Home Posts tagged "Functional Stability Training"

Making Movement Better: Positions vs. Pressures

About 15 years ago, I attended a two-day course with Dr. William Brady, a well respected chiropractor and manual therapist in the Boston area. During the event, he said this:

"Biomechanics is a combination of physics and biology. Put another way, it is the study of load applied to human tissue."

It was the most succinct and encompassing definition of biomechanics that I'd heard, so I frantically scribbled it down in my notes - and I've had it in the back of my mind to this day each time I've evaluated movement.

Assessments are very important. However, they're always limited in their scope, especially when an assessment is scaled back to a quicker "screen."

Just because someone has good passive range of motion on a table doesn't mean that they'll be able to pick that ROM up actively or demonstrate it in a weight-bearing athletic movement at higher speeds with higher forces.

Further, just because they look good at higher speeds with higher forces doesn't mean that there isn't an element of stress in the system that we can't appreciate.

And finally, that stress may be highly variable based on a wide variety of factors, both intrinsic (e.g., accumulated fatigue, growth spurts) and extrinsic (e.g., environmental conditions, terrain).

Tons of athletes can get to positions like this, but how many can do so safely - and repeatedly?

When I talk with athletes and review video, I always make sure that I'm discussing both positions and pressures. Range-of-motion is part of the discussion, but ground reaction forces and how we create stiffness via airflow/intra-abdominal pressure, neuromuscular recruitment, and the fascial system can't be overlooked.

This is why the industry-wide trend toward more comprehensive information gathering is invaluable. We've always had our classic orthopedic posture and ROM tests, usually paired with less-than-functional dynamometer strength measurements and some provocative tests to rule out the bad stuff. Now, though, we've got things like force plates to look at how we interact with the ground. And we've got the Proteus, which I've called a "rotational force plate" to help us determine how those ground reaction forces eventually work their way up the chain.

We've got far more tools for evaluating body composition, sleep quality, heart rate, fatigue status, workload, and much, much more. So, it's a very exciting time - but only if we appreciate that both positions and pressures matter.

Many of these principles are espoused in Mike Reinold and my Functional Stability Training series, so I'd encourage you to check them out if you'd like to dig deeper.

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Strength and Conditioning Stuff You Should Read: 7/9/19

I'm going to try to get back on an early-in-the-week publication calendar for this weekly feature, so here's your list of recommended reading/listening.

Functional Stability Training - Just a friendly reminder that this popular series from Mike Reinold and me is on sale for 25% off through the end of the day on Wednesday. Just enter the coupon code allstar2019cressey HERE.

Gym Owner Musings - Pete Dupuis never disappoints with these random (but excellent) insights on the business side of fitness.

Range - This book from David Epstein has been recommended to me by several people over the past month, so I'm just digging in now. I'm excited to check it out.

Stuart McGill on the Physical Preparation Podcast - Stu was a guest on my podcast last week (check it out here), and as it turns out, he had an interview with Mike Robertson published recently, too. This is a good listen.

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Movement vs. Medical Diagnoses

Recently, during my weekly Instagram Q&A, I received this question:

"Have you ever dealt with valgus extension overload syndrome and how?"

My initial response was, "Absolutely - and with every single overhead throwing athlete I've ever encountered."

You see, "valgus extension overload" simply described the two most common injury mechanisms in throwers. Your elbow can get hurt at lay-back (max shoulder external rotation) or full elbow extension. This terminology doesn't describe a specific tissue pathology, nor an underlying movement competency that is insufficient and therefore allowing an individual to become symptomatic. To me, it's a completely incomplete "diagnosis." Let's dig deeper.

You have medical diagnoses and movement diagnoses. Both are important.

A medical diagnosis might be a rotator cuff tear, MCL sprain, or tibial fracture. These deviations speak directly to the damaged tissue and relate the severity of this structural change.

A movement diagnosis (popularized by physical therapist Shirley Sahrmann) might be scapular downward rotation syndrome, femoral anterior glide syndrome, or lumbar extension-rotation syndrome. These diagnoses speak to the deviation from normal movement that’s observed.

At times, both types of diagnoses are bastardized.

On the medical side, examples would include “shoulder impingement,” “shin splints,” and “valgus-extension overload.” All of these flawed medical diagnoses speak to a region of the body, but not a specific structure.

