Here's this week's list of recommended strength and conditioning reading:
Elite Training Mentorship - In this month's update, I contributed two exercise demonstrations, an article, and two in-services. The in-services were "What is the Sports Hernia?" and "Arm Injury Mechanisms in Throwing Athletes." This latest update also featured some great contributions from Tyler English.
Hudson Training Facility Expands Footprint, Market - This was a story in the local newspaper about the expansion of Cressey Performance, which gives rise to a new offering (morning bootcamps) in our business model. If you're in our area, definitely check it out.
The HRV Roundtable - I thought this was an excellent article at T-Nation, as it draws on the experience of a number of very bright guys in the industry to highlight some forward-thinking concepts.
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Here's this week's list of recommended strength and conditioning reading:
Elite Training Mentorship - The August update at Elite Training Mentorship included some great content from all four contributors. My in-services were "Shoulder Impingement: Internal vs. External" and "Preventing and Training Around Flexion-Intolerant Low Back Pain." I also had an article and two exercise demonstrations featured. If you haven't checked out ETM, definitely do so!
Do Eggs Cause Heart Disease? - In the past week, the "Eggs Are Worse than Cigarettes" shenanigans have gotten out of control. Fortunately, Adam Bornstein (with contributions from Dr. Chris Mohr, Alan Aragon, and Mike Roussell) gets to the bottom of some very flawed research and reporting that is misleading the public.
Here's this week's list of recommended strength and conditioning reading:
Elite Training Mentorship - The most recent update includes quite a bit of content from me, including two exercise demonstrations, an article, as well as two staff in-services: "Scapular Positioning During Table Arm Care Exercises" and "Understanding and Coaching the Anterior Core." If you haven't checked out Elite Training Mentorship yet, I'd strongly encourage you to give it a shot.
By the Coach for the Coach: 10 Things I Learned During the 2011-2012 School Year - I loved this post from my buddy Todd Hamer. Todd, the head strength and conditioning coach at Robert Morris University, is one of the best college strength and conditioning coaches I know. He's a tremendous motivator and has loads of experience in the trenches, even if he doesn't have a big internet name. Up-and-coming coaches need to read stuff like this as often as possible!
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This week's strength exercise is one I learned from Dave Schmitz of ResistanceBandTraining.com. Dave's the "go-to" guy out there when it comes to training with resistance bands, and he has a knack for coming up with innovative exercises with minimal equipment. This is one such example that we've been utilizing more and more in the strength and conditioning programs we write.
The beauty of the weight shift is that it adds an extensive decelerative component to the exercise and allows us to integrate scapular control in whole body movement the way it occurs in athletics. It also allows us to get a better training effect with less resistance.
I like utilizing this with our pitchers because it educates them on how to "get long" out front (improve trunk tilt at ball release) and stiffen up on the front leg at the right time. The eccentric overload created by the band serves as a good reminder to not get lazy and go to mush on the front side.
This can also be utilized in group training settings when you want a compound exercise that folks of many different strength levels can utilize. Simply stepping closer to the band attachment point can reduce the resistance and make it appropriate for a weaker participant without having to change the load.
The exercise can be done with a cable as well, but I just don't think that the weight shift component works quite as smoothly in the cable scenario.
In terms of progressions, we typically teach the standing 1-arm cable row first to all our clients and athletes, as it educates them on proper interaction of the scapula and humerus during rowing. This is an exercise we'd consider adding into strength and conditioning programs after the first 4-8 weeks of working with a client. It's usually done either first in the training session as a power exercise, or later in the session for higher reps.
Give it a shot!
Also, if you're interested in checking out more of Dave's innovative exercises, be sure to visit EliteTrainingMentorship.com, as he's one of my co-contributors to the site and adds great content each month.
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Here's this week's list of recommended strength and conditioning reading:
Elite Training Mentorship - My new content at Elite Training Mentorship was just loaded up last week. In addition to two new exercise demonstrations and articles, I added two new staff in-services: "Preventing Anterior Shoulder Instability," and "Zones of Convergence." Tyler English also provided some great content for this update.
What Top Experts Are Doing Differently This Year - I contributed on this collection of year-in-review reflections from a number of experts in the industry. Mike Reinold organized it and published it on his blog - and you'll find some great insights there.
A Muscle Plan for Every Man - This was an article I wrote last year for the print version of Men's Health, and they just reprinted it online recently. In the article, I discuss how to go about writing your own strength training program.
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Here's this week's list of recommended strength and conditioning reading:
Elite Training Mentorship - I just had some new content loaded here for one of our twice-a-month updates. My two in-services, Progression and Regression and Understanding and Managing Acromioclavicular Joint Issues will be of particular interest.
