motion, but don’t have the control or strength at the moment to do it effectively, which is where part 2 comes in.
So how do you determine a structural limitation? The best mechanisms are simply to see what the range of motion looks like in a couple of scenarios:
a. passive – have someone move you through the range while you’re relaxed)
b. supported - pull the joint through a range without using the muscles involved in the action. (Think a hamstring stretch with a towel wrapped around the foot and pulling on it with your arms)
c. in a different position or direction – in looking at hip flexion, compare a squat to a rock-back or Thomas test to look at the same range of motion.
If you consistently get the same joint angles in different motions or positions, it’s reasonable to believe that could be the true limit of your flexibility based on structural aptitudes. There’s always a potential that the limitation could be something else, and if you involve some of the training practices and options used later and notice an improvement, it’s a happy bonus. Short of developing X-ray vision, these are some of the best options for determining structure that everyone has available to them, whether we’re talking about the clinician, trainer or average meathead looking to get all bendy and stuff.
2. Can you actually get there?
Now, let's consider shoulder mobility; imagine that we look at an individual in supine and there’s no limitation standing in the way of going through full shoulder flexion.
However, when this same individual is asked to bring their arms overhead in an upright position, they do some wonky shoulder shrug, low back arch, and their upper lip curls for some reason. In short, they aren’t able to access that flexion movement very well, even though they have the theoretical aptitude to get there on their own.
We’re looking for the image on the right, but wind up getting the image on the left:
Now the great thing about the body is it will usually find a way to get the job done, even if it means making illegal substitutions for range of motion from different joints. In this case, the lack of shoulder motion is made up with motion from the scapula into elevation instead of rotation, and lumbar extension in place of the glenohumeral motion.
This by itself isn’t a problem, but rather a solution. It’s not bad to have something like this happen by itself, but it does alter the specific benefits of an exercise when the segments you’re looking to have do the work aren’t actually contributing, and you’re getting the work from somewhere else. There’s also the risk of injury from poor mechanical loading and improper positioning that increases the relative strain on some areas that aren’t meant to be prime movers for the specific exercises.
Now, the big question is whether someone is willing to not do an exercise because they’re demonstrating that they’re not ready for at the moment. If a client wants to squat in a powerlifting competition, but his hip range of motion makes it very difficult to get below parallel to earn white lights without losing lumbar positioning or grinding the hip joints to pieces, how willing would he be to adjust his training or eliminate that possibility to save a lot of hassles? Some people identify themselves by their sport, so telling them not to do what they love isn’t an option. I’ve worked with a lot of runners, and saying “don’t run” tends to go in one ear and out the other.
Back to the overhead example, maybe going right overhead isn’t possible at the moment, but a high incline press can be done easily. This is working in what Mike Reinold calls on Functional Stability Training: Optimizing Movement “Green Zone vs Red Zone training.” Overhead at the moment is a red zone movement as they can’t get there easily and on their own. Green zone would be a landmine press, where they’re still working on flexion, but not moving into a range they can’t easily access.
One manner that could help an individual access this range of motion if they have shown an ability to get there passively is through what Dr. Andreo Spina calls eccentric neural grooving of the motion. Use either a support or pulley to get into the terminal range of motion, release the support or pulley and try to maintain the terminal position while slowly moving out of the end range as controlled as possible. Here’s Dr. Spina doing ENG work on the ankle and anterior shin for some dorsiflexion work.
Here’s another version with yours truly working on a similar variation via controlled hip abduction:
You could do this for the shoulder easily enough as well by grabbing a rope, pulling the shoulder into flexion, releasing the rope, and trying to maintain the position before slowly lowering the arm out of terminal flexion. Just make sure you’re not letting your low back arch or shrug up your shoulder blades in to your neck.
3. Can you use it with force when needed?
So now you’ve shown you have the joints to do stuff, you can get there on your own without assistance, and you want to train the heck out of it to look like your favorite Instagram bendy people.
