I suppose this blog title is more of a rhetorical statement than an actual question, but I'm going to write it anyway.
Just about every week, I get someone who comes to Cressey Sports Performance - either as a new client, or as a one-time consultation from out of town - and they have some issue that is bugging them to the point that they opted to see a doctor about it. This doctor may have been a general practitioner or an actual sports orthopedist. In many cases, the response from this medical professional is the same "Just rest."
"It hurts when you lift? Then stop lifting."
Huh? When did COMPLETE rest because a viable recommendation?
In case folks haven't noticed, a scary number of Americans are overweight or obese. Even if rest was the absolute key to getting healthy, telling them to not move is like not seeing the forest through the trees. Your bum knee will feel better, but you'll have a heart attack at age 43 because you're 379 pounds.
Oh, and nevermind the fact that exercise generally improves sleep quality, mooed, and immune, endocrine, and digestive function. I'm not going to lie: I would rather have an achy lower back than be fat, chronically ill, sleep-deprived, impotent, angry, and constipated.
But you know what? The good news is that you can still exercise and avoid all these issues - regardless of symptoms. I can honestly say that in my entire career, I've never come across a single case who couldn't find some way to stay active.
And, when I did an internship in clinical exercise physiology, we trained pulmonary rehab patients in spite of the fact that they often had interruptions during their sessions to cough up phlegm for 2-3 minutes at a time.
All over the world, people are using exercise to rehabilitate themselves from strokes, heart attacks, spinal cord injuries - you name it.
However, Joe Average who sleeps on his shoulder funny and wakes up with a little stiffness needs complete rest and enough NSAIDs to make a liver cringe.
Sorry, but you're going to need to be on crutches, in a back brace, with poison ivy and a punctured lung to get my sympathy. And, you're sure as heck not going to get it if you're just "really sore" from your workout routine. Seriously, dude?
I don't care what your issue is: "just rest" is almost never the answer (a concussion would be an exception, FYI). When a health care practitioner says it, it's because he/she either a) doesn't have the time, intelligence, or network to be able to set you up for a situation where you can benefit from exercise or b) doesn't think you have enough self control to approach exercise in a fashion that doesn't make it more harm than good.
There is almost always something you can do to get better and maintain a training effect. While adequate rest for injured tissues is certainly part of the equation, it is just one piece in a more complex puzzle that almost always still affords people the benefits of exercise.
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Call it a law of weightlifting: no matter how careful you are, at some point you're gonna get hurt. Now you probably won't decapitate yourself with a barbell or tear a pec or even rupture your spleen—the weightlifter's injuries are rarely that cool or sudden.
Nope, you'll probably just end up with a bum shoulder, a pinched elbow, a bad back, or creaky knees, all the result of years of faulty movement patterns, poor training habits, or just general wear and tear. And while these injuries are always frustrating, they're often manageable.
Because it's hard to build a good-looking body when you're hurt, I talked with Eric Cressey and Mike Robertson about how these body parts probably got jacked up in the first place, and asked them for simple strategies to get you healthy.
Continued Reading...
I had a one-time consultation client at Cressey Performance yesterday, and when I noticed that he had some interesting stuff going on, it made me realize that I need to do more "case studies" here in the blog.
This guy had a history of on-and-off right-sided lower back and left shoulder pain. Basically, it would act up every once in a while, then calm down when he cut out exercising. Then, he'd return to training for a bit - only to have another set-back. It has been one step forward, and one step back for years.
Now, if you'd seen this guy move, you'd realize that the lower back and shoulder stuff were clearly closely related. If you're at all familiar with the Postural Restoration Institute, he was a classic Left AIC pattern: adducted/internally rotated right hip and abducted/externally rotated left hip - and the compensations working their way up to lead to a low right shoulder and prominent left rib flair. Everything was definitely related.
Not surprisingly, he'd been told he had scoliosis previously - but the "interesting" thing about it is that this was an acquired posture. He hadn't had these when he was a kid; he developed them when he was a rower who was always on the right side of the boat. If you can acquire them, you can "unacquire" them - but it takes time.
