Home Posts tagged "Joint Hypermobility"

The Best of 2016: Guest Posts

I've already highlighted the top articles and videos I put out at EricCressey.com in 2016, so now it's time for the top guest posts of the year. Here goes…  

1. Cryotherapy and Exercise Recovery: Part 1 and Part 2 - Tavis Bruce absolutely crushed it with this heavily researched two-parter on one of the most controversial topics in health and human performance today.

2. Big Toe, Big Problems - Dr. James Spencer took a close look at Functional Hallux Limitus, a common problem that is frequently overlooked in the rehabilitation world.

3. 4 Strategies to Improve Athletes’ Innate Acceleration - Lee Taft introduced some excellent ways to improve your speed and agility coaching.

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4. 4 Ways Hypermobile Individuals Can Improve Their Training - Laura Canteri offered some excellent insights for a very underserved population: loose-jointed clients.

5. Building Better Core Control with “The Bear” - Mike Robertson shared one of his favorite core stability exercises and it was a big hit with the EricCressey.com audience.

I'll be back soon with the top strength and conditioning features from 2016.

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4 Ways Hypermobile Clients Can Improve Their Training

Today's guest post comes from Cressey Sports Performance coach, Laura Canteri.

From super tight to super loose, people can fall at any point on the laxity continuum. Most women fall under the more hypermobile side of things, but there are a surprising amount of women who are nonetheless unaware of their extreme laxity. As a hypermobile female who learned the hard way, I want to share my knowledge and experiences with you to help improve your training and long-term health in four simple steps. While I'll focus my attention on females in particular, the overwhelming majority of these lessons hold true for hypermobile males as well.

1. Create Self Awareness.

What is Hypermobility?

Each joint has a certain amount of laxity and can be either congenital (you were born with it; thanks, Mom and Dad) or as a consequence of repetitive activities (e.g., swimming).  It shouldn't be confused with instability, which would result from an injury that leads to excessive, uncontrolled range-of-motion. With that said, hypermobility is excessive laxity at a joint. If you often feel “tight” and don’t think that this article pertains to you, I encourage you to keep reading.

How Do I Know If I’m Hypermobile?

At Cressey Sports Performance, we like to use the Beighton scale to assess joint laxity and hypermobility. The screen is scored out of nine points in which there are five tests (see below). Unilateral tests should be scored on both sides with each positive test counting as one point. The higher the score, the higher the laxity.

1. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
2. Flex the thumb to contact with the forearm (left and right sides)
3. Elbow hyperextension > 10° (left and right sides)
4. Knee hyperextension > 10° (left and right sides)
5. Toe touch with knees straight, touch the palms flat on the floor

Beighton_Score

2. Remove Static Stretching From Your Routine.

From youth to college basketball, I had my fair share of injuries - from sprained ankles to dislocated shoulders -but despite having such loose joints, I would always feel “tight.” I couldn’t touch my toes, clasp my hands behind my back, or do any “cool” tricks. So, I incorporated static stretching before and after every game/practice to decrease my risk for injuries. Good news: I was eventually able to touch my toes and clasp my hands behind my back. Bad news: I continued to have even more shoulder instability issues, which resulted in surgery.

So, what gives? I wouldn’t feel “tight” if I was hypermobile, right? Wrong. Let me explain. When other structures aren’t working properly (i.e. your ligaments and tendons) to support a joint, the surrounding muscles work overtime to stabilize and protect it. This mechanism is known as "protective tension" and is the reason why someone who is hypermobile may feel “tight.”  Our body creates trigger points as a strategy to create stability where we don't have it. It may feel good to stretch in the moment, but stretching muscles around an already lax joint capsule will only lead to more instability and greater risk for injury.  It's like picking a scab; you feel better in the short-term, but wind up with longer term problems.

Long story short, if you're looking for a quick reduction in tightness, get rid of the static stretching and grab yourself a foam roller instead - and then follow that work up with some good stability exercises.

