We’re excited to welcome physical therapist Doug Kechijian to this week’s podcast for an awesome discussion of return-to-play practices for injured athletes. Doug has taken a deep dive into this realm over the past few years as he prepares to publish a book on the topic, and his insights on this podcast bring to light some invaluable considerations for players, parents, coaches, and rehabilitation experts. CSP-MA Director of Performance John O’Neil takes the lead as a guest host as well.
A special thanks to this show's sponsor, AG1. Head to https://www.DrinkAG1.com/cressey and you'll receive a free 10-pack of AG1 travel packets with your first order.
This episode is brought to you by AG1. AG1 is your daily foundational nutrition; it has 75 whole-food sourced ingredients designed to support your body’s foundational nutrition needs across five critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. It is the new and future way of getting a multivitamin, and a whole lot more. Head to www.DrinkAG1.com/cressey and claim my special offer today – 10 FREE travel packs – with your first purchase. I use AG1 daily myself and highly recommend it to our athletes as well. I’d encourage you to give it a shot, too – especially with this great offer.
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I hope you're having a great week. Here is some recommended reading and listening from the strength and conditioning world over the past week:
EC on the Athlete CEO Podcast - I joined the Athlete CEO podcast to talk about everything from entrepreneurship, to the origins of Cressey Sports Performance, to off-field habits that athletes can employ for success in their sport. This is a great new podcast that I'll be following closely myself.
Tone and Message in Coaching - The Resilient Performance crew never disappoints with their writing, and while this is a quick read, it's an excellent one.
Top Tweet of the Week
Always ask, “where do you feel this?” Good movement is good movement, so if individuals feel it in the right places and are asymptomatic, it’s probably correct. Trust your eyes - but use your ears, too. pic.twitter.com/kMUquhaci2
We're excited to announce that on May 20th, 2018, the Resilient Performance Systems team of Doug Kechijian, Trevor Rappa and Greg Spatz will be on-hand delivering their one-day course, “Movement Foundations.” This event will take place at our Hudson, MA location. It’s a great chance for coaches, clinicians, and fitness professionals to learn to more effectively integrate sports medicine concepts with performance training - including biomechanically efficient strength training and running technique, joint preparation for sport and fitness, and programming considerations throughout the lifespan; all within a model that accounts for different professional training and scope of practice.
Resilient seeks to systematically explore the continuum between acute rehabilitation and athletic performance. Resilient’s clientele includes athletes and operators from military special operations forces, federal law enforcement tactical teams, Major League Baseball (MLB), National Basketball Association (NBA), professional mixed martial arts, X Games, Winter and Summer Olympics, Major League Lacrosse (MLL), National Collegiate Athletic Association (NCAA), and those with a history of persistent pain and extensive surgical backgrounds. Resilient also advises organizations about medical and performance staffing, program development, and injury risk mitigation strategies.
Course Outline:
• Scientific Foundations
1. Complexity Theory
2. Managing Uncertainty
3. Principles of Adaptation
4. Variability, Capacity, Power
5. Rehabilitation to Performance Continuum
6. Emergent Order: Patterning, Checklists, Degrees of Freedom
7. Mobility, Tightness, Tone
8. Autonomic Influences
• Assessment
1. Test What Matters
2. The Training Process
• Lower Body Foundations
1. Biomechanics & Arthrokinematics
2. Anatomy Review
3. Hip Impingement
4. Proximal Motor Control
5. Appropriate Exercise Selection
6. Stretches & Exercises We Avoid
• Programming Considerations
•Practical Application: Lower Body
1. Joint Variability Preparation
2. Hip Dominant
3. Knee Dominant
4. Running
5. Plyometrics
• Lunch Break (1 hour)
• Upper Body Foundations
1. Biomechanics
2. Anatomy Review
3. Proximal Motor Control
4. Common Pathology
5. Appropriate Exercise Selection
6. Stretches & Exercises We Avoid
This event has been approved for 0.8 CEUs from the National Strength and Conditioning Association.
Date/Location:
Sunday, May 20, 2018: 9am-6pm with an hour lunch break.
