Okay, this subject line was undoubtedly the worst of all time, but I promise that the information that follows will be worth reading.
A lot of you were probably hoping that you were out of the woods after I told you how bad your lower backs and shoulders look on diagnostic imaging such as MRIs. I'm sorry to say that these "normal" structural disasters also apply to the knees.
A 2010 review from Flanigan et al. looked at studies that collectively examined the (1,862) knees of 931 athletes (40% of whom were professional athletes) using MRI and arthroscopy. They found that 36% of these knees had full-thickness chondral defects, but 14% of these subjects had no symptoms when diagnosed. The researchers concluded that "Over one-half of asymptomatic athletes have a full-thickness defect."
Years earlier, Cook et al. screened 134 elite junior basketball players (268 total knees) for patellar tendinopathy. At the time, only 19 (7%) of the 268 tendons presented with symptoms (pain) of tendinopathy. Interestingly, though, under diagnosis with ultrasound, researchers actually found that 26% of all the tendons could be labeled tendinopathy based on the degenerative changes observed. In other words, for every one that actually presents clinically with symptoms, more than three more go undiagnosed because people either haven't reached threshold, or they move well enough to keep symptoms at bay. Or they are Kurt Rambis and can just look so awkward that nobody even pays attention to their knee sleeve.
On the "move well enough" side of things, check out this study from Edwards et al. They showed that these athletes with asymptomatic patellar tendinopathy actually land differently - both in terms of muscle recruitment and sequencing - than asymptomatic athletes without tendinopathy. Fix that movement pattern neurally and strengthen the right muscles, and those issues never reach threshold. Leave it alone, and they'll be presenting with knee pain sooner than later. Mike Robertson does a great job of outlining ways to improve knee health via movement retraining in his Bulletproof Knees Manual.
This is just the tip of the iceberg. You'll see loads of chronic ACL and meniscus tears that folks never realize they have. I could go on and on. The take-home messages? Yet again, diagnostic imaging is just one piece of the puzzle, and how you move is far more important.
Related PostsThe Importance of Ankle MobilityHealthy Knees, Steady Progress
A few months ago, I gave a two-day seminar to just over 80 fitness professionals and strength and conditioning coaches. Even with a seminar this long, I can never cover everything I'd like to cover - and it's generally because much of what I'd like to address relies on some prerequisite knowledge that the attendees may not possess.
With that in mind, at the attendees' request, I sent a follow up email to all of them with a list of some of the best resources - books/manuals and DVDs - that I've encountered along my journey of self-education.
Please keep in mind that this is not an exhaustive list, by any means, but it does cover what I'd consider requisite reading to get a good foundation in a lot of the concepts I covered last weekend.
1. Any anatomy text will do, but I prefer texts that speak more to functional anatomy. Netter's Atlas of Human Anatomy is very good, and I know of many physical therapists in the US who keep a copy of this book on hand for patient education. Kinetic Anatomy is also a solid text that speaks to functional anatomy, and I believe the newer version comes with a tag-along DVD. Lastly, our Building the Efficient Athlete DVD set was created in part to educate folks on the functional anatomy side of things that they may miss during a conventional college curriculum. I know of several facilities in the US that use it extensively for staff training.
2. Anything from Stuart McGill - While there are several schools of thought with respect to low back function and rehabilitation (and I'd encourage you to check out each of them), McGill is the one that resonates with me the most. You can find a lot of his research on Pubmed, but he also has several books (and a DVD) available that I'd highly recommend. For those of you who are interested in some science and some applied, go with Ultimate Back Fitness and Performance.
For those of you who are a bit geekier and want to learn a lot more about the clinical side of things, check out Low Back Disorders. If you are going to train clients or athletes, you need to understand back pain.
3. Diagnosis and Treatment of Movement Impairment Syndromes by Shirley Sahrmann is probably the book that has influenced me more than any other in my career. It's worth every penny.