3. Stay Away From End Ranges.

Women who have a lot of joint laxity tend to stand, sit, and train in extreme end ranges (see pictures below). When joints are constantly loaded beyond normal range, the ligaments will continue to become more lax and the joint will experience more wear and tear overtime. Here are a few examples:

Hyperextended Elbows During a Push-up

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Hyperflexed Lumbar Spine and Hyperextended Cervical Spine During Sitting

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Hyperextended Knees During Standing

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Hyperextended Knees and Right Hip Shift During Standing

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Whether you are sitting behind a desk at work, attending a yoga class, or lifting weight, it is important to be aware of your body position and stop just short of end range.

4. Improve Motor Control.

Generally speaking, women have greater Q-angles (measured from hip to patella along femur) and a higher predisposition to joint laxity compared to men. Looser joints require more stability and motor control; therefore, learning better movement patterns is critical for improving long-term health and joint integrity.

For example, if you are experiencing discomfort in the front of your shoulder, one exercise you could incorporate is the standing external rotation. This is a great exercise for hypermobile individuals to increase posterior rotator cuff strength, increase shoulder stability, and improve motor control by learning how to keep the ball centered in the socket.

Regardless of what exercise you perform, in order to improve motor control you must:

a. Be present:  Eliminate distractions (e.g. texting, Facebook, etc.). If you are not focused, you will naturally fall back to your compensatory movement patterns

b. Maintain a neutral spine: It is common for hypermobile women to overextend their lower back and rely on bony stability; therefore, learning how to execute and maintain a neutral spine is important in every exercise in order to set a foundation for better alignment

c. Slow down: Perform each rep in a controlled manner, and emphasize quality over quantity.

d. Train in non-fatigued state: Be aware of how you feel, as fatigue will negatively affect your ability to learn new movement patterns

Conclusion

My personal experiences have led me to believe that hypermobility, especially for women, is more common than one might think. Creating awareness for yourself or your clients is the first step in the right direction. As Eric always says, “Assess, don’t guess.”

Happy training to all my hypermobile readers out there!

About the Author

Laura Canteri (@LC_Canteri) heads up strength camps (group training) at Cressey Sports Performance – Florida. She completed her master’s degree in exercise physiology at Florida Atlantic University, and also is Precision Nutrition certified. In addition to her work at CSP, Laura works with folks from all walks of life through her distance-based consulting. You can reach her at l.c.canteri@gmail.com. 

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Random Thoughts on Sports Performance Training – Installment 14

 It's time for the next installment of this popular series here at EricCressey.com, but I've pulled in some help from an old friend for this one. Given that his new DVD set, Elite Athletic Development 2.0, was just released this week, the one-and-only Mike Robertson agreed to chime in with some sports performance tips this week. Those beginning with "MR" are from Mike, and the ones with "EC" are me. Enjoy!

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1. MR: When working with overhead athletes, learn to love specialty bars.

When it comes to athletes in general, it’s obvious that they are not powerlifters. Is it helpful if they’re strong? Absolutely. But let's be honest - no one cares about how they get strong. You don't get bonus points for deadlifting from the floor, nor do you necessarily have any reason to put a barbell on your back. At IFAST, we're huge fans of specialty bars for our athletes, but especially for our baseball players.

Trap bars are kind of a god-send, if you ask me. It's an incredibly easy exercise to coach, you reduce the mobility demands (vs. a sumo or conventional deadlift), and you can load a guy up fairly quickly without compromising technique.

On the other hand, just because we don't put a barbell on our back doesn't mean we don't squat! The safety squat bar is an invaluable tool if you train baseball players (or really, any overhead athlete). You know that your wrist, elbow and shoulder are your money makers, so the last thing you want to do is expose yourself to injury in those areas. The safety squat bar front squat is awesome for newbies, as it teaches them a front squat pattern without having to "rack" the bar using the wrists, elbows and shoulders. I'll often start my baseball players off with this variation for a month or two, just to get them back in the swing of things. If we want to load up the squat pattern a bit more, all we have to do is flip the safety bar around and now we've got a back squat progression that again unloads the upper extremity. Quite simply, if you train overhead athletes - or any athletes, for that matter - invest in a high quality trap and safety squat bar. You'll thank me later.

