Home Posts tagged "Corrective Exercise"

Strength and Conditioning Stuff You Should Read: 12/18/17

It's a short week on the content front, as I posted last week's recommended reading a few days late. We are still making things happen, though!

Eccentric Overload with Flywheel Training and Rehabilitation - This is an awesome article from the power couple, Jennifer Reiner-Marcello and Brandon Marcello. We've been using the Versapulley more and more in our training, and this delves into some of the mechanisms that make it so great.

Brian St. Pierre on the Fundamentals of High-Performance Nutrition - Brian has been a friend, employee, and trusted resource for over a decade - and podcasts like this show why that's the case. He delivers some excellent content.

11 Ways to Make an Exercise Harder - Earlier this week, on social media, I shared this old article of mine from T-Nation. It's a collection of important programming progressions and regressions that anyone writing strength training programs should understand.

Top Tweet of the Week

Top Instagram Post of the Week

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Recency Bias and Long-Term Training Success

Last week, I was reading through a quarterly magazine published by a financial advisory firm with whom my wife and I work, and it introduced the concept of recency bias. WikiInvest.com describes this phenomenon as:

"Recency Bias is where stock market participants evaluate their portfolio performance based on recent results or on their perspective of recent results and make incorrect conclusions that ultimately lead to incorrect decisions about how the stock market behaves."

In other words, when the stock market tanks, people are - in the short-term - very reluctant to invest. And, when the market thrives, they can't wait to invest. This is in spite of the fact that these might be the exact opposite of the best approaches, and inherently at odds with a fiscally responsible long-term strategy.

stock-exchange-641907_1280

Interestingly, the concept of recency bias has implications in the rehabilitation, health, and human performance fields. To illustrate this, I'll give you an example.

Back in October of 2015, I had a one-time consult at our Jupiter, FL facility with a individual with chronic shoulder, elbow, and hip/lower back issues. After a week-long stay in Florida with an assessment and week of in-person coaching, he's followed up with online-only programs from across the country. His progress has been fantastic in that time, with his exercise pool expanding and movement quality improving significantly. What's been really interesting is seeing the shift from "movement weary" to "fired up to train." 

His first few months of programming was very much about feeling out exercise selection and technique. For example, here were three email excerpts:

November 8: "Missed my first week of workouts after I got back home. Everything has been going good since. I plan on spending some extra weeks on this program before getting a new one to master the techniques on the serratus and periscapular exercises."

December 7: ".Can you check my wall slide form? Sometimes I feel it a tad bit in the front of the shoulder on the upward rotation and lift off."

December 16: "Need some help on bottoms up KB crosswalk. Not sure if I have the proper overhead scapula position. and suspect I might be in a bit of extension." 

When it comes to movement quality, I often talk with new clients about an eight-week magic mark. Be consistent for eight weeks, and re-evaluate where you stand. If there isn't considerable progress, you may need to shake things up with your approach. Take a look at what happened to the tone of the emails in the months that followed:

December 30: "Great new program by the way. I like how you bridged the gap between weights and corrective exercise. Shoulders and elbows feel better."

April 8: "Hips are feeling better than before I started the program!! Getting better glute activation on the back leg during lunges, and also getting better hip extension on bridges and hip thrusts were both very helpful for the hips."

May 24: "Keep working on my tight hips. Feeling better there but still a little stiff. My front squat went up! Keep getting stronger, and keep the shoulders safe!"

July 26: "New program is awesome! I didn't think I would be able to bench pain free before I started. Super psyched to see bench in my program."

August 28: "New program time! Made some good gains on the last one looking forward to the new one. Hips feel 3 times better. I want to make some more strength gains on this new program. Just throw in enough corrective exercise for all my previous chronic injuries. Really excited for this new program. I'm getting a lot stronger and I feel like a beast again!"    

This is where you see how important it is to avoid recency bias in your training, whether you have a considerable injury history or you want to avoid an injury in the first place. This individual is doing a great job of recognizing that while things are going well, he needs to preserve the balance between pushing his body and taking care of it. And, I'm sure that there will be times moving forward when we'll have to remind him to pump the brakes a bit; it's the give and take of training progressions. 