4. For shoulder stuff, I think that The Athlete's Shoulder is a great resource. It is written by physical therapists and surgeons, though, so it can get very clinical at times. Those of you who are more interested in actual practical applications would be more interested in our new Optimal Shoulder Performance DVD set, which is the video of a seminar I did with Mike Reinold, who is actually one of the co-authors of The Athlete's Shoulder. If you enter the coupon code "reinold200osp" today only at checkout HERE, you can get the DVD set with free shipping today as part of Mike's "sale week" to celebrate his 200th post.
5. Muscles: Testing and Function with Posture and Pain - This is a newer version of Kendall's classic text, and it's an incredibly detailed resource that you'll find yourself referring back to time and time again. Several of the screens we use in our everyday assessments with clients and athletes were influenced in part or entirely by Kendall's text.
6. Gray Cook's work is fantastic. If you want quick, practical tips, check out Secrets of the Hip and Knee and Secrets of the Shoulder. Both DVDs give you some tips that you can immediately put into practice.
7. Anatomy Trainsby Thomas Myers is an excellent read to get you thinking more and more about the role of the fascial system. I saw Thomas speak this past weekend in Providence, and he was absolutely fantastic - so excellent, in fact, that I'll probably write up a blog with some quick notes from his lecture. And, I'll be reading this for the third time this week, too!
8. Bulletproof Knees - Mike Robertson wrote this manual and I can honestly say that I haven't seen a better product on the market with respect to information that can be quickly applied to clients with knee pain - both in terms of understanding it and correcting it.
9. Mike Boyle has some excellent products - including all the Functional Strength Coach DVDs (#3 was the most recent). You can always find some good reading at StrengthCoach.com. I believe they still have the 14 days for $1 trial period, and as part of that, you get his Designing Resistance Training Programs and Facilities book for free.
10. Anatomy of Breathing - I think it's valuable to appreciate the muscles involved in respiration and start to put them into your functional anatomy framework as soon as possible. This book is a very quick read, but you'll get that foundational knowledge and start to think about how all this stuff lines up.
11. 2008 Indianapolis Performance Enhancement DVD set - This is a product that has largely flown under the radar because it was overshadowed by several other products that were launched around the same time. However, the short vs. stiff discussion that Bill Hartman presented as part of it is well worth the cost of the entire DVD set.
12. Clinical Applications of Neuromuscular Techniques(Part 1 and 2) - These books read like stereo instructions, but they are insanely thorough. I recommend them to anyone who is really dorky like I am. They will definitely help you to collaborate with manual therapists and physiotherapists a lot more effectively.
13. Assess and Correct - Shameless self-promotion here, but I'm extremely proud of this product. It's a DVD set and four accompanying manuals that cover 27 assessments and 78 corrective exercises we use with our clients and athletes. If I had to recommend one of our products to a trainer, this would be it. Stuart McGill have us some extremely flattering reviews on Assess and Correct as part of his new DVD.
I should note that the countless journal articles I've read over the years are noticeably absent from this list, but you can easily access the abstracts of those pieces at www.pubmed.com if you search by whatever keyword relates to your area of interest. I find myself using it daily, and I'll generally follow up on these abstracts by getting the full-text articles. Also, in addition to the few resources I note below, you can find a more extensive collection of recommended readings on my resources page. This includes a collection of links to free blogs that I read daily. Many of my blog readers don't know that, in addition to this blog, I have a free newsletter where readers get exclusive content and early notice on things - so you'll definitely want to sign up HERE if you haven't already.
It's also been a matter of interacting with as many smart folks as possible, just making (and documenting) observations with our clients/athletes, and going to seminars. This list should get you started, though!
To celebrate Memorial Day and the long weekend that many call the "unofficial start to summer," Mike Robertson and I decided to put two of our most popular products to-date on sale through this Monday night - and update their websites.
So, from now until midnight on Monday 5/31, you can get both Building the Efficient Athlete and Magnificent Mobility for 20% off. The discount will be applied automatically at checkout; you just need to pick them up at the following websites:
If you'd like to order them along with other products, just check out the RobertsonTrainingSystems.com Products page.
Don't miss out on this great opportunity to pick up two of our "best sellers" at an excellent discount!
