Last Saturday night, the power went out at our house thanks to a rare October snowstorm in New England. Expecting it to come back on pretty quickly, I went to bed Saturday night assuming I’d wake up to a normal Sunday morning.
Instead, I woke up and it was 49 degrees in my house. And, that wound up being par for the course through Tuesday at about 4pm. No hot showers, no refrigeration, no coffee in the morning: it makes you realize how much you take some things for granted.
It’s not all that different than what you’ll hear from injured and sick athletes. We always just believe that we’re going to be healthy – and it’s that assumption that leads us to put too much weight on the bar and lift with poor technique, have the extra beer, go to bed an hour later, or make any of a number of other small, but crucial decisions that interfere with our short- and long-term health, and the continuity in our workout "routines."
I wish I’d foam rolled even when I wasn’t in pain.
I wish I’d eaten my vegetables even though I was just trying to shovel in as much calories as I could in my quest to get strong and gain muscle.
These are all things I've heard from injured people. Hindsight is always 20/20.
Some of these decisions are made out of negligence, but often, they’re made simply because folks don’t know about the right choices. I mean, do you think this guy would really continue doing this if he thought it was good for his body?
Nobody is immune to ignorance; we’ve all “been there, done that.”
Almost a decade ago, I had no idea how much soft tissue work, high volumes of horizontal pulling, and thoracic spine mobility drills could do to help my shoulder. It’s why I stumbled through fails attempts at physical therapy with that shoulder back in 2000-2003, only to accidentally discover how to fix it with my own training in time to cancel my shoulder surgery.
Back in that same time period, nobody ever told me how eating more vegetables would help take down the acidity of my diet, or that Vitamin D status impacted tissue quality and a host of other biological functions. I never knew most fish oil products you could buy are woefully underdosed and of poor quality. Now, I crush Vitamin D, fish oil, and Athletic Greens on top of a healthy diet that’s as much about nutrient quality as it is about caloric content and timing.
In short, I didn’t know everything then, and while I know a lot more now, I still don’t claim to have all the answers. Nobody has all of them. So what do you do to avoid taking important things for granted?
Get around people who have “been there, done that.” Ask questions. Follow workout routines they’ve followed, and consult resources they’ve consulted. I touched on this in my webinars last week.
I also discussed this topic in a blog about strength and conditioning program design a while back. The best way to avoid making mistakes and taking things for granted is to be open-minded and learn from other people.
With that in mind, let’s use this post as a starting point. What mistakes have you made when it comes to taking things for granted? And, what lessons have you learned? Post your comments below.
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Here's this week's list of recommended reading:
If You're Not Growing Your Fitness Business, Here Are Some Fixes... - This was an awesome "choose your own adventure" type of post from Pat Rigsby, as he provides options for fitness professionals facing challenges on the business side of things. Pat's ability to find opportunity in any fitness is unparalleled, and one reason why I was stoked to collaborate with him on the Fitness Business Blueprint.
Get Strong Using the Stage System - This was a guest blog I just wrote last week for Men's Health. In it, I highlight one of my favorite strength and conditioning program strategies, the stage system.
The Importance of Hip Flexion Strength - This was a great guest contribution from Chris Johnson at Mike Reinold's blog.
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In my years as a coach and a lifter, I've made plenty of mistakes and learned a lot of lessons as a result. Hopefully, this look at my past shortcomings will help you avoid those same mistakes in your training journey. Click here to access the webinar 100% free of charge!
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Today marks Part 2 of this mini-series covering just how much you can learn from looking at an elbow before writing up a strength and conditioning program. In Part 1, we talked about what can be learned from our first potential scenario, elbow hyperextension. Today, we'll focus on the lessons to be learned from three more scenarios.
Full Elbow Extension, Muscular End-Feel - This simply means that you have all your extension and no "empty" end feel; it eases to muscular stretch (of the elbow flexors).
This is probably the most common presentation pattern in the general population, and you can generally expect these folks to respond to need equal amounts of mobility and stability training. More thorough assessments will give you more information on where to focus your efforts.
Incomplete Elbow Extension, Bony End-Feel - These are, in many cases, guys who did not get full elbow extension back following a surgical procedure. Or, it may just be someone with bone spurs on the underside of the joint that interferes with elbow extension.
It's a bold assumption to make, but these individuals are almost always (in my experience) athletes who have profound limitations in other regions, as poor glenohumeral mobility, rotator cuff function, scapular stabilization, thoracic spine mobility, and terrible tissue quality can all contribute to these kind of issues presenting at the elbow. So, when I see and feel an elbow this "gross," I usually know that I have my work cut out for me. Generally, these guys wind up needing a hearty dose of mobility training, soft tissue work, breathing drills, and longer duration static stretching.
