Happy Monday! It's been two weeks since my last recommended reading compilation, as I took a little blog hiatus last week in light of some travel and the chaos that is the professional baseball offseason. The good news is that it gave me time to stockpile some good content for you. Here goes...
Tinkering vs. Overhauling - and the Problem with Average - One of our interns asked me about my thoughts on the "average" range of motion at a particular joint, and it got me to thinking about this article I wrote last year. There are big problems with using averages in the world of health and human performances, so I'd encourage you to give it a read to learn more.
Using extra conditioning to make up for poor diet is a definite path to continuing to use extra conditioning to make up for poor diet for a long time. Slippery slope. You're better off plugging the leak in the roof (diet) than you are buying more buckets to collect the water.
Happy Monday! The MLB regular season ended yesterday, so you could say that this is yet another reminder that the Cressey family "inseason" has begun. Our craziness starts when all the players' lives slow down a bit. Here's a little recommended reading for you:
Dr. Andy Galpin on How to Unplug from Tech and Social Media - This was a fascinating podcast with Dr. Galpin from Mike Robertson, where they critically review the role of technology and data collection in the training process. The points on the need to unplug from technology and social media really hit home for me, too, and I'll be checking out his book soon!
My Body Let Me Down...Again - This was a great article from Gray Cook on all the potential causative factors for why we may hurt. Many people default to the explanation that their bodies simply fail them, when in reality there were likely a lot of things "missed" on the path to that declaration. Aside from trauma, injuries are rarely just "happenstance."
As we wind down to the holidays, here's the last installment of Random Thoughts on Sports Performance for 2016.
1. One of the most overlooked benefits of medicine ball training might be the frequency at which it can be trained.
Before I get to this point, check out this old video of mine on the Absolute Strength-Speed Continuum (if you haven't seen it already):
One of the things I've been thinking about is that medicine ball training doesn't absolutely crush people the same way that absolute speed work (whether it is sprinting, jumping, throwing a baseball, or something comparable), strength-speed (Olympic lifts, jump squats), and heavy lifting does. You could likely train it every day, and while it wouldn't be optimal, people could handle it and still derive some benefit.
More than likely, it's just a sweet spot in the "Force = Mass x Acceleration" equation. The mass is pretty low (especially since there really aren't huge ground reaction forces like we see in sprinting), and the acceleration drops off quite a bit. This likely parallels what we see with baseball vs. football throwing; the football is just much less stressful.
This doesn't help us a lot in the quest for developing peak power, but it does give us a really good option for training power - especially rotationally - more frequently.
2. Good thoracic positioning will help you make the most of your overhead medicine ball training.
Speaking of medicine balls, check out this side-by-side comparison of two athletes that I recently posted on my Instagram account. On the left is one with a "normal" thoracic curvature and set of movement capabilities. He can get into thoracic extension at the top, and effectively flex at the bottom to deliver the scapula to the correct position for ball release. On the right, though, notice how flat the upper back stays at the ball release position. We'd like to see him able to round a bit more to ensuring a good convex-concave relationship between the scapula and rib cage.
3. Narrow exercise selections make for impressive lifters, but less impressive athletes.
With our typical minor league baseball player, we may actually have time to get through six 4-week programs over the course of an offseason. In six months - especially if we happen to have an athlete who is genetically gifted for strength development - we *could* get guys freaky strong on a few big lifts. We choose not to, however. Why?
A narrow exercise can lead to some very impressive weight room performances on a few lifts: squat, bench press, deadlift, clean, etc. This specificity can be great if you want to be a one (or three) trick pony (powerlifter), but not quite as helpful if you're an athlete who actually needs to change directions. To this end, a few thoughts:
a. I'd much rather see an athlete with a more versatile "strength portfolio." Show me a 200-pound athlete who can front squat in the mid-300s, deadlift in the mid-500s, turkish get-up in the 80s, and do axial-loading single-leg work in the mid-200s, and I'll show you a guy that has a great foundation to really move well.