Just thought you all might be interested in checking out a five-part feature Mike Robertson ran with material from Mike Reinold and I. Here's what it included:
In the Trenches Podcast with Eric Cressey and Mike Reinold
The podcast that started it all! Here we discuss how Eric and Mike got into the field, how they evaluate shoulders, and a bunch of baseball training. You'll definitely like this one!
Eric Cressey Q&A #1 - Shoulder Forces in Boxing
Here, I describes the forces you're going to see during a typical punch in boxing, as well as what biomechanical factors might predispose boxers to injury.
Eric Cressey Q&A #2 - Sternoclavicular Joint Dysfunction
In this post, I talk about the potential causes of sternoclavicular joint issues and how to handle them.
Mike Reinold Q&A #1 - Scalene Anatomy
Mike discusses the scalenes, their impact on the shoulder, and why asymmetry may not be bad for baseball players.
Mike Reinold Q&A #2 - Joint Capsule Surgical Techniques
Mike discusses two different surgical techniques for correcting issues with the shoulder capsule, as well as what to expect post-surgery.
Also, don't forget that today is the last day to get the $20 early-bird discount on The Single-Leg Solution. Don't miss out; the introductory price ends tonight at midnight.
About a year ago, Mike Robertson came out with an outstanding product, The Single-Leg Solution - and it reminded me of an experience I once had at a seminar. A guy posed the following question to a panel of speakers in which I was included:
"If you could only choose one exercise to do, what would it be?"
We all agreed that it was a pretty stupid and unrealistic question, but reluctantly, we each answered. In spite of my distaste for the question, I responded without hesitation: "Lunges - or any single-leg exercise, for that matter."
In my eyes, single-leg work really is that valuable - and for a lot of reasons.
(Gold star to none other than me for thinking of up the title for him. Booyeah.)
So why is single-leg work the best thing since sliced bread?
First, there is obviously going to be some direct carryover to the functional demands of life and athletics, as we spend most of our life on one foot in one capacity or another. Muscular recruitment patterns are different for bilateral and unilateral exercises, so in terms of specificity, single-leg work really can't be beat.
Second, it's much more lower-back friendly, as you can load single-leg exercises appreciably without axial loading. And, to take it a step further, it is easier to maintain neutral spine (and avoid lumbar flexion with compressive loading) with a split-stance - regardless of whether you axially load or hold the weights in the hands at one's sides. Simply stated, while single-leg exercises will never (at least in my eyes) take the place of squatting and deadlifting, they are absolutely essential supplemental exercises for one's training repertoire.
Third, in the case of back pain (or hip pain, with femoroacetebular impingement being an example), they're hugely helpful in allowing one to maintain a training effect in spite of whatever pain is present.
Fourth, single-leg exercises are hard. Let's face it: most people exercise like pansies and pick the exercises they like the most, not the ones that they need the most - or the ones that are the hardest. This is 225 pounds for eight pretty effortless reps, which makes girls want him and guys want to be him (or something like that).
Fifth, Robertson insists they are good, and this guy knows as much about knees as anyone I've ever met. If you want to keep your wheels strong and healthy for the long-term, including them is a no-brainer.
This is just five reasons to include single-leg work in your programming, and frankly, Mike includes a heck of a lot more in the 96-page tag-along manual that accompanies the 60-minute DVD in The Single-Leg Solution Package.
Knowing that single-leg work is important isn't enough, though, as I see exercise enthusiasts and fitness professionals alike absolutely butchering the technique on these exercises. And, they have absolutely no rhyme or reason for the "who, what, when, where, why" they include them; it is just throwing a wad of turd on the wall to see what sticks. Optimal progress is dependent on population-specific exercise selection, pristine technical execution, and pinpoint exercise progressions - and this is where Mike really shines with this product.
So, whether you're a personal trainer, bodybuilder, powerlifter, runner with knee pain, desk jockey with a bad back, or just some random dude who wants to get stronger, move better, and be just a little more awesome, I'd highly encourage you to check out The Single-Leg Solution..
