What the experts are saying about The Truth About Unstable Surface Training…
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Comprehensive Physical Therapy
Colmar, PA
Click here for more information on The Truth About Unstable Surface Training.
Subscriber-Only Q&AQ: I have a question about your 22 More Random Thoughts article from October of 2008 on T-Nation. In the stretch for the hips found above #10, I can't tell is that athlete bridging or are the hips on the ground. Also, can you please explain exactly what is stretched and how a little bit about how it corrects out-toeing of the feet?
A: Sure, no problem. Here's the lying knee-to-knee stretch, for those readers who missed the original article:
First off, it's a stretch for the hip external rotators, and the athlete is not bridging up. However, it's also useful to do the stretch in a more hips-extended position, as a small percentage of athletes will feel it more in that position. To perform this stretch, we'll do the exact same position, but have the athlete set up atop a stability ball (which keeps the femurs in a more extended position).
Poor hip internal rotation range-of-motion is something you'll see quite frequently in soccer players, hockey players, and powerlifters, as all spend a considerable amount of time in hip external rotation. Likewise, I monitor this closely with all my baseball pitchers, as front leg hip internal rotation deficit is a huge problem for pitchers. When the front hip opens up too soon because of these muscular restrictions, the arm lags behind the body (out of the scapular plane). As such, it isn't uncommon for pitchers with elbow and/or shoulder pain to present with a significant hip internal rotation deficit.
There is also a considerable amount of research to suggest that hip rotation deficits - and particularly, hip internal rotation deficits - are highly correlated with low back pain. There was a great guest blog post at Mike Reinold's blog recently that highlights all this research; you can check it out HERE. My personal experience with hundreds of people who have come my way with back pain overwhelmingly supports this "theory" (if you can even call it that). It's my firm belief that this is one of the primary reasons Mike Robertson and I have gotten so much great feedback on our Magnificent Mobility DVD from folks who have seen a reduction (or altogether elmination) in back pain. Teach folks to move at the hips (particularly in rotation) instead of the lumbar spine, and whatever's going on in their low backs calms down.
Our goal is a minimum of 40 degrees of hip internal rotation. This is measured in the seated position (hips flexed to 90 degrees).
In addition to the classes of athletes I mentioned earlier, we also need to watch out for hip internal rotation deficit (HIRD) in the general population because of what happens further down the kinetic chain. We all know that overpronation at the subtalar join is a big problem for a lot of folks. This can occur because of a collection of factors, from poor footwear (too much heel lift), to muscular weakness (more on this in a second), to mobility deficits (particularly at the ankle), to congenital factors (flat feet). To understand how pronation affects the hip external rotators, you'll need to listen to a brief synopsis of subtalar joint function...
During the gait cycle, the subtalar joint pronates, to aid in deceleration. Basically, the foot flattens out to give us a bigger base of support from which to cushion impact, and from there, we switch back over to supination to get a rigid foot from which to propel. The picture below shows what our foot looks like when we have too much pronation.
Here's where our hip gets involved. Physical therapist John Pallof once called the subtalar joint a "torque converter," and it really stuck with me. What that means is that while the subtalar joint allows motion in three planes for pronation/supination, it converts this motion into transverse plan motion where it interacts with the tibia. And, as you can imagine based on the picture above, when you pronate, you increase tibial internal rotation. This, in turn, increased femoral internal rotation. Taken all together, we realize that increasing pronation means that there is more tibial and femoral internal rotation to decelerate with each step, stride, or jump landing.
The hip external rotators are strong muscles with a big cross sectional area, so they can take on this burden. However, over time, they can get balled up from overuse. As a result, the hip will sit in a more externally rotated position all the time - and the feet simply come along for the ride. That said, as I wrote HERE, it isn't the only cause of this foot position, so be sure to assess thoroughly and individualize your recommendations.
Also, a quick side note, be careful using this stretch with individuals who have previously experienced medial knee injuries, as the valgus stress can be a bit too much for some folks.
New Blog ContentRandom Friday ThoughtsFor High School Pitchers, No Grace PeriodDoga? Seriously?CP Athlete Featured at Precision Nutrition
I encourage you to check out this Precision Nutrition Athlete Profile on Cressey Performance athlete and Oakland A's minor league pitcher Shawn Haviland. Shawn completely changed his body this off-season and had a nice velocity jump from 87-89 to 91-93mph - and he's off to a good start for the Kane County Cougars. A lot of this can be attributed to him making huge strides with improving his nutrition.
