Home Posts tagged "Corrective Exercise" (Page 4)

Shoulder Hurts? Start Here.

As you can probably imagine, given that I deal with a ton of baseball players - and the fact that I've written about shoulder pain a ton over the past decade - a lot of people initially come to Cressey Performance because their shoulder hurts.  It might be rotator cuff pain, AC joint irritation, or any of a host of other issues, but you'd be surprised at how many similarities there are among the ways that you address most of these issues.

The problem is that pain can throw a wrench in your plans and limit you in your ability to get to exactly where someone needs to improve movement-wise.  For instance, you might have someone who has a significant glenohumeral (ball-and-socket) internal rotation deficit, but it's hard to manually stretch them into internal rotation without further irritating a cranky AC joint.  Or, someone with a partial thickness rotator cuff tear may be dramatically limited in shoulder flexion, but even shoulder flexion with assisted scapular posterior tilt and upward rotation exacerbates their symptoms.  Very simply, you can't just pound round pegs into square holes when it comes to dealing with a delicate joint like the shoulder - and that applies to both asymptomatic and symptomatic shoulders. To that end, there are three initiatives that I think are the absolute most important places to start in just about every case. First, I'm a huge advocate of soft tissue work with a skilled manual therapist.  In our office, we have a massage therapist and chiropractor who performs both Active Release and Graston.  And, we make sure that any physical therapist to whom we refer clients uses manual therapy as an integral part of their treatment approach.  Whether you're a regular exerciser or not, tissues can get dense, nasty, and fibrotic, and integrating some hands-on work on the pec minor, posterior rotator cuff, lats, scalenes, sternocleidomastoid, and several other areas can dramatically reduce an individual's symptoms and improve range-of-motion instantly - and that allows us to do more with a corrective exercise program. Understandably, not everyone has access to a qualified manual therapist all the time, so you can always utilize self-myofascial release in the interim.  Here, in a video from Show and Go: High Performance Training to Look, Feel, and Move Better, CP massage therapist Chris Howard goes over a quick and easy way to loosen up the pecs:

The second area where you really can't go wrong is incorporating thoracic spine mobilizations.  The thoracic spine has direct interactions with the lumbar spine, rib cage, cervical spine, and scapulae; as a result, it has some very far-reaching effects. Unfortunately, most people are really stiff in this region - and that means they wind up with poor core and scapular stability, altered rib positioning (which impacts respiration), and cervical spine dysfunction.  Fortunately, mobilizing this area can have some quick and profound benefits; I've seen shoulder internal rotation improve by as much as 20 degrees in a matter of 30 seconds simply by incorporating a basic thoracic spine mobility drill.

That said, not all thoracic spine mobility drills are created equal.  Many of these drills require the glenohumeral joint to go into external rotation, abduction, and horizontal abduction in order to drive scapular posterior tilt/retraction and, in turn, thoracic spine extension and rotation. If you've got a cranky shoulder, this more extreme shoulder position usually isn't going to go over well.  So, drills like the side-lying extension-rotation are likely out:

For most folks, a quadruped extension-rotation drill will be an appropriate regression:

And, if the hand position (behind the head) is still problematic for the shoulder, you can always simply put it on the opposite shoulder (in the above example, the right hand would be placed on the left shoulder) and keep the rest of the movement the same.

Last, but certainly not least, you can almost always work on forward head posture from the get-go with someone whose shoulder hurts.  We start with standing chin tucks, and then progress to quadruped chin tucks.

Additionally, working on cervical rotation is extremely valuable, although teaching that is a bit beyond the scope of this post.

Keep in mind that these three broad initiatives are really just the tip of the iceberg when it comes to a comprehensive corrective exercise plan that would also include a focus on scapular stabilization and rotator cuff exercises, plus additional mobility drills.  They are, however, safe entry-level strategies you can use with just about anyone to get the ball rolling without making a shoulder hurt worse in a strength and conditioning program.

For more information on what a comprehensive shoulder rehabilitation program and the concurrent strength and conditioning program should include, check out Optimal Shoulder Performance, a DVD set I co-created with Mike Reinold, the Head Athletic Trainer and Rehabilitation Coordinator of the Boston Red Sox.

The Optimal Shoulder Performance DVD is a phenomenal presentation of the variables surrounding shoulder health, function, and performance. It combines the most current research, real world application as well as the the instruction on how to implement its vast amount of material immediately. After just one viewing, I decided to employ some of the tactics and methods into our assessment and exercise protocols, and as a result, I feel that myself, my staff and my clients have benefited greatly. Michael Ranfone BS, CSCS, LMT, ART Owner, Ranfone Training Systems

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How to Deadlift: Which Variation is Right for You? – Part 1 (Conventional Deadlift)

It’s no secret that I’m a big fan of the deadlift.

