We're excited to welcome Ron Hruska, the founder of the Postural Restoration Institute, to the latest podcast. Ron shares some excellent insights on the origins of PRI; how polyarticular chains impact human movement; and what to do when we observe some of the common postural adaptations we see in athletes - particularly baseball players.
A special thanks to this show's sponsor, Marc Pro. Head towww.MarcPro.comand enter the coupon code CRESSEY at checkout to receive an exclusive discount on your order.
Sponsor Reminder
This episode is brought to you by Marc Pro, a cutting-edge EMS device that uses patented technology to create non-fatiguing muscle activation. Muscle activation with Marc Pro facilitates each stage of the body’s natural recovery process- similar to active recovery, but without the extra effort and muscle fatigue. Athletes can use it for as long as they need to ensure a more full and quick recovery in between training or games. With its portability and ease of use, players can use Marc Pro while traveling between games or while relaxing at home. Players and trainers from every MLB team - including over 200 pro pitchers - use Marc Pro. Put Marc Pro to the test for yourself, and use promo code CRESSEY at checkout at www.MarcPro.com for an exclusive discount on your order.
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With this week's sale on my Thoracic Outlet Syndrome course, I thought I'd highlight a really common trigger point in throwers. Look no further than subclavius. It’s stuck right between the clavicle (collarbone) and first rib (highlighted in red here).
In normal posture, the clavicle should have a slight upslope. In many throwers who sit in scapular depression, downward rotation, and/or anterior tilt, the clavicle is pulled down even more, as the collarbone interacts with the shoulder blade at the acromioclavicular joint. Wherever the scapula goes, the collarbone goes.
Here’s the problem: with overhead motion, the clavicle actually needs to rotate up as well – and a short, dense, fibrotic subclavius will restrict that movement.
Making matters worse, the subclavius works with the often hypertonic scalenes to elevate the first rib – so this muscle gets smashed from the bottom while it’s already bunched up from the top. And don’t forget that there are important nerve and vascular structures that course between these two bones as well, so subclavius is an anatomical structure that can’t be ignored anytime a thoracic outlet syndrome diagnosis is considered.
From a referral standpoint, trigger points in subclavius can lead to symptoms in the anterior shoulder, biceps muscle belly, and lateral forearm all the way down to the thumb side of the hand. It’s also not uncommon to see the clavicular angle increase (upslope) after good manual therapy on subclavius in someone with a low shoulder.
In short, don’t overlook this muscle just because you’ve never heard of it or it’s really small. Taking care of it can be a game changer, whether it's with quality manual therapy, self-myofascial release on the Acumobility Ball, or a combination of the two.
Also, if you're looking to learn more about how I assess, coach, and program at the shoulder, I'd encourage you to check out my popular resource, Sturdy Shoulder Solutions. I dig in deep on functional anatomy of the upper extremity on a number of fronts in this resource; you can learn more at www.SturdyShoulders.com.
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A lot of people debate whether neutral neck positioning is important. I don't think it's even a debatable subject, though. Give today's video a watch to learn more:
As additional "ammo," check out this Tweet I came across the other day. Hat tip to Charlie Weingroff for sharing it. Would you want to put your spine in these extended positions while you squat or deadlift?
Realtime MRI vs traditional static MRI - seems you can learn different things from a dynamic scan? Here's my neck last week. @KingsImagingpic.twitter.com/xB8fvOciPv
If you still think that hanging out in cervical extension all day - and then loading it up when lifting - isn't a problem, then I don't know what else to tell you.
I cover this topic in quite a bit of depth in my "Nuances of the Neck" presentation as part of my popular resource, Sturdy Shoulder Solutions. For more information, please visit www.SturdyShoulders.com.
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I've got an important point to make today, and I think it's best illustrated with a hypothetical story.
Let's say that a 14-year-old, 6-0, 140-pound kid - we'll call him Joey - comes in to Cressey Sports Performance and does an evaluation with me in September. He says that he currently throws 70-72mph, but wants to hit 80mph by the start of the upcoming spring baseball season - and that he's willing to do anything to reach that goal.