b. These strength numbers aside, eventually, your priority needs to shift from just building strength to actually using that quickly. Simply chasing a number on one lift can quickly leave you unprepared in a particular movement/plane or in the context of creating more usable strength. I out-deadlift all of our pro baseball players, but many of them can broad jump longer than I can; who is using their force more efficiently?
c. If you do insist on this narrower "main" exercise selection can be offset by variety in warm-ups, sprint/agility work, and assistance strength training drills.
d. I think narrower exercise selections have the most benefit in beginning lifters and teenage athletes who need to build a solid foundation and awareness of putting force into the ground. I'd honestly have no problem with sticking with the same 3-4 "main" exercises for 3-4 months straight in this population, although you have to be sensitive to the fact that some athletes will get really bored quickly. For this reason, we'll try to simple incorporate subtle changes; as an example:
Month 1: Trap Bar Deadlift (6-8 reps per set)
Month 2: Trap Bar Deadlift (4-5 reps per set)
Month 3: Trap Bar Deadlift vs. Band or Chains
Month 4: Low Setting Trap Bar Deadlift
Obviously, we don't rigidly adhere to this, but it gives you a feel for how to add some variety without overhauling things and having to completely re-groove a new skill.
That's all for 2016; happy holidays!
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I thought I'd use today's post to throw out some thoughts on training the shoulders.
1. In the upper extremity, the assessments are often the solutions, too.
Imagine you're assessing an athlete, and their squat pattern is absolutely brutal. Usually, the last thing you're going to do is go right to a squat as part of their training. In other words, simply coaching it differently usually won't improve the pattern immediately. Rather, you typically need "rebuild" the pattern by working with everything from ankle and hip mobility to core control, ultimately progressing to movements that replicate the squatting pattern.
Interestingly, the upper extremity is usually the opposite in that the assessment might also be the drill you use to correct the movement. For instance, an aberrant shoulder flexion pattern like this...
...might be quickly corrected with some of these three cues on a back to wall shoulder flexion pattern.
This is also true of push-up assessments and shoulder abduction and external rotation tests we do; funky patterns are usually cleaned up quickly with some subtle cueing. This just isn't the case as much in the lower body, though. Why the difference?
My theory is that because we're weight-bearing all day, the lower extremity is potentially less responsive to the addition of good stiffness in the right places. Conversely, a little bit of stiffness in serratus anterior, lower trap, or posterior cuff seems to go a long way in quickly improving upper extremity movement. My experience with the Postural Restoration Institute also leads me to believe that creating a good zone of apposition can have lead to a more pronounced transient movement in the upper extremity than it does in the lower extremity. This is likely because the rib cage is directly involved with the shoulder girdle, whereas the relationship with the lower extremity (ribs --> spine --> pelvis) is less direct.
These differences also seem to at least partially explain why upper extremity posture is much easier to change than lower extremity positioning. It's far more common to see a scapular anterior tilt change markedly than it is to see an anterior pelvic tilt substantially reduced.
Just thinking out loud here, though. Fun stuff.
2. Anterior shoulder pain usually isn't "biceps tendinitis."
First off, true tendinitis is actually quite rare. In this landmark paper, Maffulli et al. went to great lengths to demonstrate that the overwhelming majority of the overuse tendon conditions we see are actually tendinOSIS (degenerative) and not tendinITIS (inflammatory). It may seem like wordplay, but it's actually a very important differentiation to make: if you're dealing with a biceps issue, it's probably tendinosis.
Second, if you speak with any forward thinking orthopedic shoulder specialist or rehabilitation expert, they'll tell you that there are a lot of differential diagnoses for anterior (front) shoulder pain. It could be referred pain from further up (cervical disc issues, tissue density at scalenes/sternocleidomastoid/subclavius/pec minor, or thoracic outlet syndome), rotator cuff injury or tendinopathy, anterior capsule injury, a lat strain or tendinopathy, labral pathology, nerve irritation at the shoulder itself, arthritis, a Bankart lesion, osteolysis of the distal clavicle, AC joint injury, and a host of other factors.
3. Thoracic outlet surgery really isn't a shoulder surgery.
Over the past few years, each time a professional pitcher gets thoracic outlet surgery, you see many news outlets call it "shoulder surgery." Sorry, but that really isn't the case unless you have a very expansive definition of the word "shoulder."