It’s a great strength exercise for the posterior chain with excellent carryover to real life – whether we’re talking about athletics or picking up bags of groceries.

It’s among the best muscle mass builders of all time because it involves a ton of muscle in the posterior chain, upper back, and forearms.

It’s a tremendous corrective exercise; I’m not sure that I have an exercise I like more for correcting bad posture, as this one movement can provide the stiffness needed to minimize anterior pelvic tilt and thoracic kyphosis.

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These benefits, of course, are contingent on the fact that one can perform the deadlift correctly to make it safe.  And, sadly, the frequency of what I’d consider “safe” deadlifts has diminished greatly as our generation has spent more and more time a) at computers, b) in high-top sneakers with big heel lifts, and c) watering down beginner fitness programs so much that people aren’t taught to deadlift (or do any valuable, compound exercises) when starting a strength training program.

To me, there are two ways to make things “safe.”  The first is to teach correct deadlift technique, which I already did with a 9-minute video that is free to anyone who subscribes to my newsletter (if you missed it, you can just opt-in to view it HERE).  This video troubleshoots three common variations of the deadlift: conventional, sumo, and trap bar.

The second is to educate lifters on which deadlift versions are the safest versions for different individuals with different injury histories and movement inefficiencies.  That’s the focus of today’s piece.  We’ll start with the conventional deadlift.

While this version of the deadlift is undoubtedly the “one that started it all,” it’s also the most technically advanced and potentially dangerous of the bunch.  Shear stress on the spine is going to be higher on the conventional deadlift than any other variation because the bar is further away from the center of gravity than in any other variation.  Additionally, in order to get down to the bar and maintain one’s center of gravity in the right position while maintaining a neutral spine, you’ve got to have excellent ankle, hip, and thoracic spine mobility.  Have a look at the video below, and take note of the position of the ankles, hips, and thoracic spine:

You’ll notice that the ankles are slightly dorsiflexed (knees out over toes).  If you are crazy restricted in your ankles and can’t sufficiently dorsiflex, two problems arise:

1. You can’t create a “space” to which the bar can be pulled back toward (a lot of the best deadlifters pull the bar back to the shin before breaking the bar from the floor).  You can observe this space by drawing a line straight down from the front of the knee to the floor at the 2-second mark of the above video:

2. Those who can’t dorsiflex almost always have hypertonic plantarflexors (calves). These individuals always struggle with proper hip-hinging technique, as they substitute lumbar flexion for hip flexion in order to “counterbalance” things so that they don’t tip over.

You’ll also notice that the hips are flexed to about 90 degrees in my example.  I have long arms and legs and a short torso, so I have a bit less hip flexion than someone with shorter arms would need.  They would utilize more hip flexion (and potentially dorsiflexion) to be able to get down and grab the bar.

Regardless of one’s body type, you need to be able to sufficiently flex the hips.  You’d be amazed at how many people really can’t even flex the hips to 90 degrees without some significant compensation patterns.  Instead, they just go to the path of least resistance: lumbar flexion (lower back rounding).

Moving on to the thoracic spine, think about what your body wants to do when the ankles and hips are both flexed: go into the fetal position.  The only problem is that the fetal position isn’t exactly optimal for lifting heavy stuff, where we want to maintain a neutral spine.  Optimal thoracic spine mobility – particularly into extension – brings our center of gravity back within our base of support and helps ensure that we don’t lose the neutral lumbar spine as soon as external loading (the lift) is introduced.

As you can see, having mobility in these three key areas is essential in order to ensure that the conventional deadlift is both a safe and effective strength exercise in your program.  The problem is that in today’s society, not many people have it.  So, what do we do with those who simply can’t deadlift effectively from the floor?

We’ve got two options:

1. We can simply elevate the bar slightly (or do rack pulls) to teach proper hip hinging technique in the conventional stance – and train the movement within the limitations of their ankle, hip, and thoracic spine (upper back) mobility.

2. We can simply opt to go with a different deadlift variation.  This is something that, for some reason, most previously injured lifters can’t seem to grasp.  They have near-debilitating low back injuries that finally become asymptomatic, and they decide to go right back to conventional deadlifts with “light weights.”  They still have the same movement impairments and flawed technique, so they build their strength back up, ingraining more and more dysfunction along the way.  They’d be better off doing other things – including trap bar and sumo deadlifts – for quite some time before returning to the conventional deadlift.

