Home Posts tagged "Hypermobility"

CSP Elite Baseball Development Podcast: June 2022 Q&A

It's been a while since we featured a Q&A on the podcast, so in this episode, I cover three questions from our audience:

1. A while back, I heard you mention that you’d rather have an athlete be too tight than too loose. Can you please explain why?

2. Is the high-low model useful for position players in-season? Or are there better strategies?

3. You spend a lot of time talking about training on the podcast, but what about recovery? Anything in particular that you’re high on?

A special thanks to this show's sponsor, Marc Pro. Head to www.MarcPro.com and enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.

 

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This episode is brought to you by Marc Pro, a cutting-edge EMS device that uses patented technology to create non-fatiguing muscle activation. Muscle activation with Marc Pro facilitates each stage of the body’s natural recovery process- similar to active recovery, but without the extra effort and muscle fatigue. Athletes can use it for as long as they need to ensure a more full and quick recovery in between training or games. With its portability and ease of use, players can use Marc Pro while traveling between games or while relaxing at home. Players and trainers from every MLB team - including over 200 pro pitchers - use Marc Pro. Put Marc Pro to the test for yourself and use promo code CRESSEY at checkout at www.MarcPro.com for an exclusive discount on your order.

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If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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CSP Elite Baseball Development Podcast: 10 Training Considerations for Hypermobile Athletes

I'm flying solo for this week's podcast, as I'm going to tackle the topic of joint hypermobility in athletes. This is an extremely important consideration in dealing with baseball and softball athletes, yet the athletes with the greatest laxity are some of the most underserved in these populations.  In this podcast, I make ten main points you should keep in mind with respect to hypermobility.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 10-pack of Athletic Greens travel packets with your first order.

 

Mentioned Articles/Resources: Functional Stability Training of the Upper Body

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This episode is brought to you by Athletic Greens. It’s a NSF-certified, all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 10 FREE travel packs (valued at $79) - with your first purchase. I use this product 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.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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Strength and Conditioning Stuff You Should Read: 7/21/20

Here's some recommended reading from around the 'Net:

What Really Constitutes Functional Balance Training? -This is an old blog of mine that I'm "re-upping" here because of a conversation about specificity of balance training that I had with an athlete the other day.

How to Have Impossible Conversations - I just finished this as an audiobook, and it was outstanding - especially in light of recent events in the world. There are definitely lessons for every strength and conditioning/fitness and sports medicine professional.

Sport specialization is associated with upper-extremity overuse injury in high school baseball players - Here's (yet another) study demonstrating a drastic increase in injury rates in those who specialize in one sport. In this particular study, highly specialized high school baseball players from California, Alabama, and Michigan were 3.77 times more likely to have had an upper extremity injury in the previous year than their non-specialized counterparts.

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Strength and Conditioning Stuff You Should Read: 11/9/19

I hope you had a great weekend. Here's a little reading and listening material to kick off your week!

EC on the Inspiring Lives Podcast - I joined the crew at Athletic Greens on their podcast to talk coaching and business.

10 Assumptions You Should Stop Making About Your Clients - This might be my favorite blog post my business partner, Pete Dupuis, has ever written, as he covers a lot of common misconceptions of gym ownership.

Training the Hypermobile Client - I've features multiple articles about training hypermobile individuals on this site over the years, and Dean Somerset puts out some good information to complement those materials (you can find them here and here, if interested).

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One of the first things some individuals notice when they come to observe at @cresseysportsperformance is that we often pair “big bang” strength and power movements with lower intensity drills that might train mobility, balance, or arm care. As an example, we might pair a prone trap raise with a deadlift, or a hip mobility drill with a bench press. We call these low-intensity inclusions “fillers.” Truthfully, though, I’m not sure that this name does them justice, as “filler” seems to imply a lack of importance. In reality, I think these drills have a profound impact on improving each client/athlete’s session. Here are five reasons why.👊 . . What are some fillers you like to use and why? Please share your comments below!

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Baseball Athleticism: It’s Probably Not What You Think It Is

A while back, I delivered an inservice for a MLB sports medicine staff, and one of the strength and conditioning interns asked me a question:

"I'm new to baseball. If there was one important reminder you'd give to someone in my position with respect to working with baseball players, what would it be?"

