Home Posts tagged "Postural Restoration Institute" (Page 3)

Strength and Conditioning Stuff You Should Read: 2/12/12

I thought I'd kick off the week with some recommended strength and conditioning reading: Michael Mullin on his Postural Restoration Institute Experiences - I thought this was a great "random thoughts" piece from Michael Mullin, who has been a great resource to me as I've learned more and more of the PRI methodology. Massage and Inflammation Due to Muscular Damage - Patrick Ward looks at some recent research on the benefits of massage - and some of the proposed physiological mechanism through which we benefit from it. Cueing: Just One Piece of Semi-Private Success - Part 1 and Part 2 - I wrote this two-part series back in 2010 to highlight some of the differences between cueing and coaching - and how appreciating that difference had made me more effective as a coach (on top of helping Cressey Performance grow). Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
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Corrective Exercise: Muscle Imbalances Revealed Review – Upper (Part 2)

This marks Part 2 of my write-up on Muscle Imbalances Revealed - Upper Body, a product that really impressed me.  In my first post, I highlighted some of Dean Somerset's great contributions to the project, and today, I thought I'd bring to light seven more great corrective exercise lessons from another excellent presenter on this resource.

Dr. Jeff Cubos is an Alberta-based chiropractor with an outstanding skill set that not only encompasses his clinical work, but also an excellent ability to relate how what he does in the clinic applies to those in the strength and conditioning field.  This "dual proficiency" was readily apparent in his presentations, too.

Here were a few highlights:

1. From an alignment standpoint, you can envision the core like a house - where the diaphragm is the ceiling, and the pelvic floor is the floor.  Just like with the house, too, the ceiling and floor should be parallel.  Having an anterior pelvic tilt and rib flair dramatically alters this:

2. Good training to address this issue isn't just about stretching hip flexors and activating glutes, though; it's about retraining breathing, "owning" one's breathing in various positions, and progressing that respiratory function (and, in turn, rib positioning) into more comprehensive strength exercises.

3. Jeff does the best job I've seen of discussing breathing drill progression - and how to sync them up with progressive strength training programs.  Just as importantly, though, he does a great job discussing the role of the diaphragm, utilizing an excellent video to show exactly how it works (as you watch it, be sure to check out how the right diaphragm attachment point is more prominent on the spine).  I've mentioned many times in the past in the blog about how we utilize breathing drills, and folks always want to know what they are.  Unfortunately, you can't really just describe a breathing drill; you need to show it and add specific cues.  Jeff does exactly that.  Here's a good excerpt on the assessment side of things, too:

4.  Dr. Cubos also discusses bits and pieces of both the Dynamic Neuromuscular Stability (DNS) and Postural Restoration Institute (PRI) philosophies.  Having been to seminars for both disciplines, I can tell you that Jeff does a great job of presenting this valuable, but sometimes confusing information in as user-friendly a format as one possibly can.  It's a cursory overview, but enough to give you an introduction to these philosophies to find out if they're right for you.

5. Even if you aren't planning to delve deeply into these disciplines, Jeff covers a few specific cues that you can apply to breathing correctly on every exercise you do - especially if you (or your clients) are stuck in anterior pelvic tilt, lordosis, and an elevated ribs posture.  For instance, Jeff uses the cue of performing a few diaphragmatic breaths at the point of greatest tension in a movement; this will enable an athlete to "own" that position more quickly.  He uses the example of holding for a count of "one-one-thousand" at the top position of the quadruped extension-rotation:

6. I've got to great lengths in several previous blog posts to distinguish between tendinitis (inflammatory) and tendinosis (degenerative) - and Dr. Cubos did a good job of reaffirming things on that front (tendinosis is much more common than tendinitis).  However, he took it even further with some excellent information on the "continuum" of tendinopathies.  I've spoken about how we're all waiting to reach "threshold" (presentation of symptoms), but haven't paid a lot of attention to sub-clinical tendinopathies.  Here's how Jeff portrayed the continuum:

Reactive Tendinopathy - This is acute overload (too much, too soon).  Soft tissue treatments are beneficial, but not locally to the tissue in question.  An example that immediately comes to my mind is a supraspinatus tendinosis; manual therapy to the pec minor, posterior rotator cuff, etc. would be very helpful, but working directly on the supraspinatus could exacerbate the problem significantly.