We put Joey on a great strength and conditioning program - lifting, sprint/agility/jumping challenges, medicine ball drills, arm care exercises, self-myofascial release, and mobility work - and he crushes it with his nutrition. Joey gets on a solid throwing program, and fine-tunes his grip on the baseball and some mechanical flaws with our pitching coordinator.
Joey gets manual therapy with our massage therapist, and also makes a dedicated effort to improve his sleep quality and quantity. He hangs out with a bunch of professional baseball players in a motivating environment, and even reads some sports psychology books to prepare himself mentally. Joey crushes his offseason with us - and puberty is still kicking in to help the cause.
And, the results show up in the spring: Joey is consistently pitching harder than 80mph, surpassing his goal.
It must have been the lifting, right? Or the medicine ball work? Or the arm care? Or the nutrition improvements and weight gain? Or the mechanical changes? Or a simple grip adjustment on his fastball? Or better sleep? Or just the gains associated with puberty?
What I also failed to mention is that Joey was taking algebra in school. He also shoveled his driveway whenever it snowed. And he stopped eating gluten because he felt like it made him bloated. And he got a new pair of sneakers. And his mother switched from a minivan to a SUV. Joey even developed a weird ritual of half-naked shadow boxing in the mirror every night with the Spice Girls playing in the background. You've got to have a routine, right?
Of course, everyone takes note of Joey's crazy progress and asks him what the "secret" was. How does Joey respond? Puberty, gluten, the minivan, and his Spice Girls infatuation are all sensitive subjects he doesn't want to publicly discuss, so those are off the table. Nobody gets excited hearing about algebra, sneakers, grip adjustments, or mobility work, so those are lame discussion points for the local newspaper interview. Hanging out with professional baseball players seems like a cooler story line, though, so that's what he goes with: his progress all had to do with environment.
Nevermind the fact that Joey gained 30 pounds and started sleeping more than six hours per night. And, forget that he can actually touch his toes and do a body weight lunge without tipping over. And, overlook the fact that he is no longer throwing accidental cutters on every pitch because his delivery was so out of whack. Heck, those old shoes may have been terribly constructed and put Joey into horrible positions in his pitching delivery.
I know what you're saying: this is an extreme example - and you're right. However, we see a modified version of it all the time. Tom Brady refuses to eat tomatoes. Marshawn Lynch eats Skittles during games. Chris Sale needs to eat fast food to keep his weight up.
Usually, progress is incredibly multi-factorial. The results come not just from a lot of different directions, but from the synergistic interaction of many factors. And, sometimes there are other factors that may confound how we evaluate the path to success.
Tom Brady is still going to be an elite NFL quarterback if he has tomatoes for dinner the night before a game.
The 40 calories worth of Skittles Marshawn Lynch eats on gameday probably have zero impact on his performance.
Chris Sale's slider is going to be absolutely filthy even if he chooses pizza over chicken, broccoli, and rice.
And, in our example above, Joey's progress was completely unrelated to a myriad of things that took place. But, that doesn't mean we can ever really know what percentage was related to strength and conditioning vs. pitching instruction vs. nutrition vs. a host of other factors. We just know that success comes for a variety of reasons, so you have to check a lot of boxes to determine what contributed to that success. And, you have to recognize that unless you have perfectly controlled research studies, you'll likely have a very hard time isolating where the success really originated.
A perfect example of this is the debate on posture's impacts on pain and performance. Anecdotal evidence tells us that it does make a difference, but the research is actually shockingly inconclusive in this regard; we just don't know exactly how big a role (if any) that it plays in one's ability to stay healthy.
If you're looking to learn more about the controversial link between posture and performance, I'd encourage you to check out my popular resource, Sturdy Shoulder Solutions. I delve into this subject - along with many others - in great detail.
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We're very excited to announce that on Sunday, October 22, we’ll be hosting our sixth annual fall seminar at Cressey Sports Performance. As was the case with our extremely popular fall event over the past five years, this event will showcase the great staff we're fortunate to have as part of our team. Also like last year, we want to make this an affordable event for everyone and create a great forum for industry professionals and fitness enthusiasts alike to interact, exchange ideas, and learn. We're happy to have Perform Better as our official sponsor again this year as well.
