I'm a big believer in the importance of the "Assess, Don't Assume" mentality. However, it's crucial that assessments be approached the right way in order to deliver optimal results in strength and conditioning programs. Here are ten thoughts on the subject:
1. Assessments are an easy way to differentiate yourself.
With this era of semi-private training and bootcamps, there are still a lot of coaches and facilities out there that pay no attention whatsoever to pre-participation screenings. On one hand, it's a sad commentary on our industry, as one could argue that omitting assessments sets clients up for injuries. On the other hand, it creates an excellent opportunity for skilled coaches and trainers to differentiate themselves in a low-barrier-to-entry industry. If you're not assessing, you're just guessing! Make it a priority to start learning more about your clients/athletes.
2. Thorough assessments include both specific and general components.
In my eyes, every assessment can be categorized as either specific or general. Specific assessments may be anything from single-joint range-of-motion (ROM) assessments to the provocative tests physicians and rehabilitation specialists may use. They identify specific things like elbow extension ROM or whether a particular test elicits pain.
Conversely, general assessments look at global movements and evaluate multiple joints at the same time. Examples include overhead squats and push-ups.
The problem is that both kinds of assessments can fall short. As examples, you may see unstable young athletes who pass all ROM assessments (specific) with flying colors, but fold up like lawn chairs when they do an overhead lunge walk (general).
You may also see athletes with perfect overhead squats, but significantly limited knee flexion ROM that would make you concerned that they'd pull a quad (rectus femoris) while sprinting. These are just two examples, though; there are countless more we could cite.
3. You must always be willing to refer out.
You're better off being a great trainer/coach than you are trying to be an incredibly subpar physical therapist or physician. Even if you had a tremendous knowledge of provocative tests and rehabilitation techniques, as a trainer/coach, you don't have the same resources (e.g., diagnostic imaging equipment) these professionals have. Furthermore, diagnosing is outside your scope of practice, anyway.
I refer out every single week. It creates great opportunities for collaboration that will benefit our clients/athletes, and for our staff to learn from related professionals. If you see something on an assessment that raises a red flag, it's better to be safe than sorry.
4. Don't assess just for the sake of assessing; make it to the point.
My biggest assessment pet peeve is when the process takes too long. You can do an incredibly thorough evaluation in about 30 minutes, and most shouldn't even take that long. The only ones that would require more time would be those with extensive injury histories or other unique circumstances.
[bctt tweet="The sooner you're done assessing, the sooner you can get to training."]
5. Assess in the context of both injury history and functional demands.
As a follow-up to point #4, you never want to go into a movement assessment "blind" with respect to the person in front of you. Rather, it's best to first review a health history and have a discussion about training history, goals, athletic demands, and expectations. I find that it's best to perform an evaluation with a better knowledge of an individual's history than it is to look at movement and then work backward from it.
For example, if your pre-assessment discussion reveals that an individual was a baseball player growing up, you can expect to see more external rotation on his dominant shoulder. That might lead you to look more closely at whether he has adequate anterior shoulder stability, and whether his scapula upwardly rotates enough. It also might help to explain a low right shoulder.
Basically, you need to see the big picture; the "answers" are usually a combination of a bunch of tests, questions, and observations.
6. You have to emotionally separate yourself your personal biases when it comes to assessments.
Baseball players are the largest chunk of my clientele. As a result, I evaluate shoulders and elbows in a ton of detail.
Recently, we started training an NFL punter, though.
I did a thorough assessment with him, but let's just say that we didn't spend a ton of time worrying about verifying that he had perfect elbow ROM. Instead, we spent a lot more time looking at his core and lower extremity; otherwise, the assessment would have taken all day, and we'd acquire a lot of information that wouldn't have a significant impact on his programming.
7. Don't let hypermobile clients/athletes "cheat" assessments.
Just like you need to have both specific and general assessments, you also need to make sure to include both mobility and stability assessments. Hypermobile (loose-jointed) individuals are notorious for cheating assessments that are biased toward ROM. Comprehensive assessments need to also evaluate stability.
