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Individualizing the Management of Overhead Athletes

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Getting Geeky with AC Joints: Part 2

Getting Geeky with AC Joints: Part 2 In my last newsletter, I went into great detail on the types of acromioclavicular (AC) joint injuries we see, and some of the common inefficiencies that cause some folks to become symptomatic.  I also outlined some corrective exercise strategies to expedite recovery time.  This week, though, I discuss a very important - yet often-overlooked - piece of the puzzle: how to maintain a training effect in spite of these injuries. Ask anyone who has ever had an AC joint injury, and they'll tell you three things to avoid if you don't want to irritate it: 1. Avoid direct pressure to the area (particularly because it has very little muscle mass to cushion it) 2. Avoid reaching across the body (horizontal adduction) 3. Avoid reaching behind the body (full extension) We can use these three guidelines to get moving in the right direction with respect to maintaining a training effect in spite of the AC joint injury. With respect to #1 from above, front squats are an absolute no-no.  The pressure on the bar across the shoulder girdle can really take an upset AC joint and make it markedly worse.  And, since this is in many cases an injury that we're just "waiting out," simply training through it will only makes things worse long-term.  So, deadlift variations, single-leg variations, and back squats (assuming no other related problems) are likely better bets.  That said, we generally use the safety squat bar and giant cambered bar exclusively with those who present with AC joint problems.

Another important consideration in this regard is overhead pressing.  Believe it or not, many individuals with AC joint problems will actually tolerate overhead pressing quite well, as direct trauma to the AC joint won't really compromise scapulohumeral rhythm very much.  However, you have to consider two things. First, as I mentioned in my previous newsletter, some folks might have developed the AC joint issue over time due to a scapular anterior tilt causing the acromion and clavicle to sit differently.  This dyskinesis would also make overhead work less safe - so the individual would actually be training through a faulty movement pattern, and potentially injuring the rotator cuff, biceps tendon, bursa, and labrum. Second, if the individual is okay to overhead press from a movement standpoint, one needs to make sure that the bar, dumbbell, or kettlebell does not come down directly on the AC joint in the bottom position. With respect to #2 from above, obviously, dumbbell flyes and cable crossovers are out (not sure why they'd be "in" in the first place, but that's a whole different newsletter).  However, close-grip bench pressing variations will generally cause pain as well.  You also have to be careful with cable and medicine ball variations that may position the arm across the body. Moving on to #3, full extension of the humerus will light up an AC joint pretty quickly.  So, dips are out - and, honestly, I generally tell folks they're out for good after one has experienced any kind of AC joint issue.  Full range-of-motion (ROM) bench pressing and push-ups are generally issues as well, so I tend to start folks with more partial ROM work.  Examples would include dumbbell and barbell floor presses and board presses.  Here's a 3-board press:

As the shoulder starts to feel better, one can move down to 2-board, 1-board, and eventually full ROM bench press.  Remember, a medium or wide grip will generally be tolerated better than a close grip.

I also really like push-up iso holds at a pain-free ROM for these individuals because closed-chain exercises are always going to be a bit more shoulder friendly than open-chain variations.  This is really quite simple: set up as if you are going to do a push-up, and go down as far as you can with no pain.  When you reach your pain-free end-range, hold there while bracing the core, locking the shoulder blades down and back, and tightening the glutes; do not let the elbows flare out or hips sag!  We'll hold for anywhere from 10-60s, depending on fitness levels.  Over the course of time, increase the ROM as your symptoms reduce.

There you have it: acromioclavicular joints - from onset to corrective exercise - in a nutshell.  Obviously, make sure you seek out a qualified professional if you think you may have these issues, but keep this progression in mind as you return to (or just try to stay in) the iron game. Feedback on Building the Efficient Athlete "In my ten years in the fitness industry, I have been to many seminars and conferences - but the Building the Efficient Athlete Seminar was by far the most informative and comprehensive event I have attended in as long as I can remember.  The amount of knowledge you get when you combine Eric Cressey and Mike Robertson is unparalleled.  The seminar was filled with great classroom information, hands-on assessments, and on-site training tips.  I highly recommend this DVD set to any coach, trainer, or athlete who is looking to get a leg up on the competition." Mike Hanley, USAW, RKC Morganville, NJ www.HanleyStrength.com

Pick up your copy of Building the Efficient Athlete today!