My response:

"You have to emotionally separate yourself from your perception of what makes athletes successful. Often, baseball players are successful because of traits and characteristics as much as they are actual athleticism."

Think about it...

We've seen position players who are phenomenal athletes who didn't make it to the big leagues because they couldn't hit breaking balls.

We know of absolutely electric arms who never panned out at higher levels of pro ball because they didn't have effective secondary offerings to complement their fastballs.

We've watched underwhelming physiques hit mammoth homeruns, and we've watched bad bodies on the mound dominate hitters because they've mastered a knuckleball.

Do you think these absurdly long fingers might be able to learn an elite changeup faster than ones that are, say, six inches shorter?

And, do you think this insanely long middle finger might impact how well he can throw a slider?

Don't you think this freaky hypermobility might be advantageous for this pitcher to contort his body in all sorts of directions to create deception and get way down the mound?

Hitters with 20/10 vision are going to stand a better chance of making it to the big leagues than those with 20/40.

I'm not saying you should encourage baseball players to be sloppy fat or weak, or to encourage them to avoid stretching or lifting. I'm just telling you that you need to appreciate that every athlete is successful for different reasons. Some of these traits will impact how you train that player, and others won't matter much at all. Either way, appreciate that baseball players rarely look, run, or jump like chiseled NFL wide receivers. And, more importantly, figure out how to heavily leverage and protect the exact characteristics that make them great.

If you're interested in learning about how your own unique structural and functional characteristics - and how they relate to your on-field performance and training preparations - I'd strongly encourage you to consider a visit to a Cressey Sports Performance facility to get a thorough evaluation to determine where your deficiencies exist. When you put a video evaluation of pitching/hitting alongside a thorough movement screen, it can be a very powerful combination to unlock hidden potential. For both amateur and professional players, we offer both short-term consultations and a more extensive Elite Baseball Development Summer Collegiate Program.

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10 Important Notes on Assessments

I'm a big believer in the importance of the "Assess, Don't Assume" mentality. However, it's crucial that assessments be approached the right way in order to deliver optimal results in strength and conditioning programs. Here are ten thoughts on the subject:

1. Assessments are an easy way to differentiate yourself.

With this era of semi-private training and bootcamps, there are still a lot of coaches and facilities out there that pay no attention whatsoever to pre-participation screenings. On one hand, it's a sad commentary on our industry, as one could argue that omitting assessments sets clients up for injuries. On the other hand, it creates an excellent opportunity for skilled coaches and trainers to differentiate themselves in a low-barrier-to-entry industry. If you're not assessing, you're just guessing! Make it a priority to start learning more about your clients/athletes.

2. Thorough assessments include both specific and general components.

In my eyes, every assessment can be categorized as either specific or general. Specific assessments may be anything from single-joint range-of-motion (ROM) assessments to the provocative tests physicians and rehabilitation specialists may use. They identify specific things like elbow extension ROM or whether a particular test elicits pain.

Conversely, general assessments look at global movements and evaluate multiple joints at the same time. Examples include overhead squats and push-ups.

The problem is that both kinds of assessments can fall short. As examples, you may see unstable young athletes who pass all ROM assessments (specific) with flying colors, but fold up like lawn chairs when they do an overhead lunge walk (general).

You may also see athletes with perfect overhead squats, but significantly limited knee flexion ROM that would make you concerned that they'd pull a quad (rectus femoris) while sprinting. These are just two examples, though; there are countless more we could cite.

3. You must always be willing to refer out.

You're better off being a great trainer/coach than you are trying to be an incredibly subpar physical therapist or physician. Even if you had a tremendous knowledge of provocative tests and rehabilitation techniques, as a trainer/coach, you don't have the same resources (e.g., diagnostic imaging equipment) these professionals have. Furthermore, diagnosing is outside your scope of practice, anyway.

I refer out every single week. It creates great opportunities for collaboration that will benefit our clients/athletes, and for our staff to learn from related professionals. If you see something on an assessment that raises a red flag, it's better to be safe than sorry.

4. Don't assess just for the sake of assessing; make it to the point.

My biggest assessment pet peeve is when the process takes too long. You can do an incredibly thorough evaluation in about 30 minutes, and most shouldn't even take that long. The only ones that would require more time would be those with extensive injury histories or other unique circumstances.