And, on that note, we’ll examine those two other deadlift variations in parts 2 and 3 of this series.  Stay tuned!

To see how all the deadlift variations fit into a comprehensive strength and conditioning program, check out The High Performance Handbook.

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Corrective Exercise: Why Stiffness Can Be a Good Thing

With reference to strength and conditioning programs, the adjective "stiff" is generally perceived to be a bad thing, as folks mean it in a general sense.  In other words, you seem "locked up" and don't move well. Taken more literally and applied to specific joints, stiffness can be a very good thing.  A problem only exists if someone is excessively stiff - especially in relation to adjacent joints.  If someone has the right amount of stiffness to prevent movement at a segment when desired, then you would simply say that it's "stable."  That doesn't sound too bad, does it? This is generally a very confusing topic, so I'll use some examples to illustrate the concept. Example #1: Reducing kyphosis. Take your buddy - we'll call him Lurch - who sits at a desk all day long.  He's got a horrible Quasimodo posture, and he comes to your for help with improving it.  You know that his thoracic spine is stuck in flexion and needs to be unlocked, so you're obviously going to give him some thoracic spine mobility drills.  That's a no brainer.

However, would you say that Lurch would make better progress correcting bad posture with those drills alone, or if he combines those drills with some deadlifting, horizontal pulling strength exercises, and a more extended thoracic spine posture during the day?  Of course Lurch would do much better with those additions - but why? All those additions increased stiffness. With the thoracic erectors adequately stiff relative to the cervical erectors (which create forward head posture when too stiff) and lumbar erectors (create lordosis when too stiff), there is something to "hold" these changes in place.  If you're just doing the thoracic spine mobilizations, you're just transiently modifying stiffness (increasing tolerance to stretch) - NOT increasing range of motion!

You know what else is funny?  In 99% of cases like this, you'll also see an improvement in glenohumeral range of motion (both transiently and chronically).  Mobilize a thoracic spine and it's easier to create stiffness in the appropriate scapular stabilizers.  When the peri-scapular muscles are adequately stiff, the glenohumeral joint can move more freely.  It's all about understanding the joint-by-joint theory; mobility and stability alternate. Example #2: The guy who can squat deep with crazy stiff hip flexors. A few years ago, one of our interns demonstrated the single-worst Thomas Test I've ever seen.  In this assessment, which looks at hip flexor length, a "good" test would have the bottom leg flat on the table with no deviation to the side.  In the image below (recreated by another intern), the position observed would be indicative of shortness or stiffness in the rectus femoris and/or psoas (depending on modifying tests):

In the case to which I'm referring, though, our intern was about twice as bad as what you just saw.  He might very well have had barnacles growing on his rectus femoris, from what I could tell.  But you know what?  He stood up right after that test and showed me one of the "crispest" barefoot overhead squats I've ever seen.

About an hour later, I watched him front squat 405 to depth with a perfectly neutral spine.  So what gives?  I mean, there's no way a guy with hip flexors that stiff (or short) should be able to squat without pitching forward, right?

Wrong.  He made up for it with crazy stiffness in his posterior hip musculature and outstanding core stability (adequate stiffness).  This stiffness enables him to tap in to hip mobility that you wouldn't think is there.

Is this a guy that'd still need to focus on tissue length and quality of the hip flexors?  Absolutely - because I'd expect him to rip a hole in one of them the second he went to sprint, or he might wind up with anterior knee pain eventually.

Does that mean that squatting isn't the best thing for him at the time, even if he can't do it?  Not necessarily, as it is a pattern that you don't want to lose, it's a key part of him maintaining a training effect, and because you want him to feel what it's like to squat with less anterior hip stiffness as he works to improve his hip mobility (rather than just throw him into the fire with "new hips" down the road).

These are just two examples; you can actually find examples of "good stiffness" all over the body.  So, as you can imagine, this isn't just limited to corrective exercise programs; it's also applicable to strength and conditioning programs for healthy individuals.  Effective programs implement mobility exercises and self myofascial release to transiently reduce stiffness where it's excessive, and strength exercises to stiffen segments that are unstable.  Effectively, you teach the body how to move correctly - and then load it up to work to make that education permanent.

Want to take the guesswork out of your strength and conditioning programming?  Check out Show and Go: High Performance Training to Look, Feel, and Move Better.

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Strength Training Programs: Lifting Heavy Weights vs. Corrective Exercise – Finding a Balance

Q: How does one find a balance between "technique/form/corrective/sissy work" and lifting heavy weights to make gains in a strength training program? I see both extremes, but am curious about what affects the balance between the two.

A: This is actually a great question, and I am actually surprised that I’ve never answered it before in over five years of writing on this site.