Here are the presentation topics:
Pete Dupuis -- Gym Ownership In Hindsight: A Decade of Lessons Learned
After designing three different gyms, negotiating five different leases, and building a team of ten fitness professionals, Pete has an informed opinion on gym design and management. In this presentation, he'll introduce you to five of the best, and five of the worst decisions we've made along the way in ten years of operating Cressey Sports Performance.
Miguel Aragoncillo -- Improving Performance for Rotational Athletes
In this presentation, Miguel will analyze performance for rotational athletes, along with discussion on case studies and techniques as they relate to asymmetries, kinetic chains, and biomechanics. This two-part presentation will feature a lecture discussing the understanding the possible origins of dysfunction, and a hands-on component which will dive into a live assessment and exercise selection.
Chris Howard -- Low Back Pain: A New Perspective on the Same Old Problem Nearly every fitness professional has encountered an athlete or client dealing with lower back pain. In this presentation, Chris will blend his experience of anatomy and muscular referred pain patterns with strength and conditioning and soft-tissue strategies to illustrate how he treats clients experiencing lower back pain. Whether you are new to strength and conditioning, or a seasoned veteran, you will see lower back pain from a new perspective following this presentation.
Nancy Newell -- Constructing Female Confidence in a Male-Dominated Gym
Some male coaches feel uncomfortable coaching female clients. They struggle to formulate an approach with which they're confident, and the client experience is often negatively impacted as a result. In this presentation, Nancy will help coaches learn how to “dance” the line between being awkward and awesome, while sharing her personal philosophy on how to build female confidence in a male dominated gym.
Eric Cressey -- How Posture Impacts Pain and Performance
Posture is one of the most controversial topics in the fields of health and human performance. In this presentation, Eric will look at the related research and present anecdotal evidence and case studies to bring some clarity to the debate on just how important having "good posture" - if it even exists - really is.
John O'Neil -- Foundational Strength: Laying Groundwork for the Untrained Youth Athlete
In this presentation, John will take a comprehensive look at how we acclimate our untrained youth athletes to the training process at Cressey Sports Performance. This information will include the technical and tactical aspects of executing training sessions in our semi-private group-training model.
Jordan Syatt - How to Build Your Own Successful Online Fitness Business
With this presentation, we kick off a new CSP Fall Seminar tradition: bringing back an accomplished former CSP intern to present from his/her realm of expertise. We're excited to have Jordan back for a no-nonsense open dialogue in which he fields your individual questions and outlines everything you need to know to make a name for yourself in the fitness industry while helping thousands of people all over the world.
**Bonus 3:00PM Saturday Session**
Frank Duffy w/Andrew Zomberg -- A New Approach to Mobility and Injury Prevention
It is important to understand the difference between functional mobility and flexibility in order to help maximize your movement capabilities. In this interactive presentation, Frank will demonstrate the protocols he implements in improving his CSP Strength Campers' movement quality for long-term success.
Location:
Cressey Sports Performance
577 Main St.
Suite 310
Hudson, MA 01749
We’re really excited about this event, and would love to have you join us! However, space is limited and most seminars we’ve hosted in the past have sold out quickly, so don’t delay on signing up!
If you have additional questions, please direct them to cspmass@gmail.com. Looking forward to seeing you there!
PS - If you're looking for hotel information, The Extended Stay America in Marlborough, MA offers our clients a heavily discounted nightly rate of just under $65.00. Just mention "Cressey" during the booking process in order to secure the discount. Their booking phone number is 508-490-9911.
This is the second half of my collection of take-home points from reviewing The Complete Shoulder and Hip Blueprint from Tony Gentilcore and Dean Somerset. In case you missed the first half, you can check out Part 1 here. Additionally, I should offer a friendly reminder that the introductory $60 off discount on this great resource ends tonight at midnight; you can learn more here.