[bctt tweet="The sooner you're done assessing, the sooner you can get to training."]

5. Assess in the context of both injury history and functional demands.

As a follow-up to point #4, you never want to go into a movement assessment "blind" with respect to the person in front of you. Rather, it's best to first review a health history and have a discussion about training history, goals, athletic demands, and expectations. I find that it's best to perform an evaluation with a better knowledge of an individual's history than it is to look at movement and then work backward from it.

For example, if your pre-assessment discussion reveals that an individual was a baseball player growing up, you can expect to see more external rotation on his dominant shoulder. That might lead you to look more closely at whether he has adequate anterior shoulder stability, and whether his scapula upwardly rotates enough. It also might help to explain a low right shoulder.

RightER

Basically, you need to see the big picture; the "answers" are usually a combination of a bunch of tests, questions, and observations.

6. You have to emotionally separate yourself your personal biases when it comes to assessments.

Baseball players are the largest chunk of my clientele. As a result, I evaluate shoulders and elbows in a ton of detail.

Recently, we started training an NFL punter, though.

I did a thorough assessment with him, but let's just say that we didn't spend a ton of time worrying about verifying that he had perfect elbow ROM. Instead, we spent a lot more time looking at his core and lower extremity; otherwise, the assessment would have taken all day, and we'd acquire a lot of information that wouldn't have a significant impact on his programming.

7. Don't let hypermobile clients/athletes "cheat" assessments.

Just like you need to have both specific and general assessments, you also need to make sure to include both mobility and stability assessments. Hypermobile (loose-jointed) individuals are notorious for cheating assessments that are biased toward ROM. Comprehensive assessments need to also evaluate stability.

elbow10365821_744096285641478_6191697364410130329_n

In this vein, the Functional Movement Screen does a good job of looking at both sides of the equation. The shoulder mobility, overhead squat, and straight leg raise tests are general assessments largely biased toward mobility, but the trunk stability push-up, hurdle step, rotary stability, and in-line lunge screens are all predominately stability challenges.

To learn more about how hypermobile folks can "cheat" assessments, check out my article, 15 Static Stretching Mistakes.

8. Have some feel; don't make new clients (or any clients) uncomfortable.

If a man is overweight and uncomfortable with his body, it's probably not a great idea to have him take his shirt off for a scapular screen. If a woman is seriously deconditioned, it's probably not a good idea to put her through a lunge assessment that she'll fail miserably. And, it's an even worse idea to do these things in front of a crowded gym.

           Remember that the first day is as much about
           building rapport and starting a friendship as it
            is about evaluating how an individual moves.

As has been said in the past, "They have to know how much you care before they care how much you know."

9. Don't forget to highlight what individuals do well, too.

In How to Win Friends and Influence People, Dale Carnegie wrote, “It is always easier to listen to unpleasant things after we have heard some praise of our good points.” This point applies to fitness and movement assessments, too. Think about it: would you like to be criticized non-stop for 30 minutes? Probably not.

By contrast, if someone highlighted what you did well while also covering some important growth areas for you, wouldn't these suggestions be more well received? Absolutely.

Again, your goal is to establish a great relationship, not just analyze movement.

10. Remember that training is a never-ending assessment.

Every exercise is an assessment. Each time your clients and athletes move, they're providing you with information. The more you pay attention, the better you'll be able to individualize their programs and coaching cues moving forward.

If you're looking for more information on the assessment side of things, I'd encourage you to check out our Functional Stability Training series. These resources go into great detail on evaluating the lower body, upper body, and core.

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Functional Stability Training of the Upper Body: Why Do You Feel “Tight?”

When Mike Reinold and I released Functional Stability Training of the Upper Body, it quickly became our most popular product of all time. In light of this week's big sale, I thought you might like a little teaser of what to expect.  Here is an excerpt from one of my webinars, "Understanding and Managing Joint Hypermobility:"

Remember, FST-Upper - as well as Lower, Core, Optimizing Movement, and the bundle package - are all on sale for 25% off this week. Just enter coupon code BF2021EC at checkout to get the discount at www.FunctionalStability.com.

fstupper

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Assessments You Might Be Overlooking: Installment 3

It's time for another installment of my series on things you might overlook when assessing a new client or athlete.  Here are three more things to which you should pay attention:
 
1. Shoulder Flexion Range of Motion - This is a valuable test to use in conjunction with a back-to-wall shoulder flexion test. If you can't effectively perform a back to wall shoulder flexion as in the video featured here, then we need to ask "why not?"