For me, it all comes down to five factors in each athlete/client: strength training experience, injury history, goals, time to commit, and training session structure.

In someone with limited strength and conditioning, more of the session is going to be devoted to technique work on entry level strength exercises.  You don’t have to worry as much about lifting really heavy weights simply because beginners can make appreciable strength gains with as little as 40% of 1-rep max on exercises.  The more advanced an athlete becomes, the less time you spend on technique work, and the more work you do with strength development and corrective exercise.  Eventually, when an athlete has a lot of strength, you have to consider whether all the time and effort that would go in to adding 20 pounds to his squat would actually be better spent elsewhere – whether it’s with corrective work, power training at a lower percentage of 1-rep max, or in introducing new exercises.  Effectively, it always comes down to finding someone’s biggest window of adaptation and exploiting it.  That's one reason why I tried to make the Show and Go program so versatile by including 2x/week, 3x/week, and 4x/week training options alongside five supplemental metabolic training protocols.

If we are talking about someone with a lengthy injury history, though, the rules get thrown out the window.  You are not only spending more time with corrective exercise, but also refining your strength exercise selection to work with this individual – so it might mean that you have to do more technique work to add in new strength exercises, regardless of that individual’s training experience.

One’s training goals impact the corrective/heavy lifting balance as well.  If I’m training someone who simply wants to improve quality of life or stay healthy in athletics, I can be a bit more cautious on the heavy lifting side of things and hold back.  However, if we are talking about someone who was put on this planet to get strong and wants to be the most badass guy in the gym, we have to lift some heavy weights to make that happen.  So, while the second scenario in many cases requires more corrective exercise, we’re talking about a population that is willing to take more risks in training to get to a goal that might not be at all interesting to a more “low key” population.  This does not, however, mean it’s okay to let strength-oriented people lift with atrocious technique.  Doing so makes you an unethical clown who is more likely to get sued – not a professional.

Time to commit is another important consideration that many folks overlook.  Very simply, if someone can only get in two exercise sessions a week, I’m not going to be spending a ton of time on corrective exercise with them.  You’re much more likely to die from being fat and having diabetes than you are from having a cranky rotator cuff.  I’ll gladly give these folks additional corrective exercise that they can do during their busy schedules (which are never as busy as they claim), but I won’t coddle them when they need to move.

The last factor, which is more about the training model than the athlete/client in question, is how one structures a training session.  At Cressey Performance, athletes start their sessions with foam rolling and then proceed to an 8-10 exercise dynamic warm-up.  For many folks – particularly young athletes – that is enough “corrective” work, and the remainder of the session can be devoted to technical instruction and increasing strength on exercises that are safe for them.  Those with more accumulated wear-and-tear on their bodies will need more corrective exercise beyond what they’ll get from strength training alone – so we add in fillers (e.g., extra mobility work) between sets, and some additional corrective work at the end of the session.  Since you have a limited amount of time with people, you may have to cut back on strength training or metabolic conditioning initially just so that you can get in this early corrective work to get them over the initial “hump.”  Trust me: it will set the stage for long-term success rather than “short-term gain, long-term pain.”

There are two final points I’d like to make.  First, in my experience, many experienced lifters/athletes have responded well to separating the heavy lifting from the corrective stuff.  When they show up to train, they may be really fired up and ready to go – so the last thing they’ll want is to do some wall slides or spend five minutes getting some length in their rectus femoris.

These folks would be wise to do just enough warm-up work to prepare for their heavy training, and then add in some separate sessions to address movement inefficiencies – whether we’re talking additional foam rolling, massage, mobility drills, rotator cuff work, or something else.  They can also add it in on the end of the session after the hardest work is done.

Second, for many folks, maximal strength can be tremendously corrective.  Increasing strength in one area can reduce excessive stress in another area of the body.  An example of this would be using the box squat or deadlift to learn proper hip hinging techniques, which would increase posterior chain contribution and take some of the burden off the quads in someone with anterior knee pain.  Likewise, all other factors held constant, a stronger muscle is less likely to become degenerative.  You can read more along these lines in two older newsletter of mine on the Law of Repetitive Motion: Parts 1 and Part 2.

Obviously, there are many things to consider, but this should at least get you headed in the right direction in finding the right balance in your strength training program.

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Everything You Need to Know About Assess and Correct

We sometimes get questions about how our products differ from one another, so Mike Robertson stepped up and created the following webinar to describe a bit about one of our most popular products, Assess and Correct.  If you're on the fence about purchasing, this should help with your decision.