2. EC: Show some love to the broad jump!

For some reason, in the world of athletic performance assessments, vertical jump testing gets all the attention. In my anecdotal experience, though, broad jump proficiency has a far greater carryover to actual athletic success. Bret Contreras has also alluded to this as part of his rationale for including hip thrusts and other loaded glute bridge variations in strength training programs; horizontal (as opposed to just vertical) force production really matters in sports.

That said, one reason some coaches shy away from programming broad jump variations in training programs is that they be a bit hard on the joints and elicit more soreness in the days that follow a training session. This is easily remedied by having an athlete land on a more forgiving surface (such as grass), or by using band-resisted broad jumps.

3. MR: Appreciate that push-ups can actually improve rotator cuff function!

Push-ups are a critical component of our training programs, and for numerous reasons. You see, push-ups (versus a traditional bench press), allow for a high degree of serratus anterior development. And I’d argue that in the upper body, the serratus anterior is one of the most overlooked, yet incredibly important, muscles we have. Strengthening the serratus anterior does a host of good things for us, most notably upwardly rotating the scapula. However, what many people don't understand is how it actually improves thoracic kyphosis.

This is a really loaded topic, so I’ll try to keep it brief. Back in the day we would look at most people and say they have an excessive thoracic kyphosis, but I’m not entirely sure that’s true. What I think we see (more often than not) is a flat thoracic spine, coupled with shoulders that are rolled forward due to an inability to expand a chest wall. (Thank you, Postural Restoration Institute). Here's an example EC posted a while back of a flat thoracic spine in action:

While we tend to get caught up on the scapular attachment site (or motion) of the serratus, it also attaches anteriorly to the ribcage. If we lock the scapulae in place and engage serratus anterior, it pulls on the rib cage and gives us a more normal thoracic kyphosis. Now I’m sure you may be thinking, why do we want a kyphosis? Isn’t more extension a good thing? You need a kyphosis (or subtle rounding of the upper back), because your scapulae are curved as well; just look at this side angle to appreciate it.

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If you have a curved scapulae sitting on a flat upper back, you lose passive stability at the shoulder. And when we lose stability at the scapulae, we are virtually guaranteed to lose stability at the shoulder. Because the rotator cuff muscles attach to the scapula, trying to stabilize the glenohumeral (ball-and-socket) joint with a flat thoracic spine is like trying to shoot a cannon from a canoe.

Want more serratus? Incorporate more push-ups, and do them correctly. As EC notes in this video, don't just let the arms do all the work; get the shoulder blades moving. The scapula should rotate toward the armpit as you press up and away from the floor:

Get this upper back positioning squared away, and you'll improve rotator cuff control both transiently (positional stability) and chronically (better training results).

4. EC: Remember that joint range-of-motion falls off over the "athletic lifespan."

It never ceases to amaze me how much a teenage athlete will change over the course of a year - even independent of training. If a kid goes through an 8-inch growth spurt at age 13, he's usually going to go from that "loosey-goosey," completely unstable presentation to the uncoordinated, stiff movement quality. Basically, the bones have stretched out quickly, and the soft tissue structures crossing the joints haven't had time to catch up (let alone learn how to establish control of new stabilization demands).

What many folks fail to recognize is that "bad" stiffness doesn't just increase in teenage athletes, but also in the decades that follow. It's well established that joint laxity decreases over the lifespan; it's one of several reasons why your 80-year-old grandmother isn't as supremely mobile as she was in her 50s.

What's the point? A lot of the foundational mobility drills you use with your teenage athletes are probably "keepers" that people can use over the course of their entire lifespan. So, teach them perfectly early on so as to not develop bad habits that will be magnified over decades.

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5. MR: Remember that good hip development for athletes should be tri-planar.

Whether it's stealing bases, returning a punt, or changing directions on the ice, there's more to the hips than sagittal (straight ahead) plane development. Sure, it never hurts to be a stronger squatter or deadlifter, but I'd also argue that's just the tip of the iceberg. We also need our athletes to be able to move well in both the frontal and transeverse planes as well. I like to think of the sagittal plane as the "key" that unlocks the frontal and transverse plane.