In this vein, the Functional Movement Screen does a good job of looking at both sides of the equation. The shoulder mobility, overhead squat, and straight leg raise tests are general assessments largely biased toward mobility, but the trunk stability push-up, hurdle step, rotary stability, and in-line lunge screens are all predominately stability challenges.
To learn more about how hypermobile folks can "cheat" assessments, check out my article, 15 Static Stretching Mistakes.
8. Have some feel; don't make new clients (or any clients) uncomfortable.
If a man is overweight and uncomfortable with his body, it's probably not a great idea to have him take his shirt off for a scapular screen. If a woman is seriously deconditioned, it's probably not a good idea to put her through a lunge assessment that she'll fail miserably. And, it's an even worse idea to do these things in front of a crowded gym.
Remember that the first day is as much about
building rapport and starting a friendship as it
is about evaluating how an individual moves.
As has been said in the past, "They have to know how much you care before they care how much you know."
9. Don't forget to highlight what individuals do well, too.
In How to Win Friends and Influence People, Dale Carnegie wrote, “It is always easier to listen to unpleasant things after we have heard some praise of our good points.” This point applies to fitness and movement assessments, too. Think about it: would you like to be criticized non-stop for 30 minutes? Probably not.
By contrast, if someone highlighted what you did well while also covering some important growth areas for you, wouldn't these suggestions be more well received? Absolutely.
Again, your goal is to establish a great relationship, not just analyze movement.
10. Remember that training is a never-ending assessment.
Every exercise is an assessment. Each time your clients and athletes move, they're providing you with information. The more you pay attention, the better you'll be able to individualize their programs and coaching cues moving forward.
If you're looking for more information on the assessment side of things, I'd encourage you to check out our Functional Stability Training series. These resources go into great detail on evaluating the lower body, upper body, and core.
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We spend a good chunk of our lives standing on one-leg. Obviously, that means we need to train on one leg, but it's also important that fitness professionals and rehabilitation specialists assess folks when they're in single-leg stance, too. Enter the overhead lunge walk, which is likely my favorite assessment because of just how comprehensive it is.
Why is it so great? Let's examine it, working from the upper extremity to the lower extremity.
First, you can evaluate whether someone has full extension of the elbows. Just tell folks to "reach the fingers to the sky." In a baseball population, as an example, you can quickly pick up on an elbow flexion contracture, as it's quick and easy to make a comparison to the non-throwing side.
Additionally, you can screen for congenital laxity, as a lot of hypermobile (loose jointed) folks will actually hyperextend the elbows during the overhead reach.
At the shoulder girdle, you can evaluate whether an individual has full shoulder flexion range of motion:
You can also tell whether the aforementioned hypermobile folks actually move excessively at the ball-and-socket joint of the shoulder, as they'll actually go too far into flexion instead of moving through the shoulder blades.
You can determine whether an individual has an excessively kyphotic, neutral, or extended thoracic spine. If they're kyphotic, they'll struggle to get overhead without compensation (arching the lower back or going into forward head posture). If they've got an excessively extended thoracic spine, they'll actually go too far with the overhead reach (hands will actually wind up behind the head if it's combined with a very "loose" shoulder).
You can tell whether an individual is able to fully upwardly rotate the shoulder blades in the overhead position.
You can tell whether someone preferentially goes into forward head posture as a compensation for limited shoulder flexion, poor anterior core control, or a lack of thoracic spine extension or scapular posterior tilt.
You can evaluate whether an individual has enough anterior core control to resist extension of the lumbar spine (lower back) during overhead reaching. This is a great test of relative stiffness of the rectus abdominus and external obliques relative to the latissimus dorsi.
You can evaluate whether an individual is in excessive anterior or posterior pelvic tilt from the side view.
Also from the side view, you can determine whether the athlete hyperextends the knees in the standing position.
With the lunge, you can see if an athlete is quad dominant - which is clearly evidenced if the stride is short and the knee drifts out past the toes of the front leg. You can also venture a guess as to whether he or she has full hip extension range of motion.