Assess and Correct may be the most comprehensive corrective exercise product on the market.  I feel this DVD is a must have for anyone looking to make positive changes in their athletes’ bodies – or their own. The assessment section provides simple and detailed information for tests that can help anyone become more aware of their body’s limitations while the correction progressions offer forward thinking solutions that guarantee optimal performance. Eric, Bill and Mike have done it again!” Mike Irr Head Strength & Conditioning Coach, Charlotte Bobcats "Assess and Correct is the most useful physical evaluation tool I’ve ever seen. It’s like having instant access to the knowledge that Hartman, Robertson, and Cressey have gained through years of experience studying anatomy and human movement, and working with real people. "But most important, it’s presented in a way that you can put it to use immediately. In fact, the design of the manual is genius because you’re given a series of simple tests to identify postural and movement problems, followed by smart exercise progressions–which you can tailor to a client’s ability—to correct any issues. So it’s a powerful tool that will help any coach create more effective training plans, customized to an individual’s true NEEDS. The upshot: Assess and Correct will make any fitness professional better at what he or she does. "One other note: Because I’m a fitness journalist, the authors offered me a free manual for review (common in the industry), but I had already purchased it. When they tried to refund my money, I requested that they not. The reason: I found the material to be so valuable that I felt like I SHOULD paid for it. I’m not sure there’s any testimonial I could give that’s better than that." Adam Campbell Fitness Director, Men’s Health

Click here to purchase Assess and Correcting: Breaking Barriers to Unlock Performance!

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Review of Rehab=Training, Training=Rehab: Top 10 Takeaways – Part 1

I wrote yesterday about how fantastic I think Charlie Weingroff's new DVD set, Rehab=Training, Training=Rehab is.  Now that it's on sale, I thought I'd use my next few posts to highlight the top ten key points he made that really stood out in my mind. Here are the first five. 1. I hear people saying all the time that they need to find a niche – and I’ve written in the past about how I found my own niche.  As Weingroff points out, we’re all working with the same platform and set of rules: how the body works.  A “niche” just comes about because we get good with working with those rules in specific populations to create a subspecialty.  I train baseball players using my unique methodology, but there are others out there getting results in this population with different modalities, too, because they're performed correctly and these folks keep the original set of rules in mind.  Likewise, there are folks with similar thought processes as mine - and they're getting results in populations outside of the baseball world. The take-home message on this point is that if you want to be a specialist in your niche, you need to understand general principles first.

2. We’re always trying to find the “link” between terrible movement and pathology/diagnosis – and Charlie offered a good perspective in light of the joint-by-joint theory of movement (a central piece of his two-day presentation).  When mobile joints become stable, we get degenerative changes (arthritis) and poor recovery.  When stable joints become mobile, we end up with dislocations, positional faults, muscle strains, and disc herniations.  Want to prevent or address these issues?  Work backward along this line of logic with your corrective exercise strategy. 3. Speaking of the joint-by-joint approach, Charlie offered the most comprehensive approach I’ve seen.  Traditionally, this approach has been discussed largely in the context of the sagittal plane only, but it definitely has frontal and transverse plane implications as well.  Weingroff also went into more detail on the neck and foot than I’ve seen – as you have alternating mobile/stable joints within these entities, too.

4. Typically, a joint in this school of thought will only really have two direct impacts: the joint above it and the one below it.  The hip might impact the knee or lumbar spine, for instance. The thoracic spine, however, has more far-reaching effects, though, and that’s likely why it’s such a crucial area of focus.  It affects four systems: the neck, ribs (respiration), scapula/clavicle, and the lumbar spine.  So, if you’re seeing a lot of “gross” dysfunction above the hips, it’s often the best place to start with your corrective exercise.

5. Charlie goes to some great lengths in defense of the vertical shin (tibia) as compared to the angled shin during various tasks, most notably squatting.  He raises an interesting question in asking whether it’s really a good thing for both the femur and tibia to move simultaneously during the angled shin squat – as it essentially works in contrast to the joint by joint theory of movement he proposes. Meanwhile, almost every day, we see folks whose knee pain disappears when we teach them to squat with a vertical shin – effectively letting the femur move as the tibia stays still.  The same goes for teaching folks to deadlift, do pull-throughs, or anything else that emphasizes “hips back” as opposed to “knees forward.”