If you're into the Postural Restoration Institute (PRI) , you can even take this a step further and think of it like this: we need the ability to shift into and load our left hip, while we need the strength and stability to push (or get off) our right hip, particularly in those demonstrating this heavily asymmetric postural presentation.

leftaic-275x300-2

Once we have that basic movement capacity, now we need to start cementing it. This can be done initially in the weight room, with exercises like dynamic chops, lifts, the TRX Rip Trainer, etc. I'm also a huge fan of concentric med ball throws as well. Start low to the hip initially, and then raise it up over time. Progress to eccentric as movement capacity and strength improve.

Taking this a step further, don't be shy in doing some aggressive lateral plyo progressions as well. Work on Heidens/skier jumps with a stick first to develop eccentric strength and control, then work on improving speed, power and explosiveness. Last but not least, we need to prepare our athletes for the specific demands of their sport, and this is where lateral acceleration and crossover stepping comes into play. At the end of the day, use the weight room to get strong in the sagittal plane, but don't forget that the frontal and transverse planes are critical for a highly-functioning athlete!

6. EC: Don't be afraid to progress birddogs.

The birddog is an awesome core stability and hip mobility exercise, but it can quickly become really easy for athletes with some training experience under their belt. Not all exercises need to be progressed, but the band-resisted birddog is one way to add some variety and additional challenge for this invaluable exercise:

As I noted earlier, Mike and Joe Kenn recently released their Elite Athletic Development 2.0 Seminar DVD set. I've reviewed this product now myself, and it's excellent. You can learn more HERE

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Random Thoughts on Sports Performance Training – Installment 12

With only one day to spare, here's the July edition of "Random Thoughts on Sports Performance Training."

1. One of the things I really heavily emphasize to our staff is that we should always be assessing. Obviously, during an initial assessment, we're going to review injury history, evaluate movement quality, and work to build rapport with the new client. However, I'm a huge believer that the initial evaluation should also include an actual training component. This is for three reasons:

a. I want the client to feel like they've actually started working toward their goals, as opposed to just hearing about all the things they need to work on.

b. We have many clients who come from out of town for short-term consultations, so we need to make the most of every training session.

c. I want to actually get a feel for what their work capacity is before I actually write a program for them.

You can measure resting heart rate, ask about training history, and take a whole bunch of other indirect measures of work capacity, but there is no substitute for seeing it first-hand. I've seen pro athletes in the early off-season who are completely deconditioned and struggle to get through incredibly abbreviated, basic sessions with lengthy rest periods. You really have to be able to take a step back and separate yourself from what you are expecting to see on the work capacity front so that you can observe what's really going on. If they are too deconditioned to put in the work you need to optimally effect positive changes with their performance, then your programming better reflect it.

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2. I often talk with my baseball guys about how every throwing session either makes you tighter or looser. This sadly hasn't been recognized very well when it comes to individualizing recovery modalities to players' arms.

If you've got a lot of joint hypermobility (collagen deficiency), you'll get looser. If you're a naturally "tight" individual, you'll get tighter and tighter.

If you're loose-jointed, you'll respond well to low-level stabilization drills that essentially "remind" your nervous system of how to create good stiffness and optimal movement at joints (particularly the shoulder).

These looser-jointed athletes also seem to respond better to mild compression (arm sleeves, not aggressive compression). Even a cut-off tube sock works just fine.

photo-61

Conversely, "tighter" throwers will generally do better with manual therapy and mobility drills. Static stretching after throwing is definitely appropriate, whereas you can skip it with the hypermobile crowd.

Regardless, these two "camps" share a lot in common. They both need great nutrition and hydration and optimal sleep quality and quantity, and they respond well to foam rolling and positional breathing drills. And, keep in mind that most pitchers don't fall to one extreme; they're usually somewhere in the middle, and can therefore benefit from a bit of everything. This is why recovery from throwing is an individualized topic; we have our theories on what works, but always have to get feedback from the athletes on what has yielded the best results for them.