We're getting him started on some drills to iron out his hip imbalances, but for the sake of this blog, I wanted to highlight what we saw with his shoulder, as I think it includes some great take-home messages on how to manage shoulder function - both in the presence and absence of pain.
If you look at the research, if you look at shoulder total motion (internal rotation + external rotation with the scapula stabilized at 90 degrees of abduction), you should see symmetry between right and left in a healthy shoulder. The internal and external components may be different between sides (e.g., more external rotation and less internal rotation in a throwing shoulder), but the total motion should be the same. When it's not, "normalizing" total motion should be a primary goal, whether you're trying to address or prevent shoulder issues.
In our case study's situation, here is what we measured with the goniometer:
Left: 39° (IR) + 98° (ER) = 137° (TM)
Right: 58° (IR) + 109° (ER) = 167° (TM)
In other words, it was a 30° total motion deficit, with most of that deficit coming from internal rotation.
The logical next step would be to manually stretch the shoulder girdle, right? Well, certainly, it may be justified. However, before I go having an athlete crank on a somewhat "delicate" joint, I like to see what we can do to get that area to relax without even touching it.
The first thing we did was simply close down that left rib cage flair a bit while flexing his left hip and flexing his left arm overhead. And, we just left him there to breath for 30 seconds or so. Then, we remeasured:
Left: 44° (IR) + 104° (ER) = 148° (TM)
In other words, we got 11° of total motion without ever touching his shoulder. His body did that work just by getting air in with a new posture (no left rib flair).
Next, I simply had him get on all fours and go through a pretty low-key thoracic spine mobilization with his arm gently positioned behind his back so that it was on absolutely no stretch. He did eight reps on each side, using cervical motion to drive a bit of thoracic extension and rotation and scapular movement. Then, we remeasured:
Left: 46° (IR) + 107° (ER) = 153° (TM)
There's another 5° of total motion, and it got us a lot closer to where he needs to be - without ever touching his shoulder. And, the coolest part was that when he stood up, the low right shoulder was markedly less prominent - and it was a positioning that "stuck around" for the rest of his session.
Sure, manual stretching of the shoulder is probably warranted for him to get those last 14 degrees, and I don't expect him to maintain all this range indefinitely after this session. He'll need to be consistent with the movements to regain range bit-by-bit and use his strength training to ingrain it in his movement patterns, but the point is that the less aggressive, seemingly indirect, and self-applied interventions are often the best way to get lasting results. And, when they work, it makes you realize just how "synced up" our entire body is from head-to-toe.
For more information on the best assessments and corrective exercises for the shoulder, check out our Optimal Shoulder Performance DVD Set.
Here are a few blasts from the past that I think you'll like to kick off the week:
Peak Power or Vertical Jump - Which one should you test in athlete training programs, and why?
Back Squatting with a Posterior Labral Tear - This is a good follow-up to last week's post on shoulder mobility with squatting because sometimes, even good mobility won't matter.
5 Relative Strength Myths - I wrote this article back in 2005, and as I look back on it, in many ways, it helped to set the stage for my Maximum Strength book.
1. I haven't done a "Random Friday Thoughts" blog in a while, so in the spirit of randomness, I thought I'd throw you a curveball and kick off the week with some Tuesday random thoughts.
2. Last week, I booked two plane tickets to Halifax, Nova Scotia for my fiancee and I. She's a bridesmaid in a wedding up there in a few weeks, so I'll be making the trip as well. As part of being what amounts to a "third wheel" for the weekend (the only people I know other than Anna in the entire wedding are the bride and groom), I'll have quite a bit of downtime while in the area. Any readers out there have any suggestions for what to do in Halifax? It's not hockey season, and I don't drink Molson, so I'm at a bit of a loss...
Also, just out of curiosity, when did one have to sell off all his/her internal organs in order to afford a flight to Halifax? Roundtrip airfare was over $1,500, and Air Canada followed up with an email that said, "We also mandate that you name your first child after us."
