Home Posts tagged "Post Rehab Essentials"

Strength and Conditioning Stuff You Should Read: 4/23/16

It's a rainy Saturday morning, so what better way to overcome the weather than to check out some good reading material? Here's some excellent stuff I've come across lately:

4 Reasons Fitness Professionals Must Understand Corrective Exercise and Post-Rehab Training - I wrote up this post a few years ago, but wanted to bring it back to the forefront in light of the fact that Dean Somerset put his excellent resource, Post-Rehab Essentials, on sale for $50 off through the end of the weekend.

PRE-header-final

"Because My Boss Sucks" is a Sh**ty Reason to Open Your Own Gym - The title is a bit aggressive, but my business partner, Pete Dupuis, wrote up a great post for all the fitness professionals out there who are considering opening their own facilities. 

Scaling Up Excellence - I finished up this excellent book by Robert Sutton on my drive back to Massachusetts last weekend. It's targeted toward managing growth of businesses, but has a ton of invaluable messages for coaches, too.

scaling-up-excellence

I've also decided to start including my top Tweet and Instagram posts of the week in this weekly feature. Here they are:

 

Top Tweet:

throwing

Top Instagram Post:

Have a great weekend!

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Expanding the “Safe” Exercise Repertoire

In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.

Back-Mechanic

As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,

“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”

As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:

layback

Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:

throwingprogression

You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.

For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”

How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.

To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.

Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.

Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).

Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:

(Feet-Elevated) Push-up Isometric Holds > (Feet-Elevated) Body Weight Push-up > Stability Ball Push-up > Weighted Push-up > Neutral Grip DB Floor Press > Neutral Grip Decline DB Press > Pronated Grip Decline DB Press > Barbell Board Press (gradual lowering) > Barbell Floor Press > Neutral Grip DB Bench Press > Low Incline DB Press > Close-Grip Bench Press > Bench Press > Bottoms-up KB Military Press > Barbell Incline Press > Barbell Overhead Pressing

Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.

A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.

This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.

With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.

PRE-header-final

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Making the Case for Training in the Post-Surgery Period

If you were to spend a day at either the MA or FL Cressey Sports Performance location, invariably, you’d see something that might surprise you: athletes training in spite of the fact that they recently had surgery. On a regular basis, we have athletes referred our way after everything from Tommy John surgeries to knee replacements. They may be on crutches, using an ankle boot, in an elbow brace, wearing a shoulder sling, or even rocking a back brace. Working with post-operative athletes has become a big niche for us; we work hand-in-hand with surgeons and rehabilitation specialists to make sure that we deliver a great training effect in spite of these athletes’ short-term limitations.

12746002_1978667715691160_7390252024425739601_n

Unfortunately, athletes will sometimes run across hyper-protective therapists and doctors who are overly cautious in this period. Certainly, for a period, this is incredibly important, as there are risks of not only the repair being vulnerable to movements and direct pressure, but also it being compromised by infection in the first few weeks. However, in my opinion, it’s absolutely unnecessary to tell an athlete to just take 3-4 months off completely from exercise and instead just “rehab” – and yes, I have heard this before.

With this in mind, I wanted to outline six reasons I think strategically implemented strength and conditioning work in the post-surgery period is incredibly important.

1. It’s important to make an athlete feel like an athlete, not a patient.

There is a different vibe in a physical therapy clinic or training room as compared to a strength and conditioning setting. This isn't intended to be a knock on rehabilitation specialists, but athletes would rather hang out in the latter realm! And, while great therapists make rehabilitation upbeat and keep the athlete's competitive psyche engaged, getting back into the gym affords a big mental boost - a break from their current physical reality - for athletes.

Speaking of mental boosts, I won't even bother to highlight the favorable impacts of exercise on mood and the reduction in risk of a wide variety of chronic diseases. Suffice it to say that there are a ton, and it's important that athletes continue to have these benefits during their rehabilitation period. If you really want to dig deeper, I'd highly recommend this recently published meta-analysis: Exercise as a treatment for depression.

2. Small hinges swing big doors in terms of behaviors.

Most people eat healthier when they train. Whether this is conscious or subconscious is dependent on the individual, but it's something I've seen time and time again.

Likewise, many student athletes perform better in the classroom when exercising regularly, and struggle to stay on task when they’re given too much free time.

What's my point? Effectively, training pushes out certain bad behaviors. Likewise, on a physiological level, it supports better brain activity that makes for more productive members of society.