6. Shifting low threshold exercises to a high threshold strategy may yield faster results.
Dean goes to great lengths to discuss how proximal (core) stability affects distal (extremity) mobility. In doing so, he cites four examples:
a. Doing front planks may help one to gain hip external rotation.
b. Doing side planks may help one to gain hip internal rotation.
c. Doing dead bugs may help to improve your deep squat.
d. Training active hip flexion (one joint) may help one to to improve a straight leg raise (multiple joints).
With that said, there is a HUGE clarification that must be made: these exercises are all performed with HIGH TENSION. In other words, if you can do eight reps of dead bugs, you aren’t bracing hard enough.
To some degree, this flies in the face of the conventional wisdom that there are high-threshold exercises and low-threshold exercises – and most folks would assume the aforementioned four drills would fall in the low-threshold category. That said, I think a better classification scheme would be high- and low-threshold STRATEGIES. In other words, there is a time to treat a plank or dead bug as a low threshold drill, but also scenarios under which bracing like crazy is appropriate. Trying to create distal mobility is one such example.
That said, don't go and turn everything you do into a high-threshold strategy! This leads me to...
7. Improving mobility is a combination of sympathetic and parasympathetic activity.
I loved this quote from Dean so much that I replayed it a few times so that I could type up this quote:
"If you hold your breath, you're going to limit your mobility. If you breath through the stretch, you're going to access a greater range of motion than you had before. So, it's kind of a dance between parasympathetic and sympathetic and neural activation. You want to be able to use high-threshold sympathetic type stuff to fire up the nervous system and produce that stability, but you want to use parasympathetic stimulation - that long inhale, long exhale - to be able to use that range of motion after you've built the stability."
That's pure gold right there, folks.
8. The term “scapular stability” is a bit of a misnomer.
Nothing about the scapula is meant to be stable. If it were meant to be stable, it would have so many different muscular attachments (17, in fact) with a variety of movement possibilities. A better term would be something originally popularized by physical therapist Sue Falsone: controlled mobility.
9. Don’t assume someone’s "aberrant" posture means an individual will be in pain.
Posture is a complex topic, and the relationship between resting posture and pain measures is surprisingly very poorly established in the research world. We can walk away from this recognition with two considerations:
a. It's important to assess movement quality, and not just resting posture.
b. Use posture as information that guides program design and coaching cues rather than something that tries to explain or predict injuries.
10. Teach movements from the position where relative stiffness principles are challenged the most - but cue high-threshold tension.
During one of his presentations, Dean was coaching a hip flexor stretch in the lunge position, and it immediately got me to thinking about the principle of relative stiffness. In this position, if there isn't adequate anterior core control, lumbar extension will occur instead of hip extension. And, if there isn't solid glute recruitment, there will be a tendency of the head of the femur to glide forward in the socket during the hip extension that does occur.In other words, being able to brace the core and have solid glute activation is key to making sure that the individual is in a good place at this position where movement is challenged the most.
In this instance, Dean cued a high-threshold strategy that allowed him to effectively coach the movement from the most challenging position - which is somewhat counterintuitive to what we've always assumed as coaches ("win the easy battles" first by owning the simple ranges-of-motion). However, if you can get to the appropriate position (adequate passive ROM) and educate a trainee on how to establish a bracing strategy, chances are that you can speed up the learning process.
As I thought about it, this is something we do quite commonly with our end-range rotator cuff strengthening exercises, but I simply haven't applied it nearly as much at the hip as we do at the shoulder. It's definitely something I'll be playing around with more moving forward.
Last, but certainly not least, just a friendly reminder that today is the last day to get the introductory $60 off discount on The Complete Shoulder and Hip Blueprint. As you can probably tell from these posts, I've really enjoyed going through it myself, and would highly recommend it to any fitness professionals and rehabilitation specialists out there. Click here to learn more.
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Today marks the 50th installment of this series; not too shabby! We want to quickly say thank you to everyone who has been following along. We have received plenty of messages, and many an in-person “thank yous” for the information passed along; we really appreciate your support. With that in mind, we (Greg and Eric) have decided to collaborate on this “momentous” 50th installment to make it extra memorable. Enjoy!