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New Blog Content Exercise of the Week Stuff You Should Read Jays Prospect Collins a Surprising Strikeout Machine Random Friday Thoughts How to Progress Back to Deadlifting After a Back Injury Have a great week! EC

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Click here to purchase the most comprehensive shoulder resource available today: Optimal Shoulder Performance - From Rehabilitation to High Performance. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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Getting Geeky with AC Joint Injuries

Getting Geeky with AC Joint Injuries Lately, I've gotten quite a few in-person evaluations and emails relating to acromioclavicular (AC) joint issues.  As such, I figured I'd devote a newsletter to talking about why these injuries are such a pain in the butt, what to do to train around them, and how to prevent them in the first place (or address the issue once it's in place). First off, there is a little bit about the joint that you ought to know.  While the glenohumeral joint (ball-and-socket) is stabilized by a combination of ligamentous and muscular (rotator cuff) restraints, the AC joint doesn't really have the benefit of muscles directly crossing the joint to stabilize it.  As such, it has to rely on ligaments almost exclusively to prevent against "shifting."

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As you can imagine, then, a traumatic injury or a significant dysfunction that affects clavicle positioning can easily make that joint chronically hypermobile.  This is why many significant traumatic injuries may require surgery.  While almost all Grade 4-6 separations are treated surgically, Grades 1-2 separations are generally left alone to heal - with Grade 3 surgeries going in either direction. In many cases, you'll actually see a "piano key sign," which occurs when the separation allows the clavicle to ride up higher relative to the acromion.  Here's one I saw last year that was completely asymptomatic after conservative treatment.  It won't win him any beauty contests, and it may become arthritic way down the road, but for now, it's no problem.

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Now that I've grossed you out, let's talk about how an AC joint gets injured.  First, we've got traumatic (contact) injuries, and we can also see it in people who bench like this:

Actually, that's probably a fractured sternum, but you can probably get the takeaway point: don't bounce the bar off your chest, you weenie.  But I digress... Insidious (gradual) onset injuries occur just as frequently, and even moreso in a lifting population.  Most of the insidious onset AC joint problems I've encountered have been individuals with glaring scapular instability.  With lower trapezius and serratus anterior weakness in combination with shortness of pec minor, the scapula anteriorly tilts and abducts (wings out) - and you'll see that this leads to a more inferior (lower) resting posture.

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In the process, the interaction between the acromion (part of the scapula) and clavicle can go a little haywire.  The acromion and clavicle can get pulled apart slightly, or the entire complex can get pulled downward a bit.  In this latter situation, you can also see thoracic outlet syndrome (several important nerves track under the clavicle) and sternoclavicular joint issues in addition to the AC joint problems we're discussing. As such, regardless of whether we're dealing with a chronic or insidious onset AC joint issue, it's imperative to implement a good scapular stabilization program focusing on lower trapezius and serratus anterior to get the acromion "back in line" with the clavicle.  Likewise, soft tissue and flexibility work for the pec minor can also help the cause tremendously. Anecdotally, a good chunk of the insidious onset AC joint problems I've seen have been individuals with significant glenohumeral internal rotation deficits (GIRD).  The images below demonstrate a 34-degree GIRD on the right side.

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It isn't hard to understand why, either; if you lack internal rotation, you'll substitute scapular anterior tilt and abduction as a compensation pattern - whether you're lifting heavy stuff or just reaching for something.  And, as I discussed in the paragraph above, a scapular dyskinesis can definitely have a negative effect on the AC joint. Lastly, you can't ever overlook the role of thoracic spine mobility.  If your thoracic spine doesn't move, you'll get hypermobile at the scapulae as a compensation - and we already know that's not good.  And, as Bill Hartman discussed previously, simply mobilizing the thoracic spine can actually improve glenohumeral rotation range-of-motion, particularly in internal rotation.  Inside-Out is a fantastic resource in this regard - and is on sale this week, conveniently! So, as you can see, everything is interconnected!  In part 2 of this series, I'll discuss training modifications to work around acromioclavicular joint problems and progress back to more "normal" training programs. New Blog Content Birddogs, Continuing Education, and Terrible Journalism Stuff You Should Read Exercise of the Week: Dumbbell Reverse Lunge Random Friday Thoughts It's All About Specialization All the Best, EC Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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Sparing The Shoulders

A Quick Tip for Sparing the Shoulders One thing we all know is that when returning someone from a shoulder problem, it's generally assumed that starting in an adducted position - meaning that the arms are at the side - is preferred over a more abducted position (where the arms are elevated) for external rotation variations.  The more adducted position minimizes the amount of impingement on the rotator cuff while still allowing us to challenge the posterior rotator cuff. As such, the side-lying external rotation is a great exercise for folks to use when trying to strengthen the rotator cuff without exacerbating their shoulder pain.  In fact, this exercise has actually shown the best EMG activity of the infraspinatus and teres minor of any exercise tested.

