By: Eric Cressey

I’m a nice guy.  I pay my taxes, get all giddy when I see new pictures of my baby niece, and never rip the tags off my mattresses.  However, when it comes to fitness and health care professionals, I’m a cynical bastard.  I read a ton and am always looking for ways to get better, so I guess you could say that I’m less than tolerant when it comes to people in this industry who are lazy and afraid to question the status quo.  This is probably why John Pallof and I get along so well (well, that and the fact that we’re both Irish, went to school at UCONN, and cheer for the Red Sox).

John is without a doubt one of the brightest therapists I know.  He’s our go-to guy in Massachusetts, and has already been out to our facility to offer one more set of eyes to our most complex cases and highest-caliber athletes.  I just had to interview a guy who “gets it” so well.

EC: Hey John, thanks for taking the time to talk shop.  As hackneyed a first question as it might be in the world of fitness interviews, could you please tell our readers a bit about yourself?

JP:  I am a physical therapist first, specializing in treating athletes of all ages and levels.  I have worked hard to develop skills in both the PT and performance enhancement arenas, as I do actively train athletes anywhere from four to ten hours a week on top of my “normal” PT job at South County Physical Therapy in Auburn, MA.  As for the physical therapy side of things, I pride myself on my manual therapy skills, biomechanical assessment perspectives, and a very solid therex background, largely developed from my interactions with numerous professionals in the strength and conditioning field.

EC:  I can’t believe you’re not even going to list “off color humor” as one of your finest qualities!  But anyway…one of the main reasons you’re our go-to guy in terms of physical therapy is that you think outside the box and really have an understanding of what it is performance enhancement coaches do.  How did you gather that perspective?

JP:  I have had the great fortune to spend the past four years working with the two coaches I view as the standard to whom all other strength and conditioning coaches should be compared:  Jeff Oliver and Brijesh Patel, from the College of the Holy Cross, in Worcester MA.  My career would not be where it is if not for them.  I have spent countless hours with these guys on a weekly basis, and they’re two of the brightest guys I know, in any field.  Above all, I have learned the value of generosity (in time, knowledge, and opportunity) and how to be a true professional from “Ollie.”  I have accepted the fact that we will probably all be working for Brijesh someday, as he is the most disgustingly organized, and hardest working person I know.  A woman at HC actually mistook me for B once – not sure if she had her glasses on!

As far as gaining perspective on performance enhancement, the only way to learn it is to do it – do the training yourself, and coach, coach, coach – and then coach some more.  Plus, there is an abundance of good seminars and reading materials out there, so there is no excuse to slack off on learning.

EC:  Along those same lines, why is it that most physical therapists aren’t able to see things like you are?  Where is the profession as a whole missing the boat?

JP:  Some of the blame falls at the feet of the academic world, and thus the American Physical Therapy Association, who designs the standardized academic criteria for accreditation.  This can be a very long conversation, but in a nutshell…more emphasis needs to be placed on teaching students clinical reasoning skills – learning how to think critically – as opposed to dogmatic memorization of theories which are just that: theories.  Not to be overlooked as well, the therapeutic exercise component of the education process is pretty bad.  Most, if not all PTs have no idea how to teach a squat, much less an Olympic lift.  I was lucky enough to have Dave Tiberio and Mike Zito (among others) as role models while at UCONN, so I learned that it’s not really about memorizing crap; it’s about learning how to think and problem solve.

EC:  You and I had a great discussion recently about lumbar stabilization, and I know our readers would love to hear some of the stuff you shared with me.  Care to fill them in a bit?

JP:  I view abdominal musculature in two categories:  global stabilizers and local stabilizers.  Local stabilizers function to give segmental stability – control what happens between individual vertebrae – primarily shearing and compressive forces.  They give your spine integrity and prevent buckling when you flex/twist.  Examples include the transversus abdominus, multifidus, psoas, and to some degree the internal oblique due to its insertions into the thoracolumbar fascia.  Global stabilizers are your larger muscles that contribute to overall stability and help generate force – think rectus abdominus, quadratus lumborum, and external oblique, amongst others.  Paul Hodges and others helped develop these classifications, and are extremely bright therapists.

EC:  Any helpful tips for training within these classifications?

JP:  First, make sure you have good local stabilizer function, especially if the client has had LBP in the past.  Second, focus on isometric endurance (these are postural muscles remember).  Then, progress to force production and movement: just my two cents.  Remember – pain shuts these local stabilizers down – so athletes with a history of pain may need to work extra on these guys.

EC: How about a few examples in this regard?  Any particular exercises you’re using frequently to retrain local stabilizers following injuries?