1. Consider doing more “core” work at the beginning of your training sessions.
Usually, we save direct, or less-indirect, core stability exercises for the latter portions of a strength training program. There is nothing wrong with this approach, and if you look at many of our programs at Cressey Performance, that’s still largely how we operate.
More recently, however, we are also including more of these core stability exercises early on. Here are a few scenarios where it makes sense:
The warm-up: Low-level core stability exercises should definitely be included in your warm-ups. They fit nicely into the theme of working from proximal to distal. In other words, you work at the trunk, thoracic spine, and pelvis before moving out to the extremities. Furthermore, hitting them early on will get athletes and clients “using” their core more appropriately before their training session.
With more hypermobile populations: These folks need to train for stability all the time. That training should be centered on the trunk first. Therefore, it makes perfect sense to include core stability exercises throughout their program, and expose them to those demands more times than just at the bottom end. To determine how hypermobile a client is, run them through the Beighton Hypermobility Test, which Eric discussed recently here.
With people who lack anterior core strength: We see a lot of grossly extended individuals walk through our doors. These clients need more exposure to core stability type drills, as well as more repetition in feeling what correct positions are. With that in mind, they are another population that can benefit from core-based drills littered between their more typical upfront exercise selections. Here are a few examples:
Additionally, keep in mind that just because an exercise doesn’t seem to be core-intensive at first doesn’t mean that you can’t make it that way. As an example, this drill is largely geared toward improving length in the lats and long head of the triceps while improving thoracic spine extension, but the anterior core should be braced to maintain the lumbar spine in neutral. At the bottom position, we cue the athlete to exhale fully to get some extra anterior core recruitment.
(For more details on anterior core training progressions, check out Eric’s presentation on the topic HERE)
2. Prevent compensation patterns when you clean up a movement.
Building on our discussion of anterior core control from point #1, athletes in extension will always find ways to shift their weight anteriorly, whether it’s via a heavily lordotic lumbar spine, anterior pelvic tilt, scapular depression, humeral anterior glide (elbows will often be behind the body at rest), forward head posture, or plantarflexion.
If you correct one, they’ll often try to go to one of the others to make up the difference. A good example would be the forward head posture that might kick in when you correct an anterior pelvic tilt and excessive lordosis on the previously featured back-to-wall shoulder flexion. As has often been said, the best athletes are the best compensators, so you need to make sure you don't let them just shift their postural dysfunction up or down a joint or two.
3. Use chia seeds in your shakes.
Chia seeds, in the opinion of many, are one of those super foods that are nearly impossible toeat. These little guys pack a ton of healthy fats, including a great amount of alpha linolenic acid (ALA), but they don’t taste so great out in the raw. However, they will make a welcomed addition to your smoothies. Along with boasting a very positive nutrient profile, chia seeds also become gelatinous when wet. That gelatinous consistency does wonders for your stomach, as well as for thickening up the consistency of your smoothie! Give them a try next time you're blending it up!
4. Improve your diet by planning ahead.
We have been big supporters of Precision Nutrition for many years now. Since the start, they have always placed a huge focus on meal planning. This habit is crucial to anyone’s success in developing better nutrition. The key word here is MEAL. Nobody likes to shop for macronutrients, or raw food items. However, that’s how many so called “healthy” people shop. A much better approach is to plan the week’s food intake based around a few recipes. From there, you can shop for the meals, not just for food.
Doing so will hold you accountable to actually cooking, and cooking tasty meals at that. This will help you develop a much better relationship with food. Additionally, as you continue to learn recipes and cook meals, you will have an arsenal of healthy eats in your pocket.
A little extra work up front will have a payoff down the road. As an action item, explore some recipes yourself, jot down a grocery list based off the ingredients and head to the grocery store this week with a plan! If you are looking for some good recipes, check out Metabolic Cooking, a great online cookbook full of delicious healthy food options.