Admittedly, Charlie says it much better than I do, though!  And, I should note that he emphasizes mastering the movement far more than simply loading it up - especially if we are talking about loading up a dysfunctional pattern (not a good idea). I'll be back with five more takeaways tomorrow, but in the meantime, check out Charlie Weingroff's Rehab=Training, Training=Rehab at the introductory price HERE. Sign-up Today for our FREE Newsletter:
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ACL Grafts: Which is Best? A Strength Coach’s Perspective

A few weeks ago, I came across this recent study of different ACL grafts.  It found that there was no difference in follow-up success rates at two-year mark between hamstrings and patellar tendon grafts.  The patellar tendon group did, however, exhibit more anterior knee pain – which isn’t a surprise because it’s not uncommon to see longer term tendinosis in athletes with patellar tendon grafts even after their “rehabilitation period” is over.  That said, I would be interested to see what would happen if they: a) evaluated those patellar tendon graft subjects who received soft tissue treatments as part of their rehabilitation versus those who didn’t (my experience says that the anterior knee pain goes away sooner when manual therapy is present) . b) evaluated those who went to effective strength and conditioning programs immediately post-rehabilitation versus those who didn’t (my hunch would be that those who continued to activation/strengthen the posterior chain would have experienced less anterior knee pain). c) looked at performance-based outcomes at ~12-18 months in the hamstrings group, as these folks have more “intereference” with a return to normal training because of the graft site (you want to strengthen the posterior chain, but can’t do that as soon if you are missing a chunk of the hamstrings).  My experience has been that patellar tendon patients can do a lot more with their strength and conditioning program sooner than those who have hamstrings grafts. It’s not to necessarily say that one is better than the other, as they both have their pros and cons – but I think this study potentially casts patellar tendon grafts in a less favorable light when the truth is that hamstrings grafts can have just as many complications down the road.  Above all else, the best ACL grafts are the ones that the surgeon is the most comfortable using – so pick your surgeon and defer to his expertise. As an interesting aside to this, I remember Kevin Wilk at an October 2008 seminar saying that 85% of ACL reconstructions in the U.S. are performed by doctors that do fewer than 10 ACL reconstructions per year.  So, don’t just find a surgeon; find a surgeon that does these all the time and has built up a sample size large enough to know which ACL graft site is right for you, should you (unfortunately) ever “kneed” one (terrible pun, I know). Related Posts Who "Kneeds" Normal Knees? An Intelligent Answer to a Dumb Question: A Review of "The Single-leg Solution" Sign-up Today for our FREE Newsletter:
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Strength Training Programs: When Did “Just Rest” Become a Viable Recommendation?

I suppose this blog title is more of a rhetorical statement than an actual question, but I'm going to write it anyway.

Just about every week, I get someone who comes to Cressey Performance - either as a new client, or as a one-time consultation from out of town - and they have some issue that is bugging them to the point that they opted to see a doctor about it.  This doctor may have been a general practitioner or an actual sports orthopedist.  In many cases, the response from this medical professional is the same "Just rest."

"It hurts when you lift? Then stop lifting."

Huh?  When did COMPLETE rest because a viable recommendation?

In case folks haven't noticed, 64% of Americans are overweight or obese.  Even if rest was the absolute key to getting healthy, telling them to not move is like not seeing the forest through the trees.  Your bum knee will feel better, but you'll have a heart attack at age 43 because you're 379 pounds.

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Oh, and nevermind the fact that exercise generally improves sleep quality, mooed, and immune, endocrine, and digestive function.  I'm not going to lie: I would rather have an achy lower back than be fat, chronically ill, sleep-deprived, impotent, angry, and constipated.

But you know what?  The good news is that you can still exercise and avoid all these issues - regardless of symptoms.  I can honestly say that in my entire career, I've never come across a single case who couldn't find some way to stay active.

I've trained clients in back braces.

I've trained clients on crutches.

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I've trained clients with poison ivy.

I've trained clients less than a week post-surgery.

I've trained a client with a punctured lung.

And, when I  did an internship in clinical exercise physiology, we trained pulmonary rehab patients in spite of the fact that they often had interruptions during their sessions to cough up phlegm for 2-3 minutes at a time.

All over the world, people are using exercise to rehabilitate themselves from strokes, heart attacks, spinal cord injuries - you name it.

However, Joe Average who sleeps on his shoulder funny and wakes up with a little niggle needs complete rest and enough NSAIDs to make John Daly's liver cringe.

Sorry, but you're going to need to be on crutches, in a back brace, with poison ivy and a punctured lung to get my sympathy.  And, you're sure as heck not going to get it if you're just "really sore" from your workout routine.  Seriously, dude?

I don't care what your issue is: "just rest" is almost never the answer (a concussion would be an exception, FYI).  When a health care practitioner says it, it's because he/she either a) doesn't have the time, intelligence, or network to be able to set you up for a situation where you can benefit from exercise or b) doesn't think you have enough self control to approach exercise in a fashion that doesn't make it more harm than good.