Tendon Dysrepair - Dr. Cubos referred to this as "a failed attempt at healing, and a disorganization of the connective tissue matrix."  Immediately, I thought of someone with chronically crank hamstrings following a previous strain.  Direct soft tissue work has much more immediate and profound benefits.

Degenerative Tendinopathy - This is the obnoxious, long-term tendinosis we've come to know - whether it's an Achilles tendon or common extensor tendon (Tennis Elbow).  Here we have cell death, disorganization of the connective tissues, and less collagen.  Unfortunately, full resolution isn't that common - but most people can respond over time to the right kind of rehabilitation programs.

7. Last, but certainly not least, Jeff introduces his audience to several common soft tissue treatment approaches, including Active Release Technique, Fascial Manipulation, Functional Range Release, and the various modalities of Instrument Assisted Soft Tissue Mobilization.  In describing each, he outlines why some may be better for others in certain instances, as well as the differences between approaches.  I think this is a "must-watch" for trainers to understand the skills of the manual therapists to whom they refer, and also up-and-coming rehabilitation specialists to decide which approaches they'll utilize in their professional careers.

All in all, Dr. Cubos was another new name (for me, at least) that I was glad to come across - and I'll definitely be following him more moving forward.  And, in addition to Cubos and Somerset's contributions, there are a host of other great professionals who have contributed to the entire Muscle Imbalances Revealed - Upper series, which is currently on sale with a 60-day money back guarantee, too, so check it out here.

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Hip Pain in Athletes: The Origin of Femoroacetabular Impingement?

Over the weekend, I attended my third Postural Restoration Institute seminar, Impingement and Instability.  I’ve written previously about how this school of thought has profoundly impacted the way that we handle many of our athletes – and this past weekend was certainly no exception.  This weekend was also my first chance to meet and learn directly from Ron Hruska, the man initially responsible for bringing many of these great ideas to light. While I am admittedly still processing all the awesome information from the weekend, I wanted to write today about one big “Ah-Ha” moment for me over the weekend.  At some point on Day 2, Ron said something to the effect of (paraphrased):

“A superior acetabulum isn’t much different than an acromion on a scapula.”

My jaw practically hit the floor.  I joked with the seminar organizer that I needed to go into the restroom to yell at myself for a few minutes for not thinking of this sooner.  Let me explain… Over the past few years, there has been a huge rise in hip injuries in athletes (I'd even written about it HERE in response to a New York Times article about number of hip injuries in baseball).  Sports hernias, labral tears, and femoroacetabular impingement (FAI) are commonplace findings on the health histories that I see every day on first-time evaluations. In terms of FAI, you can have bony overgrowth of the femoral head (cam), acetabulum (pincer), or both (mixed), as the graphic from Lavigne et al. below demonstrates:

  Many folks say that we’re getting better diagnostically and that’s why the prevalence has increased in recent years.  Let’s be real, though, folks: if we’d had hip pain and dysfunction on this level for decades, don’t you think anecdotal evidence would have at least tipped us off?  I find it hard that generations of athletes would have just rubbed some dirt on a painful hip, cowboyed up, and put up with it. Consider those over the age of 60, though.  Sher et al. reported that a whopping 54% of asymptomatic shoulders in this population have rotator cuff tears; that doesn’t even include those who actually have pain!  Why does this happen?  They impinge over and over again on the undersurfaced of the acromion process secondary to poor thoracic positioning, scapular stabilization, breathing patterns, and rotator cuff function.  The end result is reactive changes on the acromion process that lay down more and more bone as the years go on.  And, an anteriorly tilted scapula kicks that impingement up a notch.  The “early” cuff irritation likely comes in those with Type 3 (beak-shaped) acromions, whereas the Type 1 (flat) and Type 2 (hook) acromions need time to lay down more and more bone for their anterior tilt to bring them to threshold.