3. Injuries don’t occur in isolation.

Pitchers don’t just blow out their elbows because of functional deficits at the elbow. Rather, the elbow usually gets thrown under the bus from a collection of physical deficits all along the kinetic chain. As an example, Garrison et al (2013) demonstrated that players with ulnar collateral ligament tears scored significantly worse on the Y-balance test than their healthy peers.

elbows

With this in mind, it would be silly to spend months and months only focusing on rehabilitating the arm to the exclusion of the rest of the body. Unfortunately, physical therapists only have so much time with athletes because of insurance restrictions, so they may not get to these important complementary rehabilitation approaches. This is a great place for a competent strength and conditioning professional to pick up the slack.

4. Training improves body composition, which facilitates a number of favorable outcomes.

It drives me bonkers when I hear about an individual dropping a bunch of muscle mass and gaining substantial body fat during the post-surgery period. This should never happen. 

Just as a healthy body composition will help a grandfather avoid setbacks following a hip replacement, having a good strength-to-body weight ratio will increase the likelihood that a college soccer player will avoid setbacks after a meniscal repair.

These benefits aren't just conferred to weight-bearing scenarios. Remember, obesity is arguably the biggest limitation to diagnostic imaging accuracy. In other words, if you have a setback in your rehabilitation and need an MRI or x-ray, being fatter makes it hard for your radiologist to give you an accurate reading. An ounce of prevention is worth a pound of cure.

5. Exercise facilitates motor learning improvements.

When rehabbing, you’re trying to acquire new, favorable movement patterns. Research (good reads here and here) has demonstrated improved motor learning when new tasks are introduced alongside exercise (particularly aerobic exercise).

Maintaining a robust aerobic system and solid work capacity makes rehabilitation efforts more effective.

6. Contralateral strength training has carryover to immobilized limbs.

Via a mechanism known as cross-transfer (or cross-education), an untrained limb's performance improves when the opposite limb is trained. As an example, if you have knee surgery on your right leg, but do what you can do to safely train your left leg while your right knee is immobilized, you'll still get carryover to the post-surgery (right) side. It won't do much to attenuate the atrophy of muscle mass on an immobilized limb, but it will absolutely reduce the fall-off in strength, power, and proprioception. Effectively, it's "free rehab" that offers a huge leg up with respect to return to play.

As an aside, research on cross-transer from Hortobagyi et al has demonstrated that the strength carryover seems to be stronger with eccentric exercise, so prioritizing this approach seems to have extra merit.

Some Important Notes

Before I sign off on this one, I should be clear on a few things:

1. Not every trainer and strength and conditioning coach is prepared to take on every injury.

If you’ve never heard the word “spondylolysis,” you shouldn’t be programming for a kid in a back brace. And, if you don’t know the difference between an ulnar nerve transposition and an ulnar collateral ligament reconstruction, you’re not ready to take on a post-op baseball elbow. Don’t be a cowboy.

2. Effective post-operative training mandates outstanding communication.

You should be speaking on a regular basis with the physical therapist or athletic trainer who is overseeing the rehabilitation plan. They’ll let you know if an athlete is prepared for progressions, and also to help you avoid overlapping with what they do in the rehabilitation sessions. I’d even encourage you to sit in on some of their rehabilitation sessions not only to monitor progress, but also as continuing education.

3. When in doubt, hold athletes back.

One of my graduate school professors, Dr. David Tiberio, once said that physical therapists “should be as aggressive as possible, but do no harm.” I’ll take this a step further and say that fitness professionals conditioning “should be conservative and do no harm” during the rehabilitation process. It’s our job to maintain/improve fitness and facilitate return-to-play, but in no way set back the recovery process. In short, let the rehab folks take all the chances when it comes to progressions.

4. Remember that progressions occur via many avenues.

Progressions don’t just come in terms of exercise selection, but also absolute loading, speed of movement, volume, frequency, duration, and a host of other factors. You need to keep all of them in mind when programming and coaching, as even one factor that is out of whack can set a rehabilitation program back. Additionally, there will be times when stress in one area goes up, which means it must be reduced in another area. As an example, during rehabilitation from Tommy John surgery, the stress on the medial elbow increases when an athlete begins throwing at the 4-6 month mark, and many athletes will benefit from a reduction in the amount of gripping they do in their strength training and rehabilitation programs. 

EverythingElbow

5. Watch for "accidental" stabilization demands.

Many muscles work reflexively, with the rotator cuff being the absolute best example. After a shoulder surgery, you have to be careful training the opposite side too soon (or with too much loading) because the cuff on the surgery side can turn on reflexively. As the aforementioned cross-transfer effect dictates, it's not as simple as right vs. left training effects; our nervous system governs everything - and in curious ways. 