 
It might happen because you lack good stiffness in various places - anterior core, lower trapezius, upper trapezius, and serratus anterior, to name a few.  Or, it might be because you're unable to overpower bad stiffness or shortness. Maybe you lack thoracic extension, are too rhomboid dominant, or simply can't get full shoulder flexion range of motion.  To check for this last one, you'll want to put the individual in supine with the back flat and knees and hips flexed.  They should be able to get the arms all the way down to the table - so this would be no good.
 
shouderflexion
 
Shoulder flexion can be limited by a lot of things: short/stiff lats, teres major, long head of the triceps, and inferior capsule.  Regardless of what limits it, though, you can't just take someone with this limited a ROM and plug them into overhead pressing. You're just waiting to chew up a rotator cuff, biceps tendon, labrum, or all of the above.
 
As a little bonus, this is my favorite drill for improving shoulder flexion ROM:
 

 
2. Scapular Upward (or Downward) Rotation - It goes without saying that scapular control - or the ability to position the shoulder blades appropriately - is absolutely essential to safe and effective upper extremity movement.  In order for that to occur, though, the shoulder blades have to start in the right position.  With respect to scapular rotation, "neutral" posture has the shoulder blades sitting at 5 degrees of upward rotation at rest. In the picture below, the black line represents where he should be in terms of upward rotation, but instead, you'll see that he sits in about 20-25 degrees of downward rotation (for the record, there are a number of other things wrong with this posture, so this is only a start!).
 
ScapularDownwardRotation
 
The problem with starting in this much downward rotation (or any downward rotation, at all) is that it's like beginning a race from 20 yards behind the starting line.  When the arm starts to move up, the shoulder blade needs to rotate up to maintain the ball and socket congruency.  If it starts too low, it can't possibly be expected to catch up - so the ball will ride up relative to the socket, regardless of how strong the rotator cuff is to try to prevent that superior migration.  You'll wind up seeing irritation of the rotator cuff, biceps tendon, labrum, or bursa if it's left unchecked.
 
Step 1 is to simply educate people on where the scapula actually should sit, and step 2 is to work on training from that correct new starting position.

3. Constant stretching - I always take note of when I see a client who seems to be stretching "nervously" when they're just standing or sitting around.  You'll often see people cranking on their shoulders, cracking their necks, touching their toes, or any of a number of things that make them "feel better.
 
The problem is that these people are often stretching out protective tension - or stiffness that's there because they lack stability elsewhere.  This is often the case with those with significant joint hypermobility.  They're already unstable, but the stretching is like picking a scab; it gives them temporary relief from the tightness, but only makes things worse in the long run.  It might be hamstrings tightness in someone with crazy anterior pelvic tilt, biceps tightness in those with anterior shoulder instability, or any of a number of other presentations throughout the body.  Unquestionably, though, the most common one is neck stretching in those with poor scapular control.
 
There is no one solution for everyone's problem, but I would encourage you to always ask, "Why is this tight?"  And, don't even think about stretching until you know the answer.
 
I'll be back soon with more commonly overlooked assessments.  In the meantime, if you're looking for an additional resource on this front, I'd encourage you to check out Assess and Correct: Breaking Barriers to Unlock Performance and Functional Stability Training of the Upper Body
 
 fstupper

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Assessments You Might Be Overlooking: Installment 2

It's time for round 2 of my series on things you might overlook when assessing a new client or athlete.  Here are three news things to which you should pay attention:

1. Nervous Tick/Anxiety

When I see someone who is constantly "on" - foot tapping, cracking knuckles, fidgeting while standing/sitting, or any of a number of other displays of nervous energy - I'm obviously wondering if this is someone who is so wired that stress outside of training could be a serious problem.  These folks often have poor sleep quality and don't recover well. 

