Home Posts tagged "rectus femoris"

Weight Training Programs: Assess, Don’t Assume

Late last week, my buddy Nick Tumminello made the follow comment that some folks, unfortunately, took out of context:

“Everyone is talking about assessments (and that's cool). But, no one seems to talking about simply not allowing poor form in training. If you can't keep good form in a certain exercise (movement pattern), simply don't do that exercise until you've improved the movement or decided that you're simply not built for it to begin with. Not sure why things need be any more complicated than that!”

For the record, I agree 100% with Nick and understood what he meant, but it would have been easy to assume that he was referring to “trainers train, and therapists assess.”  In other words, many folks assume that as long as you aren’t symptomatic in some way, then you’re safe to start exercising because you can simply “feel” things out as you go and, if something hurts, you don’t do it.

While you obviously shouldn’t do something if it hurts, just because something doesn’t hurt doesn’t mean that it’s not harmful long-term – and to me, that’s the difference between “working someone out” and provided them with an optimal training experience.  As physical therapist Mike Reinold has said, “Assess; don’t assume.”

To illustrate my point, here are a few examples.

Let’s say you have someone with a chronically cranky acromioclavicular joint or osteolysis of the distal clavicle that might only be apparent upon reviewing a health history, palpating the area, or taking someone into full horizontal adduction at the shoulder.  While direct over-pressure on the area (as in a front squat) would surely elicit symptoms, my experience is that most folks won’t notice a significant amount of pain until the next day if the strength exercise selection is inappropriate (e.g., dips, full range-of-motion bench pressing).  You might have avoided what “hurt” during the session (presumably because the individual was warmed up), but you find out after the fact that you just set an individual back weeks in their recovery and fitness program.

How about right scapular winging?  It’s not easily observed if a client has a shirt on, and if you simply throw that individual into a bootcamp with hundreds of push-ups each week, you’re bound to run into trouble.  Here’s the thing, though: even if you observed that winging and wanted to address it in your training, you really have to consider that it can come from one or more of several factors: weak scapular stabilizers, a stiff posterior cuff, insufficient right thoracic rotation, faulty breathing patterns, or poor tissue quality of pec minor, rhomboids, levator scapulae (or any of a number of other muscles/tendons).  Just doing some rows and YTWL circuits will not work.

Also at the shoulder, a baseball pitcher with crazy congenital and acquired shoulder external rotation may have a ton of anterior instability in the “cocking” position of throwing (90 degrees of abduction and external rotation), but be completely asymptomatic.  Back squatting this athlete would exacerbate the problem over the long haul even if he didn’t notice any symptoms acutely.

Finally, in my recent article, Corrective Exercise: Why Stiffness Can Be a Good Thing, I spoke about how someone can have crazy short hip flexors and still manage a perfect squat pattern because his stiffness at adjacent joints is outstanding.  If I don’t assess him in the first place and just assume that he squats well, I’m just waiting for him to strain a rectus femoris during sprinting or any of a number of other activities.  Gross movement in a strength and conditioning program wouldn’t tell me anything about this individual, but targeted assessments would.

The point is that while Nick’s statement is absolutely true – demanding perfect form is corrective in itself – you’ve still got to assess to have a clear picture of where you’re starting.  Otherwise, many cases like this will slip through the cracks.

To that end, I’m happy to announce that my long-time friend and colleague, Mike Robertson, recently released his Bulletproof Knees and Back Seminar DVD Set.  This comprehensive product covers anatomy, assessments, program design, and coaching.  In fact, almost the entire second day is focused on coaching, and that’s an area in which most trainers really do need to improve.  All in all, this isn’t a collection of bits and pieces; it’s Mike’s entire philosophy on training someone who is suffering from knee or low back pain (and how to prevent it in the first place).  Effectively, Mike covers what both Nick and I are getting at in the paragraphs you just read.

This is tremendously valuable information that fitness professionals need to hear, so be sure to check it out.

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Strength Training Programs: Lifting Heavy Weights vs. Corrective Exercise – Finding a Balance

Q: How does one find a balance between "technique/form/corrective/sissy work" and lifting heavy weights to make gains in a strength training program? I see both extremes, but am curious about what affects the balance between the two.

A: This is actually a great question, and I am actually surprised that I’ve never answered it before in over five years of writing on this site.

For me, it all comes down to five factors in each athlete/client: strength training experience, injury history, goals, time to commit, and training session structure.