5. Have you kids take an active role in your nutritional approach.
To piggyback off my last point, I (Greg) recently learned a lesson from one of my online nutrition clients. One of our goals over the past few weeks was the inclusion of meal planning out of a cookbook. Each week, he has been using the recipes to make at least three meals per week. Slowly, he is amassing the experience to cook and shop for healthy meals with ease.
He described to me that his go-to process in selecting the meals is laying the cookbook out, and having his daughter select two recipes. When I heard this I was blown away! What an easy way to get kids involved with the process.
His daughter was excited to eat the meals she selected – and these were often meals that she normally wouldn’t touch if her parents made them without her help. I have interacted with many parents who struggle with eating healthy and feeding their kids. They lean on their kids’ distaste for the new healthier foods as an excuse to be lax in their own efforts. If you are one of these people, or just want a great way to get your kids involved in better nutrition, give this a try right away!
Wrap-up
If you enjoyed the first 50 installments of this series, we'd love your feedback in the comments section below. Are there particular areas you'd like to see us touch upon with our weekly tips? If so, please let us know! Thanks for your continued support.
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It's time for round 2 of my series on things you might overlook when assessing a new client or athlete. Here are three news things to which you should pay attention:
1. Nervous Tick/Anxiety
When I see someone who is constantly "on" - foot tapping, cracking knuckles, fidgeting while standing/sitting, or any of a number of other displays of nervous energy - I'm obviously wondering if this is someone who is so wired that stress outside of training could be a serious problem. These folks often have poor sleep quality and don't recover well.
However, it may extend beyond that. If you check out Clinical Applications of Neuromuscular Techniques, Lean Chaitow and Judith DeLany reflect on how congenital laxity (loose joints) is correlated with anxiety disorders and panic attacks. So, even in my first dealings with people, if they're really on edge, I'm wondering we're going to need to do a lot more stabilization work, as opposed to actually created new range of motion.
2. How They Carry Their Bags
A lot of people really don't understand how their daily habits impact their long-term movement quality or the presence or absence of pain. Along these lines, it always surprises me to see people with low right shoulders who always carry their backpacks or purses over the right shoulder, just feeding into this excessive asymmetry with constant scapular depression. An initial evaluation is the perfect time to pick up on these things and counsel clients and athletes on how to prevent activities of daily living from interfering with fitness progress.
3. Clavicular Angle
The clavicle is like the bastard child of the upper body; it never gets any love. In fact, there are a lot of people who don't even know what a clavicle is unless you call it by its common name, the collarbone. It's actually a tremendously important bone, as it is the link between two very important joints of the shoulder girdle: the acromioclavicular (scapula with clavicle) and sternoclavicular (sterum with clavicle) joints.
A normal resting posture of the clavicle is about a 6-20° upslope (medial to lateral). What you'll often see with folks with faulty upper extremity posture is a horizontal or even downsloped collarbone. Check out this right-handed pitcher (left side is more normal, right is really "stuck down"):
Just like a scapula needs to upwardly rotate for optimal function in overhead activies, a clavicle needs to upwardly rotate, too. From 0-90° abduction, you only need 5-10° of clavicular upward rotation. From 90-180° of abduction, you need 20-25° of clavicular upward rotation. This clavicular movement can be affected by the muscles that attach directly to it (pectoralis major) or by those that indirectly impact it (muscles attaching to the scapula and/or humerus), as well as the positioning of the thoracic spine.
Keep in mind that where most people with acromioclavicular joint pain wind up with symptoms during abduction: the final 30° of overhead reaching. Any surprise that the symptoms occur at the point where the most amount of clavicular upward rotation is needed? Nope!
If that clavicle starts as too horizontal (downwardly rotated), it's like starting a race from a few yards behind the starting line. Getting resting posture where it needs to be helps to ensure that the subsequent movements that take place will be free, easy, and pain-free.
I generally perform 8-10 new evaluations per week. They may be individuals who plan to train with us at Cressey Performance for the long haul, or they may just be popping in for a one-time consultation regarding a particular issue or training technique concern. Sometimes, they'll be rehabbing with one of the physical therapists with whom we work closely, and seeking us out to maintain a training effect in spite of their injury.