With this intervention, the surgeon is removing the first (top) rib to provide "clearance" for the nerves and vascular structures to pass underneath the clavicle.
Additionally, surgeons usually opt to perform a scalenectomy, where they surgically remove a portion of the anterior scalenes, which may have hypertrophied (grown) due to chronic overuse. Again, this is not a "shoulder" procedure.
Finally, more and more surgeons are also incorporating a pec minor release as part of the surgical intervention. This is because the nerve and vascular structures that may be impinged at the scalenes or first rib can also be impinged at the coracoid process of the scapular if an individual is too anterior-tilted. While the coracobrachialis and short head of the biceps both attach here, the pec minor is likely the biggest player in creating these potential problems.
This, for me, is the only time this becomes somewhat of a "shoulder" surgery - and it's an indirect relationship that doesn't truly involve the joint. We're still nowhere near the glenohumeral (ball-and-socket) joint that most people consider the true shoulder.
All that said, many people consider the "shoulder girdle" a collection of joints that includes the sternoclavicular, acromioclavicular, glenohumeral, and scapulothoracic articulations. In this case, though, the media just doesn't have a clue what they're trying to describe. With that in mind, hopefully this turned into somewhat of an educational rant.
4. Medicine ball scoop tosses tend to be a better than shotputs for cranky shoulders.
Rotational medicine ball training is a big part of our baseball workouts, and it's something we try to include as an integral part of retraining throwing patterns even while guys may be rehabilitating shoulder issues. When you compare rotational shotputs with rotational scoop tosses...
...you can see that the scoop toss requires far less shoulder internal rotation and horizontal adduction, and distraction forces on the joint are far lower at ball release. The shotput is much more stressful to the joint, so it's better saved for much later on in the rehab process.
5. Adequate rotator cuff control is about sufficient strength and proper timing - in the right positions.
To have a healthy shoulder, your cuff needs to be strong and "aware" enough to do its job in the position that matters. If you think about the most shoulder problem, there is pain at some extreme: the overhead position of a press, the lay-back phase of throwing, or the bar-on-your back position in squatting. For some reason, though, the overwhelming majority of cuff strength tests take place with the arms at the sides or right at 90 degrees of elevation. Sure, these positions might give us a glimpse at strength without provoking symptoms, but they really don't speak much to functional capacity in the positions that matter.
With that in mind, I love the idea of testing rotator cuff strength and timing in the positions that matter. Here's an example:
Obviously, you can make it even more functional by going into a half-kneeling, split-stance, or standing position. The point is that there are a lot of athletes who can test pretty well in positions that don't matter, but horribly in the postures that do.
6. Pre-operative physical therapy for the shoulder is likely really underutilized.
It's not uncommon to hear about someone with an ACL tear going through a month or so of physical therapy before the surgery actually takes place. Basically, they get a head start on range-of-motion and motor control work while swelling goes down (and, in some cases, some healing of an associated MCL injury may need to occur).
I'm surprised this approach isn't utilized as much with shoulder surgeries. It wouldn't be applicable to every situation, of course, but I think that in some cases, it can be useful to have a pre-operative baseline of range-of-motion. This is particularly true in cases of chronic throwing shoulder injuries where regaining the right amount of external rotation is crucial for return to high level function. Adding in some work on cuff strength/timing, scapular control, and thoracic mobility before hopping in a sling for 4-6 weeks probably wouldn't hurt the case, either. And, as an added bonus, if this was more common, I think we'd find quite a few people who just so happen to become asymptomatic, allowing them to cancel their surgeries. It's probably wishful thinking on my part, but that's what these random thoughts articles are all about.
For more information on approaches to evaluating, coaching, and programming for the shoulder, be sure to check out Sturdy Shoulder Solutions.
Have a great weekend!
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I hope everyone had a great 4th of July with friends and family. In light of the holiday, we're a day late with this recommended reading collection, but the content is top notch to make up for the delay. Enjoy!