Conversely, consider femoroacetabular impingement of the hip.  You can get bony overgrowth of the acetabulum, femoral head, or both.  It’s widely debated whether those with FAI are born with it, or whether it becomes part of normal development in some kids.  Well, I guess it would depend on whether you consider playing one sport to excess year-round “normal.” You know what?  I’d estimate that over 90% of the femoroacetabular impingement cases I’ve seen have come in hockey, soccer, and baseball players.  What do these sports have in common?  They all live in anterior pelvic tilt – with hockey being the absolute worst.  Is it any surprise that the incidence of FAI and associated hip issues has increased dramatically since the AAU generation rolled in and kids played the same sport all 12 months of the year? Conversely, I’ve never seen a case of FAI in a field hockey player.  Additionally, when I just asked my wife (who rowed competitively in college) if she ever saw any hip issues in her teammates in years of rowing, she joked that there weren’t any until they added distance running to their training. Field hockey players and rowers live in flexion (probably one reason why they have far more disc issues).  And, taking it a step further, I’ve never seen an athlete with FAI whose symptoms didn’t improve by getting into a bit more posterior pelvic tilt.

Finally, a 2009 study by Allen et al. demonstrated that in 78% of cases of cam impingement symptoms in one hip, the cam-type femoroacetabular impingement was bilateral (they also found pincer-type FAI on the opposite side in 42% of cases).  If this was just some “chance” occurrence, I find it hard to believe that it would occur bilaterally in such a high percentage of cases.  Excessive anterior pelvic tilt (sagittal plane) would be, in my eyes, what seems to bring it about the most quickly, and problems in the frontal and transverse planes are likely to blame for why one side presents with symptoms before the other. People have tried to blame the increased incidence of hip injuries on resistance training.  My personal opinion is that you can’t blame resistance training for the incidence, but rather the rate at which these issues reach threshold.  Quality resistance training could certainly provide the variety necessary to prevent these reactive changes from occurring at a young age, or by creating a more ideal pelvic alignment to avoid a FAI hip from reaching threshold. Conversely, a “clean-squat-bench” program is a recipe for living in anterior tilt – and squatting someone with a FAI is like overhead pressing someone with a full-thickness cuff tear; things get ugly quickly.

Honestly, this probably isn’t revolutionary for folks out there – particularly in the medical field – who have watched the prevalence of femoroacetabular impingement rise exponentially in recent years, but Ron made a great point to reaffirm a thought I’d been having for years and strengthened the argument.  And, more important than the simple “Ah-Ha” that comes with this perspective is the realization that an entire generation of young athletes have been so mismanaged that we’ve actually created a new classification of developmental problems and pathologies: femoroacetabular impingement, labral tears, and sports hernias. Thanks, Ron, for getting me thinking! For more information on appropriately managing kids during these critical development time periods, check out the International Youth Conditioning Association’s High School Strength and Conditioning Certification, which I helped to write.

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Shoulder Mobility Drills: How to Improve External Rotation (if you even need it)

Last summer, a college pitcher came up to Cressey Performance from the South to train for a month before his summer league got underway. He was seven months post-op on a shoulder surgery (Type 2 SLAP) and had been working his way back. Unfortunately, his arm was still bothering him a bit when he got up to see us.

After the first few days at CP, though, he told me that his arm felt as good as it’s felt in as long as he could remember. He’d been doing a comprehensive strength and conditioning program, but the “impact” stuff for him had been soft tissue work, some Postural Restoration Institute drills, an emphasis on thoracic mobility, and manual stretching into internal rotation, horizontal adduction, and shoulder flexion. From all the rehab, his cuff was strong and scapular stabilizers were functioning reasonably well – which led me to believe that his issues were largely due to tissue shortness and/or stiffness.

This realization made me immediately wonder what he’d been doing in the previous months for mobility work for his arm – so I asked. He then demonstrated the manual stretching series that every pitcher on his team went through every day on the table with their athletic trainer. Each stretch was done for 2x20s – and two of those stretches took him into extreme external rotation and horizontal abduction. I was pretty shocked.

Me: “You’re probably not the only guy on your team rehabbing right now, huh?”

Him: “No; there are actually too many to count.”

Me: “Elbows, too, I’m sure.”

Him: “Yep.”

Want to irritate a labrum, biceps tendon, or the undersurface of the rotator cuff? Stretch a thrower into extreme external rotation and simulate the peel-back mechanism. This also increases anterior capsular laxity and likely exacerbates the internal impingement mechanism over the long-term. To reiterate, this is a bad stretch!

