Home Posts tagged "Sports Injury"

Strength and Conditioning Programs: Acts of Commission vs. Omission

At the last Winter Olympics, Dutch speedskater Sven Kramer missed out on a gold medal because his coach, Gerard Kemkers, directed him into the wrong lane part way through the race.  Kramer finished the race with an Olympic record time - four seconds ahead of his nearest competitor - but was immediately disqualified because of an incorrect lane change with eight laps remaining on his long-time coach's cue. In the aftermath of the disqualification, Kemkers obviously came under a ton of scrutiny.  After all, he committed a pretty big coaching mistake - and it'll probably become a huge part of his legacy, as unfortunate as it is.


Here is a guy who has likely helped thousands of speed skaters over the years, presumably devoting countless hours to research, coaching, and becoming the best he could be - both as a coach and an athlete (he won a bronze medal at the 1988 Olympics).  And, as Kramer noted, it is hard to argue with the success Kemkers helped him achieve:  "Three times world champion, four times European champion, so many World Cups and Olympic gold in the 5,000 meters." In the process, Kemkers had to have omitted little to nothing; otherwise, he wouldn't have been coaching at such a high level. Had Kemkers never endeavored to get to a high level - or taken shortcuts to get there - there would have been countless omissions along the way: gaps in his knowledge, an inability to befriend athletes, and a fundamental misappreciation for what it takes to compete at a high level.  He would have been mediocre at best.


Kemkers' mistake was an act of commission, not omission. Meanwhile, millions of "armchair" quarterbacks around the world will criticize him for being an idiot, when in reality, the opportunity to make this mistake might never have come along if he hadn't spent so much time preparing to not be an idiot. Speedskating isn't really our thing here in the United States, so let's apply this to something that better fits our existing schema: ACL injuries in female athletes.  We know ACL tears are extremely common in female athletes, particularly those participating in basketball, gymnastics, and soccer.  I actually recall reading that the average NCAA women's soccer team has one ACL tear every year, and that typically, 1 in 50 female NCAA basketball players will blow out an ACL in a given season.  These numbers may be a bit dated now, but you get the point: if you don't train to prevent these injuries, you're omitting an insanely valuable initiative that protects your athletes...and mascots.


Now, we need to see another "ACL Injury Prevention Protocol" on Pubmed like I need to experience another Tony Gentilcore Techno Hour.  In other words, there are plenty of them out there, and we know what kind of strength and conditioning programs work; it is just about execution. So, let's take your typical strength and conditioning coach who puts his female athletes through everything he should to protect them from ACL injuries - but one girl drops a weight on her foot and breaks a toe to miss the rest of the season. Had he omitted external loading from his strength training program, this never would have happened - but he probably would have had four times as many ACL tears as broken toes and his athletes wouldn't have performed as well.  Here, an act of omission would have been far worse than an act of commission - just like we saw with Kemkers.  This isn't always the case, but it's important to realize that two kinds of mistakes occur, and sometimes you're better being proactive and making a mistake than you are ignoring a responsibility and just keeping your fingers crossed. It's been said before that strength and conditioning programs are both a science and an art - and the art is interpreting what to leave out and what to include in light of risk-reward for each unique athlete.  For instance, a front squat is a fantastic exercise from a scientific standpoint, but on the art side of things, it may not be appropriate for an athlete whose spine doesn't like axial loading.  Or, it may be a problem if an athlete hasn't been front squatting, and introducing it right before competition would cause soreness that might be counterproductive to performance. Think about how this applies to the next strength and conditioning program you write, and the next client/athlete you coach. Related Posts Risk-Reward in Training Athletes and Clients Why Wait to Repair an ACL? Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
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What Stupid Stuff Have You Seen in the Gym?

I recently came across a study in the American Journal of Sports Medicine that showed that over an 18-year period, an estimated 970,801 weight-training-related injuries presented in emergency rooms around the country.  That's an average of 53,934 injuries per year...nationwide.

Based on the market research from back when we wrote Maximum Strength, about 23 million Americans lift weights for exercise - meaning that one out of every 426 people who lifts weights actually gets jacked up enough during a training session that he/she has to to go the hospital.