One thing to consider when exploring these ranges of motion is that force production tends to be greatest in mid-range positions, likely due to the greatest torque development required to overcome natural leverage elements and also due to spending less time in the end ranges. There’s also the reduction of cross bridge linkages in these positions, limiting sarcomeric action when you’re gunning your biceps in peak flex.
Controlling these end ranges (even if the goal may not be to develop maximal force in them for moving the biggest weight from point A to B) can help expand the usable range of motion where peak torque development occurs, as well as provide the potential for expanding sub-maximal torque percentage ranges of motion. These movements aren’t easy and tend to take a lot of mental energy coupled with physical effort, but if getting awesome was easy, everyone would already be there.
Summary
To round things out, understanding and developing mobility comes down to:
a) having the structure to produce the range of motion
b) being able to get into position to effectively use that range of motion
c) building strength and conditioning within that range of motion to keep the ability to use those ranges for a long time, and through as many positions and directions of movement as possible.
Some specific movements or positions may not be possible due to your own unique structure and abilities, but work hard at using everything you do have, build strength throughout the entire range of motion, and enjoy the process as much as the outcomes.
Note from EC: If you're looking for more mobility tips and tricks - and the rationale for their inclusion in a program - I'd encourage you to check out Dean's fantastic resource, Ruthless Mobility. Your purchase includes lifetime updates and continuing education credits. Perhaps best of all, it's on sale for 60% off through this Monday (7/4) at midnight.
I published a post on this topic a few months ago, and it was really popular. With that in mind, I figured I'd do another quick brain dump on the subject - and have it serve as the second installment of what will become a semi-regular series.
1. Use people's names as much as possible.
Tony Bonvechio is an outstanding coach at our Massachusetts location, and he does this better than any coach I've ever seen. I don't know if he does it intentionally, but it's simple, yet powerful strategy that allows him to really connect with clients - and I'm confident that it makes his coaching more efficient.
This "strategy" does' just apply to coaching, though; it makes all your dealings with other people more positive. As Dale Carnegie wrote in How to Win Friends and Influence People, “A person’s name is to them the sweetest sound in any language.”
2. What you don't say matters just as much as what you say.
Body language means a lot in the world of coaching. Crossing your arms screams, "I'm not interested in talking to you." Hands in your pockets gives off the "I don't really know why I'm here, and I don't have anything of value to contribute." If you don't know how to stand, move! If you're bouncing around and interaction with a lot of athletes (in the group setting) or working from multiple coaching angles (when working with a single athlete/client), you can't give off any vibe other than, "I really care and want to help."
3. "In business, you either grow fast or die slowly."
Robert Herjavec dropped this quote in his new book, You Don't Have to Be a Shark, and I definitely think it holds true in the fitness industry.
You see, the fields of health and human performance are remarkably dynamic. New research emerges every day, and we learn better ways to do things. Likewise, the dynamics of the business of fitness is changing dramatically as well; you don't have to look any further than the growth of semi-private training opportunities over the past decade as an example of that.
These changes aren't going to slow down anytime soon, so you better stay openminded and flexible so that you can adapt and grow in the decades ahead. The second you think you have it all figured out, the fitness and business games will quickly humble you.
4. This is likely the best progression for learning how to be a complete strength and conditioning coach...
Step 1: learn functional anatomy.
Step 2: learn exercises and how to coach them (note: most coaches cover a big chunk of this step by being athletes themselves).
Step 3: learn assessments.
Step 4: refine exercise selection and coaching strategies in light of the assessments.
Step 5: learn programming strategies.
Step 5: write programs based on steps 3, 4 and 5.
Step 6: keep refining points 3-6 for the rest of your career. Tinker, but never overhaul.
Everyone thinks they can write great programs right off the bat, but the truth is that there is a lot of foundational knowledge that has to be in place before they'll deliver a great training effect. The best coaches are the ones who've had years of going through steps 3-6 over and over again. For the young coaches out there, a good internship should take you from step 1 all the way through step 5.