There is almost always something you can do to get better and maintain a training effect.  While adequate rest for injured tissues is certainly part of the equation, it is just one piece in a more complex puzzle that almost always still affords people the benefits of exercise.

A great resource along these lines with respect to shoulders is our Optimal Shoulder Performance DVD set.  If you haven't checked it out already, I'd highly recommend it, as I go into great detail in my presentations on how to work around various shoulder issues.

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Product Review: Muscle Imbalances Revealed

A while back, several industry notables launched a webinar series called Muscle Imbalances Revealed.  To be honest, I had been approached about contributing on the project, but just didn't have the time to give the project the attention it deserved.  Luckily for all of us, though, Rick Kaselj went through with pulling this together, and an excellent resource was born.

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The product consists of seven webinars all aimed at identifying and correcting muscular imbalances in the lower body.  Contributing to the project were Kaselj, Mike Robertson, Bill Hartman, Dean Somerset, Kevin Yates, and Eric Beard.  Rather than go into a ton of detail on each presentation (and I did take quite a few notes on each), I'll highlight the components from the set as a whole that stood out for me.

1. Rick Kaselj had some excellent information on the incidence of knee injuries and surgeries across various populations; they are definitely statistics to which I'll be referring for future blogs and presentations.  His presentation on ACL return-to-function would be a tremendously valuable resource to any trainer or strength and conditioning coach who has never gotten a post-ACL athlete right after discharge from therapy.  I remember when I saw my first post-ACL case; I literally went home and did 4-5 hours of research that night just to make sure that I was up to speed on where that female athlete should be, and what her restrictions were.  Scarily, we knew a lot less back then than we do now - and that's what makes Rick's presentation so valuable: it's all the latest info all in one place.  My only small criticism is that it could have used some more videos within the presentation, but that's nothing to write home about in light of the content he provides.

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2. Bill Hartman dropped some serious knowledge bombs, as only Bill can.  I found that I took the most notes during Bill's presentation.  A few things that stood out:

a. Don't just think of it as thoracic mobility; think of it as rib mobility, too.
b. A lot of people overlook how much exhaling during a thoracic extension drill can improve the efficacy of the exercise.  Try it!
c. Bill went to great lengths to discuss the differences between mobility ("the ability to achieve the desired posture or movement") and regular ol' flexibility.
d. He worked in a bit of Postural Restoration Institute flavor, and it was nice to see which specific exercises he was using the most in a group training setting, as we do quite a bit of it ourselves.
e. Bill demonstrated the quadruped extension-rotation with the arm maximally internally rotated behind the back; it's one I really like, and we'll be using it selectively with a few of our clients.  T-spine mobility is so essential to glenohumeral internal rotation range-of-motion, and it seems like internal rotation is more quickly impacted than external rotation - so it makes sense to mobilize in this position.

f. While emphasizing ankle mobility, we can't overlook the importance of strengthening the anterior compartment of the lower leg.

3. Mike Robertson was excellent as well, although I didn't take quite as many notes as I did with Bill simply because I see and speak with Mike more often.  I've written quite a bit about how the subtalar joint is a "torque converter" where pronation drives tibial/femoral internal rotation and adduction, plus anterior pelvic tilt.

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In this presentation, Mike does a great job of taking it a step further and talking about how dysfunction at the pelvis can drive pronation from the top down; poor hip strength and mobility can definitely wreak havoc on the lower extremity.  He also presents a great anteversion example, in case you haven't seen one.

4. Kevin Yates spoke to things in a much more general sense, and while I honestly didn't take a lot from his presentations myself, some of the up-and-comers in the industry certainly would.  A few points he made that I did really like were:

a. As much has technology has improved our world, it's really screwed our bodies!
b. Injuries almost always occur while we are moving, not while we're stationary - so make sure that the bulk of your mobility work comes in a standing, dynamic context, not just from static stretching.

5. Eric Beard did a great overview of the shoulder girdle and the issues we face in this complex region.  From reading this blog, you realize that I could talk about all shoulders, all the time - so it was impressive that Eric crammed as much quality content into an hour as he possibly could.  I really liked his scapulohumeral rhythm images as well as his continued emphasis that shoulder injuries often take years to come to fruition; there are often just "incidents" that become the straw that breaks the camel's back.

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If you're interested in learning more about shoulder impingement, this webinar would be a great resource for you (along with my The Truth About Shoulder Impingement Part 1 and Part 2).