Now, I'll be honest: while I have seen people do some INSANELY STUPID stuff in commercial gyms, I can't say that I've ever seen anything that warranted a trip to the hospital.  Obviously, I've lived a bit of a sheltered life in owning Cressey Performance for the past three years and working in either private training facilities or college weight rooms since 2003, but one would think that I could have come up with at least ONE gruesome story.  Alas, nothing comes to mind...not even a goofy laugh while benching.

So, I'm counting on you, my loyal and entertaining readers, to provide me with some good stories in the comment section below.  What outlandish stuff have you seen in gyms that has landed some schmuck in the emergency room?

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How to Progress back to Deadlifting after a Back Injury

Q: I'm finally recovered from my deadlifting injury, which was a strain of my right lumbar erector spinae.  I would like to start trying to deadlift again, but what's the best way to start? With rack pulls? Isolated lower back machines? Hyperextensions? Or, straight into deadlifts? A: The answer would be "E: None of the above."  Of course, it depends on the person, as always! First, you need to make sure that your body is ready to get back to deadlifting in any capacity. That's something I can't tell you without knowing more about your situation, but you should address it with a qualified professional before you get back to the activity that originally injured you. Second, in terms of maintaining a training effect while you're on the shelf, I generally stick purely with single-leg variations with recent back issues.  They allow us to gradually reintroduce compressive loading in a situation where the center of gravity is maintained within the base of support.  In other words, we minimize shear stress, and we make sure that the spine is in neutral, where it's in the best position to handle compression.  I usually start with body weight variations, then progress to variations loaded with dumbbells, and then move to a barbell reverse lunge with a front squat grip.  Depending on the person, we may also use glute-ham variations and sled pushing/pulling. Down the road, I prefer pull-throughs and trap bar deadlifts as early progressions, with sumo deadlifts and rack pulls following before any progression to conventional deadlifts from the floor.  This, of course, assumes that you have a body that's even capable of doing a deadlift correctly.  A lot of people have functional (poor ankle or hip mobility) or structural (long femurs or short arms) that make conventional deadlifting unsafe.  They may be better with other variations (as noted above) or no deadlifting at all. When the time is right, we generally start people off with speed deadlifts - emphasizing perfect technique - at 50-60% of estimated one-rep max. Of course, everyone is different - so you should get checked out and listen to your body. Recommended Reading: Lower Back Savers: Part 1 Lower Back Savers: Part 2 Lower Back Savers: Part 3
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Eric Cressey is Unbalanced

Things are pretty crazy as we get the ball rolling for summer training at Cressey Performance, but I was lucky to have some content "in the well" from an interview I recently did for Jen Sinkler at Experience Life Magazine. Check it out: Eric Cressey is Unbalanced
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A Great Read on Being Barefoot

Just came across this excellent article: Feet Hurt? Stop Wearing Shoes
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Training in Extreme Positions

Q: Regarding your latest article, though this is good info, I think rounded back training is useful – especially when it comes to the ground combat sports. Sometimes you find yourself in very odd positions and you need to know your body and how it will function in those cases when you have to exert extreme force in a bad position.

A: I have to respectfully disagree.

By that same line of reasoning, boxers get hit in the head all the time in matches. Getting punched in the face in training to prepare for that isn't going to help them much long-term, though.

The problem is that you're comparing an unloaded lumbar flexion event with a lumbar flexion event that includes marked compressive forces - a recipe for disaster (especially if rotation is involved). For more information, check out this previous newsletter.