Have a great week!
EC
Q: At what point do you think that muscle size affects one's range of motion? Just interested in your thoughts. I'm a golfer and my flexibility is important; there isn't much point for me to be really strong but not able to move properly.
A: Well, it would be joint- and population-specific. On the joint side of things, as an example, the elbow flexors (biceps, to the lay population) and knee flexors (hamstrings) can restrict elbow and knee flexion, respectively, if they get too big. Or, the pecs may inhibit horizontal adduction ROM. This list goes on and on.
I don't feel that simply making a muscle bigger means that you lose range-of-motion in that specific muscle, as the improvements are to cross-sectional area. If this was the case, the elbow flexors would be restricting us in extension, and the pecs would be restricting us in horizontal abduction, but as the examples above show, that's just not happening.
Provided that flexibility training is good, and structural balance is prioritized in programming, there is no reason to believe that you can't be big and flexible.
Now, it's important to consider the sporting population in question. A powerlifter isn't going to need as much mobility as, say, a baseball pitcher. One guy needs to be efficient in a short range of motion, while the other needs to be efficient through a larger range of motion.
In pitchers, external rotation ROM is a good predictive factor for velocity. On top of that, horizontal abduction at stride foot contact is huge, according to the research.
So, in order to have good pitching specific ROM, you need to have adequate length of the muscles that internally rotate and horizontally adduct the shoulders. And, the big muscle that does this is the pectoralis major. Bench until the cows come home, shorten it up, and then you'll lose that ROM.
Now, ask anyone who has ever trained baseball pitchers, and they'll tell you that pitcher gain external rotation over the course of a season simply from throwing. Guys who don't weight-train properly can certainly impede this velocity-aiding adaptation.
This, of course, is an example specific to baseball pitching, and demands would be different for golfers.
Okay, while this is normally RANDOM Friday Thoughts, I think it's important that we get one thing clear up-front...
While I may be covering several topics today, in reality, the only thing that warrants any discussion is the Final Four - because UCONN is going to go out and dominate this weekend (and Monday). This includes the men's and women's basketball teams, cheerleaders, mascots, fans, and hot-dog vendors.
More of these on the way!
Anyway, let's get to this week's randomness (as if yesterday'swasn't awesome enough)
1. On Tuesday, there was a great guest post from Dan Lorenz on Mike Reinold's blog; it is definitely worth checking out: Low Back Pain and Hip Motion Correlation. We've really worked in hip internal rotation aggressively over the past year or so, and it's been a huge help for our athletes. I love this stretch, in particular:
Of course, hip internal rotation is just one component of a good hip mobility program. Check out the Magnificent Mobility DVD for more details.
2. I've been outspoken in the past about how I think that higher certification requirements - and possibly even mandated licensing - ought to be imposed in the personal training industry. This article is a great example of why.
3. Can somebody tell me a) why in the world Michael Vick wants to give up a potential return to the NFL to become a construction worker, b) why any construction company would actually hire Michael Vick, and c) why this is even qualifies as news? It seems like a lose-lose-lose situation, so I'll just drop it.
4. Here is a nice article about Cressey Performance athletes Matt Miller and Jason Roth, both of whom are playing baseball at Northeastern right now.
5. Apparently, age-related mental decline begins as early as age 27. I turn 28 on May 20 - so I guess you could say that the good news is that this blog will get a lot more interesting once I'm senile (assuming I can even remember the log-in information).
6. I recently received this email before/after report from a happy Maximum Strength reader:
"Eric,
Thanks for the program. When I first started lifting July '07, I had two long term goals - 400 lb deadlift by July '08 and 1,000 lb club (squat, deadlift, bench). Well, here are my results from your program.
Broad Jump: 87" to 94"
Bench: 205 to 245
Squat: 215 to 265
Deadlift: 305 to 365
Chinups: None. Now 2. Just missed the 3rd. I am 6'4" and had never done one in my life.