Wrap-up

I hope that in publishing this article, I made a strong case for the importance of appropriate exercise during the post-surgery period. Remember that what is "appropriate" will be different for each individual, and should be determined via a collaborative effort with input from a surgeon, rehabilitation specialist, strength and conditioning professional, and the athlete. And, it should always be a fluid process that can be progressed or regressed based on how the athlete is doing.

For the fitness professionals out there, if you're looking for more information, here are a few good reads:

4 Reasons You Must Understand Corrective Exercise and Post-Rehab Training
7 Random Thoughts on Corrective Exercise and Post-Rehab Training


Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

The Overhead Lunge Walk: My Favorite “Catch-All” Assessment

We spend a good chunk of our lives standing on one-leg. Obviously, that means we need to train on one leg, but it's also important that fitness professionals and rehabilitation specialists assess folks when they're in single-leg stance, too. Enter the overhead lunge walk, which is likely my favorite assessment because of just how comprehensive it is.

Why is it so great? Let's examine it, working from the upper extremity to the lower extremity.

First, you can evaluate whether someone has full extension of the elbows. Just tell folks to "reach the fingers to the sky." In a baseball population, as an example, you can quickly pick up on an elbow flexion contracture, as it's quick and easy to make a comparison to the non-throwing side.

IMG_7810

Additionally, you can screen for congenital laxity, as a lot of hypermobile (loose jointed) folks will actually hyperextend the elbows during the overhead reach.

elbow10365821_744096285641478_6191697364410130329_n

At the shoulder girdle, you can evaluate whether an individual has full shoulder flexion range of motion:

IMG_7895

You can also tell whether the aforementioned hypermobile folks actually move excessively at the ball-and-socket joint of the shoulder, as they'll actually go too far into flexion instead of moving through the shoulder blades.

You can determine whether an individual has an excessively kyphotic, neutral, or extended thoracic spine. If they're kyphotic, they'll struggle to get overhead without compensation (arching the lower back or going into forward head posture). If they've got an excessively extended thoracic spine, they'll actually go too far with the overhead reach (hands will actually wind up behind the head if it's combined with a very "loose" shoulder).

You can tell whether an individual is able to fully upwardly rotate the shoulder blades in the overhead position.

You can tell whether someone preferentially goes into forward head posture as a compensation for limited shoulder flexion, poor anterior core control, or a lack of thoracic spine extension or scapular posterior tilt.

You can evaluate whether an individual has enough anterior core control to resist extension of the lumbar spine (lower back) during overhead reaching. This is a great test of relative stiffness of the rectus abdominus and external obliques relative to the latissimus dorsi.

You can evaluate whether an individual is in excessive anterior or posterior pelvic tilt from the side view.

Also from the side view, you can determine whether the athlete hyperextends the knees in the standing position.

With the lunge, you can see if an athlete is quad dominant - which is clearly evidenced if the stride is short and the knee drifts out past the toes of the front leg. You can also venture a guess as to whether he or she has full hip extension range of motion.

Also with the lunge, you can determine how much control the athlete has over the frontal and tranverse planes; does the knee cave in significantly?

You can make a reasonably good evaluation of foot and ankle function. Does the ankle collapse excessively into pronation? Or, does he stay in supination and "thud" down?

Does the athlete handle the deceleration component effectively, indicating solid eccentric strength in the lower extremity?

As you can see, this assessment can tell you a ton about someone's movement capabilities and provide you with useful information for improving your program design. Taking it a step further, though, it goes to show you that if you select the right "general" assessments, you can make your assessment process much more efficient.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

7 Random Thoughts on Corrective Exercise and Post-Rehab Training

If you've read much of my stuff (most notably this article), you likely appreciate that I think it's really important for fitness professionals to understand corrective exercise and post-rehab training. Folks are demonstrating poorer movement quality than ever before, and injuries are getting more and more prevalent and specific. For the fitness professional, corrective exercise can quickly become a tremendous opportunity - or a huge weakness. To that end, given that Dean Somerset put his great resource, Post-Rehab Essentials, on sale for $50 off through the end of the day, I wanted to devote some thoughts to the subject with these seven points of "Eric Cressey Randomness."

cropped-postrehabessentialsheader

1. Refer out. - With more and more certifications and seminars devoted to corrective work, the industry has a lot more "corrective cowboys:" people who are excited to be able to "fix" everything. Unfortunately, while this passion is admirable, it can lead to folks taking on too much and refusing to refer out. To that end, I think it's important for us to constantly remind fitness professionals to not work outside their scope of practice.