That said, with respect to the elbow itself, these guys need to be cognizant of maintaining every little bit they have. If you've got a 10° elbow extension deficit because of bony changes, you can probably get by. However, if you allow that 10° to become 30° because you pile soft tissue shortness/stiffness on top of it, you could be waiting for some serious problems to come around. To that end, I always encourage these guys to get routine soft tissue work and plenty of static stretching in to maintain whatever elbow extension they still have.
Incomplete Elbow Extension, Muscular End-Feel - These guys look very much like our previous category, but the end-feel has much more "give" to it; it's not a "concrete-on-concrete" end-feel. This is a very good thing, as you know you can work to get it back. This athlete, for instance, got 15° of elbow extension back in a matter of a few minutes following a Graston treatment with our manual therapist and some follow-up stretching.
I wouldn't expect him to maintain 100% of those improvements from treatment to treatment, but over the course of 3-4 bouts, he should get to where he needs to be.
Expect to see some of the same things with the rest of the body, as elbow extension deficits rarely occur in isolation. In throwers, they're usually accompanied by poor glenohumeral internal rotation on the throwing side, poor hip internal rotation on the front leg, and a host of other stiffness/shortness issues. In the general population, you see them in people who are locked up all over - especially in people who sit at computers all day long.
That wraps up our look at four elbow presentation patterns and what they may mean for your strength and conditioning programs and corrective exercise approaches. For more information, check out the Everything Elbow In-Service, an affordably priced 32-minute in-service where half of all proceeds go to charity.
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I thrilled to announce that I'll be collaborating with Mike Reinold once again - this time on a seminar, Functional Stability Training, to take place on Sunday, November 20, 2011 at Cressey Performance in Hudson, MA.
Here's the agenda for the day:
Functional Stability Training – An integrated approach to rehabilitation and performance training – Reinold
Recent Advances in Core Performance - Understand the concept of Functional Stability Training for the Core, true function of the spine, and how this impacts injuries, rehab, and training – Reinold
Maintaining a Training Effect in Spite of Common Lumbar Spine and Lower Extremity Injuries – Outlines the causes and symptoms of several common injuries encountered in the lower extremity, and how to train around these issues to keep clients/athletes fit during rehabilitation – Cressey
Understanding and Controlling Extension in Athletes – Looks into the causes of and problems with excessive lumbar extension, anterior pelvic tilt, and rib flairs in athletes – Cressey
Lunch (Provided)
LAB – Assessing Core Movement Quality: Understanding where to begin with Functional Stability Training exercises for the core – Reinold
LAB – A Dynamic Progression of Core Performance Exercises - Progression from simple core control to advanced rehab and training techniques – Reinold
LAB – Understanding and Controlling Extension in Athletes – Progresses on the previous lecture with specific technique and coaching cues for exercises aimed toward those with these common issues – Cressey
LAB – Advanced Stability: Training Power Outside the Sagittal Plane – Traditional power training programs are predominantly focused on the sagittal plane, but in most athletic endeavors – especially rotational sports – power must be displayed in other planes of motion – Cressey
It's our goal to optimize the learning environment and have lots of interaction with all of those in attendance, so to that end, we'll be keeping the seminar to 50 people or less. Given that our Optimal Shoulder Performance seminar in 2009 sold out in under a week, this one is sure to do the same - so don't delay in registering, if this is of interest.
For more information, or to sign up, check out www.FunctionalStability.com.
Here's what some of our previous seminar attendees have had to say about their experiences seeing us live:
Related Posts13 Fun Facts About Optimal Shoulder PerformanceWeight Training Programs: Assess, Don't AssumeSign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
In light of the overwhelming popularity of a recent guest blog on the topic of sports nutrition and healthy food options, I wanted to keep the ball rolling with some regular nutrition content. This week, Brian St. Pierre kicks off a three-part series on everything you want to know about dairy. Enjoy! -EC
Dairy: perhaps the most controversial food in history.
While some people would argue that we shouldn’t consume dairy at all, others recommend getting at least three servings per day. There is fat-free, 1%, 2%, whole, cream, butter, and more. There is also the pasteurization, ultra-pasteurized and raw debate. Who is right? What fat content is the best? Should you eat raw dairy?
Let’s find out.
The History of Dairy Consumption
The fact of the matter is that humans have been consuming dairy in one form or another for 10,000 years. Many cultures (e.g., people of the Lotchenstal Valley, the Masai, Mongolians) have subsisted on tremendous amounts of dairy without any problems often associated with it. The difference is that traditional dairy was from cows that ate grass, got exercise, breathed fresh air, and enjoyed the sunshine. Their quality of life – and therefore quality of milk – was excellent.