5. Recognize your individual weaknesses, and coach accordingly.
I'm a fast talker and I often fall into the trap of mumbling. It's something that I really had to work to overcome for my speaking at seminars, but when I'm bouncing around on the training floor and the gym is busy, I often fall back into the trap of speaking too quickly. Recognizing this, at least 2-3 times per day, I have to remind myself of the cues "clear, concise, and firm" in my head to make sure that my brain doesn't get going too fast for my mouth.
Some coaches are too mellow and need reminders to step up their energy levels. Some need reminders to maintain eye contact with their athletes. Every coach has weaknesses like these - and you have to be honest with yourself about what they are so that you can be cognizant of not slipping back into your old traps.
Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
Happy Monday, everyone! I hope you all had an awesome weekend. Just in case you didn't, here is some good strength and conditioning material from around the 'net over the past week:
My 5 Least Favorite Coaching Cues - Mike Robertson wrote up this great article on well-intentioned, but inappropriate coaching cues.
Autonomic Dysfunction: Real or Not Real? - This was an outstanding post from Seth Oberst and Dr. Ben House. I love the emphasis on multiple practitioners from different disciplines collaborating to assist those dealing with chronic stress.
Gym Owner Musings: 5 Random Lessons Learned - My business partner, Pete Dupuis, pulled together this blog on a few lessons we've learned in nine years in business at Cressey Sports Performance.
Facebook Live Q&A with EC and Tony Bonvechio - I forgot to post this last week, but Tony and I did a lengthy Q&A to celebrate one year of his "Technique Tuesday" videos. You can watch it here:
Today's guest post comes from Cressey Sports Performance colleague, Dr. James Spencer. Enjoy! -EC
Epidemiological research suggests that the incidence of foot problems, specifically issues with the first metatarsalphalangeal joint (MTP) is common (1). These common big toe and foot problems are exposed in the systematic approach of the Selective Functional Movement Assessment (SFMA) and Functional Movement Screen (FMS). The big toe condition I would like to highlight is Functional Hallux Limitus (FHL). FHL is a separate distinct diagnosis from Structural Hallux Limitus (SHL). FHL is characterized by a lack of dorsiflexion of the first MTP joint during the gait cycle only (2).
The one problem that I typically see with this condition is how infrequently diagnosed it is. The reason for this may be that patients may not have experienced pain in their toe or a drastic compensation pattern. Additional research also reported that the presence in foot symptoms does not necessarily correlate with the presence of dysfunction and that patients may be experiencing dysfunction without having any accompanying symptoms (1).
The big toe is a very underestimated player in the Joint by Joint Theory. Popularized by Gray Cook and Mike Boyle, the Joint by Joint approach is alternating series of stable segments on mobile joints, where (generally):
You could see how an alteration in this Joint by Joint approach could affect the mechanics and joints up and down the kinetic chain. In this article I would like to explore FHL and its interplay with Regional Interdependence, which refers to the concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient’s primary complaint (3). Therefore, you could see how a lack of big toe mobility can lead to a wide spread of conditions locally, at the joint, and systemically, up the kinetic chain and beyond. For example, some associated signs and conditions may include overpronation, ankle mobility restrictions, toe out posture, posterior tibialis tendinosis, achilles tendinosis, plantar fasciitis and patellar tendinosis, just to name a few. Regional interdependence displays the amazing anatomical and biomechanical interconnection throughout the human body.
Functional Anatomy
The first metatarsal is the shortest and thickest of the metatarsals. Two sesamoid bones, encased in the tendons of the intrinsic muscles, lie beneath the head of the first metatarsal. Suggested sesamoid function for the first metatarsal allows the big toe to plantar flex during extension of the hallux, enhance the load-bearing capacity of the first metatarsal, and to improve the mechanical leverage for the attached intrinsic muscles (4). Depending on the literature you read, the first ray is designed for 50-70 degrees of big toe extension during static evaluation. However, I would argue that 45 degrees of big toe extension is actually adequate during the gait cycle. This is supported with the work of Nawoczenski in the Journal of Bone and Joint Surgery. I could not find any published research on if these values were different during the running cycle. If you look at Thomas Myers’ work with the Superficial Back Line (SBL), you can see how the lack of big toe extension could wreak havoc on the entire kinetic chain via regional interdependence.