Cressey Sports Performance
Suite 310
Hudson, MA 01749
Registration Fee: $349.99
Students can save $50 by entering the coupon code STUDENT50 (case sensitive) at checkout.
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.
Doug Kechijian is a physical therapist and co-founder of Resilient Performance Systems. Before beginning his sports medicine practice, Doug was a Pararescueman in the U.S. Air force where he deployed throughout the world to help provide technical rescue capability and emergency medical care to U.S and allied forces. In 2015, he was selected as one of the U.S. Air Force's Outstanding Airmen of the Year. Doug received his AB in Biology from Brown University and MA in Exercise Physiology/Doctor of Physical Therapy from Columbia University.
Greg Spatz is a physical therapist and co-founder of Resilient Performance Systems. Before launching Resilient, Greg was a Strength & Conditioning Coach in the Arizona Diamondbacks organization. Greg received his BS in Health & Exercise Science from The College of New Jersey where he competed for the baseball team. He earned the Doctor of Physical Therapy degree from Columbia University.
Trevor Rappa is a physical therapist and co-founder of Resilient Performance Systems. Before beginning his sports medicine practice, Trevor completed an internship at Mike Boyle's Strength & Conditioning facility. Trevor received his BS in Biology from Amherst College where he competed for the football team. He earned the Doctor of Physical Therapy degree from Columbia University.
Happy Monday! I hope everyone had a great weekend. The baseball off-season is in full swing and I have several evaluations today, so we'll be sharing some good content from around the web to keep you entertained until I have a spare moment to pull together some content. Check it out:
Changing Baseball Culture: A Call to Action - In light of a few recent conversations, I thought it was a good time to reincarnate this guest post from my good friend Eric Schoenberg.
The Older You Are, The Worse You Sleep - I thought this essay from Dr. Matthew Walker for The Wall Street Journal was intriguing. At the very least, it was nice to see a well-researched article on a health topic in a more mainstream publication.
Top Tweet of the Week
It's amazing how many people on the internet who've never played pro sports know exactly how pro athletes should do their jobs.
I've been a fan of barbell hip thrust and supine bridges for approximately seven years now. I'd encourage you to give my What I Learned in 2012 article a read, as it describes how our usage of these drills came about (and does so in an entertaining manner) following a meeting I had with Bret Contreras in 2009. Suffice it to say that initially, I was not a fan of these drills, but in-the-trenches experimentation eventually brought me around.
Recently, there has been some controversy over the utility of hip thrusts, as some newer research publications (here and here) have demonstrated that hip thrust training does not improve sprinting speed. Bret Contreras, the man who popularized the hip thrust, has written a detailed response to these publications. For the record, I think he's handled the situation admirably, and I commend him for all his work adding to the body of knowledge so that we can all have these discussions in hopes of fine-tuning our strength training programs.
That said, not surprisingly, these research findings have created an opportunity for hip thrust critics to say "I told you so" - and several articles have emerged to highlight its lack of efficacy on this front. That said, I found Doug Kechijian's article, 'Science' and the Barbell Hip Thrust, to be the best of the articles that have recently emerged. Doug doesn't utilize the hip thrust, but used this current situation as a means of discussing how we view exercise selection on the whole. I'd strongly encourage you to give it a read.
While I must admit that I wasn't particularly surprised at the lack of carryover to sprinting performance, I don't think it's time to throw the baby out with the bath water just yet. Why? As I've often said:
[bctt tweet="Want to put an exercise in a program? You must be able to quickly and easily justify its inclusion."]
In this case, I still have plenty of justifications for including hip thrusts and supine bridges in our programs. I don't think they're ever a perfect replacement for a squat or deadlift, but I do see a role for them in special circumstances, and as assistance exercises. In today's post, I'll outline why I still find these drills to have great utility.