Fast forward to today and things have changed. Milk demand has increased greatly in the last hundred years, and so the industry responded. Cows moved off family farms and onto Concentrated Animal Feeding Operations (CAFO), which are essentially huge conglomerate farms where they:
a) are fed tons of corn,
b) stand in their own waste
c) are given antiobiotics to prevent the illnesses from that corn consumption and the unsanitary living conditions
d) are given copious amounts of growth hormones to speed their growth and increase their milk production.
Appetizing, I know.
Traditionally, cows were allowed a seasonal reproductive cycle and were milked for only six weeks after giving birth. Today, conventional dairy farmers inseminate cows only a few months after giving birth, which can compromise the immune system and decrease milk quality. What’s worse, it will also cause a huge increase in estrogens in the milk.
These estrogens can fuel the growth of several tumors and are linked to prostate, breast and ovarian cancer. Cows allowed to graze on grass and have seasonal reproductive cycles have significantly less estrogens in their milk, at levels that are not thought to be problematic.
Below is a table to give you a little perspective on the changes in the lives of milking cows brought about by the move off the family farm and onto the CAFOs.
Why Grass-Feeding Rules
While we have certainly made cows more efficient milk-producing machines – going from 336 lbs to 20,000 lbs of milk produced per year – this has had a tremendously negative impact on milk quality. Milk produced in this manner is not what I would consider a healthy food option, and I am definitely not a big fan of this conventional dairy due to the poor production, poor quality, high estrogen content, and loss of important fatty acids and fat-soluble vitamins. Fortunately, dairy from pasture-raised grass-fed cows is an entirely different animal.
Since these cows are actually allowed to eat what they were designed to eat, their milk quality is vastly superior – containing more actual nutrition like increased levels of vitamin A, vitamin K (in the more powerful form of K2), omega-3s, and CLA. In fact, grass-fed cows have been found to contain up to 500% more CLA than their conventionally fed brethren!
In addition to grass-fed dairy being far superior to conventional grain-fed dairy, full-fat dairy is also superior to low-fat or fat-free, contrary to popular belief or recommendations – but we will get to that in Part 2!
About the Author
Brian St. Pierre is a Certified Sports Nutritionist (CISSN) and a Certified Strength and Conditioning Specialist (CSCS). He received his degree in Food Science and Human Nutrition with a focus in Human Nutrition and Dietetics from the University of Maine, and he is currently pursuing his Master's degree in Human Nutrition and Dietetics from the same institution. He was the Nutritionist and a Strength and Conditioning Coach at Cressey Performance in Hudson, MA for three years. He is also the author of the Show and Go Nutrition Guide, the accompanying nutrition manual to Eric Cressey’s Show and Go Training System.
With his passion for seeing his clients succeed, Brian is able to use his knowledge, experience, and energy to create highly effective training and nutrition programs for clients of any age and background. For more information, check out his website.
References
Malekinejad H, Scherpenisse P, Bergwerff A. Naturally Occurring Estrogens in Processed Milk and in Raw Milk (from Gestated Cows). J. Agric. Food Chem., 2006, 54 (26), pp 9785–9791
Qin LQ, et al. Estrogen: one of the risk factors in milk for prostate cancer. Med Hypotheses. 2004;62(1):133-42.
Ganmaa D, Sato A. The possible role of female sex hormones in milk from pregnant cows in the development of breast, ovarian and corpus uteri cancers. Med Hypotheses. 2005;65(6):1028-37.
Dhiman TR, Anand GR, et al. Conjugated linoleic acid content of milk from cows fed different diets. J Dairy Sci. 1999;82(10):2146-56.
Over the weekend, I attended my third Postural Restoration Institute seminar, Impingement and Instability. I’ve written previously about how this school of thought has profoundly impacted the way that we handle many of our athletes – and this past weekend was certainly no exception. This weekend was also my first chance to meet and learn directly from Ron Hruska, the man initially responsible for bringing many of these great ideas to light.
While I am admittedly still processing all the awesome information from the weekend, I wanted to write today about one big “Ah-Ha” moment for me over the weekend. At some point on Day 2, Ron said something to the effect of (paraphrased):
“A superior acetabulum isn’t much different than an acromion on a scapula.”