On the movement side, examples would be vague things like “weak posterior chain,” “scapular dyskinesis,” or “poor stability.” They don’t speak to the specific movement competencies that need to be improved.

I'm all for simplifying things as much as possible. However, diagnosis is an area where oversimplifying is completely inappropriate. Diagnosis is what establishes the road map for the journey you're about to begin - so make sure to eliminate any guesswork in this regard, whether it's on the medical or movement side of things.

Perhaps nowhere in the sports medicine world is the movement vs. medical diagnosis discussion more of a consideration than in the discussion of thoracic outlet syndrome, a challenging "diagnosis of exclusion." I recently released a course discussing this complex topic, and I'd strongly encourage you to check it out if you'd like to take a deep dive into upper extremity functional anatomy. You can learn more HERE.

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Random Thoughts on Sports Performance Training – Installment 32

In light of the busy baseball offseason, I'm long overdue for an update to this series. So, here goes!

1. Have a long-term plan, but not necessarily a long-term program.

The other day, an observational visitor to CSP-FL asked me if I had a big, overarching goal for all our professional baseball players. My response was simple: "Minor league guys need to get through five 4-week programs, and big leaguers need to get through four."

The MLB regular season always ends on a Sunday, so the math is actually easy to do. We know most MLB guys report around February 14, which gives us 19.5 weeks for the offseason. That 3.5 week "buffer" accounts for some time off, some vacation, a few days over the holidays, and travel to Spring Training. We "give" a little bit on guys who played well into the postseason in the previous year.

Over this 16 weeks of training, we transition from active recovery, improving mobility and building work capacity, to building strength and power, to transitioning into more specific skill development. It's all something we've become comfortable handling as long as we can get in those four program blocks. However, while we have a long-term plan, we don't write all the programs up in advance. Why? Very simply, what you put on paper for a January program when you write it three months in advance almost always needs to be modified prior to the time when it's actually being executed. Even the best players on the planet who've established really good offseason routines have to call audibles on the fly as various things come up throughout the offseason.

Have a general framework in place, but don't be so rigidly adherent to it that you can't pivot on the fly over the course of several months. It'll save you time and make your programming more effective if you write the specific components of your offseason progressions when the time is at hand.

2. Good coaching always comes back to relative stiffness.

Give this video of a back-to-wall shoulder flexion a watch:

Now, think about what's happening from a stiffness standpoint. When the arms go overhead, we're asking good stiffness of the anterior core (rectus abdominus, external obliques), glutes, and scapular upward rotators (upper trap, lower trap, and serratus anterior) to overpower bad stiffness of the lumbar extensors, lats, and scapular downward rotators (levator scapulae, pec minor, and rhomboids).

This good vs. bad stiffness interaction is taking place in every single movement we prescribe and coach. If we don't appreciate functional anatomy and understand how to tone down the bad and tone up the good, we simply can't be efficient coaches.

If you're looking to learn more about relative stiffness, I'd encourage you to check out Functional Stability Training: Optimizing Movement.

3. Be careful with predicted max charts.

Last week, I hit a personal record (PR) with five reps at 600lbs on my conventional deadlift.

PRs aside, though, it was actually a pretty good example of how off the predicted max charts really are.

After this set, I plugged 600 pounds and 5 reps into four separate predicted max calculators I found on the internet. The projections for my 1RM were anywhere from 675 pounds all the way up to 705 pounds. That 675 might be a possibility, but taking that to a 705 might very well be two years worth of specialized deadlift training.

Predicted max calculators have their place, but don't think for a second that they're perfectly accurate. And, they're even less accurate with a) more experienced lifters and b) lifters with a heavy fast twitch profile.

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10 More Important Notes on Assessments

A while back, I wrote up an article, 10 Important Notes on Assessments, that was one of my most popular posts of the year - and I'm ready for a sequel! Here are a few thoughts that came to mind.

1. Just like training, assessments are getting more specialized.

As the sports performance and even personal training worlds get more specialized, the assessments we need to utilize with our clients must be correctly matched up to the people in front of us. As examples, rotator cuff strength tests are huge for a baseball pitcher, but relatively unimportant for a soccer player. We’d “weight” a single-leg squat test result as less significant for a kayaker than we would for a basketball player. The goals of the client and the functional demands of their sport guide the assessments – both in terms of which ones we perform and how we value the results.