1. Zero Back Pain
Yes, you read that right. In close to a decade of using these drills with clients, athletes, and our coaching staff, I've never seen anyone injured during a hip thrust or supine bridge. For how many other exercises can you say that? Certainly squats, deadlifts, kettlebell swings, or even single-leg work. In hindsight, it's shocking that a drill that looks like it could be harmful (and this was my initial reluctance to include it) actually has such an excellent record on the safety front. Obviously, we're matching it to the individual and coaching technique, but this is still an impressive observation.
Moreover, I've sold more than 8,000 copies of my flagship product, The High Performance Handbook. It includes barbell supine bridges in phase 2, and barbell hip thrusts in phase 3. This is 8,000+ people who've performed these exercises without my supervision, and I've never had a single email from anyone about an injury. Conversely, I've answered a ton of emails over the years from customers who need modifications because squatting and/or deadlifting aren't drills they can perform pain-free. I think this is remarkably telling; hip thrusts have stood the test of time in terms of safety concerns.
Finally, I've actually seen quite a few individuals who couldn't squat or deadlift pain-free actually perform barbell hip thrusts and supine bridges with zero pain over the course of years. They've bolstered a training effect that otherwise would have been markedly attenuated.
2. Hip thrusts allow us to train the posterior chain without deadlifts in a population that may not do well with scapular depression and downward rotation.
One thing we know about throwing a baseball is that it makes you very lat dominant and tends to drive scapular downward rotation.
As I discuss in this video, scapular upward rotation is incredibly important for throwers.
Sometimes, we'll see athletes who sit in so much scapular depression or downward rotation that we choose to avoid lat dominant exercises and heavy carries/holds in their programs. So, drills like deadlifts, farmer's walks, KB swings, and dumbbell lunges are out of the mix. When you lose deadlifts from a program, you realize that you've lost a big bang exercise for training the posterior chain. Barbell hip thrusts have been a huge help to us in this regard, as they give us a bilateral option for training the posterior chain. Otherwise, it'd be just safety squat bar (SSB) squats and single-leg work, the goblet set-up, belt squats, and glute-ham raise (GHR) variations. And, a lot of people don't have a SSB, belt squat, or GHR!
Interestingly, I can actually think of several instances over the years where we dropped deadlifting from a pitcher's program - and replaced it with hip thrusts - and his shoulder pain went away. I don't think improvements like this happen in isolation, but I have no doubt that it contributed to the reduction in symptoms.
3. Hip thrusts prioritize terminal hip extension, which is actually far more important to baseball success.
I want you to watch these videos of the hips during the baseball swing (and while you're at it, check out Jeff Albert's great guest post for me: Hip Extension and Rotation in the Baseball Swing).
What I'm hoping you noticed is that while hip extension is incredibly important (for both the front and back legs), there is very little of it occurring in terms of actual range of motion. The same can be said of the pitching delivery; very rarely would a pitching come close to being a 90 degrees of hip flexion on the back hip.
Tim Collins early in his career was the most extreme hip flexion I've seen, and he's not even all the way down to 90 degrees:
In other words, hips thrusts and supine bridges reflect the shorter range of hip flexion/extension motion we see in hitting and pitching than they do for a higher amplitude movement like sprinting.
Source: Darren Wilkinson
To be clear, I'm not saying that squats and deadlifts don't train this range (especially when accommodating resistances like bands and chains are utilized); I'm just saying that hip thrusts and supine bridges train it exclusively and may provide some extra carryover.
4. Hip thrusts allow us to train the lower body without a grip challenge.
Load of gripping can also be an issue during the baseball season. Guys obviously get plenty of it from their upper body work, but when you add in the stress of throwing on the flexor tendons, more work on lower body days can push some pitchers over the edge in terms of forearm symptoms. This can also be an issue during post-operative elbow scenarios, as some surgeons can "beat up" the flexor tendon a bit more during Tommy John surgeries. With these athletes, we'll often plug hip thrusts in to replace deadlifts for 4-8 week spans.
5. Hip thrusts help to maintain a training effect in post-operative elbow and shoulder situations.
Building on my last point, we utilize barbell hip thrusts and supine bridges a lot with our post-op clients. If we are talking about a Tommy John surgery, you aren't using a safety squat bar until two months post-op, or deadlifting until closer to five months (and even then, the loading has to be severely restricted). Conversely, provided they have someone to load plates for them, these athletes can hip thrust as early as 4-6 weeks (assuming we aren't dealing with a lower extremity graft site), and loading appreciably by weeks 8-10. That's a huge deal.