My jaw practically hit the floor. I joked with the seminar organizer that I needed to go into the restroom to yell at myself for a few minutes for not thinking of this sooner. Let me explain…
Over the past few years, there has been a huge rise in hip injuries in athletes (I'd even written about it HERE in response to a New York Times article about number of hip injuries in baseball). Sports hernias, labral tears, and femoroacetabular impingement (FAI) are commonplace findings on the health histories that I see every day on first-time evaluations. In terms of FAI, you can have bony overgrowth of the femoral head (cam), acetabulum (pincer), or both (mixed), as the graphic from Lavigne et al. below demonstrates:
Many folks say that we’re getting better diagnostically and that’s why the prevalence has increased in recent years. Let’s be real, though, folks: if we’d had hip pain and dysfunction on this level for decades, don’t you think anecdotal evidence would have at least tipped us off? I find it hard that generations of athletes would have just rubbed some dirt on a painful hip, cowboyed up, and put up with it.
Consider those over the age of 60, though. Sher et al. reported that a whopping 54% of asymptomatic shoulders in this population have rotator cuff tears; that doesn’t even include those who actually have pain! Why does this happen? They impinge over and over again on the undersurfaced of the acromion process secondary to poor thoracic positioning, scapular stabilization, breathing patterns, and rotator cuff function. The end result is reactive changes on the acromion process that lay down more and more bone as the years go on. And, an anteriorly tilted scapula kicks that impingement up a notch. The “early” cuff irritation likely comes in those with Type 3 (beak-shaped) acromions, whereas the Type 1 (flat) and Type 2 (hook) acromions need time to lay down more and more bone for their anterior tilt to bring them to threshold.
Conversely, consider femoroacetabular impingement of the hip. You can get bony overgrowth of the acetabulum, femoral head, or both. It’s widely debated whether those with FAI are born with it, or whether it becomes part of normal development in some kids. Well, I guess it would depend on whether you consider playing one sport to excess year-round “normal.”
You know what? I’d estimate that over 90% of the femoroacetabular impingement cases I’ve seen have come in hockey, soccer, and baseball players. What do these sports have in common? They all live in anterior pelvic tilt – with hockey being the absolute worst. Is it any surprise that the incidence of FAI and associated hip issues has increased dramatically since the AAU generation rolled in and kids played the same sport all 12 months of the year?
Conversely, I’ve never seen a case of FAI in a field hockey player. Additionally, when I just asked my wife (who rowed competitively in college) if she ever saw any hip issues in her teammates in years of rowing, she joked that there weren’t any until they added distance running to their training. Field hockey players and rowers live in flexion (probably one reason why they have far more disc issues). And, taking it a step further, I’ve never seen an athlete with FAI whose symptoms didn’t improve by getting into a bit more posterior pelvic tilt.
Finally, a 2009 study by Allen et al. demonstrated that in 78% of cases of cam impingement symptoms in one hip, the cam-type femoroacetabular impingement was bilateral (they also found pincer-type FAI on the opposite side in 42% of cases). If this was just some “chance” occurrence, I find it hard to believe that it would occur bilaterally in such a high percentage of cases. Excessive anterior pelvic tilt (sagittal plane) would be, in my eyes, what seems to bring it about the most quickly, and problems in the frontal and transverse planes are likely to blame for why one side presents with symptoms before the other.
People have tried to blame the increased incidence of hip injuries on resistance training. My personal opinion is that you can’t blame resistance training for the incidence, but rather the rate at which these issues reach threshold. Quality resistance training could certainly provide the variety necessary to prevent these reactive changes from occurring at a young age, or by creating a more ideal pelvic alignment to avoid a FAI hip from reaching threshold.
Conversely, a “clean-squat-bench” program is a recipe for living in anterior tilt – and squatting someone with a FAI is like overhead pressing someone with a full-thickness cuff tear; things get ugly quickly.
Honestly, this probably isn’t revolutionary for folks out there – particularly in the medical field – who have watched the prevalence of femoroacetabular impingement rise exponentially in recent years, but Ron made a great point to reaffirm a thought I’d been having for years and strengthened the argument. And, more important than the simple “Ah-Ha” that comes with this perspective is the realization that an entire generation of young athletes have been so mismanaged that we’ve actually created a new classification of developmental problems and pathologies: femoroacetabular impingement, labral tears, and sports hernias.
Thanks, Ron, for getting me thinking!
For more information on appropriately managing kids during these critical development time periods, check out the International Youth Conditioning Association’s High School Strength and Conditioning Certification, which I helped to write.
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Here's a list of recommended strength and conditioning reading for the week:
Strength Training Programs: The Higher Up You Go, the More Hot Air You Encounter - This is a reincarnation of an old post of mine that seemed fitting in light of a conversation I had with someone last week.
