Home Blog Strength and Conditioning Stuff You Should Read: 2/27/12

Strength and Conditioning Stuff You Should Read: 2/27/12

Written on February 27, 2012 at 1:27 am, by Eric Cressey

Here’s a list of recommended strength and conditioning reading to kick off you week.

The Prevalence of Radiographic Hip Abnormalities in Elite Soccer Players – This recently published study in the AJSM shows us just how common hip issues are in soccer players – even if they’re asymptomatic.  You can apply this to hockey players as well – and possibly on an even more pronounced level.  This goes hand-in-hand with some of my writings in the past about knees, shoulders, and lower backs.  Just because someone is asymptomatic does not mean that they are “healthy” – and this is why assessment and an understanding of population-specific norms are so important!

Band-Assisted 1-arm Push-ups: A Better Alternative – My buddy Shon Grosse outlines a good progression for those looking to build up to a one-arm push-up.

Causes InternationalThis isn’t so much fitness-related, but I think it’s a great organization worth checking out. The folks at Causes International provide an opportunity for you to help raise money for your favorite charities by donating your used electronics (a process known as upcycling).  Most people have old gadgets kicking around the house, and these can easily be upcycled to benefit others and protect the environment.

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5 Responses to “Strength and Conditioning Stuff You Should Read: 2/27/12”

  1. Scott Says:

    Wow 72% of male soccer players have hip abnormalities. I friend of mine, who was a semi-pro player, just had his second ACL surgery on the same leg (the first was at 18 and he is now 30). He asked what he was doing wrong to have caused this and the Dr. told him he was just unlucky and that it was genetic. I guess his other knee got all the good genes šŸ™‚ Of course no one has looked at his hip or ankle mobility.

  2. Kyle Ridgeway PT, DPT Says:

    Eric, with all due respect I think you are grossly misinterpreting the results of some of these asymptomatic imaging result studies. The conclusion is NOT that they HAVE pathology and it is just waiting to hit threshold or laying dormnat. The take home from them is that our imaging is too sensitive and their are many folks who have what SEEMS LIKE PATHOLOGY on imaging, but NO other signs or symptoms of dysfunction (and may actually never have dysfunction). So, it is only pathological if the image matches the clinical picture (we are talking musculoskeletal pain picture here, not other occult medical illnesses like cancer). In addition, there has been no follow up studies that suggest that these folks with abnormal imaging, but no pain or clinical signs or symptoms go on to then become symptomatic. PLEASE, PLEASE do not spread the word that the these positive imaging findings on asympomatic individuals are problematic. They just aren’t.

    The imaging studies on bulging discs in the spine have been very helpful in this regard. The finding of a bulging disc does not always correlate to any or the clinical pain picture. The progression or degression of the bulge also does not correlate with recovery. Some people get better but their bulge gets WORSE, and vice versa.

    If someone is asympomatic but has some “abnormalities” on imaging, I call this person healthy. Why? Because they are. As you have pointed other in other posts, abnormalities on imaging are actually NORMAL. So, what gives? Please do not try to sell the fact that these folks with abnormal images need some type of further assessment or intervention or are at risk for future pain or dysfunction. We have no data to support that claim. And with the hords of studies showing many, many folks with bad images feeling good, we don’t have any solid reasoning to think imaging findings are concerning in asymptomatic individuals.

    I really love that you are highlighting some of these imaging findings, and agree with 90% of what you say regarding them. I just needed to highlight that point.

    The authors even state in their conlclusion: “The establishment of the prevalence of these findings represents the first step in identifying the relationship between radiographic abnormalities and injuries of the hip and groin in athletes.”

    Long story short, even the authors are unsure of the significance (if any, likely little) of such findings….

    All the best,

    Kyle J. Ridgeway, PT, DPT
    Twitter: @Dr_Ridge_DPT

  3. Eric Cressey Says:

    Hi Kyle,

    Thanks for the great feedback – and I agree with you 100%. I think it really comes down to what we define as “healthy.” Some folks might call those with structural deviations from normalcy, but no symptoms “unhealthy,” while others might call them “healthy” because they aren’t symptomatic.