3. I wrote a guest blog for Men's Health last week; check it out: A Quick Fix for Stiff Shoulders.
4. Also on the writing note, I've written a few guest chapters lately. The first was a strength and conditioning chapter for an upcoming pitching book for young baseball players and their parents. The second (which is still a work in progress) is a chapter for a new IYCA project. So far, it's coming along really well - and I'm really honored to be on-board for this with a group of really talented guys who are trying to do something very special.
5. Tonight (Tuesday), Boston Red Sox Head Athletic Trainer (and Optimal Shoulder Performance co-creator) Mike Reinold is hosting a free webinar: "What's New for 2010." Click here for more information.
6. Speaking of Mike, he had a great post last week about Epicondylitis and Cervical Radiculopathy. It's a great adjunct to my "Understanding Elbow Pain" series from back in May. If you missed it, here's a link to the sixth (final) installment (and you can link back to the previous five).
7. I realized the other day that there is one big thing I've always considered in our training programs for pitchers, but failed to mention on this blog: they need both open- and closed-chain hip mobility, as the right and left hips must rotate independently of one another during the stride to the plate. Here's a good example:
You can see that Beckett is just short of stride foot contact here - which means that he's at just about maximal hip external rotation on the lead leg...in open chain motion. The femur is rotating on the acetabulum.
Meanwhile, he's riding out his trailing leg...in closed chain motion. The acetabulum is rotating on the femur.
As such, adequate mobility training for pitchers should include a combination of both open- and closed-chain drills, although I'd say that the majority should be closed-chain.
8. Today's Mike Robertson's birthday; head over to RobertsonTrainingSystems.com and show him a little love.
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Here's this week's list of recommended reading:
Total Football Training - I just got an advanced copy of San Francisco 49ers strength coach Duane Carlisle's new product, and read it over this past weekend. There's some really good stuff in there - definitely a good fit for the football players reading this blog. It includes an eight-week off-season training program where all the drills are demonstrated on the accompanying DVDs.
Inverted Row Ignorance - Here's one from the archived that reminds us once again just how often this exercise is absolutely butchered.
The Right Way to Stretch the Pecs - Here's a T-Muscle article that gives you some practical suggestions on loosening up these chronically tight muscles without throwing your shoulders under the bus.
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Though a somewhat "normal" day at the gym, yesterday marked Cressey Performance's three-year anniversary.
While my business partner's blog post yesterday did an excellent job of doling out "thank yous" to a lot of the important people who have been so involved in our success - from clients to parents, coaches, interns, and significant others - I wanted to add my own two cents on the matter today. More than anything, I really wanted to highlight a sentence that illustrates what makes me the most proud about where CP has been, where it is, and where it's going.
We've done this for the right reasons, and we've done it the right way.
I read a business development blog post by Chris McCombs the other day where he wrote something that really hit home for me. When he was talking about how he decides to accept or reject a new project/opportunity, here is one of his guidelines:
"Only Take on Projects That Are In Line With My Current Values and Fulfill Me Beyond Just The Money - A project must fulfill me in some way BESIDE just money...too many people spend their life JUST chasing a buck; to me, that's no way to live. For me, the money must be there, but it should fulfill me personally, be fun, help a lot of people, and build and be in line with my current brand and brand equity."
Back in 2007, I had a tough decision to make. My online consulting business had really taken off, and the Maximum Strength book deal was in the works. My other products - Magnificent Mobility, The Ultimate Off-Season Training Manual, and Building the Efficient Athlete - were selling well and getting great reviews, and I'd just had a study published in the Journal of Strength and Conditioning Research. This website was growing exponentially in popularity, and I had just wrapped up my first year on the Perform Better tour - so lots of doors were opening for me on the seminar front to present all over the world - and I could have stayed home and just written all day, every day.
I was getting really crunched for time, as I was already training clients 8-13 hours per day, seven days per week, as my in-person clientele had rapidly grown. My phone rang off the hook for about three weeks after Lincoln-Sudbury won a baseball state championship after I'd trained several of their guys, and one of my athletes was named state player of the year. And, after being featured on the front page of the Boston Globe with a nipple so hard I could cut diamonds, I was in demand as a t-shirt model (okay, not really - but it made for an awesome blog post, The School of Hard Nipples).