The head is always supported, and we generally start those entry-level folks with a towel or pad between the elbow and the side to prop the arm to about 30 degrees of abduction, which is actually less stressful on the shoulder than having the arm completely up against the side.

In addition to performing this exercise with a dumbbell or plate, you can use manual resistance to accommodate the strength curve, overload the eccentric component, and add a greater element of dynamic stabilization.

Obviously, though, we can't always just train people in the more adducted position; the rotator cuff also has to function as a dynamic stabilizer as we get more abducted - and eventually, overhead.  So, it's valuable to start doing some external rotation variations at 90 degrees of abduction.  And, this is where this week's tip comes in. Traditionally, folks will go directly to the frontal plane to position the humerus, and the rotation will occur in the sagittal plane.  I actually prefer to begin folks in the scapular plane when starting them in the more abducted position.  In the first video below, you'll see that the reps are done in the frontal plane.  In the second video, though, I reposition my body to so that the humerus is actually about 30 degrees forward of the frontal plane - which is the scapular plane.

The scapular plane is much less stressful on the shoulder, and it is a great "middle-of-the-road" between the adducted and traditional abducted external rotation variations you'll see.  For more information on the scapular plane, I'd highly recommend this article by Dr. Warren Hammer. Of course, all of this is a very "rotator-cuff-centric" mindset, and there are loads of other factors you need to consider when dealing with shoulder issues.  I discussed them in more detail in this previous newsletter. New Blog Content Things I Learned from Smart People: Installment 1 Random Friday Thoughts Things I Learned from Smart People: Installment 2 Have a great week! EC shoulder-performance-dvdcover Click here to purchase the most comprehensive shoulder resource available today: Optimal Shoulder Performance - From Rehabilitation to High Performance.

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The Opportunity Cost of Your Time

I'm sure a lot of you took economics back in the day - either in college or high school (or both).  I don't know about you, but one concept that stuck in my mind - besides the fact that one of my professors was a ridiculously annoying Yankees fan - was that of opportunity cost.  Rather than define it myself and risk missing an important component, I'll defer to Wikipedia: "Opportunity cost or economic opportunity loss is the value of the next best alternative forgone as the result of making a decision. Opportunity cost analysis is an important part of a company's decision-making processes but is not treated as an actual cost in any financial statement. The next best thing that a person can engage in is referred to as the opportunity cost of doing the best thing and ignoring the next best thing to be done. "Opportunity cost is a key concept in economic because it implies the choice between desirable, yet mutually exclusive results. It is a calculating factor used in mixed markets which favour social change in favour of purely individualistic economics. It has been described as expressing 'the basic relationship between scarcity and choice.' The notion of opportunity cost plays a crucial part in ensuring that scarce resources are used efficiently. Thus, opportunity costs are not restricted to monetary or financial costs: the real cost of output forgone, lost time, swag, pleasure or any other benefit that provides utility should also be considered opportunity costs." I see opportunity cost all the time in the world of training - both in clients/athletes and their trainers/coaches. On the fitness side of things, we know there are certainly exercise modalities that yield more effective results than others in the least amount of time.  In fact, this was the entire premise behind Alwyn Cosgrove's Hierarchy of Fat Loss article. If you want to get stronger, bigger, and more athletic, you're better off doing squats than you are leg extensions. If you only have an hour to exercise and your goal is to get stronger, drop body fat, and improve your overall fitness, then you're probably better off skipping the Hip-Hop class and instead going to the gym to do: 5 minutes foam rolling

5 minutes mobility/activation drills 30 minutes strength training 15 minutes interval training

5 minutes post-exercise flexibility

All of these modalities can be individualized, whereas a group exercise class is more one-size-fits-all.  So, if you have imbalances or injury concerns, the individualization is a major benefit.

Plus, the added benefit is that you're much less likely to get tortured on by your friends if you lift heavy stuff and push the sled than you are with Hip-Hop class. Just throwing it out there.  That's just a purely hypothetical example, though...