Referring out is AWESOME. I do it every single day - and to a wide variety of professionals. It provides me with more information, and more importantly, helps me toward the ultimate goal of getting the client/athlete better. Trainers often worry that if they refer out, they'll lose money. This generally isn't true, but even if it was, it's a short-term thing. If you appreciate the lifetime value of the client, you'll realize that getting him/her healthy will make you more profitable over the long-term.

Additionally, I've developed an awesome network of orthopedic specialists in the greater Boston area. As a result, I can generally get a client in to see a specialized doctor for any joint in about 24-48 hours. It's an awesome opportunity to "overdeliver" to a client - but it never would have come about if I hadn't been willing to refer out. As an added bonus, we'll often get referrals from these doctors as well.

2. Ancillary treatments are key. - For my entire career, I've been motivated by the fact that I absolutely hate not knowing something. It's pushed me to always continue my education and not get comfortable with what I know, and it's helped me to be open-minded to new ideas. However, I'm humble enough to recognize my limitations. I know a lot about elbows, but I'm not going to do your Tommy John surgery. I've worked with more pitchers than I can count, but I'm not a pitching coach. And, even if I was able to do all these things, there's no way I'd have time to do them all and leverage my true strengths. In other words, I rely heavily on competent professionals around me for everything from sport-specific training, to manual therapy, to diagnostic imaging, to surgery, to physical therapy, to nutritional recommendations. Surround yourself with great people with great skillsets, and corrective exercise quickly becomes a lot easier.

manual_therapy_page

3. Soft tissue work is effective.

Here's what I know: people feel better after they foam roll, and their range of motion improves. Additionally, soft tissue treatments have been around for thousands of years for one reason: they work!

For some reason, though, every 4-6 months, somebody with a blog claims that foam rolling is the devil and doesn't work, and then dozens of people blow up my email address with questions about whether the world is going to end.

The truth is that we know very little about why various soft tissue approaches work. I recall a seminar with bodywork expert and fascial researcher Thomas Myers from a few year back, and he commented that we "know about 25% of what we need to know about the fascial system." If Myers doesn't have all the answers, then Johnny Raincloud, CPT probably hasn't found the secrets during his long-term stay in his parents' basement.

With that in mind, I do think it's safe to say that not all people respond the same to soft tissue work, and certainly not all soft tissue approaches are created equal. Foam rolling doesn't deliver the same results as an instrument-assisted approach, and dry needling likely works through dramatically different physiological avenues than cupping. As a result, we're left asking the client: "does it make you feel and move better?" If the answer continues to be "yes," then I'll keep recommending various soft tissue treatments - including foam rolling - until someone gives me a convincing contrarian argument with anecdotal evidence.

4. Strength can be corrective.

Ever had a friend with anterior knee pain (patellar tendinopathy) who went to physical therapy, did a bunch of leg extensions, and somehow managed to leave asymptomatic? It was brutally "non-functional" and short-sighted rehab, but it worked. Why?

Very simply, the affected (degenerative or inflamed) tissues had an opportunity to rest, and they came back stronger than previously. A stronger tissue is less likely to become degenerative or inflamed as it takes on life's demands.

Good rehab would have obviously focused on redistributing stress throughout the body so that this one tissue wouldn't get overloaded moving forward. In the patellar tendon example, developing better ankle and hip mobility would be key, and strength and motor control at the hip and lumbar spine would be huge as well. Certainly, cleaning up tissue quality would be a great addition, too. However, that doesn't diminish the fact that a stronger tissue is a healthier tissue.

This also extends to the concept of relative stiffness. As an example, a stronger lower trapezius can help to overcome the stiffness in the latissimus dorsi during various upper extremity tasks.

And, a stronger anterior core can ensure corrective spine and rib positioning during overhead reaching - again, to overcome stiff lats.

Don't ever forget that it's your job to make people stronger. If you get too "corrective" in your mindset, pretty soon, you've got clients who just come in and foam roll and stretch for 60 minutes, then leave without actually sweating. You still have to deliver a training effect!

5. Minimalist sneakers might be your worst nightmare if you have high arches.

I love minimalist sneakers for my sprint and change-of-direction work. I don't, however, love to wear them on hard floors for 8-10 hours a day. I'm part of the small percentage of the population that has super high arches and doesn't decelerate very well, so cushioning is my best friend. Throwing in a $2 "cut-to-fit" padding in my sneakers has done wonders for my knees over the years, and I'll actually wear through them every 4-6 weeks.

The New Balance Minimus 00 is a sneaker I've been wearing recently to overcome this. It's a zero drop shoe (no slope down from the heel to the toe), and while lightweight, it offers a bit more cushioning (and lateral support, for change of direction) than typical minimal options.

mx00gy_nb_14_i

All that said, just don't force a round peg in a square hole with respect to footwear. Some people just aren't ready for minimalist footwear - and even if they are ready to try them out, make sure you integrate usage gradually.