Also with the lunge, you can determine how much control the athlete has over the frontal and tranverse planes; does the knee cave in significantly?
You can make a reasonably good evaluation of foot and ankle function. Does the ankle collapse excessively into pronation? Or, does he stay in supination and "thud" down?
Does the athlete handle the deceleration component effectively, indicating solid eccentric strength in the lower extremity?
As you can see, this assessment can tell you a ton about someone's movement capabilities and provide you with useful information for improving your program design. Taking it a step further, though, it goes to show you that if you select the right "general" assessments, you can make your assessment process much more efficient.
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It's time for this month's sports performance training musings. Many of these thoughts came about because we have a lot of our professional baseball guys back to kick off their off-season training, so I'm doing quite a few assessments each week. In no particular order...
1. There is a difference between "informative" assessments and "specific" assessments.
I recently spoke with a professional baseball pitcher who told me that his post-season evaluation included a 7-site body fat assessment, but absolutely no evaluation of scapular control or rotator cuff strength/timing. Skinfold calipers (especially in the hands of someone without a ton of experience using them) are hardly accurate or precise, but they can at least be "informative." In other words, they tell you something about an athlete.
However, I wouldn't call a body fat assessment a "specific" assessment. In other words, it's really hard to say that "Player X" is going to get injured because his body fat is 17% instead of 15%.
Conversely, we absolutely know that having poor scapular control and rotator cuff function is associated with a dramatically increased risk of injury in throwers. Checking out upper extremity function is a "specific" assessment.
This example, to me, illustrates why good assessments really are athlete- and sport-specific. Body fat assessments mean a lot more to hockey players than they do to baseball players, but nobody ever attributed a successful NHL career to having great rotator cuff strength.
Don't assess just for the sake of assessing; instead, assess to acquire pertinent information that'll help guide your program design to reduce injury risk and enhance performance.
2. Extremes rarely work.
Obviously, in a baseball population, most athletes have at least some kind of injury history. It's generally a lot of elbows and shoulders, but core and lower extremity injuries definitely show up on health histories. When I see these issues, I always try to ask plenty of questions to get a feel for what kind of training preceded these injuries. In the majority of cases, injuries seem to come after a very narrow focus - or specialization period.
Earlier this week, I saw a pro baseball guy with chronic on-and-off low back pain. He commented on how it flared up heavily in two different instances: once in college, and the second time during his first off-season. In both cases, it was after periods when he really heavily emphasized squatting 2-3 times per week in an effort to add mass to his lower body. Squats were the round peg, and his movement faults made his body the square hole. Had he only squatted once a week, he might have gotten away with it - but the extreme nature of the approach (high volume and frequency) pushed him over the edge.
I've seen command issues in pitchers who threw exclusively weighted balls, but rarely played catch with another human being. I've seen plenty of medial elbow discomfort in athletes who got too married to the idea of adding a ton of extra weight to their pull-ups.
General fitness folks, powerlifters, and other strength sport athletes can get away with "extreme" specialization programs. Heck, I even co-created a resource called The Specialization Success Guide!
However, athletes in sports that require a wide array of movements just don't seem to do well with a narrow training focus over an extended period of time. Their bodies seem to crave a rich proprioceptive environment. I think this is why "clean-squat-bench press only" programs leave so many athletes feeling beat-up, unathletic, and apathetic about training.
3. Consider athletes' training experience before you determine their learning styles.
I'm a big believer in categorizing all athletes by their dominant learning styles: visual, kinesthetic, and auditory.
Visual learners can watch you demonstrate an exercise, and then go right to it.
Auditory learners can simply hear you say a cue, and then pick up the desired movement or position.
Kinesthetic learners seem to do best when they're actually put in a position to appreciate what it feels like, and then they can crush it.
In young athletes and inexperienced clients, you definitely want to try to determine what learning style predominates with them so that you can improve your coaching. Conversely, in a more advanced athlete with considerable training experience, I always default to a combination of visual and auditory coaching. I'll simply get into the position I want from them, and try to say something to the point (less than ten words) to attempt to incorporate it into a schema they likely already have.