Shoulder surgeries are a bit slower to come around, but you're definitely able to hip thrust well before you use the safety squat bar or integrate deadlifts. In short, if you want bilateral loading in a post-operative situation, hip thrusts below right up there in the discussion with glute-ham raises - and serve as a good complement to sled dragging with a belt/harness and various single-leg drills.
6. Hip thrusts don't create much delayed onset muscle soreness.
It's hard to really overload the eccentric (lowering) component of a hip thrust - and this may be one reason why it doesn't carry over to sprinting as much as a squat would. However, this non-soreness-inducing quality can actually be of benefit, as we often want to avoid it with in-season athletes or those trying to achieve a higher volume of work in their training programs. This is actually a perk of several deadlift variations, too.
7. Hip thrusts are a safe way to get in higher-rep sets.
In the quest to put on some muscle, high-rep squatting and deadlifting often wind up getting pretty ugly by the end of the sets unless they're regressed in some fashion (e.g., goblet squats). And, on a personal note, any time that I deadlift for more than eight reps, I get a massive headache that lasts about three days. I've found that higher rep barbell supine bridge (moreso than hip thrusts) are a good option for sets of 12-15 at the end of a session to kick in some extra volume safely. It's pretty darn hard to screw this up, you know?
Thoughts on Loading
On several occasions, I've heard folks criticize barbell hip thrusts and supine bridges because even seemingly untrained individuals can use so much weight. It's a valid assertion - but only to a point.
My experience has been that many individuals moving big weights are really short-changing themselves on the last 5-10 degrees of hip extension. They're either stopping short or getting lumbar extension (moving through the lower back). Often, when you fine-tune the technique and make them hold for a count at the top, they'll have to reduce the weight significantly. As a rule of thumb, though, I view the risk:benefit ratio with hip thrusts as being comparable to that of deadlifts in an athletic population; going heavier than 495 pounds probably isn't worth the risk or time involved. You're better off changing the tempo (longer pauses at the top) or switching to a different (and possibly more technically advanced) exercise that doesn't "come naturally" to the lifter. In short, find a different window of adaptation instead of just trying to move big weights through a short range-of-motion.
As an interesting aside to this, my deadlifts are actually significantly stronger than my hip thrusts. It's likely a function of "getting what you train," but I think it's an interesting argument against the idea that even weak people can automatically move big weights.
Last, but not least, remember that relatively untrained people can often push a lot of weight on sleds on turf, and rack pulls are usually substantially heavier than one's deadlift. Does that make them useless, too?
Closing Thoughts
New research is always warranted in any field, but particularly in strength and conditioning, a dynamic industry that has changed remarkably over the past few decades. In many cases, it takes a lot of time and experimentation to understand just how something fits (or doesn't fit) in our training approaches. Personally, I always come back to the "justifying the inclusion of a lift" question I noted earlier in this article. My experience has been that barbell hip thrusts and supine bridges have stood the test of time in this regard - and done so safely. I view them much more as an assistance exercise, as opposed to something that would ever replace squats or deadlifts. However, in the special circumstances I've outlined above, I think they will continue to fill in nicely.
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I hope that everyone had a good weekend - and that our readers who are all safe in light of Hurricane Irma. Here's a little recommended reading/listening to kick off your week. Before I get to it, though, I should give a friendly reminder that each month, Cressey Sports Performance staff and I upload webinars, in-services, exercise demonstrations, and articles to Elite Training Mentorship. This is a super affordable and thorough continuing education resource that is updated regularly, and I'd encourage you to check it out HERE.
Why "Just Stretch Your Hamstrings" is Bad Advice - This article is a few weeks old, but I'd forgotten to add it to our weekly collection when I first came across it in mid-August. As always, Doug Kechijian hit several nails on the head.