Spark - This book is a few years old, but that doesn't make it out-of-date by any stretch of the imagination. This an absolutely fantastic look at how exercise impacts the brain and our overall health, with respect to everything from learning, to depression, to menstrual symptoms, to ADHD. If you work in the world of health and human performance, it's must-read material.
RTS Coaching: Thorax Rotation - Mike Robertson posted this coaching video, and I love the "laser" cue he utilizes to help athletes differentiate between movement of the thorax and that of the shoulders.
The Cressey Sports Performance Difference: Individualization - Here's a new promotional video we filmed this past offseason for our Elite Baseball Development program.
Top Tweet of the Week: My Twitter game was lame over the past week, so I'll just plug in a friendly reminder that I'm now on Snapchat.
After reading Bobby Tewksbary's great resource, Elite Swing Mechanics, I've been thinking about the characteristics of elite hitters. Just as Bobby breaks down swing mechanics to identify growth areas, I'm always looking to find physical limitations that might interfere with an athlete's ability to best "acquire" the swing mechanics guys like Bobby are seeking. Here are six physical attributes I've noticed in most elite hitters.
1. Sufficient Hip Mobility
You don't have to look any further than the rise in hip injuries over the past decade to recognize just how aggressive the hip rotation is during the baseball swing. In particular, it's essential for hitters to have sufficient hip internal rotation and extension. Unfortunately, these ranges of motion are usually the first to go in the dysfunctional lumbopelvic (hip/lower back) postural presentations we see. As the pelvis dumps forward into anterior tilt, it blocks off internal rotation - and the athlete will preferentially extend through the lower back instead of the hip.
This leads to not only limited hip function, but also an increased risk of injury. The athlete may develop bony overgrowth (femoroacetabular impingement; read more here) on the head of the femur or the hip socket, a torn labrum, a sports hernia, or a number of other hip issues. There may also be extension-based lower back pain, including stress fractures and disc injuries. This loss in hip motion is generally related to point #2...
2. Sufficient Core Control
Many of the hip mobility restrictions we see in these athletes aren't just because muscles are actually short, or bony blocks have developed to restrict range of motion. Rather, they may be in place because the athlete's core control is so out-of-whack that alignment issues actually limit range of motion. Imagine driving a car that's out of alignment; turning to one side will ultimately wind up being more difficult. The good news about this scenario is that it's often possible to get quick changes in an athlete's hip mobility just by modifying posture, incorporating positional breathing, and doing a bit of activation work. I've seen athletes gain more than 30 degrees of hip internal rotation in a matter of 30 seconds without manual therapy or stretching, so adding some core control in the right places can definitely be a powerful thing.
Remember, the research clearly demonstrates that the core works to transfer - not develop - force during the baseball swing. Its job is to take the force developed in the lower extremity and make sure that it is delivered to the upper extremity and, ultimately, the bat. This function should be reflected in the exercise selection we use, as we gravitate toward rotational medicine ball variations and chops/lifts rather than sit-ups, crunches, and side bends.
3. Sufficient Thoracic (Upper Back) Mobility
One of the key points Bobby made in his article earlier this week was that Pujols - like all elite hitters - gets his hips moving forward while his hands are still held back and up (and actually moving further back and up). To do this, you need three things. We've covered the first two: hip mobility and core stability. However, you also need sufficient mobility through your upper back to allow this "separation" to occur. Even if the hip and core components are ideal, if the upper back isn't sufficiently mobile, the hands can't stay back to allow a) force transfer without "energy leaks" and b) the right timing for this transfer. As Bobby also noted, if the hands can't stay back long enough, the hitter has less time to see and react/adjust to the pitch that's thrown. In short, a physical limitation can quickly become a mechanical issue. I should note that while thoracic rotation (transverse plane) is predominantly what we're seeking, you can't have sufficient rotation if you're stuck in a rounded upper back posture (flexion/sagittal plane). If you look like this, you'll need to get your extension back to help unlock the rotation you seek.