Originating from the plantar aspect of the calcaneus, the plantar fascia is more than just a passive band of connective tissue. As the plantar fascia travels distally towards the toes, it separates into five slips of fascia. Each plantar fascia slip inserts plantarly onto each of the five digits. As the foot transitions from midstance into push-off, the toes begin to dorsiflex and the plantar fascia is activated. This activation of the plantar fascia upon hallux dorsiflexion is referred to as the “windlass mechanism” and is the second step in preparing the foot for propulsion.
Since power during propulsion is dependent upon the foot’s ability to become a rigid lever, ensuring proper hallux dorsiflexion during the gait is key to achieving full foot supination (5). Considering that during gait, the entire body is advancing past this single joint, the ability to dorsiflex, and subsequently raise the heel during single support phase while simultaneously supporting against the developing forces for forward motion is essential for normal, efficient gait. If this mechanism fails, sagittal plane compensation will be forced to occur (6). When the first MTP joint motion is disrupted enough to prevent stabilization of the foot structure during maximal hallux dorsiflexion, through the effect of the windlass mechanism, then normal foot stabilization during propulsion is disrupted, and becomes clinically significant (7).
Aside from the specific biomechanics that are addressed in the lower quarter, looking at mobility loss more globally will always relate to an anterior weight shift. Repetitive function with an anterior weight shift yields facilitation and inhibition in a very predictable pattern.
Common Compensations with FHL
Compensations will occur due to injuries, faulty mechanics and previous experiences. We have to take a step back and realize our CNS (Central Nervous System) is a high-speed train moving forward with “Life;” therefore, compensations will inevitably occur throughout our lives. We could blame previous injuries, posture, ergonomics, it really doesn’t matter what we point the finger at, but our CNS will continue to move forward whether the movement is mechanically advantageous to us or not. The key is not allowing compensatory patterns to become engraved as movement patterns. The CNS loves stimulation and constant feedback for neuroplasticity.
This video displays amazing neurological changes and shows how habits, movement patterns and previous experiences influence our neurological systems. Plus, you have to appreciate the MacGyver Mullet comment! I also want this to be an eye opener for people to see how long it can take to learn new motor skills and how easily it is to revert right back in to an old pattern.
Some of the most common compensations that I see consist of limited proprioception in the midfoot, limited ankle mobility, and limited hip extension. Limited proprioception in the midfoot can lead to plantar fascitis or medial arch stress. Limited ankle mobility - typically dorsiflexion - is another common imbalance that must be assessed in a client seeking power at propulsion. Normal gait requires at least 10 degrees of ankle dorsiflexion with maximum ankle dorsiflexion occurring during late midstance. Limited ankle mobility can lead to a myriad of compensations including midfoot pronation, knee hyperextension and an early heel rise during gait (5). Limited hip extension can lead to abduction compensation and produce the classic overpronated foot type and abducted stance position. The stride length shortens and reduces hip extension and glute activation. As Charlie Weingroff has noted, this is caused when the correct pathway of motion is blocked by the lack of 1st ray dorsiflexion, the person will produce an abducted foot in order to roll off the inside of the toe in order to allow for hip extension (8). I find that this compensation is most often related to the development of Hallux Valgus and bunion formation.
Corrective Strategies
Here's one of my favorite simple drills to use (in combination with manual therapy) with folks with FHL:
I also like to progress individuals to 2x4 walks to integrate this pattern in balance training:
Final Thoughts
Your big toe is essential for proper balance, running, walking and many other athletic activities or exercises. As the foundation to human movement, optimal power during propulsion is dependent upon proper foot posture and muscle activation patterns. With every step, the human foot must convert from a mobile adaptor at midstance to a rigid lever for propulsion. Integrating foot-specific exercises sets the foundation for sufficient foot strength and forefoot re-supination. The quicker the foot can become a rigid lever, the greater the power that is unleashed during propulsion (5). I believe that there is inadequate diagnostic criteria for clinicians to properly diagnose FHL. Since FHL is diagnosed during closed kinetic chain, we should look in to a more definitive way to diagnose this functional condition. Moreover, a dynamic gait analysis that shows timing and pressure differences in the foot may be a good source of objective measurement for future diagnostic criteria.