However, the challenge is that you can’t test everything, so it’s important to prioritize. If we used every assessment under the sun, the evaluation would last all day – and we’d spend an entire session pointing out everything that’s wrong with someone. I’d much rather use this time to build rapport.

A VO2max test isn’t high on my list of priorities for baseball players even if it might shed some light on their aerobic base. I can probably get the information I need just as easily – and much more affordably – by taking a quick resting heart rate measurement.

2. Every good test that has an unfavorable outcome immediately sets you up for an even more telling retest.

Assessments give you a glimpse into what could potentially be wrong or right about how someone moves. The more important question is: what interventions make a difference? Their squat pattern improves when you give them an anterior counterbalance? Their hip internal rotation improves when you add some core recruitment? Their shoulder pain goes away when the massage therapist works on their scalenes?

One tenet of the Selective Functional Movement Screen (SFMA) system is to always start with dysfunctional, non-painful patterns. What interventions clean up aberrant movement in non-painful areas to give us "easy" adaptations? This not only expands our movement repertoire, but also facilitates buy-in from the athlete/client.

3. Never go to movement screens without first performing a thorough health history and client “interview.”

I think we can all agree that a pre-participation evaluation can dramatically reduce the likelihood in training. And, I'd argue that the single most important part of this evaluation is the health history and conversation you have with them before they even start the movement screen portion of it.

As an example, imagine you have a hypermobile female client with a history of serious anterior shoulder instability that hasn't been surgically treated. If you do thorough paperwork and a detailed conversation with her, you'll quickly ascertain that you have to be careful with anything that involves shoulder external rotation. If you don't do that preliminary work, though, you might very well pop her shoulder out of the socket doing a basic external rotation range-of-motion test.

Summarily: paperwork first, conversation second, movement third!

4. Have assessment regressions for people who can’t perform certain tests due to pain or poor movement competencies.

I like to use a Titliest Performance Institute screen – lumbar locked rotation – to assess thoracic rotation. It requires an individual to get into a lot of knee flexion, though. So, if you have someone who is extremely short in their quads – or has had a knee replacement and permanently lost that motion, then it’s not a solid test.

You’re better off going to a seated thoracic rotation screen with these folks.

As a good rule of thumb, you’ll need more alternatives to general screens (involving more joints and motor control challenges) than you will for specific assessments (involving fewer). So, as you look through your assessment approach, start to consider how you’ll regress things when things don't go as planned.

5. Don’t overlook evaluating training technique as a means of assessing.

During almost every evaluation of someone who has struggled with pain or performance (which is really everyone), I look at technique exercises they commonly perform. For our pitchers, this might be arm care exercises, or a video of a bullpen. For powerlifters, it might be technique on the squat, bench press, or deadlift. As much as our assessment protocols can be thorough, they’ll never fully offer the specificity that comes from watching people actually train.

6. Don’t use tests to embarrass people.

As an extension of the previous point, if you know someone is going to fail miserably on a screen, don’t test it. If you have a 350-pound woman who wants to lose 200 pounds, she’s not going to do well on a push-up test. You can assume that her upper body strength and core stability aren’t sufficient to handle her body weight.

I keep coming back to it:


7. Watch for straining.

This is something I’ve watched for a lot more in recent years after spending time around my business partner, Shane Rye, who’s one of the best manual therapists I have ever seen. He’s a master of watching people move and picking up on where they tend to store their tone. Maybe it’s jaw clenching when you test rotator cuff strength, or making an aggressive fist when you check their active straight leg raise. Watching for changes in accessory tone can give you a glimpse into where you might get the best benefit with your manual therapy work – and how you might coach them differently while they’re training.

8. The best outcome of an assessment might actually be a referral for a more thorough assessment.

At least once a year, I have an assessment come in - but without doing any training, I refer them on for further evaluation. Usually, it's because something very "clinical" in nature presents, and I feel that they need to see a medical professional before we start working with them. It doesn't happen often, but I'm never shy about "punting" when I feel that someone else is better equipped than I am to help the person in front of me.

9. Don’t take their word for it on body weight.

I once had a 6-8 pitcher tell me that he weighed 235 pounds. The next day, he walked in and remarked, “Coach, I actually weighed in this morning. I was 253 pounds.” Now, 18 pounds isn’t as huge a percentage of total body mass on a 6-8, 253 guy as it is on a 14-year-old, 110 pound female teenager, but it’s still tell us a lot that he could actually swing 18 pounds without even feeling it. That’s a sign of an athlete with poor body awareness and a lack of nutritional control (they definitely weren’t a good 18 pounds). You're better off measuring than just asking.