6. The pendulum needs to swing back to center with respect to thoracic spine mobilizations. - Thoracic spine mobility deficits are a big problem in the general population, given the number of people who spend too much time sitting at a computer. Athletes are a bit of a different situation, though, as some actually have flat (excessively extended) thoracic spines and don't need more mobility. As an example, check out the top of this yoga push-up before we corrected it.

yoga

This athlete has a flat thoracic spine, limited shoulder flexion, and insufficient scapular upward rotation. So, he'll logically go to the path of least resistance: excessive thoracic motion (as evidenced by the "arch" in his upper back). The shoulder blades don't rotate up sufficiently, and he's also "riding" on the superior aspect of his glenohumeral (shoulder ball-and-socket) joint. Here is it, "mostly" corrected a few seconds later:

yoga1

By getting him to "fill up" the space between his shoulder blades with his rib cage (encouraging more thoracic flexion) and cueing better upward rotation of his scapula, we can quickly recognize how limited his shoulder flexion is. In the first photo, he's forcing shoulder ROM that isn't there, whereas in the second one, he's working within the context of his current mobility limitations.

If we just feed into his thoracic spine hypermobility with more mobilizations, we'll just be teaching him to move even worse.

7. You'll never address movement impairments optimally unless nutrition and supplementation are spot on. - It never ceases to amaze me how many athletes will bust their butts in the gym and in rehab, following those programs to a "T" - but supplement that work with a steady diet of energy drinks and crappy food. I'm not talking about debating whether grains and dairy are bad, and whether "paleo" is too extreme for an athlete; those are calculus questions when we should be talking about basic math. A lot of athletes literally don't eat vegetables or drink enough water. That's as basic as it comes. Movement quality will never improve optimally unless you're healthy on the inside, too.

This article was actually a lot of fun to write, so I'll probably turn it into a series for a bit down the road. In the meantime, though, I'd encourage you to check out Dean Somerset's Post-Rehab Essentials resource to learn more in this regard. I don't hesitate to endorse this comprehensive corrective exercise resource, as the content is fantastic, Dean is an excellent teacher, and the product provides some continuing education credits. The $50 off just sweetens the deal. Check it out HERE.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

The Best of 2013: Strength and Conditioning Product Reviews

To wrap up my “Best of 2013″ series, I’ll highlight the top product reviews I did at this site in the last year.  Here they are:

1. Bulletproof Athlete - I firmly believe that Mike Robertson created the best "beginner lifter" resource available on the market today.  This resource is an awesome start-up program that'll prepare novice trainees for a program like you'd find in my High Performance Handbook.  I wrote up a detailed piece on training beginners when I reviewed Mike's resource; check it out: 5 Mistakes Beginner Lifters Make.

BPA Cover Photo

2. The Supplement-Goals Reference Guide - At a price of only $39 and with over 700 pages of content and lifetime updates, this resource is a game-changer, thanks to the folks at Examine.com.  I explained why in this post: The Question I Hate to Be Asked.

supp331

3. Post Rehab Essentials 2.0 - I love reading Dean Somerset's stuff.  A lot of people "think outside the box" because they haven't mastered what's inside the box in the first place.  Dean has a great foundation of knowledge, and it gives rise to some innovative ideas and a forward-thinking corrective exercise approach.  This article is a perfect example.

4. Off the Floor: A Manual for Deadlift Domination - This was Dave Dellanave's first foray into the world of product development, and he crushed it!  It's a great resource not only for learning deadlift techniques, but also because it provides a great program for improving your pull. Check out my review here.

dlBookSmall

5. The MX20V3 Training Sneaker - This was my pick for training sneaker of the year in 2013.  Full disclosure: I'm a consultant to New Balance, but that relationship was in part established because I was such a big fan of the original Minimus!  Since then, they've taken sneaker prototypes for test-drives with our staff at CP, and done focus groups with our athletes to make sure that the products get the job done.  Check out this commercial I filmed for the MX20V3 in August to learn more:

There were certainly some other great products I encountered this year, but these five proved to be the most popular with my readers.  Obviously, I also introduced some new products of my own in 2013, most notably The High Performance Handbook. However, Functional Stability Training of the Lower Body and Understanding and Coaching the Anterior Core were hits as well.  Hopefully, there will be plenty more to come in 2014!

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Pelvic Arch Design and Load Carrying Capacity (Or, How the Heck Does EC Deadlift So Much?)