Trunk Stability for Young Athletes - Mike Robertson did a great job with this post on preparing today's young athletes without skipping steps.
Understanding USA Hockey's American Development Model (ADM) - This is an excellent post from my friend (and former CP intern) Kevin Neeld. I love how Kevin has sought out to be "the guy" when it comes to hockey much like we have done so in our work with baseball players. I also really enjoyed this post, because I think we can learn a lot on long-term development models by looking to the successes and failures encountered in other sports. In particularly, I loved his quote, "We're winning the race to the wrong finish line."
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Here's a list of recommended strength and conditioning resources for the week:
Elite Training Mentorship - This continuing education resource we introduced last month has started off with a bang, as we've gotten a lot of great feedback. It'll update twice per month, and the first happened yesterday. Content came from Dave Schmitz (two in-services and two exercise demonstrations) and me (two in-services and two exercise demonstrations). My in-services this month were "Understanding and Managing Congenital Laxity" and "Understanding the Hip Adductors." Updates from Mike Robertson and BJ Gaddour will come later this month. Click here for more information.
9 Strategies to Train Around Lower Body Pain - Speaking of Mike Robertson, this is a great article he had published at T-Nation this week.
Pressing Considerations for the Older Lifter - This was a super-detailed post from Jim "Smitty" Smith on what the seasoned veteran of strength training programs needs to keep in mind when doing a lot of pressing.
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Growing up, my mother always told me that I had a remarkable ability to spot the good (and bad) in people; I generally could get pretty quick reads on what kind of folks I was encountering, and then choose my friends/colleague accordingly. As a result, as I think back on it, this is probably why I never had "bad" friends: people who got into trouble or rolled with the wrong crowd.
More recently, my wife has commented on how I always seem to find the good in people. I shrug off not-so-positive nuances in their behaviors and can become friends with just about anyone. I think this has helped me a lot as a coach, employer, and presenter.
So, I guess you could say that I'm an optimist. In my eyes, this glass is half full.
This applies to not only my interaction with other people, but also to the way that I view the fitness industry in which I make my living.
Every day, I hear people pissing and moaning about how many things are wrong with the fitness industry:
1. The barrier to entry is too low and most personal trainers suck.
2. Heart disease is still on the rise.
3. People use too many machines and not enough free weights.
4. The functional training revolution has turned many personal training sessions into a circus act.
5. Crossfit butchers exercise technique and ignores periodization.
Cry me a river. If you're so down on our industry, do something to change it - or just pick a new one. I've met thousands of trainers over the years, and there is no bigger turn-off to me than when someone goes on and on about how terrible the industry is and how awful the trainers they're around are. I've also heard people bring it up in internship and job interviews, and it's a huge turnoff that puts them in the "rejected" pile instantly.
As I've said in the past, "small hinges swing big doors," so if you're frustrated with where the industry is headed, start with yourself and what you can change to make things better. For me, that starts with optimism. I look at the quotes above and think:
1. That low barrier to entry has also opened doors to some ridiculously outstanding personal trainers who are changing lives every single day. And, having more terrible personal trainers has afforded more opportunities for others to show just how good they are, comparatively speaking.
2. That means more cardiac rehabilitation jobs are opening up. Plus, all the research on cardiovascular disease has taught us a ton on how to modify training, nutrition, and supplementation approaches for our otherwise healthy clients. There's no way that we know as much about low carb diets nowadays if cardiovascular disease and diabetes research hadn't received so much attention and funding over the past 20 years.
3. If other facilities are relying heavily on machines, but I'm not, it's an opportunity for me to show one more stark contrast that makes Cressey Performance training a better fit. It's one more way for me to educate someone and win them over.
Additionally, the heavy reliance on expensive machines in the 1980s and 1990s likely gave rise to an entire industry of portable training devices like the TRX in the 21st century (remember the old business advice: if you want to be successful, do the opposite of what everyone else is doing). Were it not for the TRX and other devices that provide similar portability and versatility, we might not be able to pull off semi-private training and bootcamp set-ups on the level that they take place in the fitness industry today.
4. The functional training revolution has also produced some outstanding coaches who effectively bridge the gap between corrective exercise and high performance training. It's brought about more collaboration among fitness professionals and rehabilitation specialists. And, on an industry-wide level, it's helped us to inform clients that exercise should enhance quality of life and improve the way you move, not just make you stronger, more muscular, and less fat while you suffer through pain.