You'll see a lot of really business-savvy trainers who are always reading personal development books, but never actually pick up a book or attend a seminar to learn how to train people.  They are really just good salespeople in  revealing and/or tight workout clothes.  In fact, if you search Google Images for "personal trainer," photos like this are just about all that you get!

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The opportunity cost of their time is that they could have spent time becoming better trainers instead of just prioritizing something at which they're already effective.  Or, perhaps they're better off hiring a good trainer to take that duty over so that they can best leverage their selling.

Likewise, you'll see some trainers who are great at assessment, programming, coaching, and getting results, but clueless on the business side of things.  These people need to be reading more business books and attending seminars on how to run a business effectively.  And, as with the previous case, they should consider collaborating with someone who has good business know-how so that they can leverage their strengths.  I actually do a lot of this myself at Cressey Performance; while I'm about 80/20 training/business, having Pete as our full-time business guy allows me to spend more time specializing in various contexts to expand our market segment. Just some food for thought.  I'd encourage you to look at what you do on a daily basis, and consider the concept of opportunity cost as it relates to your fitness and professional development.  I know I do it all the time. New Blog Content Things I Learned from Smart People: Installment 1 Random Friday Thoughts Things I Learned from Smart People: Installment 2 Have a great week! EC
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Training Males and Females: Similar, but Different

Males and Females: Similar, but Different During my weekly Pubmed scan, I came across this study the other day: The Core and Hip in Soccer Athletes Compared by Gender It seemed like a good fit for this week's newsletter for a few reasons. First, we always hear that men and women should train exactly the same.  While there are certainly a lot of similarities between how I personally approach the training of men and women, as I noted in a previous newsletter, there are also a lot of important considerations specific to females.  This study highlights on such consideration: increased hip internal rotation as compared with their male counterparts. Ask anyone who has ever trained male soccer or hockey players or powerlifters, and if they know anything about assessment, they'll tell you that a hip internal rotation deficit (HIRD) is a huge problem.  It can lead to knee, hip, or lower back pain and have a markedly negative impact on movement.  Improving length of the hip external rotators - with flexibility drills like the knee-to-knee stretch - is of paramount importance.

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Well, those exact same drills would actually increase the typical female's injury risk.  Excessive hip internal rotation and knee valgus are just a few of the many reasons (also including the hip abductor and core control weaknesses outlined in this study) that most females have more anterior cruciate ligament injuries than males.

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The lesson could end there - but it won't. Why? I had a female distance runner in for an evaluation on Saturday, and she had very poor hip internal rotation.  A flexibility drill that would be inappropriate for the female "masses" is a great fit for her.  Cases like this make it very clear that it's important to assess and not just assume. This is why I'm so excited about the impending release of our new product, which outlines a series of self-assessments and corrective exercises one can use to pinpoint these issues and address them in a targeted fashion.  Keep an eye out for an announcement on its release in the weeks to come. Feedback on Maximum Strength "This program took me to the next level of performance with my lifting. After using a variety of programs focusing on fat-loss and hypertrophy and having limited results from them it was great to see such solid increases in strength and physique changes from the program.  In addition, the program focus on dynamic flexibility and foam rolling has resulted in an injury free training cycle and major flexibility and posture improvements.  I would highly recommend this program and book to anyone wanting to make real progress with strength, performance and body composition." Dan Hibbert - Calgary, Alberta Increased body weight by 14 pounds, broad jump by seven inches, box squat by 80 pounds, bench press by 30 pounds, deadlift by 70 pounds, and 3-rep max chin-up by 27.5 pounds.

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New Blog Content Random Friday Thoughts Shoulder Range-of-Motion Norms Stuff You Should Read Tips for a Bigger Bench Have a great week! EC
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Newsletter 162

Tis the Season...for Spondylolysis? I've written previously about the prevalence of spondylolysis (lumbar fractures) in young athletes - and particularly those in rotational sports.  You can read my in-depth newsletter on the problem HERE.  It's a huge problem in young athletes; I'd estimate that I've trained more than 15 athletes since 2006 through their entire 12-16 week back-bracing periods.