    Truth be told, a definition of pathology is “a departure or deviation from a normal condition.” So, you could make the argument that every single person on the planet has some degree of pathology, whether it’s a disc herniation, labral tear, or any of a number of other things that a MRI, bone scan, x-ray, or whatever else can pick up. Again, it’s just wordplay.

    I’m the absolute last one to dump a huge amount of significance on diagnostic imaging alone because it’s just one piece of a larger diagnostic puzzle, but I do think it provides some insights for us in terms of managing asymptomatic athletes. In other words, I wouldn’t call them problematic; I’d call them “noteworthy” and “enlightening” in the context of our discussion to try to keep/get people healthy.

    Hopefully this clarifies my perspective on things.

    Thanks again for your feedback.

  4. Kyle Ridgeway PT, DPT Says:


    Quick reply!! Thank you for your comments, and that definitely clears some points up for me. Much appreciated.

    “Truth be told, a definition of pathology is ā€œa departure or deviation from a normal condition.ā€”

    ^That is essentially my entire point. When what we call “abnormal” on imaging is actually normal (i.e. disc bulges, joint degeneration, etc) then what we have is an improper operational definition of pathology. If everyone is pathologic, then our definition is wrong. Asymmetry is the norm, and abnormal imaging findings are the norm. So, maybe we need to adjust our language and definitions so the masses benefit?? No one needs to be under the impression that their incidental, likely insignificant imaging finding is “abnormal” or “pathologic.” I think the language and word play used, in the context of medicine, rehab, training, or health is very important.

    Most of these imaging findings only matter, when they matter, which I think makes this situation even more complex. For example, when the L4-5 disc bulge severity, location, etc correlates with the clinical picture of symptom reports and clinical testing (sensation, strength, etc). Yet, literally millions of Americans (% increasing every decade older they are) are walking around with severe bulging discs and “degenerative disc and joint disease” in their spines….without pain or limitation. That is the problem with pain and “pathology” on imaging. They are not always (and maybe rarely) well linked.

    Hopefully, as we better understand the neuroscience and physiology behind pain and it’s mechanisms we can apply pain neuroscience to these issues.

    Per your quote “but I do think it provides some insights for us in terms of managing asymptomatic athletes.” I would definitely like your insights on this, because I think I am missing the connection somehow with that…

    Sorry to go off on a tangent a bit.

    I sincerely thank you and respect you for providing such a venue and your willingness to discuss. Cheers!

  5. Eric Cressey Says:

    Not a tangent at all, Kyle! I appreciate your contributions and agree with you 100%.

    While I know there is actually evidence to suggest that routine imaging for low back pain can actually decrease the likelihood of success in clinical populations, having some diagnostic imaging at our fingertips can be advantageous. Lots of professional teams pre-MRI/x-ray/CT scan free agents and draft picks to potentially spot issues before they reach threshold. Take a look at how John Lackey’s contract (RE: elbow) was structured with the Red Sox, as an example. There are loads more out there. Whether imaging is perfect or not, it has saved a lot of people a lot of money in professional sports.

    In the S&C world, I think it’s safe to say that we should be cautious about squatting populations like hockey and soccer when we know the high prevalence of FAI. There are likely better ways to improve performance without the same risk of pain creeping up eventually.

    A lot of the professional baseball players with whom we work have had imaging at the shoulder or elbow at one point or another, too, and it can be helpful with respect to managing an athlete – both in terms of exercise selection, and knowing how hard to push someone. As an example, at the elbow, if I have a guy who has apparent calcification on the UCL, I’m going to be more conservative with his throwing program and give him more downtime throughout the year. At the shoulder, if I have someone with a more exaggerated SLAP 1 – but not full SLAP 2 – I’m going to be extra sensitive to him commenting on shoulder stiffness, as opposed to simply chalking it up to adjusting to a higher volume of throwing.

    Hope this clarifies a bit. Like I said, I am not a “MRI first!” guy, but I don’t want to throw the baby out with the bath water, either!

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