3. Building on point #2, I never quite understood why some pitchers insist on doing their band work after starting pitching outings. It doesn't match up with either the "loose" or "tight" scenarios from my previous point, as fatigue changes everything. Fatigue is the enemy of motor learning - or re-learning, in this case. In my opinion, post-game band work is pretty silly.

stretch-300x192

If you're tight, get right to your manual therapy and mobility/stretching work. If you're loose, throw on a compressive arm sleeve and do your low-key band work the next day as part of that "stabilization re-education" I outlined earlier.

4. Good coaching isn't just about making clients and athletes move well; it's about doing so efficiently.

To me, there is a hierarchy in play in the coaching progression. First, a coach must know what an exercise is, and then understand how to coach that exercise. The third step is to learn to assess so that one knows when to include the exercise in a program. This last step is key, because to do an accurate assessment, one must understand what quality movement really looks like, how relative stiffness impacts things, and which compensation patterns an individual might resort to during that exercise. If you appreciate and follow this hierarchy, you continue to refine your ability to make technique perfect - but you can do so far more efficiently. 

Once you get to this point, it's all about coaching as many individuals as possible so that you have a giant sample size of incorrect patterns from which to draw. How do hypermobile folks compensate differently than those who don't have as much laxity? Why do individuals with long femurs struggle with an exercise, while those with "normal" anthropometry do just fine? Eventually, answering questions like these becomes second-nature, and that's where the efficient coaching happens, particularly when you learn about internal/external focus cues, and kinesthetic/visual/auditory learning styles.

5. Earlier this week, we had a 6-7 athlete doing stability ball rollouts - and the exercise was (unsurprisingly) pretty challenging for him. The combination of long arms and a long spine put him at a very mechanically disadvantageous position. It got me to thinking about how everyone seems to think about how tall guys have it tough when they squat and deadlift, but nobody seems to carry this thinking over to most core exercises. Imagine being seven-feet tall and trying to perform a stir the pot, where the forearms are a great distance from the feet:

Even on cable chops and lifts, the center of mass on a tall athlete is considerably further up from the base of support. The external loading that can be used is going to have to be lower if you don't want compensations to kick in.

One thing that can actually help a bit in this regard is athletes putting muscle mass on in the lower half of the body. It has a "grounding" effect as the center of mass is shifted slightly lower on the body.

Regardless, though, core stability exercises may need to be modified for taller athletes, especially initially. This might be in terms of regressing (e.g., going to prone bridges instead of rollouts), limiting range of motion (e.g., shortening the excursion on a rollout), or reducing the external loading relative to your "typical" expectations of where an athlete can start. 

6. Speaking of core stability exercises, have you checked out Mike Reinold and my Functional Stability Training? These resources have been our most popular collaborations, and we have modules covering our approach to rehab and training of the upper body, lower body, and core. It’s essentially a snapshot of how we think when designing our programs. You can learn more and purchase HERE.

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What is a “Big League Body?”

You might be surprised to know that I'm an "outsider" to baseball. I played up through 8th grade, but was actually a much better tennis player. Since they were both spring sports, the decision to go the tennis route was effectively made for me even though I loved baseball as both a player and fan.

Years later, in my first three years of strength and conditioning during graduate school at the University of Connecticut, I actually spent most of my time working with basketball and soccer players. I still loved baseball, but hadn't really been exposed to it "from the inside."

It just so happened that when I went to the private sector after graduate school, some of my first clients were high school baseball players. They had some good results and my phone started ringing off the hook. Now, almost ten years later, Cressey Sports Performance has facilities in both FL and MA, and we work with players from all 30 Major League Baseball organizations. 

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I'd argue that if I had been an "insider" from the get-go, we never would have been able to differentiate ourselves so quickly. Why? As an outsider, I had to do a lot of listening and observing. I had to ask a lot of questions. And, I was fortunate to NOT be married to personal biases of what baseball training programs should look like.

Distance running for pitchers didn't make sense to me. It was absurd to hear that players shouldn't lift because it'd make them "bulky and inflexible." The list goes on and on - but the point remains the same: good baseball strength and conditioning mandates logical thinking, not just reliance on tradition and personal biases. 