4. The Ability to Hip Hinge
This point really goes hand-in-hand with #1 from above, but I think it's important to distinguish the hip hinge (hip flexion with a neutral spine) as pre-loading, whereas the extension and internal rotation that takes place is actually unloading. In other words, the former stores the elastic energy we need, while the latter releases it over a sufficient range of motion. Candidly, I'm shocked at how many young athletes have lost the ability to hip hinge correctly. You'll see it quite a bit in more advanced hitters as well, and they're usually the higher-level guys who have hip and lower back problems. If you can't effectively pre- load your hips, you'll have to go elsewhere to get your power - or you just won't create it. A detailed review of what a good hip hinge is and how to train for it could be (and is) a full-day seminar. Basically, this is as much a stability limitation and patterning problem as it is an actual flexibility deficit. Put these three components together, and you have your "mobility" potential.
Without getting too sidetracked, here's a quick rule with respect to the hip hinge: players need to be able to touch their toes without a huge knee bend (greater than 30 degrees) or hyperextension of the knees.
Sure, we need to consider how much posterior hip shift there is, whether they can reverse the lumbar curve, and whether they return from the toe touch with predominantly hip or lower back motion, but I think the quick screening rule from above is a good place to start.
5. Lower Body Strength/Power
You don't have to be an elite powerlifter or Olympic lifter to hit home runs. However, you do need enough strength and - just as importantly - the ability to display that force quickly. On the strength side, I seriously doubt you'll find many hitters in the big leagues who aren't capable of deadlifting at least 1.5 times their body weight, and if you do find some, they're probably guys who have been around for quite some time and gotten much more efficient with their patterning to use every bit of force they have in the tank. Or, they're just carrying too much body fat. On the power side, it's not good enough to just be a weight room rockstar. It's also important to be able to take that strength and apply it quickly in more sport-specific contexts with drills like rotational medicine ball throws, sprinting, jumping and, of course, hitting and throwing. Once you've got the foundation of strength, your power training can really take off - and that includes your swing mechanics. Until you're able to put more force into the ground, it's going to be difficult to generate more bat speed unless you have glaring deficiencies in your swing mechanics that can be cleaned up.
6. Great Sports Vision
You can't hit what you can't see - and elite hitters almost always have elite vision. Some of this is outside your control, but I always encourage all our baseball guys to get thorough yearly eye exams. I'm a bit biased because my wife is an optometrist, but I've seen players for whom vision corrections with contact lenses and glasses has been a complete game-changer.
Wrap-up
This is certainly not an exhaustive list of physical attributes of high-level hitters, but it's a good start. Building on this point, as examples, you'll notice I didn't say "tremendous forearm strength" or "a huge bench press." Some guys might have these "proficiencies," but that doesn't mean they're absolutely essential for high-level hitting. Many hitters might develop appreciable forearm strength from the act of hitting over many years, but that doesn't mean they had to specifically train it to make that advancement. And, on the bench press front, there may be guys who've trained the bench press heavily, but never recognized that it might not have had much of an impact on their hitting performance. This is why we have to look at the big picture and see what ALL elite hitters are doing to be successful.
If you're looking to learn more about the technical aspects of hitting that go hand-in-hand with these points, be sure to check out Bobby's Elite Swing Mechanics e-book. I highly recommend it - especially at such a great price.
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With my last post, I kicked off the "Best of 2014" series with my top articles of the year. Today, we'll highlight the top five videos of the year. These videos only include instructional videos, not quick exercise demonstrations.
1. Thoracic Mobility and Back Squatting - Upper back positioning is a key factor in squat technique, but not everyone starts in the same position. Check out the video to learn more:
2. Serratus Wall Slide Variations - Serratus anterior is an incredibly important muscle for shoulder health and function. Here are two exercises we use in our serratus anterior activation progression.
3. Do You Really Have Poor Ankle Mobility? - It's been my experience that ankle flexibility restrictions are really "overdiagnosed," and in reality, people just don't know how to shut off their plantarflexors (calves) as part of a heavily extended posture. I elaborate in this video:
4.Are You Packing the Shoulder Correctly? - It's important to be able to pack the shoulder, but in many cases, folks don't know exactly what is or should be going on functionally. This webinar should clarify.