I was exhausted and stressed - but absolutely, positively, "living the dream" that I'd always wanted.
To make matters a bit more interesting, I had just started dating a great girl (now my fiancee) who I really had a good feeling was "the one" after about three months. The work days, however, were insanely long and I was worried that I'd screw up a good thing by not spending enough time with her.
Every business development coach out there would have seen a "simple" answer to all my problems: stop training people in person. Just write, consult, make DVDs, and give seminars. It would have cut my hours by 80% and still allowed me to earn a pretty good living - and enjoy plenty of free time. There was a huge problem with that, though; as Chris wrote, it wouldn't "fulfill me personally, be fun, help a lot of people, and build and be in line with my current brand and brand equity." I like doing evaluations, writing programs, coaching, sweating, training with my guys, cranking up the music, helping people get to where they want to be, collaborating with and learning from other professionals, and watching my athletes compete - whether it's at some high school field or at Fenway Park. Giving that up wasn't an option; I guess I'd have just been a crappy business coaching client, as I would have been stubborn as an ass on giving that up.
Fortunately for me, Pete Dupuis, my roommate from my freshman year of college, had just finished his MBA and was in the midst of a job search. And, during that MBA, he'd started to train with me and packed on a ton of strength and muscle mass - making him realize and truly appreciate the value in what I was doing (especially since he was and is a goalie in a very competitive soccer league). Pete had also met and become friends with a ton of my clients - and taken a genuine interest in my baseball focus, as a lifelong Red Sox fan. Almost daily, Pete would encourage me to do my own thing and let him handle all the business stuff for me.
Simultaneously, Tony Gentilcore was ready for a change of scenery on the work front. Having been Tony's roommate and training partner for almost two years at that point, I knew he was a genuinely great guy, that he'd read everything on my bookshelf, and that he could coach his butt off and "walk the walk." He, too, had met a lot of my clients - so there was continuity from the get-go.
So, on July 13, 2007, Cressey Performance was born. Here is what we started with.
Boatloads of renovations and equipment additions later, it wound up looking like this.
Of course, we outgrew and demolished this space after about nine months and moved three miles east to a facility twice the size. And, we've continued to grow right up to this day; June was our busiest month ever, and July should be busier. We've got regular weekly clients who come from four states (MA, NH, CT, RI), and in the baseball off-season, I have college and pro guys who come from the likes of OH, AZ, CA, SC, NC, GA, FL, and VA. And, we had 33 applicants for this summer's internships.
To be very candid, though, I don't consider myself a very good "businessman." No offense to Pete or Tony, either, but I don't think they even come close to the textbook definition of the word, either. We just try to be good dudes. "We've done this for the right reasons, and we've done it the right way."
We don't allocate a certain percentage of our monthly revenues to advertising. In fact, we haven't spent a single penny on advertising - unless you count charitable donations to causes that are of significance to us.
We don't search high and low for new revenue streams to push on our clients. In fact, if I get one more MonaVie sales pitch, I'm going to suplex whoever delivered it right off our loading dock. Rather, we bust our butts to set clients up for success in any way possible - and trust that those efforts will lead to referrals and "allegiance" to Cressey Performance. We ask what they want from us and modify our plans accordingly. It's what led to us bringing in manual therapy, a pitching cage, and, of course, pitching coach/court jester Matt Blake's timeless antics.
Along those same lines, we don't measure our success based on revenue numbers; we measure it based on client results. In three years of seeing LOADS of baseball players non-stop, we've only had three arm surgeries: one shoulder and two elbow. All three were athletes who came to us with existing injuries, and in each case, we kept them afloat as long as we could and trained them through their entire rehabilitation. I don't want to toot our own horn, but this is a remarkable statistic in a population where over 57% of pitchers suffer some form of shoulder injury during each competitive season - and that doesn't even include elbows! And, our statistics don't even count literally dozens of players who have come to us after a doctor has told them they needed surgery, but we've helped them avoid these procedures. The college scholarships, draft picks, state titles, individual honors, and personal bests in the gym are all fantastic, but I'm most proud of saying that we've dedicated ourselves to keeping athletes healthy so that they can enjoy the sports they love.