Want to make an acromioclavicular joint unhappy? Stretch a thrower into horizontal abduction like this (again, this is a BAD stretch that is pictured):

Want to irritate an ulnar nerve or contribute to the rupture of an ulnar collateral ligament? Make sure to apply direct pressure to the forearm during these dangerous stretches to create some valgus stress. This is a sure-fire way to make a bad stretch even worse:

These stretches are very rarely indicated in a healthy population – especially pitchers who already have a tendency toward increased external rotation. The shoulder is a delicate joint that can’t just be manhandled – and when you’re dealing with shoulders that are usually also pretty loose (both from congenital and acquired factors), you’re waiting for a problem when you include such stretches. In fact, I devoted an entire article to this: The Right Way to Stretch the Pecs.

Everyone thinks that shoulder external rotation and horizontal abduction alone account for the lay-back in the extreme cocking position.

In reality, though, this position is derived from a bunch of factors:

1. Shoulder External Rotation Range-of-Motion – and this is the kind of freaky external rotation you’ll commonly see thanks to retroversion and anterior laxity:

2. Scapular Retraction/Posterior Tilt

3. Thoracic Spine Extension/Rotation

4. Valgus Carrying Angle

So, how do you improve lay-back without risking damage to the shoulder and elbow?

1. Soft tissue work on Pec minor/major and subscapularis – Ideally, this would be performed by a qualified manual therapist – especially since you’re not going to be able to get to subscapularis yourself. However, you can use this technique to attack the pecs:

2. Exercises to improve scapular retraction/depression/posterior tilt – This could include any of a number of horizontal pulling exercises or specific lower trap/serratus anterior exercises like the forearm wall slide with band.

3. Incorporate specific thoracic spine mobility drills – In most pitchers, you want to be careful about including thoracic spine mobility drills that also encourage a lot of glenohumeral external rotation. However, when we assess a pitcher and find that he’s really lacking in this regard, there are two drills that we use with them. The first is the side-lying extension-rotation, which is a good entry level progression because the floor actually limits external rotation range-of-motion, and it’s easy to coach. I tell athletes that they should think of thoracic spine extension/rotation driving scapular retraction/depression, which in turn drives humeral external rotation (and flexion/horizontal abduction). Usually, simply putting your hands on the shoulder girdle and guiding them through the motion is the best teaching tool.

A progression on the side-lying extension-rotation is the side-lying windmill, which requires a bit more attention to detail to ensure that the range-of-motion comes from the right place. The goal is to think of moving exclusively from the thoracic spine with an appropriate scapular retraction/posterior tilt. In other words, the arm just comes along for the ride. The eyes (and head) should follow the hand wherever it goes.

Again, these are only exercises we use with certain players who we’ve deemed deficient in external rotation. If you’re a thrower, don’t simply add these to your routine without a valid assessment from someone who is qualified to make that estimation. You could actually make the argument that this would apply to some folks in the general population who have congenital laxity as well (especially females).

4. Throw!!!!! – Pitchers gain a considerable amount of glenohumeral external rotation over the course of a competitive season simply from throwing. Sometimes, the best solution is to simply be patient. I really like long toss above all else for these folks.

In closing, there are three important things I should note:

1. You don’t want to do anything to increase valgus laxity.

2. You’re much more likely to get hurt from being “too loose” than you are from being “too tight.” When it comes to stretching the throwing shoulder, “gentle” is the name of the game – and all mobility programs should be as individualized as possible.

3. Maintaining internal rotation is a lot more important than whatever is going on with external rotation. In fact, this piece could have just as easily been named "The Two Stretches Pitchers Shouldn't Do, Plus a Few That Only Some of Them Need."

To learn more about testing, training, and treating throwing shoulders, check out Optimal Shoulder Performance: From Rehab to High Performance.

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17 Reasons I’m Excited for 2011

With the new year upon us, I got to thinking about how excited I am for all that 2011 has in store for me – and thought that it’d make for a good post to kick off the year.  Here’s why I’m excited: 1. Being Married – My wife, Anna, and I got married on October 3, and it was just the tip of the iceberg in a whirlwind year (new job for her, wedding planning, new house, new puppy).  Both of us are pretty excited for a low-key 2011 where we can just hang out and enjoy one another’s company!  And, we left our honeymoon for this year (I couldn’t escape for that long during the baseball off-season), so we’re excited about that.