My goal of this article is to raise awareness of how important the big toe mobility and stability is for every day life and function. Please don’t take the movement algorithm of walking for granted because it is one of the most complex movements the human body performs. Let this final picture be a reminder to never chase pain when evaluating or treating someone and keep the thought of regional interdependence in mind.
Note: references for this article will be posted as the first comment below.
About the Author
Based in South Florida, Dr. James Spencer is a Sports Performance Chiropractor, Certified Athletic Trainer, and Fellow of the International Academy of Medical Acupuncture. He has formal training in Active Release Techniques, Graston Technique, Kinetacore Functional Dry Needling, SpiderTech Kinesiology Tape, RockTape Fascial Movement Taping, Postural Restoration Institute, Y-Balance Test, FMS, SFMA, Mike Boyle’s Certified Functional Strength Coach and the Onnit Academy of Unconventional Training. You can find Dr. Spencer on Facebook, Instagram and at www.DrJamesSpencer.com.
Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
I’m excited to announce that the 2016 edition of the Cressey Sports Performance Elite Baseball Development t-shirts (powered by New Balance Baseball) are now available for sale. Here's the front-back design:
And a real-life shot:
These shirts are insanely comfortable and run true to size.
Each shirt is $24.99 + S&H. Click the links below to add shirts to your cart:
When I first started getting some noteworthy publications back in 2003, I was a green-around-the-gills 22-year-old graduate student. I had a decent foundation of knowledge in a very specific realm, but in reality, I knew very little about the real world.
In the years that followed, I learned a lot about a lot of things. I competed extensively in powerlifting, read and wrote a ton, and attended and spoke at loads of seminars. We opened Cressey Sports Performance in 2007, and went through three expansions – and trained athletes from all walks of life, including baseball players from all 30 Major League organizations.
In spite of all these experiences, it wasn’t until the fall of 2014 that I really learned about true responsibility. That September, my very pregnant wife and I moved to Jupiter, FL to open up our second Cressey Sports Performance location.
Three weeks after the new facility opened, amidst the chaos of moving to a new state and opening a new business, I awoke one morning at 5AM to my wife yelling, “Eric, my water broke!” Five hours later, we were proud parent of twin daughters – and I was in for more lessons than I’d learned in the previous 14 years of coursework, reading, seminars, training, and business.
It was at that point that I realized I’d never had any empathy for clients I’d trained who had kids at home. I’d always been selfish; I ate, slept, and trained whenever I wanted to do so – and I had assumed that they could always do the same. When you have kids, you back-burner your own needs for good.
As you can probably infer, having twins dominated me. For the first 12 weeks, I typically slept 8:30PM through midnight each night, with any other shut-eye during the day serving as bonus. The quality of my training suffered, and my nutrition slipped as my meal-prep time went by the wayside. I ate more protein bars on the fly, and consumed way too much caffeine to get through the days.
By the time the girls were six months old, I was down roughly ten pounds and a fair amount of strength in spite of the fact that I’d tried like crazy to not miss a beat with my training. It was far and away the most challenging six months of my life, but it was also remarkably rewarding on a number of fronts.
Our daughters are about 18 months old now, and the new facility is much more established – so things are a lot easier today. It’s given me some time to reflect on what I learned, and what I would have done differently in the way I took care of myself during that initial phase. Whether you’re a new father or planning/hoping to become one, I sincerely hope that you’ll take these strategies to heart.
1. Use caffeine to make up for sleep deprivation, but not for crappy diet.
Fatigue during exercise is an extremely complex topic, and we’re still somewhat unclear of all the mechanisms for it. By contrast, fatigue in your daily life is remarkably simple: outside of medical conditions that may cause it, you’re tired because you either a) aren’t sleeping enough or b) aren’t putting the right stuff in your body. The former is a normal part of parenting, but the latter doesn’t have to be.