The same goes for our non-competitive athlete clients. The fat loss and strength gains they experience are awesome and quantifiable, but beyond that (and more qualitatively), I love knowing that they're training pain-free and are going to be able to enjoy exercise and reap the benefits of training for a long time.
We don't penny-pinch during our slowest times of the month (late March through mid-May - the high school baseball season). We see it as an opportunity to do more staff continuing education, renovate the facilities, and get out to watch a lot of baseball and support our athletes. And, we adjust our hours to open up on Sundays and stay later on weeknights during the baseball season to make it easier for athletes to get in-season training in whenever they can. If a pitcher wants to come in and get his arm stretched out before or after an outing, he stops by and we do it for him - but don't charge him a penny for it. It's about setting people up for success.
We don't try to just "factory line" as many clients through our facility as possible with everyone on the same program. You might walk into CP and see 20 different clients on 20 different programs - because a 16-year old pitcher with crazy congenital laxity is going to have a markedly different set of needs than a 16-year-old linebacker with shoulder mobility so bad that he needs help putting a jacket on. One program on one dry erase board for hundreds of athletes isn't training; it's babysitting.
Taking this a step further, we don't boot clients out after a certain amount of time. Clients take as long as needed to complete the day's program. And, when they're done (or before they even begin), loads of our clients spend time hanging out in the office just shooting the breeze and enjoying the environment. As an example, Toronto Blue Jays Organizational Pitcher of the Year Tim Collins spends a minimum of five hours a day at CP all off-season.
Tim has sold girl scout cookies for the daughter of one of our clients, and he's been our back-up front desk guy when Pete is out of town. Yesterday, he was back to visit on his all-star break - and he said hello to every client he saw - and remembered them by name. If you're a 15-year-old up-and-coming baseball pitcher, how cool is it to get that kind of greeting when you walk into the office? Well, at CP, kids get that greeting from 10-15 pro guys all the time. And, if they're lucky, they might even get to throw on a bobsled helmet and join these pro guys in a rave to Miley Cyrus, apparently.
At least once a week, I get an email from an up-and-coming coach asking for advice about starting a facility. When I get these emails, I now think about how Rachel Cosgrove recently mentioned that more than 80% of fitness coaches leave the industry within the first year. In most cases, this happens because these people never should have entered the fitness industry in the first place - because their intentions (money) were all wrong. They usually leave under the assumption that they could never make a living training people, but in reality, these folks are going to have a hard time making a living in any occupation that requires genuinely caring about what you do and the people with whom you work, and being willing to hang your hat on the results you produce.
As such, the first advice, in a general sense, is obvious: do it for the right reasons, and do it the right way. Sure, making a living is essential, but only open a facility because it would fulfill you "personally, be fun, help a lot of people, and build and be in line" with who you are and what your values are - which together constitute your "brand." Making the move to start up this business was one of the most daunting decisions I have ever had to make, and all the efforts toward actually getting the business started were equally challenging. However, in the end, it has been more rewarding both personally and professionally than I could have ever possibly imagined.
Thank you very much to all of you - clients/customers, parents, EricCressey.com readers, seminar attendees, and professional colleagues - for all your support over the past three years. We couldn't have done it without you - and look forward to many more years of doing things for the right reasons and in the right way.
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I've seen a few acromioclavicular (AC) joint impingement cases at our facility in the last couple of weeks and thought it'd be good to do a quick blog to talk about how different they are from "regular" (external) shoulder impingement cases. And, it is a very important differentiation to make.
I've already written at length about AC joint issues in Getting Geeky with AC Joint Injuries: Part 1 and Part 2. And, I kicked out a two-part series called The Truth About Shoulder Impingement; here are Part 1 and Part 2.