5. Crossfit has also created a tremendous camaraderie among thousands of athletes, and motivated loads of people to exercise when they might have otherwise become sedentary. They've created a competitive outlet for a lot of former high school, college, and professional athletes. And, there are some Crossfit franchisees who actually do an outstanding job with coaching technique and catering programming to each individual's needs. You can't just judge them all based on the garbage you see on Youtube.
I could go on and on all day, but the truth is, the folks doing the criticizing often ought to take a look in the mirror, as they're usually in need of a lot of improvements in their own right. I'm not perfect, and neither is anybody else - and that's a great thing, as we can always find ways to get better. To that end, in the spirit of optimism, here are five current fitness industry trends that bode well for those of us looking forward to where the next few decades will take us.
1. New fitness research every single day - For the longest time, all researchers seemed to care about was aerobic exercise, but then, in the 1990s, there was a big boom of resistance training research that continues to this day.
It's exciting to be in such a dynamic field, as it keeps you on your toes and guarantees that you'll be constantly improve if you simply attempt to stay up-to-date with new research.
2. Increased communication across disciplines - There are more opportunities than ever for professionals in the health and human performance fields to network and learn from each other, and collaborate on treatments/training for patients/clients/athletes. Look at professional sports teams; they've gone from just having an athletic trainer in the old days, to now also having strength and conditioning coaches, physical therapists, massage therapists, nutritionists, chiropractors, sports psychologists, acupuncturists, you name it. This same "team-oriented" approach has extended to the private sector, whether it's under one roof or simply in collaborative efforts in similar geographic areas.
3. Improved business resources - In years past, personal trainers were supposed to work long "floor hours" at big box gyms in the hopes that they could bully gym goers into personal training with them. It pissed most people off, made the trainer look like a super sketchy used car salesman, and didn't exactly give this fitness professional an opportunity to demonstrate his expertise. Plus, in the past, people would open gyms simply because they liked to exercise and thought it'd be cool - and most of those operations went belly up pretty quickly. Nowadays, there are much more solid resources available to fitness professionals if they're looking to do a better job of not only building a business, but managing it. So, without having the actual numbers in front of me, the success rates are probably higher - especially if you have #4...
4. Sustainability within a niche - As you probably know, I train a ton of baseball players; it's about 85% of our clientele at Cressey Performance. I'm not sure that this would have been possible ten years ago. While early youth sports specialization has been a terrible idea in the context of injuries, it has given rise to increased specialization in training to prevent injuries, and management of the injuries that are already in place. The end result is that it is more feasible for a fitness professional to make a career out of his/her true passion. In my case, it's been baseball.
5. Accessibility to training information - Let's face it: you probably would have not have heard of Eric Cressey (much less EricCressey.com) if it wasn't for the internet. I'd likely still be training loads of baseball players in Hudson, MA - but I don't know that I would have as many guys coming from across the country to train with me if it wasn't for the internet. It's made our expertise easier to perceive, and working with those players has made me a better coach faster.
That same ease of information gathering is available in a wide variety of formats. In the old days, you had to hit up a library, buy a book out of a catalog, or visit a coach locally to observe. Nowadays, you can order books, DVDs, webinars, podcasts, and video presentations completely online. You can easily apply for an internship across the country, email a coach or facility you'd like to visit to observe, or pick out a seminar of interest - and then instantly book a flight, rental car, and hotel to make it happen. You can hop on pubmed.com and search thousands of journals for specific information you want. You can read free blogs, newsletters, and articles in areas of interest to you. In short, you can get better faster than ever before. A while back, I jokingly tweeted "Using the phrase 'I'm bored' is synonymous with saying 'I'm too lazy to read to educate myself in my free time.'" The truth is that I wasn't joking, though; you can always be doing something to improve yourself professionally if you're willing to put the time and effort in.
This is one reason why I'm so psyched to be a part of Elite Training Mentorship, the online resource we introduced almost two years ago.
You get frequent updates from several contributors - Mike Robertson, Dave Schmitz, Tyler English, Vaughn Bethell, Steve Long, Jared Woolever, and me - all industry professionals who are running successful facilities. The information covers several facets of the industry, too. You get everything from videoed staff in-services, to webinars, to sample programs, to coaching demonstrations, to articles from the contributors. And, you get it conveniently, as you can access it from any computer, iPad, or phone. There's no need to book a plane ticket, hotel, or rental car like you would with a regular seminar. To learn more, check out Elite Training Mentorship.
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This project has been in the works for almost a year now, and represents a great opportunity for you to receive a multi-faceted fitness education from the comforts of your own home. Mike Robertson, BJ Gaddour, Dave Schmitz, and I all have unique specialties within the fitness industry, and we're thrilled to have this opportunity to share them with you, as we all genuinely love to teach, coach, and learn - and this resource allows us to do all these things in one convenient set-up.