5. Limited Shoulder Flexion in Pitchers - We often hear that shoulder dysfunction relates to elbow pain in throwers, but very rarely do we hear the "why" behind this link. In this video, I elaborate:
I'll be back soon with the top guest posts of 2014!
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It's been nine months since I last posted an update to this coaching cues series, so this post is long overdue! Here are three technique coaching cues you can put into action:
1. "Follow the arm with the eyes."
We'll often see individuals who try to do thoracic mobility drills like the side-lying windmill, but wind up turning them into potentially harmful stretches for the anterior shoulder. Basically, you'll see too much arm movement and not enough upper back movement. One way to increase movement of the upper back is to "drive" it with the eyes, which effectively keeps us in a more neutral neck position. Check out the demonstration video from The High Performance Handbook video library for more details:
2. "Build up tension through the hamstrings over the next five seconds."
I normally don't like internal focus cues, but this would be an exception. I generally use this cue specifically when we have a beginning lifter who is learning to deadlift, but it can also be incorporated with an intermediate lifter who struggles with early knee extension and the hips shooting up too early. Basically, it slows the lifter down, but still encourages him to apply force into the floor.
I'll have the individual set up the starting position, but not initiate the deadlift unless everything is perfect - from the feet up to the head. Then, I'll tell him to gradually build up tension in the hamstrings over the course of five seconds, with the bar slowly breaking the floor at the end of that period of time. It won't lead to great bar speed (something we ultimately want), but that's not of great concern when we're simply trying to optimize technique.
As an important add-on, make sure the athlete has already taken the slack out of the bar before you initiate the hamstrings cues:
3. "Where the arm goes, the shoulder blade goes" - and vice versa.
This is a coaching cue I recently heard physical therapist Eric Schoenberg use at one of our Elite Baseball Mentorships, and I loved it. It simplified something I'd been trying to create with kinesthetic coaching (actually putting an athlete's shoulder blade in the position I wanted).
There are a lot of folks out there still teaching clients and athletes to "lock down" the scapula during rowing exercises, or make the rowing motion segmented into "retract and THEN pull." The truth is that the upper extremity doesn't work like this in the real world; otherwise, we'd all move like robots. Healthy upper extremity action is about smooth, coordinated movements of the scapula on the rib cage (scapulothoracic joint) while the ball and socket (glenohumeral joint) maintain a good congruency, just like a sea lion balancing a ball on his nose.
If you move the ball (humerus) without moving the socket (sea lion) with it, the ball falls off (comes unstable). The same thing can happen if you move the socket without moving the ball. The question then becomes: what active or passive restraints have to pick up the slack for the excessive motion that takes place? It can be the biceps tendon, rotator cuff, labrum, or shoulder capsule.
If we teach people to move the shoulder blade and humerus independently of one another - and load that pattern - we're really just establishing a faulty movement strategy that can't be safely reproduced under higher velocities. You can learn a bit more in this video:
Hopefully you enjoyed these tips and will benefit from applying them in your strength training programs. If you have other exercises you'd like covered, please just let me know in the comments section below.
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We spend a good chunk of our lives standing on one-leg. Obviously, that means we need to train on one leg, but it's also important that fitness professionals and rehabilitation specialists assess folks when they're in single-leg stance, too. Enter the overhead lunge walk, which is likely my favorite assessment because of just how comprehensive it is.
Why is it so great? Let's examine it, working from the upper extremity to the lower extremity.
First, you can evaluate whether someone has full extension of the elbows. Just tell folks to "reach the fingers to the sky." In a baseball population, as an example, you can quickly pick up on an elbow flexion contracture, as it's quick and easy to make a comparison to the non-throwing side.
Additionally, you can screen for congenital laxity, as a lot of hypermobile (loose jointed) folks will actually hyperextend the elbows during the overhead reach.
At the shoulder girdle, you can evaluate whether an individual has full shoulder flexion range of motion:
You can also tell whether the aforementioned hypermobile folks actually move excessively at the ball-and-socket joint of the shoulder, as they'll actually go too far into flexion instead of moving through the shoulder blades.