My weight went from 221 to 237. I gained an inch in my arms, around the shoulders, and legs. In the end, I went from 725 lbs to 875 lbs; only 125 lbs to go.
Thank you!
Andy"
Pick up your copy of Maximum Strength today!
Have a great weekend!
The positioning of the feet in a static posture assessment can tell you a lot, but simply looking without following up won't give you a definitive answer. The most common postural distortion you'll see is an externally rotated foot position.
It's common to assume that this is simply a case of an athlete with hips that are stuck in external rotation. And, in many cases, this is definitely the culprit. For these athletes, a hearty dose of knee-to-knee stretches will do the trick (along with some stretches for the hip external rotators in a position of hip extension).
For other athletes, though, this foot position is simply a compensation, as athletes will turn the feet out to compensate for a lack of dorsiflexion (toe-to-shin) range-of-motion. These athletes need to work hard to improve ankle mobility with a combination of lower-extremity soft tissue work and mobility drills.
With today being Friday the 13th, I figured we'd roll with that theme for today. As you probably know, Friday the 13th is - according to superstition - a day of bad or good luck. Honestly, I didn't know that good luck was a feasible outcome until I just Googled it, but apparently it is, and I'm just a stupid pessimist without even knowing it. So, in hopes of turning my day around, I'm going to post this video and make all the villagers rejoice because they know they're smarter than this girl:
2. Did you know that there is actually a term - paraskavedekatriaphobia - forthe fear of Friday the 13th? Apparently, this problem is a more specialized form of triskaidekaphobia, which is just fear of the number 13. Fortunately, though, these phobias aren't nearly as bad as:
a. Logophobia - fear of words (reading this blog would really suck for those folks, huh?)
b.Electrophobia - fear of electricity (turning on the computer would must have been terrible, but missing out on my electric sense of humor must have been the worst!)
c.Arithmophobibia - fear of numbers (you'll be happy to note that I'm using a, b, c, and d instead of a numerical listing scheme because I am sensitive to your concerns)
d.Hippopotomonstrosesquippedaliophobia - fear of long words (coincidentally, they gave this guy a syndrome with 36 letters)
A few other honorable mentions to to levophobia (fear of objects to the left of the body), geniophobia (fear of chins), chronomentrophobia (fear of clocks), and Gentilcorophobia (fear of painfully bad techno music).
3. Yesterday, I gave a guest lecture/hands-on session for an exercise science class at UMASS-Boston. I've done this several semesters in a row, and this semester's topic was "Core Stability and Mobility." While I think that folks like me who have been in the trenches for a while and attend a lot of seminars need another presentation on core stability like I need a whole in the head, it was cool to speak about the topic to a younger audience that didn't have as much experience under their belts. One book I encouraged all of them to pick up was Ultimate Back Fitness and Performance by Stuart McGill.
4. Along those lines, one movement I find us using around the facility quite a bit is the split-stance cable lift:
5. Mike Robertson's just begun doing a podcast component in his newsletters, and it allows him to cover more material than he would with writing along. Check out the first installment HERE; I think you'll like it.
6. About two years ago, I was featured on the front page of the Boston Globe in a picture with Steph Holland-Brodney, CP's most tenured client, as she prepared for the Boston Marathon. Almost immediately, I was thrown into a world of international fame as "the dude with the hard nipple" - and I added to the already-insane media frenzy by authoring a literary masterpiece known as The School of Hard Nipples. For weeks, I couldn't even go grocery shopping without being swarmped by paparazzi and adoring fans who couldn't wait to catch a glimpse of the nipple that had changed so many lives.
Fortunately, Boston won the World Series in 2007 about six months later, and it was about the same time that "The Departed" came out to put Boston in the spotlight. So, thanks to the Red Sox and Marky Mark, some of the pressure was lifted - and I managed to move forward.
As I learned this week, though, the stardom hasn't died down altogether. You see, when I check my website stats, I can find out what people most frequently type in with search engines when they ultimately come to EricCressey.com. And, would you believe that I average about 3.5 "hard nipples" searches per day? In other words, random people are typing "hard nipples" into Google, and in many cases, they're winding up at EricCressey.com instead of many of the millions of adult entertainment sites out there.