While I talk a lot about the symptoms for both, several provocative tests for these issues, and training modifications to avoid exacerbating pain under these conditions, there was one important "differential assessment that I missed." Mike Reinold actually taught me it as we were planning the Optimal Shoulder Performance DVD set.
Just paying close attention to (and asking about) where folks have their pain during overhead motion can tell you quite a bit. In an external impingement - where we're talking about the rotator cuff tendons and bursa rubbing up against the undersurface of the acromion - you'll usually get pain as folks approach 90 degrees of abduction (arm directly out to the side). That pain will persist as they go further overhead, and in my experience, start to die off as they get to the top.
Conversely, for those with AC joint impingement - what is essentially bone rubbing up against bone - you see a "painful arc" only at the last portion of abduction:
You can usually confirm your suspicions on this front with direct palpation of the AC joint and checking to see if folks have pain when reaching across the chest.
Much of the training modifications will be the same for these two conditions, but there are also going to be several key things that should be managed completely differently. For instance, front squatting someone with an AC joint issue would not be a good idea due to the direct pressure of the bar on the AC joint; it would, however, be just fine for most cases of external shoulder impingement. In another example, some serious AC joint issues are exacerbated even by just doing the end-range of a rowing motion (to much shoulder extension/horizontal abduction) - whereas even folks with full-blown rotator cuff tears can generally do rows pain-free.
Q: What do you think of Bodyblades and how - if at all- should they be incorporated into a pitcher's routine?
A: As many of you know, I'm a fan of integrating rhythmic stabilization drills that train the true function of the rotator cuff: maintaining the humeral head in the glenoid fossa. I wrote about it in some depth HERE, and Mike Reinold and I spent quite a bit of time on it in our Optimal Shoulder Performance DVD set.
Of course, if you compare the perturbations to stability that the Bodyblade provides, it appears to simulate some of what you'd get with a rhythmic stabilization drill. So, it's probably a good alternative to a pitcher who doesn't have a training partner, therapist, or coach who can provide those destabilizing torques. Shirts, apparently, are optional.
That said, to me, using a Bodyblade is a more closed-loop (predictable) drill, whereas manual rhythmic stabilizations are more open-loop (unpredictable). So, it goes without saying that the benefits of "surprise" stabilization probably extend a lot further - and they don't cost a penny. Moreover, I've heard claims about the Bodyblade being an effective way to build muscle, which (outside an untrained population) just isn't going to happen. There are also much better ways to train the core.
In the same grain as Monday's post on lower back pain, today, I thought I'd highlight some of the common findings in diagnostic imaging of the shoulder, as these findings are just as alarming.
Do you train loads of overhead throwing athletes (especially pitchers) like I do? Miniaci et al. found that 79% of asymptomatic professional pitchers (28/40) had "abnormal labrum" features and noted that "magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of 'nonclinical' findings." Yes, you can have a torn labrum and not be in pain (it depends on the kind of labral tear you have; for more information, check out Mike Reinold's great series on SLAP lesions, starting with Part 1).
This isn't just limited to baseball players, either; you'll see it in handball, swimming, track and field throwers, and tennis as well. And, it isn't just limited to the labrum. Connor et al.found that eight of 20 (40%) dominant shoulders in asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears on MRI. Five of the 20 also had evidence of Bennett's lesions.
The general population may be even worse, particularly as folks age. Sher et al. took MRIs of 96 asymptomatic subjects, finding rotator cuff tears in 34% of cases, and 54% of those older than 60 - so if you're dealing with older adult fitness, you have to assume they're present in more than half your clients!
Also, in another Miniaci et al. study, MRIs of 30 asymptomatic shoulders under age 50 demonstrated "no completely 'normal' rotator cuffs." People's MRIs are such train wrecks that we don't even know what "normal" is anymore!
As is the case with back pain, these issues generally only become symptomatic when you don't move well - meaning you have insufficient strength, limited flexibility, or poor tissue quality. For more information on how to screen for and prevent these issues from reaching threshold, check out Optimal Shoulder Performance from Mike Reinold and me.
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