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Now, while July is usually recognized for barbecues, baseball, and beaches (and anything else that's exciting and begins with a "B"), I've begun to recognize it as "back-bracing season."  What gives? Well, for starters, I've seen two new spondy cases come through our door in the past week.  Considering that prevalance is estimated at anywhere from 15-63% in the general population, it isn't a huge surprise.  However, why would more present with symptoms at this time of year? Think about the sports we play in the spring and summer: baseball, tennis, and lacrosse.  And, many soccer and hockey players have been going non-stop since the fall.  In other words, rotational sports have been going on for a long time, and kids are getting more and more detrained - with less flexibility and strength - as these neverending seasons go on. Likewise, as a great article in the Portland Press Herald observed this past weekend, many high school athletes are riding multiple horses with one saddle. In other words, now that they're out of school, you've got kids participating in basketball/hockey (winter) and lacrosse/baseball at the same time - and doing their best to attend fall sports (field hockey, soccer, football) practices.  And, just when they are ready for a day off, they're going to play golf with Dad on Sunday.  When are these kids removing the rotational challenges and preparing themselves physically with good strength, stability, and flexibility training? Anybody who says that the era of the three-sport athlete is dead doesn't know his arse from his elbow.  While early sports specialization has definitely taken off, now, multi-sport athletes are expected to "specialize" in three different sports at once.  They compete all the time, but never prepare their bodies to compete - or play at all. In The Ultimate Off-Season Training Manual, I go into great detail on how those athletes who do choose to specialize should do so.

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However, in younger populations, a lot of these guidelines don't apply, as they're balancing multiple sports.  They need to hang out with their friends, play multiple sports, and get involved in less organized physical activity.  And, most importantly, they need to participate in strength training and flexibility programs, as these exercise modalities are different than traditional sports because they can be fluctuated on a regular basis to avoid imbalances. I know there are a lot of parents who read this newsletter and are trying to do the right thing for their kids.  It isn't fair to condemn them for signing their kids up for another travel team, as that's the game as it's played with respect to player development and college recruiting nowadays.  However, I would encourage those parents to "undo" some of the early specialization damage by encouraging sons and daughters to participate in training to prepare their bodies for this specialization. Lastly, for those of you who are looking to learn more about low back pain, I can't say enough great things about Dr. Stuart McGill's Ultimate Back Fitness and Performance book.  It's a great investment.

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A Quick Congratulations... Just a quick note to recognize CP athlete Danny O'Connor, who moved his professional boxing record to 7-0 last Saturday night.  Check out a great write-up in the Boston Globe featuring Danny, his coach, and some nutcase named Cressey: Punching His Ticket in the Pros
New Blog Content Random Friday Thoughts Stuff You Should Read A Sneak Peak at the New Project EC Finally Understands Women Have a great week! EC
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Newsletter 161

I have the normal weekly newsletter posted below, but first a quick announcement: Mike Robertson, Bill Hartman, and I just filmed a new DVD set!  Those of you who have enjoyed all of our products individually can now see what happens when the three of us collaborate.  For more information, check out today's blog post: A Sneak Peak at the New Project.
The Law of Repetitive Motion: Part 2 In last week's newsletter, I talked about the first three component of the law of repetitive motion: "I" (injury/insult), "N" (number of repetitions), and "F" (the force of each repetition, expressed as a percentage of maximal strength).

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This week, I'll discuss the "A" and the "R" of this equation.  To begin, amplitude, stated simply, is range of motion.  If we spend our entire lives in limited ranges of motion, we run into problems.

Obviously, this refers to those who sit too often and too long - particularly in poor postures.  I'm a big believer that the best posture is the one that is constantly changing, so I always encourage people to try to get up and move around every 20-30 minutes whenever possible.  If not, I love the idea of simply "shuffling" positions at your computer.  Complement this constant fluctuation of posture with some good training to open up the hips and thoracic spine, and strengthen the upper back and glutes, and you'll find that being stuck in a job with a small amplitude is a "manageable" problem.

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Amplitude can also refer to only doing certain exercises in the gym, particularly those who exercise through a partial range of motion.  It might be people who simply press too often and pull too infrequently, or those who perform a lot of bilateral exercises, but nothing unilateral.  We aren't just talking about ranges of motion at the joints; we are also talking about the muscles recruited and type of muscle action - concentric, eccentric, isometric - that takes place.

Lastly, working at a specific task for extended periods of time can be a huge issue for some.  Just ask musicians, factory line workers, and even baseball pitchers.  These issues can all impose huge asymmetries that must be addressed both directly (soft tissue work, flexibility training) and indirectly (training the contralateral side, or just exposing the individual to a broader excursion of movement outside this specific task).