Regardless of the scenario, I'm fortunate to see a lot of variety in a typical week of evaluations, and it has led to me thinking outside the box and appreciating a few things that are commonly overlooked by trainers and rehabilitation specialists. With that in mind, today, I wanted to kick off a new series about these under-appreciated observations that can really make a difference in your takeaways from an evaluation.
1. Standing/Sitting Posture
There are a lot of trainers who'll observe this in passing, but in many cases, they'll only note something if it's something really dramatic. My suggestion along these lines would be to note not just what's going on in the sagittal plane (kyphosis, lordosis, forward head posture), but also what's happening in the frontal and transverse plan. Do they always cross one leg over the other? Does one shoulder sit markedly lower than the other? Do they sink into one hip and carry more weight on that side?
As an aside, Greg Robins recently wrote up a great posture blog about some of the most common aberrant patterns we see.
2. Handshake
Believe it or not, a handshake can tell you a ton. If it goes like this, it's safe to say that you probably won't need to do any direct arm work with this individual, who'll quickly become either the coolest (or most awkward) client of all time.
Joking aside, handshakes can tell you a lot, particularly with respect to joint hypermobility. First off, what's the feeling of the fingers? Are they more rigid or "pliable?" If they're more pliable, chances are that you're going to be dealing with someone who has considerable congenital laxity (loose joints). Second, are the hands cold, even in the middle of the summer? Chances are their circulation is poor - another common symptoms of those with considerable joint hypermobility.
To test these theories, here's a challenge for you. Go shake the hands of ten of your friends/colleagues today. Note the feel of the hands, and then follow up the handshake with a Beighton Hypermobility Test. The screen consists of five tests (four of which are unilateral), and is scored out of 9:
1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees
I'm sure you'll find that the coldest hands with the most pliable fingers are the ones who have high scores on the Beighton test. When you have folks like this, they need more stability work than mobility training. And, if an individual has a noteworthy injury history, you need to ask if he/she has been stretched aggressively in previous training or rehabilitation scenarios - particularly if he/she had negative outcomes with those experiences.
Also, if a young athlete gives you a lame, limp-wristed handshake, it's a sign that he's going to need to step up his game if he doesn't want to live in his parents' basement for the rest of this life. I recommend introducing him to the foundation of the Ron Swanson Pyramid of Greatness to get the ball rolling (definitely worth a zoom-in):
3. Medications
It is absolutely shocking to me how many people in the fitness industry overlook medications on an initial evaluation. Perhaps it is the new era of bootcamps and semi-private training leading to a less individualized approach (particularly with respect to assessment), but you can learn so much about what a client needs by reviewing medications. And, it's one reason why we have an initial one-on-one assessment with every new client at Cressey Performance.
Of course, you're looking for the obvious stuff - beta-blockers, prescription inhalers, etc. - that have definite impacts on how someone will respond to exercise. Taking it a step further, though, there are hundreds of other medications that can impact how you program for and coach a client. The problem is that not everyone views the term "medication" the same - so people will generally underreport on their health histories. In other words, you need to "pry" and ask if there really aren't any pills they take. Recently, there was even an instance when I was able to guess a medication a kid was on just by asking his mom after observing his habits during the evaluation.
As an obvious example, there are loads of people out there who pop non-steroidal anti-inflammatory (NSAID) pills like candy because they've got chronic low back, shoulder problems, or any of a number of other issues. In their eyes, though, these "get-me-by" pills don't count as drugs because they can be bought over the counter. They can mask pain during exercises, and obviously have significant side effects. It's a trainer's responsibility to be "in the loop" with a client, his doctor, and a rehabilitation specialist to determine what the right course of action is to get this individual off those NSAIDs over time.
In a youth athlete population, we've had three kids who have had extensive and prolonged negative reactions to the Isotretinoin (Accutane) that was prescribed to treat acne. In two of these cases, the kids were excellent D1-caliber athletes who gradually felt worse and worse over the course of months in spite of no change to training volume or lifestyle factors. We were all stumped because they had never reported that they'd started taking the medication.