Eric Cressey
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Prevent Striking Injuries

Q: Technique aside, what is your prescription for combat sport athletes looking to prevent injury from striking? To clarify; when myself and a few of my boxing brethren hit the super-heavy bag, or the firm thai pads, we often feel the reverberation in our arms and rear delts. Personally, I have an injury to my left shoulder, which means any impact reverberation is extra bad and cuts my workouts down to about three minutes (less if I'm doing low hooks). I know that some of the others have similar problems, mine is just more acute thanks to the bum shoulder. I don't feel this when hitting other people, or the softer bags, only the heavy duty, or extra thick ones. If you have any suggestions as to what work we should do to prevent this turning into injury, we'd all appreciate it. A: Something interesting for you. I work with a local high profile theatrical performance group that involves a lot of drumming. These guys have more upper extremity issues than anyone I've ever seen - baseball players included – and that's a really screwed up population). Is striking a thai pad anything more than a really hard drumming stroke in terms of the force dissipation? I've had good success with those guys with getting maximal strength up; check out this article where I talk about the role of maximal strength in the law of repetitive motion (“F” is expressed as a percentage of maximal strength; get tissue stronger, and each rep is perceived as less challenging overall). In particular, I’m talking strength of the elbow flexors (biceps, etc), upper back, “core,” and larger muscles from the hip-down. Soft tissue work is huge at the forearms/elbow (flexor carpi ulnaris, flexor carpi radialis, pronator teres, anconeus) and shoulder (pec minor, long head of triceps, coracobrachialis, subscapularis, infraspinatus/teres minor, and levator scapulae). I love the movements on the Inside-Out DVD; we've used it with great success. Tags: shoulder pain, combat athletes, drumming, baseball, Inside-Out, boxing, heavy bag
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Correlating Pec Tears and Benching

Q: Is there any reason why there is such a big incidence of pec tears during benching in comparison to shoulder/triceps/lat tears, especially if powerlifting style is supposed to de-emphasize the use of the pecs? A: Research at Indiana University found that cross-sectional area of the subscapularis is the best predictor of powerlifting performance, believe it or not. If you're getting that much hypertrophy of the subscapularis, it's doing a lot of work - and for a small muscle. Ask any manual therapist, and they'll tell you that subscapularis is always balled up - and frequently shuts down due to repetitive microtrauma. Shut subscapularis down, and pec major will work overtime as an internal rotator of the humerus. Reference Shirley Sahrmann's work; if you see an strained/tight muscle, look for an underactive synergist. You'll also get a humeral anterior glide, and additional tightness/restrictions on infraspinatus/teres minor. So, the name of the game is to activate subscapularis with exercises like those in Inside-Out, and also improve the length and tissue quality of your external rotators. Eric Cressey
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Active vs Passive Restraints

I’m of the belief that all stress on our systems is shared by the active restraints and passive restraints. Active restraints include muscles and tendons – the dynamic models of our bodies. Passive restraints include labrums, menisci, ligaments, and bone; some of them can get a bit stronger (particularly bone), but on the whole, they aren’t as dynamic as muscles and tendons. Now, if the stress is shared between active and passive restraints, wouldn’t it make sense that strong active restraints with good tissue quality and length would protect ligaments, menisci, and labrums (and do so through a full ROM)? The conventional medical model – whether it’s because of watered-down physical therapy due to stingy insurance companies or just a desire to do more surgeries – fixes the passive restraints first. In some cases, this is good. For instance, if you have an acromioclavicular joint separation with serious ligament laxity, you’ll likely need surgery to tighten those ligaments up, as the AC joint is an articulation without much help from active restraints. In other cases, it does a disservice to the dynamic ability of the body to protect itself with adaptation. Consider the lateral release surgery at the knee, where surgeons cut the lateral retinaculum on the outside of the knee, allowing the patella to track more medially. I’ve seen a lot of people avoid the surgeries (and, in turn, the numerous possible complications) with even just 2-3 weeks of very good physical therapy focusing on the active restraints. I’m not saying all these surgeries are contraindicated – just that we need to exhaust other options first. So, the next time you’ve got an ache or pain, consider whether it’s an active or passive restraint giving you problems – and if it’s the latter, work backward to find out which active restraint you need to bring up to par.
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Public Access: Not Just for Wayne and Garth

Click the link below to view an hour-long interview I did on the Audrey Hall Show alongside Rich Gedman (former Red Sox catcher and current manager of the Worcester Tornadoes) and Bunky Smith (head coach of Framingham's American Legion Team) on the topic of youth baseball training.

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