In someone with limited strength and conditioning, more of the session is going to be devoted to technique work on entry level strength exercises.  You don’t have to worry as much about lifting really heavy weights simply because beginners can make appreciable strength gains with as little as 40% of 1-rep max on exercises.  The more advanced an athlete becomes, the less time you spend on technique work, and the more work you do with strength development and corrective exercise.  Eventually, when an athlete has a lot of strength, you have to consider whether all the time and effort that would go in to adding 20 pounds to his squat would actually be better spent elsewhere – whether it’s with corrective work, power training at a lower percentage of 1-rep max, or in introducing new exercises.  Effectively, it always comes down to finding someone’s biggest window of adaptation and exploiting it.  That's one reason why I tried to make the Show and Go program so versatile by including 2x/week, 3x/week, and 4x/week training options alongside five supplemental metabolic training protocols.

If we are talking about someone with a lengthy injury history, though, the rules get thrown out the window.  You are not only spending more time with corrective exercise, but also refining your strength exercise selection to work with this individual – so it might mean that you have to do more technique work to add in new strength exercises, regardless of that individual’s training experience.

One’s training goals impact the corrective/heavy lifting balance as well.  If I’m training someone who simply wants to improve quality of life or stay healthy in athletics, I can be a bit more cautious on the heavy lifting side of things and hold back.  However, if we are talking about someone who was put on this planet to get strong and wants to be the most badass guy in the gym, we have to lift some heavy weights to make that happen.  So, while the second scenario in many cases requires more corrective exercise, we’re talking about a population that is willing to take more risks in training to get to a goal that might not be at all interesting to a more “low key” population.  This does not, however, mean it’s okay to let strength-oriented people lift with atrocious technique.  Doing so makes you an unethical clown who is more likely to get sued – not a professional.

Time to commit is another important consideration that many folks overlook.  Very simply, if someone can only get in two exercise sessions a week, I’m not going to be spending a ton of time on corrective exercise with them.  You’re much more likely to die from being fat and having diabetes than you are from having a cranky rotator cuff.  I’ll gladly give these folks additional corrective exercise that they can do during their busy schedules (which are never as busy as they claim), but I won’t coddle them when they need to move.

The last factor, which is more about the training model than the athlete/client in question, is how one structures a training session.  At Cressey Performance, athletes start their sessions with foam rolling and then proceed to an 8-10 exercise dynamic warm-up.  For many folks – particularly young athletes – that is enough “corrective” work, and the remainder of the session can be devoted to technical instruction and increasing strength on exercises that are safe for them.  Those with more accumulated wear-and-tear on their bodies will need more corrective exercise beyond what they’ll get from strength training alone – so we add in fillers (e.g., extra mobility work) between sets, and some additional corrective work at the end of the session.  Since you have a limited amount of time with people, you may have to cut back on strength training or metabolic conditioning initially just so that you can get in this early corrective work to get them over the initial “hump.”  Trust me: it will set the stage for long-term success rather than “short-term gain, long-term pain.”

There are two final points I’d like to make.  First, in my experience, many experienced lifters/athletes have responded well to separating the heavy lifting from the corrective stuff.  When they show up to train, they may be really fired up and ready to go – so the last thing they’ll want is to do some wall slides or spend five minutes getting some length in their rectus femoris.

These folks would be wise to do just enough warm-up work to prepare for their heavy training, and then add in some separate sessions to address movement inefficiencies – whether we’re talking additional foam rolling, massage, mobility drills, rotator cuff work, or something else.  They can also add it in on the end of the session after the hardest work is done.

Second, for many folks, maximal strength can be tremendously corrective.  Increasing strength in one area can reduce excessive stress in another area of the body.  An example of this would be using the box squat or deadlift to learn proper hip hinging techniques, which would increase posterior chain contribution and take some of the burden off the quads in someone with anterior knee pain.  Likewise, all other factors held constant, a stronger muscle is less likely to become degenerative.  You can read more along these lines in two older newsletter of mine on the Law of Repetitive Motion: Parts 1 and Part 2.

Obviously, there are many things to consider, but this should at least get you headed in the right direction in finding the right balance in your strength training program.

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Pulled Quad – or is it?