Don't only do your correctives when you are a) hurt or b) have recently been hurting; make sure to keep at least some of them around for the long haul. As my physical therapist buddy, Eric Schoenberg, has said, 

[bctt tweet="What gets you healthy keeps you healthy."]

Likewise, just because you've been healthy and managed to get away with brutal training technique and horribly designed programming doesn't mean that it'll last forever. As I Tweeted in the past, 

 

Now, please keep in mind that I'm not advocating that you foam roll for four hours per day and complete a two-a-day, 57-exercise mobility routine. If you're efficient with your exercise selection and pristine with your training technique, it can be accomplished relatively easily. If you look at the warm-ups in The High Performance Handbook, they cover the overwhelming majority of any "correctives" you'd need, and the rest is accounted for with the comprehensive, well-balanced strength and conditioning programs. It's not a rehab program; but it could very well be called an "avoid rehab" program.

HPH-main

The take-home point of this article is every successful approach to training avoids the recency bias trap. Just because something happened in the recent past doesn't necessarily mean it should be more heavily weighted in your planning or execution. In other words, have a smart plan - and stick to it!

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Strength and Conditioning Stuff You Should Read: 4/23/16

It's a rainy Saturday morning, so what better way to overcome the weather than to check out some good reading material? Here's some excellent stuff I've come across lately:

4 Reasons Fitness Professionals Must Understand Corrective Exercise and Post-Rehab Training - I wrote up this post a few years ago, but wanted to bring it back to the forefront in light of the fact that Dean Somerset put his excellent resource, Post-Rehab Essentials, on sale for $50 off through the end of the weekend.

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"Because My Boss Sucks" is a Sh**ty Reason to Open Your Own Gym - The title is a bit aggressive, but my business partner, Pete Dupuis, wrote up a great post for all the fitness professionals out there who are considering opening their own facilities. 

Scaling Up Excellence - I finished up this excellent book by Robert Sutton on my drive back to Massachusetts last weekend. It's targeted toward managing growth of businesses, but has a ton of invaluable messages for coaches, too.

scaling-up-excellence

I've also decided to start including my top Tweet and Instagram posts of the week in this weekly feature. Here they are:

 

Top Tweet:

throwing

Top Instagram Post:

Have a great weekend!

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Expanding the “Safe” Exercise Repertoire

In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.

Back-Mechanic

As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,

“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”

As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:

layback

Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:

throwingprogression

You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.

For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”

How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.

To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.

Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.

Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).

Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:

(Feet-Elevated) Push-up Isometric Holds > (Feet-Elevated) Body Weight Push-up > Stability Ball Push-up > Weighted Push-up > Neutral Grip DB Floor Press > Neutral Grip Decline DB Press > Pronated Grip Decline DB Press > Barbell Board Press (gradual lowering) > Barbell Floor Press > Neutral Grip DB Bench Press > Low Incline DB Press > Close-Grip Bench Press > Bench Press > Bottoms-up KB Military Press > Barbell Incline Press > Barbell Overhead Pressing

Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.

A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.

This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.

With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.

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Quick and Easy Ways to Feel and Move Better – Installment 61

This installment of quick tips comes from Cressey Sports Performance coach, Miguel Aragoncillo.

1. Use “discovery learning” as a way to improve retention for movement patterns.

Going to continuing education courses consistently allows me to adjust my perspective based on the “latest” information available in the industry. However, one of the biggest things that allows me to shift my perspective further is to listen in and converse with other professionals during lunch breaks to further understand the topic at hand in a more productive way.

This first point divulges how to implement a sense of discovery about movement patterns and gives some very straight forward tips for coaching anything that is new to your clients or athletes.

Keep these points in mind when using this new technique of teaching.

Use your athlete/client's words and language to help them learn a movement better.

Not every person will know where their glutes are, for example. Have the athlete just point to the part of their body where they feel it; you don’t need a PhD in Exercise Science to teach a basic movement pattern.