Cressey Performance was lucky to have Kevin Neeld around the facility last summer, and all our coaches were much better off thanks to this experience. Kevin always makes some great points and is never afraid to question the norm - and do a ton of research. Kevin's specialty is hockey, and he recently introduced an Off-Ice Performance Training E-Manual for hockey players and coaches that is absolutely fantastic. I was fortunate enough to get an advanced copy, and it was so good that I couldn't wait to get an interview with him up here at EricCressey.com. So, without further ado, here it is.
EC: I'll be the first to admit that if I see another seminar presentation or article on "core training," I'm going to lose my lunch. Interestingly, though (and to be blunt), yours in this product doesn't suck. In other words, there is a lot to be learned both specific to hockey and in a general sense. Can you explain for my readers in a bit of detail?
KN: Sure thing. In my experience, the reason core training is so poorly practiced is because people don't understand what muscles are involved in the core and what their collective function is. Beyond the rectus abdominis ("6-pack" muscles) and the external and internal obliques, the core encompasses over a dozen other muscles that attach to the hips, rib cage, and spine. Collectively, these muscles serves a few major, inter-related functions: 1) Control movement of the hips; 2) provide a stable base for leg and arm movement; and 3) create stiffness for efficient force transfer between the upper and lower body.
My approach to core training is pretty straight forward: 1) Teach athletes awareness-what core stability is and feels like; 2) Train for core stability; 3) Progress to dynamic stability (stability challenged by internal or external forces); 4) Progress to training core stiffness and force transfer; 5) Combine force transfer and dynamic stability into one exercise.
The progressions are explained in more detail in the course, but to give you an idea of what that looks like:
1) Abdominal draw-ins (for awareness, NOT transversus abdominis isolation...which is a stupid concept), and simply having the athlete put their hands over their stomach, fill their belly up with air, squeeze their core and continue to breathe.
2) Planks and bridges
3) Planks and bridges with partner perturbations
4) Medicine ball throws, tosses, and slams
5) Combined med ball exercises with holds in various positions challenged by a partner perturbation
I hope that all makes sense. The course doesn't go into full detail on medicine ball exercises because I really wanted to make the exercises and progressions realistic for a team setting, and typically there isn't a lot of equipment available.
EC: Along these same lines, what are the specific injury issues that you prioritize in this e-manual?
KN: Hockey players are plagued by hip and lower abdominal injuries. What's scary is that the true causes and predisposing risk factors to these injuries are only starting to be explored in the research community. Usually, creating an appropriate balance within and between the hip and core musculature can prevent these injuries. For example, if you have a strength imbalance between the muscles on the outside and inside of your hip, your risk of adductor (commonly referred to as the "groin") strain increases. If you have a strength imbalance between your adductors and your anterior abdominal musculature, your risk of lower abdominal injury increases. As with most injuries, the key is creating a balance.
As a quick note, creating balance often means utilizing unbalanced training. Your readers may know this already since you talk about the same things with your baseball guys. Hockey players take several dozens shots every week. These shots usually involve forceful rotation in the same direction. The best way to create balance would be to use an unbalanced training program with more rotation or anti-rotation exercises in the direction OPPOSITE to that in which they shoot. This is where sport-specific training really threw people off. Training "sport-specific" patterns again and again off the ice is likely to increase injury risk, not performance.
Getting back to hip and lower abdominal injuries...Typically these injuries are a result of under-preparation or overuse, both of which can be addressed with similar training methods. I first implemented some of the dynamic warm-up and core training exercises outlined in the course with the University of Delaware Men's Ice Hockey Team in 2006. We had ZERO pre-season hip flexor or "groin" injuries. Not a single player missed a single practice or game. I've refined a lot of things since then, but a lot of the concepts are still the same. Warm-up appropriately by improving range of motion around the right joints and activating the right muscles, and train the core for its true function, and you'll likely avoid these injuries.
EC: Hockey players, like all athletes, have loads of competing demands - from on-ice technical work, to energy systems training, to resistance training, to flexibility training. This manual does a great job of integrating all these features. Where do you feel that most people make the biggest mistakes in this regard?
KN: It really depends on the team, but the three things that seem to come up most often are:
1) The training of most youth programs involves a couple laps around the rink, a long stretch, maybe some jumping, push-ups and sit-ups. These programs leave out a lot of important forms of training (e.g. dynamic flexibility, core stability, reactive agility, acceleration/deceleration, etc.).