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Here are some reading recommendations for the week:
Q&A: Partial Knee Meniscectomy - Here is a great blog from Mike Robertson about training modifications for those who have had a portion of the meniscus removed. Mike's a brilliant knee guy (definitely check out Bulletproof Knees if you haven't already). Stick around Mike's site and read a bit; he's been kicking out some great content lately.
Are You Inflamed? - This is a good one on the nutrition side of things from Mike Roussell.
What Makes Roy Run? - This was an awesome article about Roy Halladay from a few weeks ago in Sports Illustrated. To be blunt, a ton of professional baseball pitchers are lazy, one-trick ponies who rely on natural talent and don't work hard to fulfill their potential. Halladay is an exception to that rule: a guy who has worked incredibly hard to become arguably the best pitcher in the game. This is a tremendously well-written and entertaining piece about the path he took and how he deserves every bit of success that comes his way. Phillies fans are lucky to have him.
1. I thought I'd kick this post off with a little technique troubleshooting. Yesterday, one of the "guinea pigs" for my new project emailed this video to me and asked for some suggestions on bench press technique:
BP from Caleb Chiu on Vimeo.
My suggestions to him were as follows:
a. Your feet are antsy and jumping all over the place. Get them pulled up a bit more under you so that they can't move around. Then, focus on pushing them into the floor the entire set.
b. Get more air in your belly. Notice how the stomach sinks in? That's because you don't have any air in it!
c. Get a handoff. The #1 reason guys flair the elbows out is that they lose scapular stability - and you lose that the second you hand off to yourself.
2. I'm headed to a Postural Restoration Institute Myokinematic Restoration Seminar this weekend up in Portland, ME - while my fiancee and my mother work on stuff for the wedding. It is amazing what lengths guys will go to in order to escape wedding planning, huh?
Just kidding; I'm actually really excited about it. Neil Rampe of the Arizona Diamondbacks turned me on to the PRI stuff and it's really intrigued me from the get-go.
3. It's been a fun week around here with the start of the high school baseball season. I got over to help out with some warm-ups and movement training with the Lincoln-Sudbury guys during tryouts on Mon-Tue. In all, we saw 33 Lincoln-Sudbury high school baseball players - from freshman to seniors - this off-season, so it was pretty easy to pick up where we left off with them in the weight room. There was great energy, and lots of excitement about the new season.
4. Here's a great feature on Blue Jays prospect Tim Collins and his training at Cressey Performance.
5. I was interviewed last week for an article about pitch counts. It's now featured HERE.
"I was pretty excited when I received an e-mail from Eric and Mike saying that I was getting an advanced copy of their new Assess and Correct product. Mike and Eric have had a history of putting out top notch information and products and when I saw that Bill Hartman was also involved in this new product I knew that this was going to be even more special.
"Since I own a fitness facility, I'm always looking for cutting edge information that I can recommend to my trainers. After viewing the DVDs and reading through the manuals, my first thought was, 'Wow, a home run!'
"Finally, a product that I could wholeheartedly recommend to all of my trainers as an excellent go-to reference tool to enhance their abilities in assessing their clients needs; pinpointing their weakness &/or imbalances and then effectively addressing these findings to make sure their clients can achieve their goals safely."
Joe Dowdell, CSCS - Founder & Co-owner of Peak Performance, NYC
www.peakperformancenyc.com
Click here to pick up a copy of Assess and Correct.
7. Last, but certainly not least, CP athlete Danny O'Connor aims to run his professional boxing record to 11-o tonight with a bout at Twin River Casino in Rhode Island. Good luck, Danny!
Mike Robertson, Bill Hartman, and I recently participated on a roundtable with Pat Rigsby at his blog. The discussion is all about assessment and its role in the training process.
You definitely ought to check it out - not only for the content itself, but also the special offer in place for Assess & Correct. Here it is:
Just wanted to give you all a heads-up that Mike Robertson is running a customer appreciation sale on Bulletproof Knees this week. If you enter the coupon code KNEES2010 at checkout, it'll get you $15 off the cost of the product. I've raved about this resource in the past, as I think it's the single-best corrective exercise product on the market with respect to knee pain.
Check it out: Bulletproof Knees. This sale only goes through the end of the day on Thursday, February 11.