However, it may extend beyond that.  If you check out Clinical Applications of Neuromuscular Techniques, Lean Chaitow and Judith DeLany reflect on how congenital laxity (loose joints) is correlated with anxiety disorders and panic attacks.  So, even in my first dealings with people, if they're really on edge, I'm wondering we're going to need to do a lot more stabilization work, as opposed to actually created new range of motion.

clinical20.d35f2625985e82b04b487d9433e44543

2. How They Carry Their Bags

A lot of people really don't understand how their daily habits impact their long-term movement quality or the presence or absence of pain.  Along these lines, it always surprises me to see people with low right shoulders who always carry their backpacks or purses over the right shoulder, just feeding into this excessive asymmetry with constant scapular depression.  An initial evaluation is the perfect time to pick up on these things and counsel clients and athletes on how to prevent activities of daily living from interfering with fitness progress.

3. Clavicular Angle

The clavicle is like the bastard child of the upper body; it never gets any love.  In fact, there are a lot of people who don't even know what a clavicle is unless you call it by its common name, the collarbone.  It's actually a tremendously important bone, as it is the link between two very important joints of the shoulder girdle: the acromioclavicular (scapula with clavicle) and sternoclavicular (sterum with clavicle) joints.

A normal resting posture of the clavicle is about a 6-20° upslope (medial to lateral).  What you'll often see with folks with faulty upper extremity posture is a horizontal or even downsloped collarbone.  Check out this right-handed pitcher (left side is more normal, right is really "stuck down"):

claivicle

Just like a scapula needs to upwardly rotate for optimal function in overhead activies, a clavicle needs to upwardly rotate, too. From 0-90° abduction, you only need 5-10° of clavicular upward rotation.  From 90-180° of abduction, you need 20-25° of clavicular upward rotation.  This clavicular movement can be affected by the muscles that attach directly to it (pectoralis major) or by those that indirectly impact it (muscles attaching to the scapula and/or humerus), as well as the positioning of the thoracic spine.

Keep in mind that where most people with acromioclavicular joint pain wind up with symptoms during abduction: the final 30° of overhead reaching.  Any surprise that the symptoms occur at the point where the most amount of clavicular upward rotation is needed?  Nope!

painfularc-for-acj

If that clavicle starts as too horizontal (downwardly rotated), it's like starting a race from a few yards behind the starting line.  Getting resting posture where it needs to be helps to ensure that the subsequent movements that take place will be free, easy, and pain-free.

I'll be back soon with more commonly overlooked assessments.  In the meantime, if you're looking for an additional resource on this front, I'd encourage you to check out Assess and Correct: Breaking Barriers to Unlock Performance.

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Assessments You Might Be Overlooking: Installment 1

I generally perform 8-10 new evaluations per week.  They may be individuals who plan to train with us at Cressey Performance for the long haul, or they may just be popping in for a one-time consultation regarding a particular issue or training technique concern.  Sometimes, they'll be rehabbing with one of the physical therapists with whom we work closely, and seeking us out to maintain a training effect in spite of their injury. 

Regardless of the scenario, I'm fortunate to see a lot of variety in a typical week of evaluations, and it has led to me thinking outside the box and appreciating a few things that are commonly overlooked by trainers and rehabilitation specialists.  With that in mind, today, I wanted to kick off a new series about these under-appreciated observations that can really make a difference in your takeaways from an evaluation.

1. Standing/Sitting Posture

There are a lot of trainers who'll observe this in passing, but in many cases, they'll only note something if it's something really dramatic.  My suggestion along these lines would be to note not just what's going on in the sagittal plane (kyphosis, lordosis, forward head posture), but also what's happening in the frontal and transverse plan.  Do they always cross one leg over the other?  Does one shoulder sit markedly lower than the other? Do they sink into one hip and carry more weight on that side?

IMG_8938

As an aside, Greg Robins recently wrote up a great posture blog about some of the most common aberrant patterns we see.

2. Handshake

Believe it or not, a handshake can tell you a ton.  If it goes like this, it's safe to say that you probably won't need to do any direct arm work with this individual, who'll quickly become either the coolest (or most awkward) client of all time. 