This doesn't just apply to baseball insiders' perspectives on what players should look like, though. Rather, it also must apply to how strength and conditioning coaches - baseball outsiders like me - view what players should look like. And, my decade in baseball strength and conditioning has taught me that you have to emotionally separate yourself from what an athlete "should" look like, especially when dealing with pitchers.

While you might think that every athlete - regardless of sport - needs to be 7% body fat with a 500+ pound squat and 18-inch biceps, you have to throw that perception out the window when you're dealing with baseball players (and many other athletes, for that matter). The truth is that big leaguers come in all shapes and sizes.

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I've seen pitchers with 16-inch vertical jumps who throw 95mph. I've seen guys at 25% body fat win Gold Gloves and hit over .300 in the big leagues. I'm not saying that you should just "allow" your athletes to be unathletic, but rather that you need to recognize the following:

Players are often successful because of traits and not just athleticism. 

Maybe a hitter has tremendous sports vision. Maybe a pitcher was blessed with freaky congenital laxity (joint hypermobility) to contort his body into crazy positions to create better deception and get on top of hitters faster. Maybe a pitcher has really long fingers that enable him to throw a great change-up or splitter. 

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The point is that natural selection definitely plays a big role in success, and it's your job to make sure your training doesn't interfere. Bartolo Colon has pitched in parts of 21 years in the big leagues and won 213 games, and he's making $12.5 million this year. He throws more than 85% fastballs and walk less than one batter per nine innings. 

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He is also clinically obese and probably has about 50-60 pounds of body fat to lose. Conventional wisdom says that shedding that excess body weight would make him a better athlete, but as I wrote with respect to CC Sabathia, that's a very slippery slope. That extra body weight may help him with absolute power development, and he may also be so accustomed to that larger frame after all these years that his mechanics might negatively impacted if you took a lot of weight off him, especially in a short amount of time. I've actually seen this quite a bit over the years in athletes who have come our way to sort out their struggles: try to get a guy too lean, and you'll deliver a six-pack - and a poop arm to go with it. For Colon, fastball command (and velocity) is clearly more of a priority than flab (or lack thereof).

I'm not telling you that you should let your guys get fat. I'm not telling you that you shouldn't train them for strength. I'm not telling you that we should just assume that the freaks will make it and hard work won't take a non-freak to the big leagues. I'm just telling you that you need to take a step back and consider exactly what makes an athlete a) successful and b) durable. 

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Guys aren't getting hurt because they only deadlift 450 and not 500 pounds. And, they aren't stuck in Triple A instead of living the big league dream because they're 10% body fat and not 9%. There are such things as strong enough, lean enough, and flexible enough. If they don't meet the minimum standards and they aren't at the level at which they hope to compete, you need to improve these qualities. If they don't meet these minimum standards, but they're already competing at the highest level, then you have to be very careful about how you tinker with things. Subtle changes are the name of the game, and extremes should be avoided. And, you should look for easy gains first.

Improving a pitcher's cuff strength is a lot quicker and easier than adding 100 pounds to his deadlift. Adding 10 degrees of hip internal rotation or thoracic rotation can make a hitter feel far more confident at the plate. Getting 10 minutes of soft tissue work on a gritty shoulder or elbow can be absolutely game-changing for a pitcher who has thrown through chronic pain.

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These aren't the sexy training exercises or boast-worthy gains that make for YouTube videos that go viral, but they're the ones that can take athletes to the next level - or keep them at the highest level. I'll take a good serratus anterior over a good six-pack, even if it makes for lame Instagram content. I'll take great end-range rotator cuff strength over big arms, even if it won't make the ladies go wild.

Our athletes are still going to lift heavy weights, sprint, throw med balls, do plyos and agility drills - but it's all part of a larger plan where we appreciate them as individuals with unique needs. If you try to fit baseball players into a physical mould that you've built in your mind, you'll waste training time as you study for the wrong test. And, more importantly, you'll miss out on key performance benefits and opportunities to keep them healthy.

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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.

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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.