Remove body parts.

If a hip hinge is too difficult, reduce the neuromuscular challenge by having them start on two knees instead of two feet. Now the movement is largely a singular hinging pattern when they start on their knees, instead of stabilizing on their feet.

2. Consider reducing the number of “corrective exercises” you perform.

I’m a big fan of Dan John and his easily quotable phrase, “Keep the goal the goal.” Maintain your perspective of the goal at hand. If your goal is to improve strength, lose fat, or improve at your sport, how many corrective exercises are you performing? How much time are you utilizing doing foam rolling? Minimize your time spent analyzing your own problems by seeking out the best coaches, therapists, or nutrition coaches, and get to work on that goal. Sometimes, you'll find that exercises can even be combined to improve efficiency without sacrificing the benefit.

Corrective exercises are supposed to correct something. By omitting these movements, will the athlete miss any crucial movement patterns? Play “Devil’s Advocate” and make sure to incorporate all that is necessary, but no more. If you aren't careful, your "correctives" can wind up becoming a cumbersome majority of your training sessions.

3. Learn the difference between blocked and random practice - and apply each appropriately.

On the topic of training youth athletes, I recently attended a seminar in which blocked vs. random practice was presented. For the purposes of this article, blocked practice is specific training of a singular skill with no changes in environmental surroundings (like swinging a bat against a pitching machine over and over). Conversely, random practice involves having an individual adapt to the surroundings and incorporate different (but similar) skills (like swinging a bat for different scenarios - with a live pitcher).

The biggest question of the day was, "Which athlete excelled when it came time for performance?"

When tested in the short-term, blocked practice performed better than random practice. This makes sense, because if you practice a singular skill over and over, you will get better at that skill.

However, when enough time passed for participants to “forget,” retention of skills was the name of the game. So when retaining skills for a longer term, blocked practice did not do as well, and practicing “randomly” prevailed.

From a logical point of view, this is similar to memorizing sentences when you’re cramming for a final exam. Sure, you’ll do great if the teacher just has the same exact sentences or questions as the book - but what happens if the teacher forces you to critically think, and asks questions that are different than the material presented during class?

This leads quite appropriately into the context of a long term athletic development model. By increasing skills and techniques in a broad sense, athletes will more easily acquire specific sport skills. Conversely, with early sports specialization, athletes are practicing (almost always) one skill over and over, and struggle when diverse, more unpredictable movement is required for success.

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What are the actionable items you can take away from this?

If you coach youth athletes, or you yourself have a young son or daughter:

• Encourage them to try multiple sports.
• Allow them to “figure it out” when it comes to decision making skills, especially as it applies to sports.
• Provide feedback - but much, much later after the competition, game, or practice session.
• This will allow for them to come up with their own unique thoughts, and allow them to be uninhibited when it comes to creating a solution to whatever problems occur during a game.

While this is a “Quick and Easy Way to Move and Feel Better” series, I imagine that we can help everyone of all ages move and even feel better by taking this information and acting on it.

4. Try this quick oatmeal snack.

I’ve been preparing for a powerlifting meet for the past few months, and an easy go to snack in the morning and/or at night is a quick oatmeal snack.

It’s fast, needs little ingredients, is a flexible snack, or even as a snack if your goal is to gain mass.

PB2 Oatmeal

• 1/2 cup Oatmeal
• 2 tbsp Chocolate Peanut Butter or Powdered Peanut Butter
• 1 Scoop of Protein Powder
• Handful of [Frozen] Blueberries
• Honey for taste
• 1 cup of almond or whole milk

Macros
Fat: ~9g
Carbs: ~54g
Protein: ~42g

Prep time: Pour the oats in first, followed by milk, then heat to 90-120 seconds. Then, add everything in and mix it up. The easy clean-up makes this a go-to for the past few weeks/months with all the snow in Massachusetts!

5. Remember that band can increase resistance - or assist in cleaning up a movement pattern.

Whether your goal is maximal strength, increased hypertrophy, or even learning an exercise for the first time, bands are a useful tool.