Joking aside, handshakes can tell you a lot, particularly with respect to joint hypermobility.  First off, what's the feeling of the fingers?  Are they more rigid or "pliable?" If they're more pliable, chances are that you're going to be dealing with someone who has considerable congenital laxity (loose joints).  Second, are the hands cold, even in the middle of the summer?  Chances are their circulation is poor - another common symptoms of those with considerable joint hypermobility.

To test these theories, here's a challenge for you.  Go shake the hands of ten of your friends/colleagues today. Note the feel of the hands, and then follow up the handshake with a Beighton Hypermobility Test. The screen consists of five tests (four of which are unilateral), and is scored out of 9:

1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees

I'm sure you'll find that the coldest hands with the most pliable fingers are the ones who have high scores on the Beighton test.  When you have folks like this, they need more stability work than mobility training.  And, if an individual has a noteworthy injury history, you need to ask if he/she has been stretched aggressively in previous training or rehabilitation scenarios - particularly if he/she had negative outcomes with those experiences.

Also, if a young athlete gives you a lame, limp-wristed handshake, it's a sign that he's going to need to step up his game if he doesn't want to live in his parents' basement for the rest of this life.  I recommend introducing him to the foundation of the Ron Swanson Pyramid of Greatness to get the ball rolling (definitely worth a zoom-in):

rspyramid_1500

3. Medications

It is absolutely shocking to me how many people in the fitness industry overlook medications on an initial evaluation.  Perhaps it is the new era of bootcamps and semi-private training leading to a less individualized approach (particularly with respect to assessment), but you can learn so much about what a client needs by reviewing medications.  And, it's one reason why we have an initial one-on-one assessment with every new client at Cressey Performance.

Of course, you're looking for the obvious stuff - beta-blockers, prescription inhalers, etc. - that have definite impacts on how someone will respond to exercise.  Taking it a step further, though, there are hundreds of other medications that can impact how you program for and coach a client.  The problem is that not everyone views the term "medication" the same - so people will generally underreport on their health histories. In other words, you need to "pry" and ask if there really aren't any pills they take.  Recently, there was even an instance when I was able to guess a medication a kid was on just by asking his mom after observing his habits during the evaluation.

200534351-001

As an obvious example, there are loads of people out there who pop non-steroidal anti-inflammatory (NSAID) pills like candy because they've got chronic low back, shoulder problems, or any of a number of other issues.  In their eyes, though, these "get-me-by" pills don't count as drugs because they can be bought over the counter.  They can mask pain during exercises, and obviously have significant side effects. It's a trainer's responsibility to be "in the loop" with a client, his doctor, and a rehabilitation specialist to determine what the right course of action is to get this individual off those NSAIDs over time.

In a youth athlete population, we've had three kids who have had extensive and prolonged negative reactions to the Isotretinoin (Accutane) that was prescribed to treat acne. In two of these cases, the kids were excellent D1-caliber athletes who gradually felt worse and worse over the course of months in spite of no change to training volume or lifestyle factors.  We were all stumped because they had never reported that they'd started taking the medication.

Once we found out the cause, their parents got them off the Accutate right away, and symptoms resolved over the course of a month. However, these experiences led me to look further into the side effects of this prescription medication. I was astounded.  There are reports of depression, muscle weakness, joint pain, vision problems, dry skin skin dryness, and several other side effects. The FDA even warns, "Accutane may stop long bone growth in teenagers who are still growing." I'm not a dermatologist, so it's not my place to say that it's right or wrong.  However, it absolutely, positively is something you need to inquire about on a health history if you see it listed - or even if you suspect that a kid might be a candidate for it.  That said, I've known a lot of kids whose acne has improved considerably once they've gotten all the crap out of their diet, but that's a conversation for another day!

If you see a sleep aid listed on a health history, you may need to think twice about programming high-volume training for an client, and spend some extra time discussing recovery methods.  If you see anti-depressants, anti-anxiety, or ADHD medications on a health history, it may change the way you approach coaching this individual.  These are really just the tip of the iceberg; you have to keep your eyes open and consider/discuss the implications when appropriate.

I'll be back soon with more assessments you might be overlooking.  In the meantime, if you'd like to learn more about some of our approaches to assessment, I'd encourage you to check out Assess and Correct: Breaking Barriers to Unlock Performance.

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