JP:  Well, there are two main ones that I find myself using frequently – cable column (or stretch band) pushes and quadruped multifidus lifts.  CC pushes – standing in an athletic position (good lordosis, butt back, chest up/scaps back, feet beneath hips), the cable is parallel to your body – holding the handle with both hands in front of your belly button.  Without allowing trunk movement and maintaining good positioning, you slowly extend your arms to full extension (at stomach height), than slowly return.  Can do for reps or holds.  You are basically resisting a rotational force.

EC: They’re called Pallof Presses, dude!  Tell the world!

JP: Quadriped multifidus lifts – quadruped, with one knee on airex pad (knees beneath hips, hands beneath shoulders).  Slowly lift the down femur vertically by rotating your pelvis to level – no actual hip movement, more pelvis on spine motion.  Again, for reps, then progressing to holds for isometric endurance.

EC: I know you’ve seen a lot of really bright physical therapists and coaches speak; who do you feel would be the best for trainers and ordinary weekend warriors to see?

JP:  Mike Boyle; some of the Australian therapists (e.g., Mark Comerford) who are starting to make the rounds; and Brijesh Patel.  For PTs, any of the Maitland manual therapy seminars or Mulligan courses.  There are a ton of people who I have not seen but would like to in the years to come.

EC: How about resources?  What five books, DVDs, manuals, CD-ROMS, etc. have impressed you?

JP:  In no particular order:

1. Theory and Applications of Modern Strength and Power Methods, by Christian Thibaudeau

2.  Nutrient Timing, by John Ivy and Robert Portman

3. Atlas of Human Anatomy, by Frank Netter – by far the best and most accurate anatomy book, bar none.

4. Freakonomics, by Stephen Levitt – excellent book, examining how the “conventional wisdom” of anything is often wrong, when looked at objectively in the right context.

5. Spinal Mobilization Made Simple: A Manual of Soft Tissue Techniques, by Jeffrey Maitland – more of a reference – the Maitland manual therapy/clinical reasoning seminars are the best continuing education series out there – rock solid, phenomenal results, bulletproof reasoning methods.  Check out www.ozpt.com.  Lots of great research backing up the superior efficacy of manual therapy combined with corrective exercise.

6. Therapeutic Exercise for Lumbopelvic Stabilization: A Motor Control Approach for the Treatment and Prevention of Low Back Pain, by Paul Hodges and Carolyn Richardson.  Once again, those damn Aussies are ahead of the game when it comes to rock solid science.  Not “I think,” but “research shows” – and they don’t just talk about it, they apply it.

Oops – that was six – had to include the anatomy book, because most people have no idea about something as basic as origins and insertions.

EC: Thoughts on Stuart McGill’s stuff?

JP: I like most of his concepts – very practical, and they make sense.  I have not seen him speak first-hand, but I’ve heard nothing but positive reviews.  I’m not sure that I agree with avoiding rotational movements in the spine – you can twist all you want, but you’re not going to get a lot of rotation in the lumbar spine due to the orientation of the facets – primarily compressive forces between opposing joint surfaces.  However, I completely agree with shearing forces, not so much compressive forces, being damaging to the spinal column.  The idea of isometric endurance rather than force production when training the core also makes tons of sense.

EC: Randomly throw some idea out there that will really make our readers say “Oh, crap, that really makes sense!”

JP:

1.  A muscle that often gets overlooked with shoulder impingement type problems – like the plain looking girl at the dance – the serratus anterior.  It’s very important for a few reasons: helps rotate and protract the scapula/acromion up and out of the way of the humeral head, and is also important for force coupling with the rhomboids/lower and middle trapezius.

2. Many “hamstring pulls” – especially chronic ones – are actually symptoms of a mild nerve irritation – neural tension dysfunction.  Just like a brake cable on a bike, your nerves need to glide through the tissue they travel through.  If they get hung up, they will become symptomatic to varying degrees.  Picture a brake cable on a bicycle – the metal cable glides through the plastic casing.  Your nerves need to be able to glide through the structures and tissues they travel through – as much as 7 to 10 mm in some areas!

3.  A topic of contention – the elephant in the room – the psoas.  While there are many theories out there, I believe the psoas acts along with the TVA/multifidus/internal oblique as a local/segmental stabilizer of the spine.  Think about the origins on the anterior surface of the transverse processes of the lumbar spine.  Why the hell would it attach so intricately if all it did was flex the hip?  The psoas atrophies in a fashion similar to the multifidus with back pain.  The multifidus and the psoas form a force couple/agonist-antagonist relationship, giving stability of one vertebrae on the other.

EC: Very cool stuff, John; thanks again for taking the time.