Band placement is critical for learning how an exercise can increase resistance, or assist during a movement.

For example, you can improve strength by performing a band resisted push-up, or help the push-up by utilizing a band under the waist to elicit a “pop” out of the bottom of the push-up (where the exercise is most difficult).

Band Assisted Push-Up - Miguel

At the same time, bands can help to improve reactive core engagement, or in other words, your body will have to reflexively react in a favorable way.

About the Author

Miguel Aragoncillo (@MiggsyBogues) is a strength and conditioning coach at the Hudson, MA location of Cressey Sports Performance. More of his writing can be found on www.MiguelAragoncillo.com.

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Seminar Announcement: Jupiter, FL on March 29, 2015

I just wanted to give you a heads-up on one-day seminar with me at Cressey Sports Performance in Jupiter, FL on Sunday, March 29, 2015.

CSP florida-02(1)

We’ll be spending the day geeking out on shoulders, as the event will cover Shoulder Assessment, Corrective Exercise, and Programming.  The event will be geared toward personal trainers, rehabilitation specialists, and fitness enthusiasts alike.

Agenda

9:00AM-9:30AM – Inefficiency vs. Pathology (Lecture)
9:30AM-10:15AM – Understanding Common Shoulder Injuries and Conditions (Lecture)
10:15AM-10:30AM – Break
10:30AM-12:30PM – Upper Extremity Assessment (Lab)
12:30PM-1:30PM – Lunch
1:30PM-3:30PM – Upper Extremity Mobility/Activation Drills (Lab)
3:30PM-3:45PM – Break
3:45PM-4:45PM – Upper Extremity Strength and Conditioning Programming: What Really Is Appropriate? (Lecture)
4:45PM-5:00PM – Q&A to Wrap Up

Location

Cressey Sports Performance
880 Jupiter Park Drive
Suite 7
Jupiter, FL 33458

Continuing Education Credits

The event has previously been approved for 0.7 NSCA CEUs when I've presented it elsewhere, and we expect the same to be the case here in FL as soon as the paperwork goes through.

Cost:

Early Bird (before March 2) – $149.99
Regular (after March 2) - $199.99

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 offering sold out well in advance of the early-bird registration deadline.

Registration

Click here to register using our 100% secure server!

Accommodations

We've secured a discounted hotel rate with the following hotel, which is less than five minutes from Cressey Sports Performance:

Fairfield Inn & Suites
6748 Indiantown Rd.
Jupiter, FL 33458

Simply call 561-748-5252 and mention the "Cressey rate," and they'll take care of you.

Here's that registration link again. Looking forward to seeing you there!

Questions? Please email cspflorida@gmail.com

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The Overhead Lunge Walk: My Favorite “Catch-All” Assessment

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.

IMG_7810

Additionally, you can screen for congenital laxity, as a lot of hypermobile (loose jointed) folks will actually hyperextend the elbows during the overhead reach.

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At the shoulder girdle, you can evaluate whether an individual has full shoulder flexion range of motion:

IMG_7895

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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7 Random Thoughts on Corrective Exercise and Post-Rehab Training

If you've read much of my stuff (most notably this article), you likely appreciate that I think it's really important for fitness professionals to understand corrective exercise and post-rehab training. Folks are demonstrating poorer movement quality than ever before, and injuries are getting more and more prevalent and specific. For the fitness professional, corrective exercise can quickly become a tremendous opportunity - or a huge weakness. To that end, given that Dean Somerset put his great resource, Post-Rehab Essentials, on sale for $50 off through the end of the day, I wanted to devote some thoughts to the subject with these seven points of "Eric Cressey Randomness."

cropped-postrehabessentialsheader

1. Refer out. - With more and more certifications and seminars devoted to corrective work, the industry has a lot more "corrective cowboys:" people who are excited to be able to "fix" everything. Unfortunately, while this passion is admirable, it can lead to folks taking on too much and refusing to refer out. To that end, I think it's important for us to constantly remind fitness professionals to not work outside their scope of practice.