Q: How should I warm up properly before sprinting sessions? Back in the day when I did sports my quads were always prone to injuries. Funny thing is I haven't had any problems when doing squats of any kind. Recently I decided to involve some alactic work in my workout and immediately pulled a quad doing sprints. It's obviously something wrong with my warm-up! A: Saying "pulled quad" might be a little bit too general.  In reality, most of the time, you're looking at a rectus femoris strain.  While it is one of the quadriceps, the rectus femoris is also active as a hip flexor.  So, as the picture below shows, it crosses two joints.

rectus-femoris

The rectus femoris is responsible for both hip flexion and knee extension.  So, as you can imagine, it is placed on a huge stretch when an athlete goes into a position of hip extension and knee flexion - kind of like this:

lewis

You're asking the rectus femoris to go on a huge stretch there - and under very high velocities.  With a squat, you're not putting it on full stretch, as the hip and knee are both flexed.  So, with that in mind, it's not surprising at all that sprinting would bother your "quad" when squatting doesn't - especially since we know the overwhelming majority of folks out there are tight in the rectus femoris.  Why?

Well, first, you don't need to be a rocket scientist to know that, as a society, we sit far too much.  Second, though, is the fact that most people never really get above 90 degrees of hip flexion in anything that they do.  Mike Boyle has done a great job of outlining how we can develop imbalanced hip flexion patterns; essentially, we never use our psoas, the only hip flexor active above 90 degrees of hip flexion. The picture below is kind of rudimentary (and somewhat awkward), but it shows what I'm getting at with respect to the advantageous attachment points for psoas with respect to hip flexion above 90 degrees:

psoas1

How many of the folks at your gym are getting 90+ degrees of hip flexion with their treadmill, stairclimber, and elliptical work?  None.  So, we underuse psoas, and overuse rectus - and it shortens up over time.  Take a short muscle through a maximal stretch at high-velocities, and it's going to hate you.  So, what to do?

Well, first, I'd recommend running through some warm-ups from Assess and Correct, and that'll cover a lot of the fundamentals (especially if you go through the assessments to figure out what else is going on).  One important thing that'll cover is activation work for psoas; Kevin Neeld demonstrates one option here:

Second, just add in some targeted static stretching for the rectus femoris a few times a day using this stretch (don't start using it until the "pulled quad" has settled down, though).

kneelingheeltobuttstretch

Third, and most importantly, ease your way into sprinting.  Not everyone is prepared to just jump right in full-throttle.  I discuss this in further detail in my contribution to the most recent Mythbusters article at T-Nation.  Basically, just get out there twice a week and do some 60-yd build-ups at 80% of your best on a grass field.

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Quad Pulls in Baseball

Q: There have been a few quadriceps pulls in MLB this year. Have you seen these before in baseball players? What gives? A: This is why I love baseball; it's probably one of the most at-risk sports you'll ever see (particularly in pitchers). Here's a little excerpt from a slide in a recent presentation I gave on training for overhead athletes: -Very Long Competitive Season >200 games as a pro? >100 College/HS? -Unilateral Dominance/Handedness Patterns Asymmetry is a big predictor of injury Switch hitters – but no “switch throwers!” -The best pitchers – with a few exceptions – are the tallest ones. The longer the spine, the tougher it is to stabilize. -Short off-season + Long in-season w/daily games = tough to build/maintain strength, power, flexibility, and optimal soft tissue quality Specific to the quad pulls, I'd add to this list that baseball guys rarely hit top speed; all of their sprint work is done in acceleration, where the quads are dominant. Factor in that they spend a lot of time sitting on airplanes/buses, and it's no surprise that they'd get tight anteriorly. It's why it's so important to really hammer on hip mobility in any population that sits a lot.

The stop and go nature of the sport also dictates that strains would be common, whether they are groins, hip flexors, hamstrings, or quads (likely rectus femoris, which is a hip flexor that can get overactive, particularly alongside poor psoas function). So, all that said, before anyone jumps to conclusions and tries to criticize some strength coach, it's important to consider: a) the certain amount of happenstance that occurs with any baseball player due to the nature of the game and the season b) what that athlete does on his own in the off-season In terms of "b," I’ve seen some pretty bad stuff, unfortunately. For many guys, it becomes a leg extensions and curls off-season if they're on their own - or they do nothing. I'd like to think that our success in working with baseball guys is not just in the fact that we've made the programming good, but also in the fact that we've changed the culture a bit in our guys: they appreciate what lifting is doing for them and look forward to getting after it in the gym. Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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