2) Conditioning is still horribly misunderstood. The idea that hockey players need to train for a well-developed "aerobic system" by going for long runs is pretty ridiculous. We're talking about a sport that typically involves 30-45 second shifts, followed by several minutes of rest. Within each shift, there are typically a few bouts of 3-5 second all out efforts, followed by periods of gliding, and usually a stoppage or two. This breaks down into something like 20 seconds of high intensity effort every five minutes. Repeated 20-minute jogs around the rink will make you well-conditioned for the wrong sport.
3) The largest problem I see in team settings is a complete disregard for the QUALITY of movement. Hockey players and coaches are very driven, which usually means they want more, not better. The first thing I do when working with a new team is sit them all down and tell them that focus will be placed on quality of movement before intensity or quantity of movement. Moving the wrong way, at a high intensity or volume, will only make bad patterns worse. I made a strong effort in the course to emphasize proper movement and technique and provide simple coaching cues so that people without a background in sport biomechanics can still move the right way.
EC: A large percentage of the folks reading this resource are going to be high school athletes and coaches - many of whom play multiple sports. What pieces of advice do you have for these folks? How can they make the most of this training when they've got other sports on top of the competing demands we discussed above?
KN: My advice: Keep playing multiple sports. Early specialization (only playing hockey from a young age) will have detrimental effects on your development and movement quality as you get older. Typically these are the players that dominate when they're 12-14, then drop off the map or are plagued by injuries at 20.
To get to the heart of your question, good training is good training. The course outlines quality training in the context of hockey, but the principles are mostly the same for all sports. A strong, functional core will improve performance in all sports. Training to improve acceleration, and your ability to rapidly decelerate and change direction explosively will improve performance in all sports. I use many of the same dynamic warm-up progressions for hockey players as I do for athletes in all other sports (rowing, soccer, football, basketball, lacrosse, etc.). All team-sport athletes need to be mobile, stable, strong, explosive, and quick. I honestly can't think of a sport that wouldn't benefit from the training outlined in the course, which details how to alter the intensity and volume of your training in preparation for more important games (which becomes an increasingly important concept for athletes playing multiple sports at the same time).
EC: Thanks for taking the time, Kevin. Great points - and definitely a great resource, too.
For more information on Kevin's Off-Ice Performance Training Course, head over to HockeyTrainingU.com.
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It's been established pretty clearly that gluteal amnesia - or insufficient recruitment of the glutes - is a contributing factor to lower back and knee pain. Fortunately, lots of people have gotten their act together and worked to get it firing correctly via both dynamic flexibility and activation drills and specific cuing during resistance training movements.
Unfortunately, the overwhelming majority of these drills have focused strictly on activating the glutes in the sagittal plane (divides the body into left and right sides). In the process, a lot of folks have overlooked the fact the the glutes are actually active in three planes of motion. As you can tell from points of attachment in the picture below, the line of pull of the glutes also allow it to abduct and externally rotate the hip.
With this functional anatomy in mind, I think it's very important for coaches and trainers to implement more multi-planar movements in warm-ups. For more information on the what, why, and how, check out the Building the Efficient Athlete DVD Set.
Q: I know that you're a bid advocate of including barefoot weight training in your strength and conditioning programs. What in general is your "shoeless" policy with your athletes, if any?
A: Yes, we use a lot of barefoot weight training around Cressey Performance in our strength training programs. In addition to strengthening the smaller muscles of the feet, barefoot training "accidentally" improves ankle mobility in athletes who have been stuck in restrictive shoes their entire lives.
Here are the exercises we're open to doing barefoot:
All deadlift variations (rack pulls and DB variations included), box squats (hip dominant), and all any body weight mobility drills.
We don't go barefoot for any loaded single-leg movements (aside from 1-leg RDLs and 1-leg squats/pistols) or more quad-dominant squatting variations.
All that said, we are careful about integrating barefoot drills in very overweight or very weak clients. These individuals do not go barefoot for any of our dynamic flexibility warm-ups aside from in-place ankle mobilizations, as lunging variations can be a bit too much stress on them at first.