And, to sweeten the deal, you can sign up for Elite Training Mentorship right now for only $1 for a month to see if it's the right fit for you. This launch special ends on Friday (3/9) at midnight, so don't delay. I, personally, already have three staff in-services, one webinar, two exercise tutorials, and two articles available on the site - and Mike, BJ, and Dave have plenty of their own as well. As the saying goes, "Content is King" - and we intend to deliver a lot of it each month.
Check it out for yourself: Elite Training Mentorship.
Today, we have a guest blog from former Cressey Performance intern Eric Oetter, who is well on his way to a great career in physical therapy. Eric is an extremely bright up-and-comer from whom you'll be hearing a lot in the years to come. Here's a little sampling.
As part of the “pre-launch” phase for his new collaborative project, Elite Training Mentorship, Eric posted an outstanding video covering the lower-extremity assessment protocol he uses at Cressey Performance. For those who haven’t yet seen it, follow the link here; you won’t regret it.
In the video, Eric mentions three different factors that can contribute to mobility deficits at the hip: muscular restrictions, capsular restrictions, and bony restrictions. While the first two – muscular and capsular – can be relatively easy to decipher based on the test position of the hip, identifying bony restrictions can be tricky unless you’ve got access to a client’s radiological imaging. For this reason, it’s important to appreciate any structural variations in the skeletal system that can underlie joint malalignment at the hip.
The focus of this piece is a structural variation called hip anteversion. We’ll be covering the joint morphology associated with anteversion, along with a quick orthopedic test and some implications for programming.
What is hip anteversion?
Excerpted from the 2002 text Diagnosis and Treatment of Movement Impairment Syndromes, Shirley Sahrmann describes hip anteversion as the following:
“ … the angle of the head and neck of the femur is rotated anteriorly, beyond that of the normal torsion with respect to the shaft. The result is a range of medial hip rotation that appears to be excessive, whereas the lateral rotation range appears to be limited.”
Essentially, clients who present with this structural abnormality were born with, or have acquired, a more internally oriented neutral position for their femurs as they sit in the acetabulum (or hip socket). To be classified as anteverted, the femoral head and neck must be rotated more than 15° anteriorly with respect to the plane of the femoral condyles (Sahrmann 2002). (Conversely, a posterior rotation of the femoral head and neck would constitute a retroverted hip.)
When observed standing, clients with hip anteversion will often present with femoral adduction and genu valgum – the classic “knock-kneed” posture. As kids, these clients likely eschewed “indian-style” for W-sitting – a position much more congruent with their natural femoral alignment.
While some might also classify “pigeon-toes” as an indicator for anteverted hips, this is not always the case. In the presence of anteversion, some clients – especially athletes – will develop a tibial torsion as a result of the applied stresses to the lower extremities. This adaptation allows for a neutrally aligned sub-talar joint in the face of morphological changes up the kinetic chain.
The largest implication of hip anteversion or retroversion is a significant discrepancy between hip internal and external rotation. As described in the Sahrmann quotation above, hip anteversion creates an apparently large amount of internal rotation (IR) with a reciprocal loss of external rotation (ER).
I liken these morphological changes to those seen in the retroverted shoulder of an overhead throwing athlete. The total hip range of motion (IR + ER) can present at around 90°, or “normal”, but these measures are drastically skewed in one direction of rotation.
Whereas a retroverted shoulder presents a favorable adaptation in baseball, the same cannot always be said for the athlete with anteverted hips.
If undiagnosed or mismanaged, hip anteversion can create pathology. Expect issues like knee pain, back pain, and hip instability (Sahrmann 2002). For this reason, it’s imperative to recognize anteversion when it presents and apply the programming modifications necessary to accommodate this structural abnormality.
So how can I test for it?
Although checking IR and ER in both supine and prone can highlight limitations in the capsule or surrounding hip musculature, you’ll need an extra orthopedic test at your disposal to clear the skeletal system. For this purpose, we’ll use the Craigs’s test.
Assuming you’re following the assessment outlined in Eric’s video, the best time to perform a Craig’s test is immediately after you’ve assessed a client’s hip rotation in prone, especially if you detect a glaring asymmetry between IR and ER.
Note the client in the photos below – here, we see an excessive amount of IR (~50°) met with limited ER (only ~20°). With a rotational deficit of ≥30°, this client may have some torsional issue at play; thus, a Craig’s test indicated.