2. The Continued Growth of EricCressey.com - I really enjoy writing, and each year, this website grows – which means I get to share my passion and interact with some very cool people.  Here were 2011’s year-end statistics for EricCressey.com: 450,791 unique visitors 1,106,748 visits 2,901,970 pages 2,730,922 hits Thanks to everyone who visited the site this year! 3. The book I’m reading now: The 4-Hour Body. Tim Ferriss has become a good friend, and I was fortunate enough to be one of those who received an advanced copy of The 4-Hour Body prior to publication.  With the crazy goings-on at CP as well as the holidays, I’m just now getting a chance to read through it and give it the time it deserves – and I must say that it’s fantastic.  Tim does an awesome job of providing “info-tainment;” his entertaining writing style will keep you reading, and the background research he put in to this book will guarantee that you walk away with some ideas that will immediately benefit you.

4. The book I’m reading next: The New Rules of Lifting for Abs. As with Tim’s book, I got a copy of The New Rules of Lifting for Abs in advance, but haven’t even had a chance to open it up.  As with any Cosgrove/Schuler collaboration, though, I’m sure it’ll be high quality and a huge hit.  I’m looking forward to checking it out.

5. Cutting Back on Travel – 2010 was a crazy busy year for me personally – from buying a house, to moving, to planning a wedding, to getting married, to getting a puppy.  These “firsts” wouldn’t have been tough to pull off normally, but it seemed like every time my wife and I encountered one of them, I was getting ready to hop on a plane to go do a seminar somewhere.  As such, I’ve started turning down a lot more seminar opportunities not because I don’t enjoy doing them, but simply because the travel wore me out in 2010.  I will, however, still be traveling some – but this year, it’ll be with my wife…and we’ll be traveling for fun! 6. Another Year on the Perform Better Tour – While I may be cutting back on seminar travel, I wouldn’t miss the Perform Better Summits for the world.  I’m still waiting on final confirmation of which cities I’ll get in 2011, but I can say definitively that these are some of the best continuing education opportunities in the fitness business and that I thoroughly enjoy all of them – from the information to the great people I always wind up meeting.  Hopefully, I’ll get to meet some of you in person thanks to Perform Better this year.

7. Continuing on my Postural Restoration Institute Journey – I’ve spoken a bit in the past about the Postural Restoration Institute and how it dramatically impacted the way we evaluate and program for many of our athletes and clients.  In fact, I’d go so far as to say that it has been some of the best continuing education money I’ve ever spent.  I’ve only gone through two of their seven courses, though, and am excited to learn more.  I’ve covered Myokinematic Restoration and Postural Respiration, and already on the agenda for 2011 is Impingement and Instability. If you’re a physical therapist, athletic trainer, or fitness professional and haven’t seen any of their stuff already, I’d highly encourage you to check it out. 8. The New Cressey Performance – I’ll have pictures of the newly-renovated Cressey Performance soon, but suffice it to say that adding 1,000 square-feet can go a very long way.  I’ve finally got my own office at the facility, which I know will make things a lot easier moving forward, but even beyond that, just getting a bit more space can really change the “flow” of the facility to make it more coaching friendly.  We see all sorts of articles and presentations on how to coach, but nobody ever considers how the set-up of your facility can make your coaching duties remarkably easier or more difficult. On top of that, Cressey Performance is busier than ever, with double digit percentage growth again in 2010.  Thanks to everyone for your continued support! 9. Relishing my Fantasy Football Championship – In the most impressive managerial run in Cressey Performance Fantasy Football history, I crushed the competition this year.  This trophy will reside on my desk for the entire year.  Those of you who visit CP can have your picture taken with it, if you’d like.