A side note: this applies to male athletes only; I never weigh female athletes for obvious reasons.

10. Take meticulous notes.

I often find myself looking back on notes we have on long-term clients to see how their movement (and prescribed training) has evolved over the years. It wouldn't be possible if I wasn't very detailed in my note-taking - and this is something I'm always striving to improve upon, as we want to create sustainable systems in our business.

Employees move on, so a client's programming responsibilities may be shifted to other staff members. Sports medicine professionals may want to work from some of our notes. Teams and agents might want information on what we discovered with a player and how we plan to manage them. The more you document, the more prepared you'll be in these situations when collaboration is necessary.

Most importantly, though, whenever I write a new program for a client, I have their evaluation form and their previous program open on my computer. I want to see what I initially noticed and put it alongside the up-to-date programming to verify where we are in our progressions. It's this kind of documentation that allows me to program for dozens of athletes who are not only in our facility, but across the country and overseas.

Wrap-up

I've been assessing athletes for close to 15 years, and I find that our evaluations evolve every single year. If you're looking to stay on top of some of the latest developments on this front, I'd strongly encourage you check out our Functional Stability Training series.

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Making Sense of Bad Rehab and Fitness Advice

"Don't assume; it makes an ASS out of U and ME." It's one of the most hackneyed expressions of all time, but it's a lesson many folks in the fitness industry - and casual observers to this industry - will never seem to learn. Assuming an exercise or methodology will help or hurt someone is one of the biggest mistakes I see across all training programs. Perhaps the most readily apparent example is in individuals with back pain.

“Your back hurts? You should try yoga.”

“Back pain? Just give up squats and deadlifts and only do single-leg work instead.”

"Your low back is cranky? Try McKenzie press-ups and it'll fix you right up."

You know what? I’ve seen people whose back pain got considerably worse when they took up yoga. I’ve also seen people whose low backs feel better when they avoid single-leg work and stay with bilateral exercises like the deadlift. And I've seen extension-intolerant individuals integrate McKenzie press-ups on a friend's recommendation and flare up their symptoms.

That doesn't mean any of these recommendations are inherently bad, or that the ones giving the recommendations aren't well intentioned. It's just that you're going to a podiatrist to get dental advice; it isn't a qualified recommendation, nor is it backed by a solid sample size of success.

Sometimes, the exercise selection is the problem (the wrong yoga poses).

Other times, it’s the technique is the problem (your squat form is horrific).

Occasionally, the timing is the problem (disc pain is worst first thing in the morning, so it's probably not the time to test out deadlifting for the first time in six months.

Often, the volume is the problem (maybe it would have been good to run 1/2 mile pain-free before trying to jog ten miles).

Rarely does an entire discipline (ALL of yoga or ALL of strength training) need to be contraindicated.

We need to avoid assuming that all back pain is the same and instead dig deeper to find out what works for each individual. The same can be said for shoulders, hips, knees, ankles, necks, and just about every other musculoskeletal malady we encounter. Good assessment and a solid library of knowledge from which to draw both help to solidify recommendations as sound.

 

Here, we basically have a missing infraspinatus. That's your largest - and likely most important - rotator cuff muscle. It's secondary to a suprascapular cyst. I usually see 1-2 of these in professional pitchers each offseason, and while most are usually completely asymptomatic, it has a dramatic impact on the way we approach their offseason arm care programs. We want to them to REMAIN pain-free. 😮 Here, we also have a friendly reminder of why you should always, always, always do upper extremity assessments shirtless (or in a tank top/sports bra, with females) if you deal with overhead athletes. 🤔 Never miss a big rock with your assessments. Know your population. #cspfamily #shoulderhealth #shoulderpain #rotatorcuff #SportsMedicine

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Injuries and conditions are usually very multifactorial. We rarely hurt simply from an isolated traumatic incident; rather, it's the accumulation of various aberrant movements over the course of time that bring us to a symptomatic threshold. And that's why we need to build broad skillsets that encompass assessments, programming strategies, coaching cues, and an appreciation for how all the pieces fit together in determining whether someone hurts or not.