The two biggest culprits we see with the athletes we encounter always seem to be dehydration and too many of the wrong carbs at the wrong times. If you aren’t drinking enough water, and you’re letting your blood sugar bounce all over the place, you’re going to get tired.
Having a few cups of coffee a day isn’t a problem; having 27 of them plus five energy drinks is. If your nutrition is reasonably good, you won’t have to go to this excess.
2. Clearly communicate a reasonable training schedule.
The old adage goes, “Failing to plan is planning to fail.” This is as true in training with a newborn at home as it is in almost any other part of your life.
I’ll be direct with you: if you try to find time, you’ll fail miserably. If you make time, you’ll do a lot better. However, that’s easier said than done, as there are a lot more competing demands for your attention when you have a baby at home.
This is where I was very fortunate: my wife is a gym rat herself. In fact, I had to hold her back from kicking down the door to the gym to train just 7-10 days after her C-section. To that end, we had some gym schedule reciprocity going; I’d watch the kids while she trained, and she’d watch them while I trained. Sometimes, when the girls were very young, we could bring them with us while we both trained. We also had a nanny who could help out to make sure that we had time when we needed it.
Regardless of how you approach it, it only works if you schedule it. Trust me on this one, as it will endure for a long-time.
3. Pare back on frequency.
Get the delusion of training six days a week out of your head right now. I tried to do it while sleeping 3-4 hours per night, and it went over like a fart in church. You can’t just keep adding when your recovery capacity is compromised.
For most people, three full-body lifts per week is a good bet. You might be able to get away with four if you aren’t doing much, if any, metabolic conditioning. If you have to pare back to two lifts per week in the short-term, you can certainly get away with that, too. Scenarios like this are one reason I offered 4x/week, 3x/week, and 2x/week training options in my High Performance Handbook; sometimes, life gets in the way and you need a strategy to prioritize certain portions of your training while eliminating other components.
The point is that you have to be realistic with your training goals. Maintenance is an acceptable goal in this situation, as much as it might be unchartered waters for you.
4. Fluctuate intensity and volume.
One lesson I’ve learned over the years that never ceases to amaze me is that the more experienced you are, the less frequently you need to lift to maintain your strength. It’s really hard to improve your strength, but surprisingly easy to maintain it. Even just taking a few heavy singles over 90% of your max each month seems to do the trick for most intermediate and advanced lifters.
This is an especially important “phenomenon” to remember during a period of sleep deprivation. “Fatigue masks fitness,” so the chances of you feeling good enough to push huge weights aren’t very high. You just have to do “enough.”
A good general guideline I would put out there is to always work high or low, but rarely in the middle. This has two meanings:
a. With your metabolic conditioning, either do high-intensity interval training, or stick to low-key aerobic work to help with recovery. Spending a lot of time doing work at 80% of your max heart rate is like trying to ride two horses with one saddle (check out my old article, Cardio Confusion, for details on why).
b. You need to cycle sessions of higher intensity or volume in to your training program to maintain a training effect. I think a good rule of thumb at this time frame in your life is to hit the higher intensity portion once a month and higher volume once a month. The other two weeks would be lower key in a format like this:
Note: for more information on deloading strategies, check out my e-book, The Art of the Deload.
5. Condition at home.
This is one way in which you might be able to slightly up the training frequency without adding a ton of stress. If you can score a quick 20-30 minute conditioning session at home (or sprinting at a park nearby), it can definitely go a long way. I use my rowing machine at home once a week year-round. Additionally, if you’re really badass, you can throw on a 100-pound weight-vest while pushing the double stroller and walking the dog.
6. Outsource wherever possible, and welcome help.
I often tell our athletes that “stress is stress.” At the end of the day, your body doesn’t really care whether you have a big project due at work or you’re trying to squat 405 for 10 reps; both are stressful to your system.
Having a kid shifts a big chunk of your “stress allotment” to outside the gym. And, it pushes out a lot of the important stress management approaches – sleep, quality nutrition, massage – that you might normally employ to manage the stress the body encounters.