We do, however, encourage clients (in most cases) to go with a good minimalist shoe. My personal favorite is the New Balance Minimus.
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1. I'm speaking at the Massachusetts High School Baseball Coaches Association's Annual Clinic this morning, so this week's random thoughts will be somewhat abbreviated. I didn't even have time to pick out this week's music selection, so you have to settle for this dude getting owned!
2. Speaking of baseball, one thing I'll be discussing in some detail is hip flexion range-of-motion asymmetries in pitchers. You'll almost always see far more hamstrings flexibility on the front leg for obvious reasons, but it's also important to consider how throwing styles contribute to this issue. Guys who throw on stiff front legs are ones who will most commonly present with big asymmetries. Justin Verlander would be a great example:
Guys like Verlander need to pay close attention to maintaining adequate length of the right hamstrings (the opposite would be true of a left-handed pitcher). Conversely, a guy like Greg Maddux who - at the same point in his throwing motion - is more flexed on the front knee, generally won't have big issues in this regard (although they should still be assessed and addressed).
Leaving these issues unaddressed can lead to a host of problems, most notably hamstrings strains on the back leg.
3. Manuel Buitrago has put some excellent Olympic lifting demonstrations online to help those of you at home who are trying to pick up these complex lifts on your own. Here's a little sample:
4. While I think it's awesome that a lot of folks are finally catching on that glute activation is important for both injury prevention and rehabilitation, a lot of folks have lost sight of the fact that you have to be careful about just training the glutes in hip extension. It's also very important to pay attention to theirs roles as external rotators and abductors. Once you've mastered bilateral movements in the sagittal plane (e.g., supine bridges), you need to get into single-leg and emphasis movements like bowler squats and lunges with reaches to various positions. These are great inclusions in the warm-up, and we highlight several options in our Magnificent Mobility DVD.
And, to take it a step further, you've got to load up those single-leg movements and challenge frontal plane stability to lay some strength down on top of those newly discovered movement strategies.
5. In light of the flexibility/mobility tone of this series of random thoughts, I thought it might be a good time to remind you that "creep" typically sets in at about 20 minutes. So, if you've been sitting at your desk reading for longer than that, it'd probably be a good idea to stand up for a few minutes, Quasimodo.
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used by Cressey Performance Pitchers after they Throw!
Q: For years, I have had difficulties with acquiring any real depth in my back squats. I took on board all the thoughts some authors had about working on ankle mobility and then what others had to say about weak abdominals and how they can wreak havoc on one's ability squatting into the hole. However, it wasn't until I went to get fitted for a pair of orthotics recently at the podiatrist's that I realized that even though I have done STACKS of ankle mobility and soft tissue work, genetically, I am limited by my foot and ankle structure to ever really squat deep.Why on earth have these authors of whom I have a great deal of respect for continued not to acknowledge that for some people, squatting DEEP is simply not an option due to structural limitations. I rate you among the best of the best out there Eric so if anyone should tackle this one and explore why genetics can dramatically improve or hinder someone's ankle mobility it should be you!
A: I have actually seen a fair amount of high-level athletes with feet like this, and you just have to realize that you can't put a round peg in a square hole. If you have a foot that won't allow for much dorsiflexion (toe-to-shin range-of-motion), it just won't let you squat deep safely. These are the guys who get better results from single-leg work in place of squatting.
And, if you are going to try squatting variations, it ought to be more sitting back (box squats or powerlifting-style free squats) where the shin is more vertical, but the spine remains in neutral. Have a look at this squatting video and you'll see that sitting back minimizes how much dorsiflexion ROM one needs to get the benefits of squatting:
Conversely, check out this more quad-dominant, "traditional" squat. You'll see that the knees come forward more, indicative of more dorsiflexion occurring.
Why has this become such an issue? Well, there are still a lot of coaches out there who are just "clean, squat, bench only" - and a one size fits all approach like that is sure to throw some athletes under the bus. These guys want to do what they've always done rather than recognize that everyone isn't the same; otherwise, they've lost one-third of their training arsenal! The more open-minded guys are looking to functional mobility and stability deficits - and the guys who "get it" are realizing that some athletes are just "stuck" with the ankles they've got.
For more information, check out To Squat or Not to Squat, featured previously in Newsletter 91.