This approach effectively allows me to leverage their previous learning to make coaching easier. Chances are that they've done a comparable exercise - or at least another drill that requires similar patterns - in previous training. As such, they might be able to get it 90% correct on the first rep, so my coaching is just tinkering.
Sure, there will still be kinesthetic learners out there, but I find that they just aren't as common in advanced athletes with significant training experience. As such, I view kinesthetic awareness coaching as a means to the ultimate end of "subconsciously" training athletes to be more in tune with visual and auditory cues that are easier to deliver, especially in a group setting.
4. Separate training age from chronological age.
This can be a difficult concept to relate, so I'll try an example.
I have some 16-year-old athletes who have trained with us at Cressey Sports Performance for 3-4 years and have great anterior core awareness and control. I'd have no problem giving them the slideboard bodysaw push-up, which I'd consider a reasonably advanced anterior core and upper body strength challenge that requires considerable athleticism.
Conversely, I've had professional baseball players in their mid 20s who've shown up on their first day with us and been unable to do a single quality push-up. The professional athlete designation might make you think that they require advanced progressions, but the basics still work with the pros. You might just find that they picked things up quicker - and therefore can advance to new progressions a bit more rapidly than the novice 13-year-old.
Quality years of training means a lot more than simply the number of years a young athlete has been alive, so make sure you're working off the right number!
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The positioning of the feet in a static posture assessment can tell you a lot, but simply looking without following up won't give you a definitive answer. The most common postural distortion you'll see is an externally rotated foot position.
It's common to assume that this is simply a case of an athlete with hips that are stuck in external rotation. And, in many cases, this is definitely the culprit. For these athletes, a hearty dose of knee-to-knee stretches will do the trick (along with some stretches for the hip external rotators in a position of hip extension).
For other athletes, though, this foot position is simply a compensation, as athletes will turn the feet out to compensate for a lack of dorsiflexion (toe-to-shin) range-of-motion. These athletes need to work hard to improve ankle mobility with a combination of lower-extremity soft tissue work and mobility drills.
Last week, I was fortunate enough to get a free copy of Mike Robertson and Bill Hartman’s 2008 Indianapolis Performance Enhancement Seminar DVD Set. To be honest, the word “fortunate” doesn’t even begin to do the product justice; it was the best industry product I’ve watched all year.
The DVD set is broken up into six separate presentations:
1. Introduction and 21st Century Core Training
2. Creating a More Effective Assessment
3. Optimizing Upper Extremity Biomechanics
4. Building Bulletproof Knees
5. Selecting the Optimal Method for Effective Flexibility Training
6. Program Design and Conclusion
To be honest, I’ve already seen Mike Robertson deliver the presentations on DVDs 1 and 4 a few times during seminars at which we’ve both presented, so more of my focus in this review will be on Bill’s presentations because they were more “new” to me. That said, I can tell you that each time I’ve seen Mike deliver there presentations, he’s really impressed the audience and put them in a position to view training from a new (and better) paradigm, debunking old myths along the way. A lot of the principles in his core training presentation mirror what we do with our clients – and particularly with those involved in rotational sports.
Bill’s presentation on assessments is excellent. I think I liked it the most because it really demonstrated Bill’s versatility in that he knows how to assess both on the clinical (physical therapy) and asymptomatic (ordinary client/athlete) sides of the things. A few quick notes from Bill’s presentation that I really liked:
a. Roughly 40% of athletes have a leg length discrepancy – but that’s not to say that 40% of athletes are injured or even symptomatic. As such, we need to understand that some asymmetry is normal in many cases – and determining what is an acceptable amount of asymmetry is an important task. As an example, in my daily work, a throwing shoulder internal rotation deficit (relative to the non-throwing shoulder) of 15 degrees or less is acceptable – but if a guy goes over 15°, he really needs to buckle down on his flexibility work and cut back on throwing temporarily. If he is 17-18° or more, he shouldn’t be throwing – period.
