Home Posts tagged "Ron Hruska"

What Do You Think of XYZ Method?

Often, I'll get inquiries that go something like this:

What do you think of yoga?

How do you feel about Pilates?

I have a friend who liked MAT. Do you think it's legit?

These are always challenging questions to answer because there are actually a number of variables you have to consider. To illustrate my point, let's try for some parallels in different industries. What do you think of real estate attorneys? Accountants? Veterinarians? Plumbers? General contractors?

As you can probably infer, there's going to be a high amount of variability in the delivery of each method, so you have to ask the following questions:

1. Is the method actually legit?

Sometimes, entire methodologies are based on bad science or bad people manipulating science for their own financial gain. A good example of this would be the thousands of different kinds of "cleanses" marketed in the nutrition/supplement industry.

2. Is the practitioner actually educated (and, where appropriate, licensed) in the method?

This is something that is near and dear to me. Each week, we get emails from young baseball players and their parents who say they train with a "Cressey guy" or someone "Eric has mentored." Then, they tell me that coach's name and I've never heard of him, and he's never even purchased one of my products or attended our actual baseball mentorship. Instead, he saw me give a one-hour talk in 2009. In describing himself, however, he positions himself on par with one of our interns who spent 3-5 months side-by-side with me six days per week. That's a markedly different level of education in our method.

As a good rule of thumb, think of the telephone game. The further away from the founder of a method, the more watered down the product becomes. As an example, Ron Hruska created the Postural Restoration Institute, and it's mostly disseminated through courses he's designed and by instructors he's trained himself. If an attendee then returns and teaches his/her staff the principles, then they teach their clients, and then the clients share their favorite positional breathing drill with a friend after a few adult beverages at a cocktail party, is it really representative of how impactful PRI can really be?

3. Does the practitioner actually have attention to detail?

Having just built a brand new Cressey Sports Performance facility, this is fresh on my mind. Not all contractors are created equal. Two can look at the exact same finished product and one person says it's beautiful, and the other says it's terrible work. No matter how great the method might be, if someone is lazy, it won't be positioned in a great light.

4. Does the practitioner understand how to "pivot" within a philosophy?

The back-to-wall shoulder flexion exercise is a central piece of our philosophy at Cressey Sports Performance. We think it's imperative to get the arms overhead without compensation at adjacent joints. Give this a video a watch to learn how we'd coach it under the three most common challenges one will typically encounter:

As you can see, these modifications rely on being able to do some basic, quick evaluations on the fly. If you don't have the ability to perform them, the client will likely just wind up banging on the front of the shoulder.

This is where a lot of group exercise methodologies can fall short. They don't understand how to pivot when someone can't perform a drill, so they wind up plowing through a bony block or exacerbating an existing movement fault.

5. Has the practitioner evolved with the methodology?

I tweeted this several years ago, but it still holds true:

 

If you look at CSP years ago versus now, it's easy to see how much we've evolved. What you would have learned in a single day of observation at the facility in 2010 is a lot different than what you'd learn on a 2020 visit. This might refer to the methodologies represented, coaching approaches, or equipment utilized.

6. Does the practitioner utilize one methodology exclusively?

As the hackneyed expression goes, "If you're a carpenter who only has a hammer, everything looks like a nail." For example, I'm very leery of chiropractors who only do adjustments when there are undoubtedly many other associated therapeutic interventions that could further help their patients. I'll always refer to multi-dimensional providers over one-trick ponies.

Pulling It All Together

As you can see, five of my six qualifications had nothing to do with the method, but rather the practitioner carrying out that method. That, my friends, is why I always refer to PEOPLE and not just methods. And, it's why you should always try to find good people - regardless of the methodologies they utilize - to help you get to your goals.

It's also why continuing education is so important: we need to understand the principles that govern how successful people can be within various methodologies. If you're looking to learn more about some of those principles and how I apply them to evaluation, programming, and coaching at the shoulder, be sure to check out my popular resource, Sturdy Shoulder Solutions. You can get $50 off through tonight at midnight at www.SturdyShoulders.com by entering coupon code podcast50.

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Mobility Exercise of the Week: Left-Stance Toe Touch

They say that nothing in the fitness industry is really "new" nowadays.  Rather, new concepts usually originate with things that are already out there simply being "spun" in different ways.  Maybe it's a different cue, or a new way to program an old exercise. Today's post is a great example.

Gray Cook has put out some outstanding stuff with respect to improving the toe touch pattern (and outlining why a toe touch is an essential movement skill in the first place).  And, Ron Hruska of the Postural Restoration Institute (PRI) has brought to light how asymmetry is normal and somewhat predictable (based on our anatomy), but must be managed within acceptable limits.  A central focus of both these approaches is that we have to get closer to neutral before we try to perform, especially if that performance includes strength training that will further solidify neural patterns.

Greg Robins gave a great introduction to some of the PRI postural distortions and corrections in a recent post here at EricCressey.com.  As a Cliff's Notes version, we often get "stuck" in our right hip (adduction/internal rotation) like this:

IMG_8938

When you look at these individuals from the front, you'll see an adducted right hip, low right shoulder, and anterior left rib flare:

adductedrighthip

However, this isn't just a frontal and transverse plane problem; rather, it also generally is accompanied by a sagittal plane concern: poor control of extension, meaning our weight is carried excessive forward via a number of different compensations: excessive plantarflexion (ankle), anterior pelvic tilt (hips), lordosis (lower back), scapular anterior tilt (shoulder blade), humeral extension past neutral (upper arms), or cervical hyperextension (neck/forward head posture).  At the end of the day, virtually all of these folks - regardless of where they get their excessive extension - have a compromised toe touch pattern.  They simply aren't able to posteriorly shift their weight sufficiently to make it happen.  And, given their asymmetries from above, you'll often see a big side-to-side difference in the form of a posterior right rib humb when they demonstrate a toe touch for you.  I have literally hundreds of photos exactly like this on my computer from working with clients, and I can honestly say that I've only seen three that have a posterior left rib hump!  Effectively, they're in left thoracic rotation and right hip adduction.

IMG_8443

As you can see, then, many folks may be better off performing their toe touch progressions with a bit of frontal and transverse bias, and that's where I started experimenting with the left-stance toe touch (with toe lift and med ball).  Right handed individuals with the aberrant posture Greg demonstrates above tend to be "slam dunks" for improving a toe touch with this variation; the results are markedly better than if they do the drill with the feet side-by-side.

By learning to "get into" that left hip, we're actually activating the left hip adductors to help pull us back to neutral.  And, when we're in neutral. We can pick up heavy stuff, throw 95mph, and sit in the car for more than 20 minutes without right-sided low back pain. All the villagers rejoice.

This is one exercise demonstration I include in my "Understanding and Managing the Hip Adductors for Health and Performance" presentation in our new resource, Functional Stability Training of the Lower Body.  This collaborative effort with Mike Reinold has been a big hit already, and is on sale at a big introductory discount for this week only.  You can check it out here.

FST-DVD-COVER-LB

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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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