So, all that in mind, improving amplitude is all about increasing range of motion in one's daily life.  Of course, this must be specific range of motion.  You wouldn't, for instance, want to increase lumbar spine range of motion in most back pain patients, but you would want to optimize hip and thoracic spine mobility.

Rest, the "R" in our equation, is pretty straight-forward: if a tissue is angry, you need to give it time to settle down.  However, just stopping all exercise isn't always the best bet.

Often, it's simply a matter of keeping the stress on the tissue below its capacity for loading.  As a great example, a lot of manual therapists with whom I've worked actually like people to go out and lightly load tissues that have just been worked in order to teach the tissue to "deform" properly.  For instance, I got a little "Graston Loving" on my biceps a while back, and spent the rest of the day lightly loading the tissues and doing some prolonged stretching sets.  It worked like a charm.

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Taking it a step further, though, much of the time, it's about redistributing stress.  For instance, someone with anterior knee pain may not be able to do a more quad-dominant squat, but instructing that same lifter to sit back into the glutes and hamstrings more can markedly take down the stress on the anterior knee.  Sure, it changes the muscular recruitment of the exercise, but the lifter derives great benefit and keeps the loading on the affected tissues below capacity.  And, in this particular case, he's strengthening the posterior chain muscles that almost always help to prevent anterior knee pain in the first place.

That wraps up our look at the law of repetitive motion.  It's certainly not an exhaustive review, but my hope is that it got you thinking just enough to consider how this law applies to the issues you see on a daily basis, as well as those you want to prevent from ever reaching threshold.  For more information, check out the Building the Efficient Athlete DVD Set.

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Random Friday Thoughts The Who-What-When-Where-Why of Flexibility Training In the Presence of Greatness

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EC


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The Law of Repetitive Motion

Back in early May, I published a newsletter discussing some alternatives I've used as replacements for traditional interval training.  Basically, the goal was to show that one can work to address inefficiencies while still getting some good energy systems development training. One of the key concepts I briefly outlined in this newsletter - and also thoroughly in Mike Robertson and my Building the Efficient Athlete DVD Set - is the Law of Repetitive Motion.  This law is expressed as the equation I=NF/AR.  In this equation, injury equals the number of repetitions multiplied by the frequency of those repetitions, divided by the amplitude of each repetition times the rest interval.

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Looking at this equation and understanding each of these factors sheds some light not only on how we can prevent injuries, but also address these issues once they reach threshold.  Truth be told, as I related in another previous newsletter, I'm a firm believer that we're always just see-sawing back and forth, getting closer to threshold when tissues are loaded in excess of their capacity. Providing adequate stability, mobility, recruitment patterns, and tissue quality with the appropriate training loads and recovery measures ensures that we stay below this threshold.  All of these issues are covered in one way or another by the equation from above. "I" is the injury, or insult to the tissues.  In the active restraints - muscles and tendons - this may present in the form of soft tissue restrictions that can be addressed with manual therapy and foam rolling.  In other words, sometimes simply doing some soft tissue work can bring someone back below threshold (one reason why I refuse to refer any athletes or clients to physical therapists who do not put their hands on patients, but that is a whole other newsletter altogether).

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"N" is the number of repetitions imposed on the tissues.  This may be working on a factory line doing the same motion over and over again.  It may also be simply sitting with poor posture, which is the equivalent of a high number of reps (constant activation). Or, it could come from doing as many chin-ups as possible simply because your business partner told you that he didn't think you could do it - and the Mudvayne in the background motivated you to action (but I wouldn't know anything about that).

With respect to "N," the general assumption is that simply reducing the number of repetitions is what it takes to reduce insult to the tissues.  That's absolutely true, but not exhaustively true.

Take someone who bench presses with the elbows flared, and teach them to tuck the elbows and activate the upper back and scapular stabilizers.  You may instantly relieve their pain without altering the number of repetitions; you're just redistributing the load.

The same is true of someone with anterior knee pain who has pain with forward lunging, but not with reverse lunges.  So, the lesson to be learned isn't just to modify the number of repetitions, but also the manner in which those repetitions are performed.