Once we found out the cause, their parents got them off the Accutate right away, and symptoms resolved over the course of a month. However, these experiences led me to look further into the side effects of this prescription medication. I was astounded. There are reports of depression, muscle weakness, joint pain, vision problems, dry skin skin dryness, and several other side effects. The FDA even warns, "Accutane may stop long bone growth in teenagers who are still growing." I'm not a dermatologist, so it's not my place to say that it's right or wrong. However, it absolutely, positively is something you need to inquire about on a health history if you see it listed - or even if you suspect that a kid might be a candidate for it. That said, I've known a lot of kids whose acne has improved considerably once they've gotten all the crap out of their diet, but that's a conversation for another day!
If you see a sleep aid listed on a health history, you may need to think twice about programming high-volume training for an client, and spend some extra time discussing recovery methods. If you see anti-depressants, anti-anxiety, or ADHD medications on a health history, it may change the way you approach coaching this individual. These are really just the tip of the iceberg; you have to keep your eyes open and consider/discuss the implications when appropriate.
I'll be back soon with more assessments you might be overlooking. In the meantime, if you'd like to learn more about some of our approaches to assessment, I'd encourage you to check out Assess and Correct: Breaking Barriers to Unlock Performance.
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Sorry, everyone, for being a bit MIA of late. I'll use today's post as a quick catch-up on what's been going on, and what is on tap for EricCressey.com in the months to come.
Last week, I flew out to Phoenix on Tuesday to attend a seminar with Dr. Pavel Kolar. With the exception of just a few of us, everyone in attendance was a strength and conditioniong coach, athletic trainer, or physical therapist with a major league organization. For those who aren't familiar with Kolar, he is somewhat of a "rehabilitation rockstar" in the Czech Republic, with "clients" that include Jaromir Jagr, Roger Federer, Petr Korda, countless world-class track and field athletes, multiple Czech Olympic teams, and the president of the Czech Republic himself. Needless to say, he's a really smart dude; otherwise, people all around the world wouldn't be paying to hear him give seminars in Czech (yes, the majority of the seminar was through a translator).
All of us in attendance are probably still trying to wrap our heads around his ideas, but Kolar presented a very interesting perspective on dynamic neuromuscular stabilization (DNS) based on developmental kinesiology. The "Cliff's Notes" version is that the central nervous system and muscular system it governs are immature at birth, and must go through a very specific adaptation process to achieve anatomical maturation. In rehabilitation down the road, examining this sequence of events during the first few years of life - from rolling over, to crawling, to standing up, to walking - can help us to understand how we must re-educate the nervous system to optimize function in those with aberrant patterns.
According to Kolar, one can have altered stabilization patterns for any of three reasons: 1) abnormal early development, 2) abnormal training methodology, and 3) trauma. Sounds simple, right?
Unfortunately, it's not that easy. Sequencing of patterns - from the feet all the way up to the head (and including things like diaphramatic breathing and optimal tongue positioning) - is what's important...NOT recruitment of specific muscles.
So, while EMG of the vastus medialis, posterior rotator cuff, lower trapezius, transversus abdominus, and loads of other muscles that's important, it's how all those muscles work together that's important.
All in all, it was an awesome seminar that really tested those in attendance. A pessimist would have walked away from it saying that it was too complex and that it couldn't be applied right away. The optimist (and I'd include myself in this camp) left realizing that there were a lot of things I'm anxious to research and integrate in one's programming to get our clients back to their "roots" of rolling and moving from ground-based to upright movements (think sprint-start from the ground and Turkish Get-ups).
We're also looking a ton more at breathing patterns in all our athletes - especially after spending a few days in AZ with my buddy Neil Rampe, a great manual therapist with the Arizona Diamondbacks. Most people don't realize that the diaphram is both a respiratory and postural muscle, so if you're not using it properly, it'll interfere with both oxygenation and muscular activity.
Fun stuff. Just trying to get better...