That's what Mike Reinold and I aimed to do with our Functional Stability Training resources; give both rehabilitation specialists and strength and conditioning professionals the tools they need to help keep people healthy - or, in the clinical sense, help them get healthy in the first place. This four-part series is on sale for 25% off through Sunday at midnight by using the coupon code ALLSTAR2022 at checkout; for more information, check out www.FunctionalStability.com.


 

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Strength and Conditioning Stuff You Should Read: 11/20/17

I hope you had a great weekend. Before I get to the recommended reading for the week, I wanted to give you a heads-up that with it being Thanksgiving week, we're kicking off our Black Friday/Cyber Monday sales early so that you have an entire week to take advantage of them. From now though Monday, November 27, you can get 25% off on any (or all) of the Functional Stability Training resources from Mike Reinold and me. You can check them out at www.FunctionalStability.com. No coupon code is necessary.

6 Principles to Improve Your Coaching - Speaking of Functional Stability Training, here's an excerpt from the latest offering on this front, FST: Optimizing Movement.

NFL Teams Address Fatigue Factor - We've worked a lot with Fatigue Science to monitor sleep quantity and quality with our athletes, and this article goes into detail on how they're impacted NFL teams as well.

Why We Use End-Range Lift-off - Cressey Sports Performance coach Frank Duffy discusses how to build active control of your passive range of motion.

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A Tip for Turning Off the Lats (Video)

The Back to Wall Shoulder Flexion is one of my favorite shoulder mobility exercises, as it forces individuals to learn how to integrate good core positioning with adequate overhead range of motion and stability. Unfortunately, some people struggle with really learning to shut the lats off to allow for proper overhead movement. Here's one strategy we like to employ:

*note: during the video, I said "reflex neuromuscular training" and meant to say "reactive neuromuscular training." Sorry, I get excited when I'm talking about shoulders. 

For more strategies like this, be sure to check out my new resource, Sturdy Shoulder Solutions.

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Strength and Conditioning Stuff You Should Read: 3/31/17

It's almost MLB Opening Day, which is just about my favorite "holiday" of the year. With that in mind, Mike Reinold and I decided to put our Functional Stability Training products on sale for 20% off. Using the coupon code MLBFST, you can pick up the individual components or get an even bigger discount on the entire bundle.

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This sale runs through Monday at midnight; head to www.FunctionalStability.com to take advantage of it.

Good vs. Bad Stiffness - With FST on sale, I thought it would be a good time to "reincarnate" this webinar except from my presentation in the Optimizing Movement component. Relative stiffness is an important concept for all fitness and rehabilitation professionals to understand.

Cryotherapy Doesn't Work - This was an excellent post from Dean Somerset on the topic of icing. It's a great follow-up to the two-part series Tavis Bruce authored up for us last year, too, so be sure to check those out: Cryotherapy and Exercise Recovery: Part 1 and Part 2.

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Work, Sleep, Family, Fitness, or Friends: Pick 3 - This was an interesting article at Inc.com on the topic of balancing life's demands. It resonated with me because it was another good reminder that it's our job as fitness professionals to make people realize they CAN still be fit even if they don't have a ton of time. And, fitness might be a great avenue through which to spend time with family and friends, so it can "check a few boxes" in folks' busy lives.

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The Best of 2016: Strength and Conditioning Articles

With 2016 winding down, I'm using this last week of the year to direct you to some of the most popular content of the past 12 months at EricCressey.com, as this "series" has been quite popular over the past few years. Today, we start with the most popular articles of the year; these are the pieces that received the most traffic, according to my hosting statistics.

1. 5 "Combo" Core Stability Exercises - Great strength and conditioning programs are all about delivering results as efficiently as possible. Here are some exercises that'll help you do so by making your core stability training more efficient.

2. 10 Ways to Remain Athletic as You Age - The popularity of this article makes me realize that I need to devote more of my writing to the more mature athlete who still likes to get after it in the gym! 

3. How Lower Body Exercises Can Impact Upper Body Function - This article debuted around the time we released Functional Stability Training: Optimizing Movement. Squats, deadlifts, and other lower body drills can have a dramatic impact on the upper body in ways you might not realize.

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4. 5 Strength and Conditioning Exercises That Overdeliver - Similar to #1 from above, these are some of my favorite "big bang for your buck" exercises.

5. 6 Saturday Shoulder Strategies - You would think people would be sick of reading articles on the shoulder from me by now. Apparently not.

I'll be back soon with another "Best of 2016" feature. Up next, the top videos of the year! 

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