Referring out is AWESOME. I do it every single day - and to a wide variety of professionals. It provides me with more information, and more importantly, helps me toward the ultimate goal of getting the client/athlete better. Trainers often worry that if they refer out, they'll lose money. This generally isn't true, but even if it was, it's a short-term thing. If you appreciate the lifetime value of the client, you'll realize that getting him/her healthy will make you more profitable over the long-term.

Additionally, I've developed an awesome network of orthopedic specialists in the greater Boston area. As a result, I can generally get a client in to see a specialized doctor for any joint in about 24-48 hours. It's an awesome opportunity to "overdeliver" to a client - but it never would have come about if I hadn't been willing to refer out. As an added bonus, we'll often get referrals from these doctors as well.

2. Ancillary treatments are key. - For my entire career, I've been motivated by the fact that I absolutely hate not knowing something. It's pushed me to always continue my education and not get comfortable with what I know, and it's helped me to be open-minded to new ideas. However, I'm humble enough to recognize my limitations. I know a lot about elbows, but I'm not going to do your Tommy John surgery. I've worked with more pitchers than I can count, but I'm not a pitching coach. And, even if I was able to do all these things, there's no way I'd have time to do them all and leverage my true strengths. In other words, I rely heavily on competent professionals around me for everything from sport-specific training, to manual therapy, to diagnostic imaging, to surgery, to physical therapy, to nutritional recommendations. Surround yourself with great people with great skillsets, and corrective exercise quickly becomes a lot easier.

manual_therapy_page

3. Soft tissue work is effective.

Here's what I know: people feel better after they foam roll, and their range of motion improves. Additionally, soft tissue treatments have been around for thousands of years for one reason: they work!

For some reason, though, every 4-6 months, somebody with a blog claims that foam rolling is the devil and doesn't work, and then dozens of people blow up my email address with questions about whether the world is going to end.

The truth is that we know very little about why various soft tissue approaches work. I recall a seminar with bodywork expert and fascial researcher Thomas Myers from a few year back, and he commented that we "know about 25% of what we need to know about the fascial system." If Myers doesn't have all the answers, then Johnny Raincloud, CPT probably hasn't found the secrets during his long-term stay in his parents' basement.

With that in mind, I do think it's safe to say that not all people respond the same to soft tissue work, and certainly not all soft tissue approaches are created equal. Foam rolling doesn't deliver the same results as an instrument-assisted approach, and dry needling likely works through dramatically different physiological avenues than cupping. As a result, we're left asking the client: "does it make you feel and move better?" If the answer continues to be "yes," then I'll keep recommending various soft tissue treatments - including foam rolling - until someone gives me a convincing contrarian argument with anecdotal evidence.

4. Strength can be corrective.

Ever had a friend with anterior knee pain (patellar tendinopathy) who went to physical therapy, did a bunch of leg extensions, and somehow managed to leave asymptomatic? It was brutally "non-functional" and short-sighted rehab, but it worked. Why?

Very simply, the affected (degenerative or inflamed) tissues had an opportunity to rest, and they came back stronger than previously. A stronger tissue is less likely to become degenerative or inflamed as it takes on life's demands.

Good rehab would have obviously focused on redistributing stress throughout the body so that this one tissue wouldn't get overloaded moving forward. In the patellar tendon example, developing better ankle and hip mobility would be key, and strength and motor control at the hip and lumbar spine would be huge as well. Certainly, cleaning up tissue quality would be a great addition, too. However, that doesn't diminish the fact that a stronger tissue is a healthier tissue.

This also extends to the concept of relative stiffness. As an example, a stronger lower trapezius can help to overcome the stiffness in the latissimus dorsi during various upper extremity tasks.

And, a stronger anterior core can ensure corrective spine and rib positioning during overhead reaching - again, to overcome stiff lats.

Don't ever forget that it's your job to make people stronger. If you get too "corrective" in your mindset, pretty soon, you've got clients who just come in and foam roll and stretch for 60 minutes, then leave without actually sweating. You still have to deliver a training effect!