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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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Random Thoughts on Sports Performance Training: Installment 4

In light of the recent launch of The Specialization Success Guide, I feel like there have been a lot of posts on the site lately on the topic of powerlifting. With that in mind, I thought I'd shuffle things up with a bit more discussion about training in a broader sense, so let's talk some general athletic development.

1. We don't any regular barbell bench pressing with our baseball guys, and it's even pretty rare for us to use dumbbell bench pressing in their programs. This is, in part, because we want to utilize movements where the scapulae can move freely, as opposed to having them pinned down on a bench. In light of this exclusion, we're often ask: what do you do instead?

The answer, as many of you know, is landmine presses, push-up variations, and cable press variations. However, what a lot of people might not realize is that another good option is to simply replace a press with some kind of overhead hold variation, whether it's a Turkish get-up or bottoms-up carry.

One other variation I really like is the kneeling overhead hold to stand. I'll often use this with beginners who might need a little stepping stone before they get to the Turkish get-up. In addition to getting some great reflexive rotator cuff work, we're driving scapular upward rotation in a population that really needs it. Still, that doesn't mean that everyone is ready for it. Watch the video to learn more:

2. It's not uncommon at all to see medial (inside) elbow pain in lifter.s This usually comes from the tremendous amount of grip work one does in combination with lots of loaded elbow flexion. Usually, when these issues pop up, cutting back on lifting volume and modifying exercise selection is imperative.

However, what a lot of folks fail to appreciate is the impact that supplemental conditioning work can have on the overuse pattern. Just imagine how much abuse your common flexor tendon is taking when you hop on the rowing machine for 20 minutes to log a few thousand meters, or add in some barbell or kettlebell complexes. These are very grip-intensive approaches and need to be incorporated carefully - and certainly not all the time. Cycle them in, and then cycle them out.

As an example, I'm someone who deals with medial elbow irritation here and there, and most of the time, it's when I'm doing more work on the rower. As such, I've learned that one rowing session a week is really all I can handle if I'm doing my normal upper body training workload.

3. Having a good hip hinge is a huge contributor to athletic success, and to that end, we include toe touch progressions with a lot of our athletes. Without a doubt, the biggest mistake I see with athletes doing a toe touch is the substitution of knee hyperextension for hip flexion. Here's what that looks like:

photo-68

You'll notice that there really is absolutely no posterior shift of the center of mass, and he stays in plantarflexion (calves don't stretch). This is something you'll see really commonly in athletes with very hypermobile joints. I've demonstrated it before with the following video; you'll notice that this loose-jointed athlete can actually get a crazy toe touch without any sort of hip hinge, as he's blocked by the wall. Hypermobile athletes will always try to trick you!

Every time you allow them to use a faulty hip hinge pattern, you're giving them two opportunities to work themselves closer to an ACL injury. First, you're putting them in a position where the glutes can't control the femur, and where the hamstrings are too overstretched to really help stabilize the knee effectively. Second, knee hyperextension is commonly a part of the typical ACL injury mechanism (especially in contact injuries where an opponent tackles an athlete low); do we really want to be going to this dangerous end-range over and over again in our training? With that in mind, when coaching the hip hinge, you want to ensure that the athlete establishes and maintains a slight bend in the knee; the "soft knees" cue usually works well.

4. I've often heard people talk about how prone bridges (front planks) are useless if you can already do quality push-ups. While I can certainly appreciate this line of reasoning, I think it overlooks two things.

First, most people rattle through push-ups pretty quickly, so the time under tension may actually be considerably lower than what one would get on a prone bridge.

Second, you can make a prone bridge considerably more difficult via a number of different means, and my favorite is adding full exhalations on each breath. This is something that's very difficult to "sync up" with push-ups, but the benefits are excellent: more serratus anterior recruitment, better posterior tilting of the pelvis, better anterior core engagement, and relaxation of overused supplemental respiratory muscles.

So, don't rule out bridges just yet! I love them as a low-level motor control exercise at the end of a training session - and after the loaded core work (chops, lifts, etc) have been completed.

Have a random thought of your own from the past week? Feel free to post it below; I'm all ears!

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