10. Doing more charity work – I’ve helped out here and there with various charities since I moved to Boston in 2006, but in 2011, I’m excited to do much more – and I’m in a position to do more now, too.  Nowadays, I can use my exposure and expertise a lot more to help – and thanks to my work with Kevin Youkilis, I can work directly with his great charity, Youk’s Hits for Kids. Along those lines, those of you in New England might be interested to check out his February 3 event at the State Room in Boston.  The CP staff will be there along with a bunch of pro athletes, Tony Gentilcore, actors, Tony Gentilcore, musicians, Tony Gentilcore, comedians, and Tony Gentilcore.  For more information, check out YouksKids.org. 11. The New Sports Rehab to Sports Performance Teleseminar – Joe Heiler has done a great job the past few years in bringing in great minds to contribute to his Sports Rehab to Sports Performance teleseminar series – and this year is no exception.  I’m really excited about this line-up: 1.  Sue Falsone – PT, Athletes' Performance 2.  Ron Hruska - PT, Postural Restoration Institute 3.  Dr. Mike Leahy - Sports Chiropractor and inventor of ART 4.  Thomas Myers - Anatomy Trains author 5.  Brian Grasso – IYCA Founder 6.  Greg Roskopf - Muscle Activation Technique 7.  Brian Mulligan – PT, Mulligan Technique/Joint Mobilizations with Movement 8.  Dr. Warren Hammer - Chiropractor, Graston Technique Instructor, Fascial Manipulation 9.  Dan John - Strength Coach, author, Never Let Go 10.  Gray Cook - PT, FMS

Click here for more information. 12. New Projects – In 2010, I introduced two products: Optimal Shoulder Performance and Show and Go: High Performance Training to Look, Feel, and Move Better. For me, a product every six months is a pretty good “pace,” as I don’t want to become one of those guys who puts out mediocre stuff every single week.  As of right now, the only confirmed project for 2011 is a collaborative one with Mike Reinold and Mike Robertson.  I am thinking, however, that this is the year that I finally create a baseball-specific product in light of the fact that it’s 80-85% of our clientele and what I do all-day, every day!  Only time will tell! 13. Continued Show & Go Feedback – Speaking of Show and Go, it was released in late September, and since it’s a four-month strength and conditioning program, we’re coming up on the point in time where I start getting loads of emails from those who have wrapped up the program and have results to report.  I get a lot of feedback along the way, but it’s awesome to hear where things end up when the entire program is complete.  So, to those of you doing the program, please pass along your results!

14. More Writing at T-Nation – I only published two articles at T-Nation in 2010, and I don’t plan to repeat that poor output!  I’ve already been contacted by them about doing a monthly piece, and while I’m not sure that my schedule will allow me to get one to them every month, I definitely expect to be blowing that 2010 total out of the water.  I’ve already submitted one and have two more in the works.  I owe a lot to the folks at T-Nation and Biotest for the opportunities and exposure they’ve afforded me and hope to continue to return the favor with good content for years to come. 15. Watching Tank grow up – Our puppy, Tank, is about five months old right now, and he’s awesome.  He is pretty much housebroken, and definitely man’s best friend.  As you can tell, he loves hording his toys.

16. The 2011 MLB Season - In addition to the fact that my team (the Red Sox) is looking good, we have quite a few clients who are on the cusp of big league debuts, so I am excited to get out to see them play in the show and enjoy the fruits of their off-season labor.

17. The 2011 MLB Draft - Let's just say that I very well might just stay home and hit refresh on my computer over and over again during the two days in June that make up the MLB draft.  We have a lot of talent athletes - both high school and college - training at Cressey Performance who will be getting calls.

There are quite a few other things that get me excited for 2011, but this is a good start – and probably all that you care to read!  Speaking of YOU, what are YOU looking forward to in 2011?  Got a big goal for the year?  Share it in the comments section. Happy New Year! Sign-up Today for our FREE Newsletter and receive a detailed deadlift technique tutorial!
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Stuff You Should Read: 3/22/10

I had a great weekend at a Postural Restoration Institute Myokinematic Dysfunction course, so it seems fitting that my first reading recommendation of the week would direct you to their website: Postural Restoration Institute.  There are a lot of free articles that give you a good introduction to the PRI philosophy.  I'd highly recommend checking out their courses, as I'm going to be going more.  It was worth every penny. Does a SLAP lesion affect shoulder muscle activity as measured by EMG activity during a rugby tackle? - This is a really interesting study that shows that in athletes with labral tears (SLAP lesions), the serratus anterior fires sooner - presumably as a compensation strategy to make up for the slower reaction time of the biceps.

rugby-tackle

It is just another example of how our body has a great system of checks and balances.  When a passive structure is injured, the active restraints can pick up the slack. For related reading, check out Active vs. Passive Restraints.
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