"F" is the force of each repetition, and it's important to remember that this force is expressed as a function of maximum muscular strength.  So, in other words, the "F" figure will be higher - and more injurious - on a weak tissue.  This is one reason why resistance training is a big portion of modern physical therapy - including physical therapy that the brighter minds in the PT community wouldn't consider "comprehensive" or "good."

Here's an example.   Average Joe gets anterior knee pain and, of course, he gets diagnosed with patellar tendinitis when it's really more of a tendinosis (but I won't digress on that).  He spends six weeks in PT to really "build up his quads."  It's obvious that the patellar tendon was just weak and inflamed, so strengthening it and knocking back NSAIDs like candy will fix everything.  Riiiiight.

Chances are that the patellar tendon was just overused because Joe had no hamstrings or glutes.  Getting the quads strong just reduces the "F" figure in the equation above.  They push him away from threshold, but not as far as he'd have gone if they'd also worked on recruiting glutes and hamstrings better, optimizing hip and ankle mobility, or performing soft tissue work.  Or, maybe he just got better because they reduced the "N" we discussed above by resting the knee.  Regardless, Joe's not in the clear and very well might be back in PT in a few months if he doesn't address the other issues in the equation.

And, with that in mind, I'll get to the final two components of the Law of Repetitive Motion in my next newsletter.  In the meantime, check out the Building the Efficient Athlete DVD Set for more details.

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Taking on the Yoga Question

What do you think of... I got the question again this week: What do you think of yoga? Don't get me wrong; this newsletter isn't going to be about yoga.  To be honest, I already wrote an article about my thoughts on yoga a while back.  Admittedly, I probably should have taken a more impartial standpoint, but I wrote it more for shock value to outline some of the fundamental problems with some practices that I felt were becoming universally accepted without question. That said, with respect to this newsletter, the word "yoga" in the question above could easily be replaced with "lifting weights," "static stretching," "weighted balls," "Chinese food," "owning your own business," or "curling in the squat rack." Lifting weights is generally great.  Deadlifting with a rounded back isn't.  Doing 150 sets of pull-ups as fast as possible probably isn't going to make your shoulders and elbows happy.  Overhead pressing two weeks after you had a rotator cuff repair isn't a good idea. Static stretching can be of huge benefit if you've got muscles that are legitimately short.  If you're an individual with crazy congenital laxity on top of ten-years of gymnastics, then static stretching will probably chew up your joints really quickly.

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Weighted balls have worked wonders for some of my athletes, particularly those who have already built a great foundation of velocity with long tossing and optimization of on-the-mound mechanics.  For others, they're premature and inappropriate. I like water chestnuts, but not mushrooms.  I guess the jury is out on whether Chinese food is good or not in my book, huh?  I never met General Tso, but I'll give him the benefit of the doubt. Owning my own business is fantastic.  I get a lot of autonomy, set my own schedule, and have my name on a t-shirt.   I also get a lot of hours and the last paycheck of the month - for whatever is left over. Curling in the squat rack is the most annoying thing in the world if you are the guy waiting to squat.  If you're the guy curling, though, it's a great way to impress your frat buddies.  If looking like a complete tool is your goal, there is no better way to do it. Where am I going with all this? Yoga isn't good or bad.  Some lifts aren't appropriate for some people.  Static stretching can help or hurt.  There is good and bad Chinese food, depending on the person and restaurant.  Owning a business has its perks and drawbacks; it isn't for everyone.  There are no absolutes.  Okay, maybe there is just one: curling in the squat rack is always dumb, but I digress... One of my primary goals in writing over the past eight years has been to empower folks with knowledge.  in fact, it was the entire premise behind Mike Robertson and my Building the Efficient Athlete DVD set; rather than simply handing people fish and telling them it's good for them, we tried to teach people how to fish.

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"Dumbing things down" can certainly be valuable when dealing with clients (particularly those with no injuries).  However, as fitness and strength and conditioning professionals, it's important to not do the same with our own education.  You can't dumb something down until you've fully understood it.

That, I feel, is where the industry has gone a bit astray.  Resistance training research really didn't even start up until the 1980s; there is still a ton we have to learn.  And, to be honest, there is much better information coming out of experimentation in the trenches than there is in any research lab out there. There are new methods to be discovered, and old methods that can better be leveraged in (or removed from) certain scenarios.

In short, this is a very dynamic field.  If things just keep getting dumbed down to "good and bad" and "just do this," though, then we're really selling ourselves short.

Or maybe I don't know anything.  I guess it depends on who you ask.

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