6. Dean Somerset was last, but certainly not least.  Dean spoke at length about the role of fascia in governing movement.  In the past, I've written at length about how we may have terrible x-rays, MRIs, or other diagnostic imaging - and be completely pain-free.  Well, as Dean discusses, we can have a boatload of pain, but absolutely nothing abnormal on these images.  In fact, 85% of lower back pain has no definitive diagnosis - so what gives?  Well, this is where fascia comes in.  We're talking about the entire extracellular matrix of the body.  It's proprioceptively-rich and incredibly strong - yet it doesn't really get any of the attention it deserves.  Ever had annoying pain that went away with soft tissue work?  Here's a rationale for "why" it went away.  For related reading, check out my recent blog post, The Fascial Knock on Distance Running for Pitchers.

All in all, Muscle Imbalances Revealed was an excellent resource that I'd highly recommend you view.  And, I think it's particularly valuable because you can conveniently watch it from the comfort of your own home or office without having to spend hundreds of dollars on travel and accommodations while taking time off from work.  On an even cooler note, when I reached out to Rick and mentioned that I was writing this review, he went out of his way and provided a special discount offer for my readers.  You can check it out at THIS PAGE.

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CP Internship Blog by Sam Leahey – Appreciating Differences

Preface 1 If you're like me, you foster a great appreciation for the work Eric Cressey does both in cyberspace and in person through mediums like seminars, conferences, etc. However often times Eric's readers do not benefit from what goes on behind the scenes at Cressey Performance. In fact, I would venture to say that at most top notch Strength & Conditioning facilities around the country this privilege often falls upon interns, as they are learning day in and day out from the entire staff. So, my fellow Cressey disciples, never fear because there is a solution! Eric has asked me to write regular blog posts regarding my internship here at Cressey Performance. This will include many training epiphanies and revelations, "ah-ha" moments, coaching insights, and just flat-out Eric Cressey madness! Being able to get inside the mind of Eric Cressey and his staff is a tremendous honor and I would love to share all that comes out it. Hope you enjoy!

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Appreciating Differences We had a splendid seminar recently at Cressey Performance with Neil Rampe as the speaker. Beyond the actual shop talk I noticed a similar thread in his speech. He often would finish up a slide summary with the question "Can you appreciate that?" He'd present his knowledge and then ask the audience, "Can you appreciate that?" Notice what he did not say. Neil didn't present his rationale, science, and/or theory and ask attendees "Do you see how I'm right and so and so is wrong?" In fact, I don't recall him ever even using the words "right" or "wrong."  It was always "Can you appreciate this or that?"  In one such example he taught to appreciate asymmetries in the body. More specific to this discussion though, Neil discussed the appreciation of different schools of thought from Janda, Sahrmann, Kolar, Myers, PRI, and others.

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This concept of appreciating different perspectives, instead of trying to prove right or wrong, I find more and more useful the longer I coach. More practically, I find this coming into fruition over simple things in the Strength & Conditioning field. Take a simple exercise like the One-Arm Cable Row for example. Should you retract both shoulder blades when your row or just the side that is doing the rowing? Is one way right and the other is wrong? Really? A more noble argument I've found is which one is more optimal for what you're trying to accomplish. In reality neither one is wrong; they're just different! What about if you place certain components of your program in different spots than others. Is it "wrong" to put static stretching at the beginning or end of a workout? Is either way "right?" I don't think so. They both can be applied appropriately at either end of the session. What about a quadruped t-spine mobility drill. Should the arms and femurs be completely perpendicular to the ground or should you be sitting back slightly on your calves?

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Again, is either version wrong? Nope, just another example of different ways to skin a cat. Oftentimes, it's young up-and-coming coaches like myself that fall victim to training arguments. Alwyn Cosgrove talked about this once when he said something to the effect of: "If you put all the greatest coaches in a room they will agree on most things and disagree on few things. If you put all their students in one room they'll be arguing all day long over the differences." I hope I quoted Alwyn correctly, but either way, you get the point. In most cases, one perspective or difference may be more optimal than the other in terms of the goals it's trying to accomplish. Only in a few cases is either side wrong or right. So, the next time you're listening to someone give advice - be it for programming or just in general terms - appreciate where they're coming from. Understand WHY he is suggesting something. Is the person a powerlifter? Is he a physical therapist? Is the person a Strength & Condtioning coach, athletic trainer, doctor, chiropractor, or a professor? Does he work in group training settings, semi-private, or a one-on-one situation? Understanding all these different perspectives can allow you to APPRECIATE what the other person is saying without getting all indignant because you think he's "wrong." Thanks, Eric, for helping me realize this valuable lesson! You can contact Sam Leahey at sam.leahey@gmail.com.
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