Metabolic Flexibility - This was a very well researched piece from Mike Nelson that I enjoyed reading.
Intimidate the Weight - More people need to get fired up about life in general, but especially lifting weights. My business partner, Tony, elaborates here.
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I've got no time for a blog today, but a little live action from CP should do the trick. Big shout-out to AJ Wnukowski for bringing the A game.
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When it comes to corrective exercise programs, everyone simply wants to know "what" is and isn't included - and rightfully so. Picking the right strength exercises and mobility drills - and contraindicating others - is absolutely crucial to making sure you get folks to where they want to be.
However, very rarely will you hear anyone specifically discuss the "when" in these scenarios, and as I'll demonstrate in today's piece, it's likely just as crucial to get this aspect correct.
To begin to illustrate my point, I'm going to reuse a quote from an article I wrote a few weeks ago, Correcting Bad Posture: Are Deadlifts Enough?, on the Law of Repetitive Motion :
Consider the law of repetitive motion, where “I” is injury to the tissues, “N” is the number of repetitions, “F” is the force of each repetition as a percentage of maximal strength, “A” is the amplitude (range of motion) of each repetition, and “R” is rest. To reduce injury to tissues (which negative postural adaptations can be considered), you have to work on each of the five factors in this equation.
You perform soft tissue work – whether it’s foam rolling or targeted manual therapy – on the excessively short or stiff tissues (I). You reduce the number of repetitions (length of time in poor posture: R), and in certain cases, you may work to strengthen an injured tissue (reduce F). You incorporate mobility drills (increase A) and avoid bad postures (increase R).
What I failed to mention a few weeks ago, though, was that the sequencing of these corrective modalities must be perfect in order to optimize the training/corrective effect and avoid exacerbating symptoms. Case in point, we recently had a client come to us as a last resort with chronic shoulder issues, as he was hoping to avoid surgery. Physical therapy had made no difference for him (aside from shrinking his wallet with co-pays), and following that poor outcome, he'd had a similar result with soft tissue treatments twice a week for six weeks. In a single four-week program, we had him back to playing golf pain free. What was the difference?
In the first physical therapy experience, he'd been given a bunch of traditional rotator cuff and scapular stabilization exercises. There had been absolutely no focus on soft tissue work or targeted mobility drills to get the ball rolling. In other words, all he did was improve stability within the range of motion he already had. In the equation above, all he really worked on was reducing the "F" by getting a bit stronger.
In his soft tissue treatment experiences, he felt a bit better walking out of the office, but ran into a world of hurt when his provider encouraged him to "just do triceps pressdowns and lat pulldowns" for strength training. In other words, this practitioner worked on reducing "I" and increasing "A," but totally missed the boat with respect to enhancing strength (reducing "F") and increasing rest ("R") because of the inappropriate follow-up strength exercise prescription. Doh!
What did we do differently to get him to where he needed to be? For starters, he saw Dr. Nate Tiplady, a manual therapist at CP, twice a week for combination Graston Technique and Active Release treatments (reducing "I") at the start of his training sessions. He followed that up with a specific manual stretching, positional breathing, and mobility exercise warm-up program (increase "A") that was designed uniquely for him. Then, he performed strength training to establish stability (decrease "F") within the new ranges of motion (ROM) attained without reproducing his symptoms (decreasing "N" and increasing "R).
The sequencing was key, as we couldn't have done some of the strength exercises we used if we hadn't first gotten the soft tissue work and improved his ROM. He may have had valuable inclusions in his previous rehabilitation efforts, but he never had them at the same time, in the correct sequence.
This thought process actually closely parallels a corrective exercise approach Charlie Weingroff put out there much more succinctly in his Rehab = Training, Training = Rehab DVD set:
Get Long. Get Strong. Train Hard.
Keep in mind that there are loads of different ways that you can "get long." You might use soft tissue work (Active Release, Graston Technique, Traditional Massage, etc.), positional breathing (Postural Respiration Institute), mobility drills (Assess and Correct), manual stretching, or any of a host of other approaches (Mulligan, DNS, Maitland, McKenzie, etc). You use whatever you are comfortable using within your scope of practice.
When it's time to "get strong," you can do so via several schools of thought as well - but the important thing is that the strength exercises you choose don't provoke any symptoms.
It's interesting to note that this corrective exercise approach actually parallels what we do with our everyday strength and conditioning programs at Cressey Performance - and what I put forth in Show and Go: High Performance Training to Look, Feel, and Move Better. We foam roll, do mobility warm-ups, and then get cracking on strength and stability within these "acutely" optimized ranges of motion to make them more permanent.