Today's guest post comes from Dean Somerset.  In reviewing his outstanding resource, The Complete Shoulder and Hip Blueprint (which is currently on sale for $100 off), I loved the section Dean devoted to pelvic structure as it relates to our ability to handle heavy weight training. I asked if he'd be willing to expand on the topic in a guest post, and he kindly agreed.  I really enjoy Dean's work and think you will, too. - EC

I love the deadlift, but it doesn’t love me back all that much. I can pull about 455 on a good day at a body weight of 230, but I haven’t tested a max pull in a few months. I just finished training for a kettlebell course, so it would be interesting to see if it’s gone up at all without specific deadlift training but more accelerative training, but that’s neither here nor there, nor is it relevant to today’s post. It’s just a cool thought.

One reason why I am at the mercy of the deadlift is a previous injury to my right sacroiliac (SI) joint. This causes the arch structure of the pelvis to be compromised, and limits my ability to withstand the shear forces of a heavy deadlift.

Arch structures are an integral feature of a lot of architectural structures, and for good reason. They help to disburse compressive loads across a span towards abutments on either side of the span. Think of ancient Roman aqueducts, bridges, or even more contemporary structures such as the arch in St Louis.

300px-Pont_du_Gard_Oct_2007

The ability to withstand compressive forces and maintain a powerful structure is so impressive in an arch structure that many ancient arches were constructed without the use of mortar between the joints of the stones. This compressive resistance is of massive importance not only in buildings, but in our own anatomy.

The pelvis is essentially an amazing structure that’s a composite of a single bone made of dozens of noticeable arch structures that integrate between the left and right sides, using the sacrum as the keystone.

As the pelvis and its arches form a span between the two abutments of the legs, it allows for a tremendous amount of compressive force to be relatively easily dispersed across it with relative ease.

The downside to an SI joint injury comes when in the bottom position of the deadlift, or any forward flexed position for that matter, as the arch structure runs directly across the back of the SI joint and it is required to be completely and perfectly integrated, much like the keystone in an arched doorway. If not, the structure comes down.

Now, I have some theories as to how you could use genetics to your advantage to lift heavy weights, as well as some observations about our mutual good friend Eric here as to why that bugger can pull so much weight, training, diet, and focus aside (hey, we all know he’s a cyborg, but there’s some advantages that a solid work ethic can’t provide everyone). A lot of it depends on how much compressive stress your pelvis can manage.

First, there are four different types of pelvis when looking at the width, breadth and angulations of the sit bones (technically known as the ischial tuberosities). This is important because the wider and shorter the arches, the less likely they can sustain during crazy heavy loadings. The best hips for heavy vertical loading are narrow and deep.

The Android and Anthropoid hip positions are the most favorable for pulling a sick deadlift off the floor, whereas the wider and shallower gynecoid and platypelloid hips would most likely result in an epic fail and probably injury.

It should come as no surprise to anyone who reads EricCressey.com that there are different types of pelvises (pelvii?). He’s mentioned a lot that there are different types of acromions in the shoulder and that specific angulations would affect rotator cuff function and risk of shoulder impingement. Everyone has different joints and bones, and it’s the combination of these that allows for some of us to do specific things that others can’t. For instance, I can get my hips way wider and longer in the sagittal and frontal plane than most people can, which means mobility isn’t a problem, regardless of what amount of stretching I do.

As a result of my pelvic angles, I’ve got that on lock down. Conversely, loading through a hip flexed sagittal plane loading means I have to brace like no ones business and use some of my active tissues as passive restraints instead of as drivers for the weight. The form closure of the joint is less effective with a wider pelvis than in a narrower one, and the form closure has to work harder, meaning the amount of weight I can pull is less than optimal, and the amount of weight Eric can pull makes grown men weep and kick walls in frustration.

However, it also means he has some minor issues getting unrestricted mobility outside of the sagittal plane. This video shows a very subtle restriction to femoral external rotation during abduction. Check out the kneecap of the extended leg.

Here’s another view of the same leg, but with a similar movement.

Hey, I’ve got a ton of my own movement restrictions, just like everyone else. Check this action out:

That was terrible! But did you see my earlier Cossack squat? Like a boss.

Eric owns sagittal plane, potentially due to a stacked pelvis that’s designed to bear weight like no ones business. However, in nature you typically don’t see the combination of excellent characteristics. In many cases the yin of mobility is in sharp contrast to the yang of max strength. For liner force production, the guy’s one of the best in the world hands down.

I can hit up lateral mobility like a champ, but sagittal force production is an issue.