b. It’s important to consider not only a client/patient/athlete looks like on a “regular” test, but also under conditions of fatigue. There’s a reason athletes get hurt more later in games: fatigue changes movement efficiency and safety! This is why many tests should include several reps – and we should always be looking to evaluate players “on the fly” under conditions of fatigue.
c. Bill made a great point on “functional training” during this presentation as well – and outlined the importance difference between kinetics (incorporates forces) and kinematics (movement independent of forces). Most functional training zealots only look at kinematics, and in the process, ignore the amount of forces in a dynamic activity. For example, being able to execute a body weight lateral lunge with good technique doesn’t guarantee that you’ll be “equipped” to handle change-of-direction challenges at game speed. In reality, this force consideration is one reason why there are times that bilateral exercise is actually more function than unilateral movements!
d. Bill also outlined a multi-faceted scoring system he uses to evaluate athletes in the context of their sports. It’s definitely a useful system for those who want a quantifiable scheme through which to score athletes on overall strength, speed, and flexibility qualities to determine areas that warrant prioritization.
DVD #3 is an excellent look at preventing and correcting shoulder problems – and in terms of quality, this presentation with Mike is right on par with their excellent Inside-Out DVD. Mike goes into depth on what causes most shoulder problems and how we can work backward from pathology to see what movement deficiency – particularly scapular downward rotation syndrome – caused the problem. There is a great focus on lower trapezius and serratus anterior strengthening exercises and appropriate flexibility drills for the pec minor, levator scapulae, and thoracic spine – as well as a focus on the effects of hip immobility and rectus abdominus length on upper body function.
To be honest, I think that DVD #4 alone is worth far more than the price of the entire set. It actually came at an ideal time for me, as I’m preparing our off-season training templates for our pro baseball guys – and flexibility training is a huge component of this. Whenever I see something and it really gets me thinking about what I’m doing, I know it’s great. Bill’s short vs. stiff discussion really did that for me.
Bill does far more justice to the discussion than I can, but the basic gist of the topic is that the word “tight” doesn’t tell us much at all. A short muscle actually has lost sarcomeres because it’s been in a shortened state for an extended period of time; this would be consistent with someone who had been immobilized post-surgery or a guy who has just spent way too long at a computer. These situations mandate some longer duration static stretching to really get after the plastic portion of connective tissue – and this can be uncomfortable, but highly effective.
Conversely, a stiff muscle is one that can be relatively easily lengthened acutely as long as you stabilize the less stiff segment. An example would be to stabilize the scapula when stretching someone into humeral internal or external rotation. If the scapular stabilizers are weak (i.e., not stiff), manually fixing the scapula allows us to effectively stretch the muscles acting at the humeral head. If we don’t stabilize the less-stiff joint, folks will just substitute range of motion there instead of where we actually want to create it. In situations like this, in addition to good soft tissue work, Bill recommends 30s static stretches for up to four rounds (this is not to be performed pre-exercise, though; that’s the ideal time for dynamic flexibility drills.
DVD #5 is where Mike is at his best: talking knees. This is a great presentation not only because of the quality of his information, but also because of his frame of reference; Mike has overcome some pretty significant knee issues, including a surgery to repair a torn meniscus. Mike details the role of ankle and hip restrictions in knee issues, covers the VMO isolation mindset, and outlines some of the research surrounding resistance training and rehabilitation of knee injuries in light of some of the myths that are abundant in the weight-training world.
DVD #6 brings all these ideas together with respect to program design.
I should also mention that each DVD also includes the audience Q&A, which is a nice bonus to the presentations themselves. The production quality is excellent, with “back-and-forths” between the slideshow and presenters themselves. Bill and Mike include several video demonstrations in their presentations to break up the talking and help out the visual learners in the crowd, too.
All in all, this is a fantastic DVD set that encompasses much more than I could ever review here. In fact, if it’s any indicator of how great I think it is, I’m actually going to have all our staff members watch it. If you train athletes or clients, definitely get it. Or, if you’re just someone who wants to know how to keep knees, shoulders, and lower backs healthy while optimizing flexibility, it’s worth every penny. You can find out more at the Indianapolis Performance Enhancement Seminar website.