5. Minimalist sneakers might be your worst nightmare if you have high arches.

I love minimalist sneakers for my sprint and change-of-direction work. I don't, however, love to wear them on hard floors for 8-10 hours a day. I'm part of the small percentage of the population that has super high arches and doesn't decelerate very well, so cushioning is my best friend. Throwing in a $2 "cut-to-fit" padding in my sneakers has done wonders for my knees over the years, and I'll actually wear through them every 4-6 weeks.

The New Balance Minimus 00 is a sneaker I've been wearing recently to overcome this. It's a zero drop shoe (no slope down from the heel to the toe), and while lightweight, it offers a bit more cushioning (and lateral support, for change of direction) than typical minimal options.

mx00gy_nb_14_i

All that said, just don't force a round peg in a square hole with respect to footwear. Some people just aren't ready for minimalist footwear - and even if they are ready to try them out, make sure you integrate usage gradually.

6. The pendulum needs to swing back to center with respect to thoracic spine mobilizations. - Thoracic spine mobility deficits are a big problem in the general population, given the number of people who spend too much time sitting at a computer. Athletes are a bit of a different situation, though, as some actually have flat (excessively extended) thoracic spines and don't need more mobility. As an example, check out the top of this yoga push-up before we corrected it.

yoga

This athlete has a flat thoracic spine, limited shoulder flexion, and insufficient scapular upward rotation. So, he'll logically go to the path of least resistance: excessive thoracic motion (as evidenced by the "arch" in his upper back). The shoulder blades don't rotate up sufficiently, and he's also "riding" on the superior aspect of his glenohumeral (shoulder ball-and-socket) joint. Here is it, "mostly" corrected a few seconds later:

yoga1

By getting him to "fill up" the space between his shoulder blades with his rib cage (encouraging more thoracic flexion) and cueing better upward rotation of his scapula, we can quickly recognize how limited his shoulder flexion is. In the first photo, he's forcing shoulder ROM that isn't there, whereas in the second one, he's working within the context of his current mobility limitations.

If we just feed into his thoracic spine hypermobility with more mobilizations, we'll just be teaching him to move even worse.

7. You'll never address movement impairments optimally unless nutrition and supplementation are spot on. - It never ceases to amaze me how many athletes will bust their butts in the gym and in rehab, following those programs to a "T" - but supplement that work with a steady diet of energy drinks and crappy food. I'm not talking about debating whether grains and dairy are bad, and whether "paleo" is too extreme for an athlete; those are calculus questions when we should be talking about basic math. A lot of athletes literally don't eat vegetables or drink enough water. That's as basic as it comes. Movement quality will never improve optimally unless you're healthy on the inside, too.

This article was actually a lot of fun to write, so I'll probably turn it into a series for a bit down the road. In the meantime, though, I'd encourage you to check out Dean Somerset's Post-Rehab Essentials resource to learn more in this regard. I don't hesitate to endorse this comprehensive corrective exercise resource, as the content is fantastic, Dean is an excellent teacher, and the product provides some continuing education credits. The $50 off just sweetens the deal. Check it out HERE.

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6 Tips for People Who Stand All Day

Sitting has been blamed for a lot of the "modern" musculoskeletal conditions and poor posture we see in today's society, and rightfully so: having this posture all day is an absolutely terrible way to treat your body.

Fortunately, by teaching folks to get up and move around during the day, we can break the "creep" that sets in over the course of time.  Additionally, we can implement ergonomic adjustments (e.g., standing desks) and mobility and strength training programs that favorably impact posture to prevent these issues from becoming a serious problem long-term.

Unfortunately, though, in the process of focusing our heavy attention on those who sit all day, we've forgotten to show some love to the individuals who have to spend the entire day on their feet.  And, this is actually a large segment of the population, encompassing the majority of young athletes, manual laborers, and - you guessed it - fitness professionals and coaches. 

My name is Eric, and I have a problem: standing 8-10 hours per day.