With the client remaining in prone the knee held in flexion, the Craig’s test is performed by first palpating the same side greater trochanter, a landmark on the femur that protrudes laterally about 5 inches below the iliac crest. Make sure to apply flat-hand contact with the pads of the fingers – this posture allows for greater sensory feedback and precision. Once this position is assumed, begin internally and externally rotating the femur through its full range of motion.
As you rotate the leg, you’ll notice the greater trochanter tracking against your fingertips, becoming more or less prominent depending on the direction of rotation. Start shortening your oscillations until you determine the position at which the trochanter is most prominent laterally and pause once you locate it. At this range of rotation, the femoral head is optimally situated within the acetabulum.
We get a positive Craig’s test when the hip rotation at the point of ideal femoral alignment is ≥15° into IR. Also, we can now classify the hip as anteverted, providing useful insight for the dexterous coach.
Check out the video below to see a Craig’s test performed on our client from above.
One thing worth noting – a 1992 study by Ruwe et al. showed the Craig’s test to be more reliable than radiological techniques in the assessment of femoral torsion. So, even if you have client X-rays available, a Craig’s test is still worth administering.
If the Craig’s test is positive, how should I alter programming?
Now that we’ve performed a Craig’s test and determined whether or not any torsional qualities exist, it’s time to write an effective program that respects our findings. Here are a few do’s and don’ts to consider when programming:
• DON’T stretch the hip into external rotation – this only creates impingement. We wouldn’t force the retroverted shoulder of a pitcher into an end-range sleeper stretch, so we need to take the same approach with an anteverted hip. Even though the hip is a much more durable joint, there’s no reason to drive motion that a client simply doesn’t have, as this only serves to jam the femoral head against the acetabulum.
• DO increase the amount of core work in clients with femoral torsion. When someone is stuck in internal rotation at the hip, the kinematics of the lower-extremities become predisposed towards a pronation pattern (sub-talar pronation, tibial/femoral IR, and anterior pelvic tilt).
The hip external rotators often become excessively stiff and overused, as they are constantly checking motion into adduction, internal rotation, and flexion. While increasing external rotator strength will improve the first two, we can employ the posterior fibers of external oblique and rectus abdominis to aid in flexion control, creating a more stable pelvis. By doing so, we’re also increasing stiffness at the lumbar spine, fighting any compensatory motion created by the hip external rotation deficit.
As far as exercise selection goes, focus on half-kneeling chops/lifts and anti-extension – both integrate the hips and core simultaneously to check hip flexion ROM. I especially like rollout variations for clients with hip anteversion, which are highlighted in Eric’s video below.
• DON’T introduce quad-dominant lifts until the client shows dramatic improvements in hip stability. The pronation pattern I described above is essentially a cookbook for ACL and MCL injuries. In a population that is likely anteriorly tilted at the pelvis and anterior weight bearing, the last thing we want to do is make them even more reliant on their quads. An adroit posterior chain should precede any anterior chain-focused movement.
• DO hammer the posterior chain as if your life depended on it. While this statement could serve as a mantra for most general population programming, it is even more important when dealing with anteversion of the hip. These clients sometimes present with femoral control so poor, our first goal is to simply get them to baseline.
Mastering stability in the sagittal plane takes precedence. Start bilateral with deadlift and box squat variations and increase stability demands as the client advances. Great second tier progressions include single-leg RDLs, single-leg hip thrusts, and bowler squats, all of which introduce frontal and transverse plane stability.
Lastly, exercises that force the femur into an abducted and externally rotated state are contraindicated – sumo deadlifts provide a great example. Even though pulling sumo is a fantastic variation for hip strength, it can create malalignment in the acetabulum if the hip is anteverted. In this case, it’s safer to stick with either trap bar deadlift or conventional deadlift variations.
Conclusion
Hip anteversion isn’t something you’ll likely see in every client. Johns Hopkins Medical School reports the prevalence to be ~8-10%, but that number varies based upon cultural norms and neurodevelopmental patterns, which can alter skeletal growth.
Regardless, it is an important structural variation to recognize and program for, especially in an athletic population. Taken as supplement to Eric’s lower-extremity video, I hope this article provides you another piece towards building a better assessment.
About the Author
Eric is currently a senior at the University of Georgia majoring in Exercise and Sport Science, with plans to pursue a Doctorate of Physical Therapy. After concluding a Division-1 football career at the Georgia Institute of Technology, Eric has ardently pursued his passion for coaching, garnering experience with clients of all ages and ability levels through internships at both Indianapolis Fitness & Sports Training and Cressey Performance. His articles can be found on EricCressey.com, 8weeksout.com, and in Fighting Fit magazine. You can follow him on Twitter or reach him via email at ecoetter@gmail.com.
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