So how would you assess each of us to develop a program that would help each of us, given our unique capabilities and hindrances? Would you focus on working towards building up the weakness in an isolative manner (as many corrective strategies employ) or would you look to hit up more of an all-encompassing manner, where we could still use our strengths to our advantage and make progress, without feeling like minor restrictions were a big issue?

I’d rather train like a beast than do stuff that may or may not provide much benefit based on my hip positioning and the arch structure of my specific anatomy any day of the week, so having a big tool box to draw from can make or break a program that gets both of us excited to train and fist pump like champs, which means we’re both going to be more likely to see it through to the end and get some sick gains.

The simple difference could be having me do way more loaded carries to use loading without exposing my spine to as much shear forces, as well as sagittal plane stabilization exercises like front planks and anti-extension presses. For Eric, it may mean using a lot more lower load hip rotational movements that still challenge the core, such as low crawl patterns a la Ido Portal.

Follow this up with stupid amounts of loading through sagittal plane dominant movements and he’d be a champ fo’ sho’.

At the end of the day, programming for the individual is most effective when you balance the “yin and yang” of their strengths and weaknesses, but understand the structural benefits the individual may have available to them, as well as the restrictions. Having a broad hip structure versus a narrower structure can be the difference between someone who loves deadlifts versus someone who wants to hit up rotational drills all day long. Having the tools to assess and develop an awesome program for them can be the difference between being a good trainer and a great trainer. 

Looking for more great information like this? Check out Dean and Ton Gentilcore's product, The Complete Shoulder and Hip Blueprint.  It's on sale through Wednesday for $100 off, and includes tons of fantastic information.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more

Strength and Conditioning Stuff You Should Read: 5/21/13

Here's this week's list of recommended strength and conditioning reading:

Post Rehab Essentials Version 2.0 - Dean Somerset just released this today and it's excellent.  Candidly, I didn't get a chance to start it until Sunday night, so I'm only partway through.  I'll be writing up a review of it as soon as I can find some time to finish up with it.  The first edition was very good, and this new version has fantastic content as well.  Dean is a super bright guy who kind of flies under the radar, but you'd be wise to check it out, especially since you can get CEUs for it.

PRE-header-final1

The Food Freak Show - Brian St. Pierre wrote up this article for T-Nation on where our food production industry is headed.  The article is based on a presentation he gave at last year's CP Fall Seminar, and you can actually listen to it here, too.

Breathing Pattern Disorders - This was an excellent recap Mike Reinold wrote up after a small seminar with Leon Chaitow.  Chaitow is one of the best manual therapists on the planet, and in this review, Mike discusses his approaches to the assessment and treatment of breathing pattern disorders.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

 

Name
Email
Read more

The Best of 2011: Product Reviews

I've already featured the top articles at EricCressey.com from 2011, and now it's time to highlight the top product reviews I did at this site in the last year. 1. Metabolic Cooking - This was the most popular product review I did on the year for a very simple reason: everybody needs to eat!  And, the folks reading this site prefer to eat "clean" - and Dave Ruel did a great job of making this easier and tastier with an outstanding recipe book to which I still refer every week.  I made two posts about the product: Metabolic Cooking: Making it Easier to Eat Clean with Healthy Food Options A Must-Try Recipe - and My Chubby 4th Grade Pics! (this is the best chicken fingers recipe in history; try it!)

2. Muscle Imbalances Revealed - Upper Body - This was the sequel to the popular lower-body product that was released by Rick Kaselj et al. in 2010.  I went through and highlighted each presenters contributions to the product via four posts: Muscle Imbalances Revealed Review - Upper: Part 1 (Dean Somerset) Muscle Imbalances Revealed Review - Upper: Part 2 (Dr. Jeff Cubos) Muscle Imbalances Revealed Review - Upper: Part 3 (Tony Gentilcore and Rick Kaselj)

3. Lean Hybrid Muscle - As the review below will demonstrate, this program offered me a nice change of pace from my "normal" training when I needed to shake things up earlier this year.  It's a nice follow-up to Show and Go.  Here's my review: How I'm Breaking Out of My Training Rut: The Lean Hybrid Muscle Strength and Conditioning Program

4. Post-Rehab Essentials - Based on the fact that Dean Somerset has now gotten two shout-outs in my top product reviews of 2011, you might think that I have somewhat of a man-crush on him.  The truth is that I think Dean relates complex terms in simple terms and "teaches" about as well as anyone in the fitness industry.  Check out this post that touches on why his product has merit: 4 Reasons You Must Understand Corrective Exercise and Post-Rehab Training

There were certainly some other great products I encountered this year, but these four reviews proved to be the most popular with my readers, based on hosting statistics. We'll be back soon with the top features of 2011. Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
Name
Email
Read more

4 Reasons You MUST Understand Corrective Exercise and Post-Rehab Training

Over the years, I've probably become best-known for my writing, consulting, and presenting in the corrective exercise field.  It's become a great niche for me; I get to help people who may be frustrated with injuries, bad posture, or movement limitations that prevent them from doing the things they enjoy.  And, I'm able to have fun in the process and make a good living while doing so.