It's important to appreciate that "good posture" is different for everyone.  If I sit all day, I'll probably wind up in posterior pelvic tilt. Conversely, when you see folks who stand all day, it's generally greater lordosis and anterior pelvic tilt):

Of course, I should reiterate that this is a generalization. There are folks who sit all day who do so in anterior tilt, and those who stand all day in posterior tilt.  As such, you have to be careful to assess and not assume.

With all that aside, let's talk about my top six tips for those who stand all day.

1. Stand differently.

This is clearly the most obvious of the bunch, but it never ceases to amaze me that folks will ask for all the best exercises to correct X posture or Y condition, yet they won't pay attention to modifying their daily postural habits to get the ball rolling.

If you're on your feet and stuck in extension all day, engage the anterior core and activate the glutes to get yourself into a bit more posterior pelvic tilt.  Doing so can take you to a position of discomfort to one of complete relief in a matter of seconds. 

Remember that these adjustments have to be conscious before they can become subconscious.  In other words, be consistent with these basic adjustments and eventually you'll find yourself establishing a better resting posture.

Also, if your posture looks like this...

leftaic

...make sure you check out this great post from Greg Robins to change your "standing strategy."

2. Learn to exhale fully.

The rectus abdominus and external obliques are two prominent muscles responsible for exhalation.  Both of them also posteriorly tilt the pelvis.  As such, when you learn to exhale fully, the pelvis posteriorly tilts and the ribs come down, taking you out of excessive lordosis and relieving some of the annoying lower back tightness you may be experiencing.  One of my favorite drills for this was inspired by the Postural Restoration Institute.  Deep squat belly breathing gets you some length of the latissimus dorsi (a gross extensor) and flexes the spine back toward neutral.  During inhalation, the belly pushes out against the quads to make sure that the individual isn't breathing into the supplemental respiratory muscles (e.g., sternocleidomastoid, scalenes, pec minor) we don't want to use.  Then, we just try to get all the air out on each exhale.

Of course, there are several other options you can use on this front as long as you understand the positions you're trying to achieve and the cues you want to integrate.

3. Break your day up with "relief" postures.

I always tell our clients that the best posture is the one that is constantly changing.  It's healthy to be a good "fidgeter." This also applies to the way you stand - or your avoidance of excessive standing.  You simply have to break up the day.  Maybe you try to find time to sit, lay on your back for a bit, or go into a half-kneeling (lunge) position.  These are great benefits of being a fitness professional; you're constantly going from one position to the next for the sake of demonstrating or coaching an exercise.

If rolling around on the ground isn't an option, look to integrate a split-stance position while standing.  It's much more difficult to hang out in excessive lordosis and anterior pelvic tilt if you're in a split-stance position than if your feet are side-by-side.  It's also one reason why we teach all of our wall slide variations with one leg forward (usually the right leg).

4. Work in low-level anti-extension drills throughout the day.

If you do have the freedom in your schedule and responsibilities to incorporate some different mobility drills during the day, here are some quick and easy ones you can apply without any equipment.

5. Avoid feeding into your resting postural dysfunction with flawed training approaches.

People who stand in extension can usually "get away with it" if they train well.  When they stand in extension all day and then feed into this dysfunction in their training programs, things can get worse sooner than later.  In other words, if you're standing all day and then you crush hyperextensions in all your workout routines, expect to have a really tight lower back. 

However, it's not just hyperextensions that would be a problem.  Rather, doing a ton of arching on the bench press and squat could make things worse as well.  You may not be a candidate for an aggressive powerlifting-style bench press with a big arch, as an example. However, a more moderate set-up should be fine.

As important as what not to do is what you should do - and you should definitely work on glute activation/posterior chain strength...

...as well as anterior core stability with prone bridges, reverse crunches, and rollout/fallout variations.

Take all together, I'm basically saying that if you have an extension bias in your daily life, you probably need a flexion bias in your training.  Likewise, if you have a flexion bias in your daily life, you probably need an extension bias in your training.