Hip CARs in the Push-up Position - This is a great video Cressey Sports Performance coach Frank Duffy posted recently. It's an excellent example of the interaction between hip mobility and core stability.
7 Ways to Get Strong Outside the Sagittal Plane - I reincarnated this old article from my archives yesterday, as I think it's a collection of important progressions for rotational sport athletes as they kick off the offseason.
We're 2/3 of the way through the MLB Draft, so I haven't had much time to write up new content. I'll have some video content later in the week, though. In the meantime, here's a little recommended reading from around the strength and conditioning world:
Manual Therapy: Neither Panacea Nor Gateway to Despair - Physical therapist Doug Kechijian discusses the current "state" of manual therapy in the health and human performance worlds and shows us that "it depends" is yet again the most important answer to just about any question we can ask.
Time Management for Personal Trainers - Eric Bach and Daniel Freedman wrote up this great post on how those in the fitness industry can get more efficient.
Deadlift Grip Considerations - I meant to include this in last week's edition, but completely forgot. As usual, great stuff from Dean Somerset.
Top Tweet of the Week
Just had an argument w/a 2-year-old over whether she could pour her own cereal. It felt just about as productive as arguing on social media.
We missed this regular feature last week, as I penned some extra original content in lieu of posting the regularly scheduled "redirects" around the 'net. Luckily, it allowed me to stockpile some stuff for this installment:
Conscious Coaching - Brett Bartholomew just released this excellent book for coaches, and it's already getting rave reviews. Add my name to the list of that list of impressed reviewers, as I'm halfway through and really enjoying it. I'd call this must-read material for any up-and-coming member of the fitness industry.
The Resilient Performance Podcast with Bill Hartman - Bill is one of the brightest guys in the industry, and I learn something each time he speaks. Put him on a call with another super bright guy, Doug Kechijian, and you get an awesome podcast like this!
The 12 Best Ways to Build Shoulders - This roundtable was published this morning at T-Nation, and I was one of 12 contributors. You'll get a nice blend of contributions from bodybuilding and performance backgrounds.
Top Tweet of the Week
Specificity with power training wins again! Prepare in the plane where you perform. Applies heavily to throwing velocity, too. https://t.co/0h9jtsRLN0
After a week in Massachusetts for Thanksgiving, the Cressey family is back in Florida. While up there, we celebrated our twin daughters' second birthday. I'm not sure they're fans of the cold yet...
With that said, let's get to the recommended reading!
30 Days of Arm Care Updates - You can see all these videos (currently on day 17) via the hashtag #30DaysOfArmCare on both Twitter and Instagram.
Settling the Great Grain Debate - Here's some great stuff on the nutrition front from Precision Nutrition's Brian St. Pierre.
Jim Harbaugh's Circle of Friends Is Even Cooler Than You Think - I often say that successful people find value in unexpected places. I love the discussion about how Harbaugh pries to ask questions and elicit deeper responses in his conversations with friends from all walks of life. The best coaches I know are always looking outside their fields to find ways to improve.
Top Tweet of the Week
No bigger injury risk than a 150lb pitcher w/a 90+ mph arm & a Dad who loves showcasing. Sometimes you have to say "no" to help development.
Happy Election Week! I'm happy to report that today's recommended reading list has absolutely nothing to do with politics, as I'm sure you're all sick of hearing about the election on social media. Enjoy the following non-political reads:
The Art of Relationships Based Coaching - This article from Purdue Basketball strength and conditioning coach Josh Bonhotal is one of the best coaching reads I've seen in a long time. It's must-read.
An Interview with Doug Kechijian - This is a fantastic interview with a former CSP intern who is currently doing a great job in NYC as a physical therapist. It's free to the public for the week (Sports Rehab Expert is normally a members-only site).
Gym Owner Musings: Installment 3 - My business partner, Pete Dupuis, always has some great thoughts on the business side of fitness - and this series has been the beneficiary of what pops into his head.
Top Tweet of the Week
It's unfortunate so many coaches meticulously monitor arm action with throwing, but ignore ugly band warm-ups in bad positions.