With that in mind, I wanted to devote today's piece to my top four reasons that you, too, should make a dedicated effort to become knowledgeable in the world of corrective exercise.  The timing is quite fitting, as our Functional Stability Training series (which provides thorough insights into the corrective exercise field for rehabilitation specialists and fitness professionals alike) is on sale for 20% off through tonight (Sunday) at midnight.

Anyway, without further ado, here are my top 4 reasons you ought to get involved in this component of the fitness industry.

1. Health care quality and quantity are changing all over the world.

The push toward universal health care has dramatically increased the need for qualified people to fill the gap between "healthy" and "injured" populations.  When more people have health insurance, but there aren't any more providers, not everyone can get access to what they need - and certainly not nearly as quickly.  Two stories come to mind in this regard:

a. A guy I know in Canada actually waited nine days to have a ruptured patellar tendon repaired.

b. An online consulting client in England who sought me out after a hip surgery reported that he had to wait three months for the hip surgery following the point at which they concluded that physical therapy wasn't going to get the job done.

While the push for universal health care in the United States is still being sorted out (and it's certainly not a topic to be covered in this blog, as I have no interest in taking this down political lines), the truth is that we've seen a "crack-down" on what insurance companies afford folks in terms of physical therapy visits for a given condition.  Very simply, physical therapists rarely have the time to do everything they want to do to get people truly healthy, so folks often have to just settle for "asymptomatic."

In the U.S. and abroad, there is a huge need for qualified personal trainers and strength and conditioning coaches to step in and take the baton from physical therapists in the post-rehab setting to help improve patient outcomes.  And, there is certainly a big need for these fitness professionals to step in and help people who may move terribly, but not have symptoms...yet.

2. New expertise enables a fitness professional to tap into a new market and carve out a niche.

Roughly 85% of our clients at Cressey Sports Performance are baseball players; it's a population we've really gone out of our way to understand for years now.  Specific to the current discussion, baseball players have the most extreme collection of upper extremity injuries you'll encounter (on top of lower back, oblique, hip, and knee issues) - so demand is never lacking for our services.

This just one sport, though.  Almost every golfer experiences lower back pain at some point.  Hockey players have load of hip issues.  Swimmers have so much laxity that their shoulders are always banged up.  The opportunities to carve out a niche in a specific sport or population are endless - but you have to know your stuff first.

3. Everybody is injured - whether they know it or not.

I've written quite a bit previously about how absolutely everyone you encounter has some kind of structural abnormality on diagnostic imaging.  This applies to lower backs, shoulders, knees, and every other joint you'll encounter in your professional career.

The importance message to take from this knowledge is that even though everyone is "injured," not everyone is symptomatic.  Rather, the ones who hurt are those who have poor mobility, stability, and tissue quality.  They're in pain because they simply don't move well.

Taking away someone's pain is a tremendous way to win them over for life - and I can assure you that keeping them out of pain when they know they should be in pain isn't far behind on the appreciation scale.

4. Structural abnormalities are becoming a part of normal physical development.

I work with a lot of 10-18 year-old athletes, and I'm constantly amazed at how we are "de-evolving."  Kids' movement quality is worse than every nowadays, as they're sitting too much and playing too little.  And, their yearly athletic calendars lack variety because of early sports specialization.

The end result is that our society has created an epidemic of injuries (e.g., ulnar collateral ligament tears in pitchers, ACL ruptures in soccer/basketball players) and conditions (e.g., femoroacetabular impingement, atrocious ankle mobility) that were much less common in the past.  Getting involved with corrective exercise education is a way to not only help understand why this is happening, but also to manage it and hopefully prevent it from continuing.

I'm speaking very broadly with respect to the need for significant corrective exercise education in order to make a difference in this industry, but the truth is that it is a subject that warrants a ton of detail.  Fortunately, Mike Reinold and I delve into this topic in great detail in our Functional Stability Training resources: Core, Upper Body, Lower Body, and Optimizing Movement. You can learn more - and save 20% through the end of the day today - at www.FunctionStability.com.

Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!

Name
Email
Read more
Page
LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
  • 9 - minute instructional video
  • 3 part follow up series