6. Play around with footwear.

Not all feet are created equal, and I'm a perfect example: I have super high arches.  Heavy supinators like me typically don't do well on hard surfaces for extended periods of time, as we're built more for propulsion than deceleration (probably one more reason that I'm a powerlifter and not a distance runner).  So, you can imagine what walking around on these floors for 8-10 hours per day does to my knees and lower back.

I'm able to minimize the stress by putting some cushioned insoles in my sneakers and changing them every 6-8 weeks.  The insoles don't change the contour of the shoe; they just offer some padding.  Conversely, heavy pronators may do better for extended periods of times on their feet by wearing firmer shoes, or trying out some orthotics.  The answer is different for everyone, but at the end of the day, the take-home message is the same: if you're going to be on your feet all day, you better find the right footwear for you.

Wrap-up

If you've read this entire article, chances are that you feel my pain - literally and figuratively - and realize the standing all day can be just as problematic as sitting all day.  Fortunately, I can promise you that these strategies do work, as I employ them every day myself.  Give them a shot and you'll find that "standing around" is much more tolerable.

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3 Coaching Cues for Strength and Conditioning Programs – Shoulder Edition

Since this series was so popular this year, I figured I'd try to squeeze in just one more collection of suggestions before the 2012 wraps up. Here are three more coaching cues for your strength and conditioning programs:

"1. Pull the elbows to your hips."

As I discussed a while back in my Cleaning Up Your Chin-up Technique post, you want to be careful about extending the humerus past neutral at the top position of a chin-up. If the elbow moves behind the body In this position, the humeral head can glide forward, irritating the biceps tendon and anterior capsule. Additionally, the thoracic spine becomes excessively kyphotic, and the scapula may anteriorly tilt, closing down the subacromial space and exacerbating impingement on the rotator cuff tendons. Here’s what the bad looks like:

I’ve found that encouraging athlete to pull the elbows to the hips prevents this excessive humeral extension, and it also makes athletes stricter with their technique; they have to get the chest to the bar instead of just reaching with the chin and creating a forward head posture.

Conversely, if you encourage many young athletes to “just get your chin to the bar,” you get some garbage kipping concoction that looks like Quasimodo on the monkey bars with his pants on fire.

"2. Keep the biceps quiet."

Piggybacking on our previous point, just like excessive humeral extension can create anterior (front) shoulder stress, uncontrolled external rotation can be equally problematic, as the humeral head will once again want to glide forward if it isn’t appropriately controlled by a combination of rotator cuff recruitment and scapular stability.

If an athlete feels external rotations in the front of his shoulder even in what appears to be the correct position, he’s performing them without monitoring humeral anterior glide. If this occurs, I’ll have him place his opposite hand on the front of the shoulder to monitor any kind of anterior glide of the humeral head, and encourage him to “keep the biceps quiet.” I’d say that 90% of the time, athletes are good to go once this correction takes place. In the other 10% of cases, we’ll regress the athlete to supine and prone external rotations, as well as manual resistance “holds” at the 90/90 position.

"3. Try to touch your butt to the ceiling."

The yoga push-up is one of my favorite push-up variations. Just like all other push-up variations, it gives our shoulder blades freedom of movement, which is important when you consider that they’re essentially stuck in place during bench press movements.

I especially like the yoga push-up because it doesn’t just combine protraction/retraction, but also involves near-full humeral flexion. By elevating the humerus further, we force athletes to work on getting more scapular upward rotation.

If you tell an athlete, “Push your butt away from the floor,” you get greater recruitment of serratus anterior and upper trapezius to really get that last bit of scapular upward rotation – and, at the same time, get some good thoracic spine extension.

That wraps up this installment of cues.  If you like what you're reading, I'd encourage you to check out the Muscle Imbalances Revealed - Upper series, which features a collection of outstanding webinars from some really bright guys in the industry.  Rick Kaselj, who organized the collaborative effort, has the product on sale at a great discount with a 60-day money-back guarantee.  You can check it out here for yourself.


 

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