With that in mind, it’s to your advantage to deflect some of this stress here and there. I’m not encouraging you to have a nanny raise your kid for you; I’m simply saying that it’s okay to ask for help. Nobody is going to judge you as a bad parent if a babysitter or family member watches your kid for a few hours while you get a lift in. And, if you have the financial resources, outsourcing food preparation can ensure that you’ve got healthy nutrition options at your fingertips. My mother-in-law lived with us for six weeks after our daughters were born, and it was a game-changer for us.
Just as Bill Gates doesn’t waste his precious time mowing his own lawn, you shouldn’t try to handle absolutely everything. It’s okay to ask for help.
7. Embrace simplicity – and do the simple things savagely well.
In my early days as a father, I had a habit of trying to take complex solutions to simple problems. The babies would cry, so I’d try to change the setting on their swing, turn on some music, give them an elaborate toy, or make a bunch of silly faces. Usually, the solution was just to feed them, change a diaper, or simply hold them.
A simple approach has merit for your training – especially during this crazy time of your life. When you have a newborn at home, it’s not the time for an elaborate squat specialization program, loads of direct arm work, or a 45-minute feel-good foam rolling session. Stick to the meat and potatoes: squats, deadlifts, presses, rows, lunges, chin-ups, etc.
I’d even argue that if you were ever going to embark on a one-set-to-failure machine based training block, this would be the time to do it. There’s quick adjustments on most selectorized equipment and the prospects of doing 6-8 sets in a training session will sound pretty appealing with you are working on three hours sleep and only have 30 minutes to get a training session in. Simplicity works.
It also works on the nutrition front. Make sure drink plenty of water and eat protein and veggies at every meal. Nobody is going to judge you if you have eggs for dinner because you didn’t have time to prepare something elaborate.
8. Remember that someone always has it harder than you do.
Strategies are all well and good, but perspective is invaluable.
Very simply, your significant other has it as lot worse than you. Pregnancy and childbirth are tremendously hard on women.
First, a lot of women deal with nausea (“morning sickness”) early in pregnancy. Constantly wanting to vomit isn’t exactly good for consistent, high-quality training. The truth is that this is the tip of the iceberg, though; they may experience heartburn, constipation, or any of the other fun symptoms elevated progesterone can deliver.
Second, as the baby grows during pregnancy, the woman’s center of mass is displaced forward relative to the base of support. This effectively rewires a long-term, engrained pattern of stabilization – and explains why many pregnant women wind up with back pain.
Third, remember that the baby grows under the rectus abdominus. So, the muscles of the anterior core are heavily overstretched and in a tough position to provide much support. I can remember when my wife – who can normally bang out 10-12 chin-ups – tried to do one when she was about six months pregnant. She did a half a rep, told me that it didn’t feel good at all – and she didn’t attempt another one for the rest of her pregnancy. Just putting the arms overhead can really stretch and already-lengthened anterior core significantly.
Fourth, during pregnancy, concentrations of the hormone relaxin increase dramatically to prepare the “lower quarters” for the stretching that takes place during childbirth. This hormone also works on ligaments at other joints, so women – who are normally more loose-jointed than man, anyway – become even more hypermobile. Less passive stability – combined with the anterior weight shift and lengthened core musculature – is a recipe for pain.
Just when you think things can’t get any physically harder for women, though, they have to go through the trauma of childbirth – or have a hole cut in their abdomen for a C-section. And, instead of the rehabilitation they deserve at this point, they get to start breastfeeding – and encountering sleep deprivation that’s far worse than yours.
Sorry, dude; someone has it rougher than you.
Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
Based in South Florida, Dr. James Spencer is a Sports Performance Chiropractor, Certified Athletic Trainer, and Fellow of the International Academy of Medical Acupuncture. He has formal training in Active Release Techniques, Graston Technique, Kinetacore Functional Dry Needling, SpiderTech Kinesiology Tape, RockTape Fascial Movement Taping, Postural Restoration Institute, Y-Balance Test, FMS, SFMA, Mike Boyle’s Certified Functional Strength Coach and the Onnit Academy of Unconventional Training. You can find Dr. Spencer on 