You can determine whether an individual has an excessively kyphotic, neutral, or extended thoracic spine. If they're kyphotic, they'll struggle to get overhead without compensation (arching the lower back or going into forward head posture). If they've got an excessively extended thoracic spine, they'll actually go too far with the overhead reach (hands will actually wind up behind the head if it's combined with a very "loose" shoulder).
You can tell whether an individual is able to fully upwardly rotate the shoulder blades in the overhead position.
You can tell whether someone preferentially goes into forward head posture as a compensation for limited shoulder flexion, poor anterior core control, or a lack of thoracic spine extension or scapular posterior tilt.
You can evaluate whether an individual has enough anterior core control to resist extension of the lumbar spine (lower back) during overhead reaching. This is a great test of relative stiffness of the rectus abdominus and external obliques relative to the latissimus dorsi.
You can evaluate whether an individual is in excessive anterior or posterior pelvic tilt from the side view.
Also from the side view, you can determine whether the athlete hyperextends the knees in the standing position.
With the lunge, you can see if an athlete is quad dominant - which is clearly evidenced if the stride is short and the knee drifts out past the toes of the front leg. You can also venture a guess as to whether he or she has full hip extension range of motion.
Also with the lunge, you can determine how much control the athlete has over the frontal and tranverse planes; does the knee cave in significantly?
You can make a reasonably good evaluation of foot and ankle function. Does the ankle collapse excessively into pronation? Or, does he stay in supination and "thud" down?
Does the athlete handle the deceleration component effectively, indicating solid eccentric strength in the lower extremity?
As you can see, this assessment can tell you a ton about someone's movement capabilities and provide you with useful information for improving your program design. Taking it a step further, though, it goes to show you that if you select the right "general" assessments, you can make your assessment process much more efficient.
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If you've read much of my stuff (most notably this article), you likely appreciate that I think it's really important for fitness professionals to understand corrective exercise and post-rehab training. Folks are demonstrating poorer movement quality than ever before, and injuries are getting more and more prevalent and specific. For the fitness professional, corrective exercise can quickly become a tremendous opportunity - or a huge weakness. To that end, given that Dean Somerset put his great resource, Post-Rehab Essentials, on sale for $50 off through the end of the day, I wanted to devote some thoughts to the subject with these seven points of "Eric Cressey Randomness."
1. Refer out. - With more and more certifications and seminars devoted to corrective work, the industry has a lot more "corrective cowboys:" people who are excited to be able to "fix" everything. Unfortunately, while this passion is admirable, it can lead to folks taking on too much and refusing to refer out. To that end, I think it's important for us to constantly remind fitness professionals to not work outside their scope of practice.
Referring out is AWESOME. I do it every single day - and to a wide variety of professionals. It provides me with more information, and more importantly, helps me toward the ultimate goal of getting the client/athlete better. Trainers often worry that if they refer out, they'll lose money. This generally isn't true, but even if it was, it's a short-term thing. If you appreciate the lifetime value of the client, you'll realize that getting him/her healthy will make you more profitable over the long-term.
Additionally, I've developed an awesome network of orthopedic specialists in the greater Boston area. As a result, I can generally get a client in to see a specialized doctor for any joint in about 24-48 hours. It's an awesome opportunity to "overdeliver" to a client - but it never would have come about if I hadn't been willing to refer out. As an added bonus, we'll often get referrals from these doctors as well.
2. Ancillary treatments are key. - For my entire career, I've been motivated by the fact that I absolutely hate not knowing something. It's pushed me to always continue my education and not get comfortable with what I know, and it's helped me to be open-minded to new ideas. However, I'm humble enough to recognize my limitations. I know a lot about elbows, but I'm not going to do your Tommy John surgery. I've worked with more pitchers than I can count, but I'm not a pitching coach. And, even if I was able to do all these things, there's no way I'd have time to do them all and leverage my true strengths. In other words, I rely heavily on competent professionals around me for everything from sport-specific training, to manual therapy, to diagnostic imaging, to surgery, to physical therapy, to nutritional recommendations. Surround yourself with great people with great skillsets, and corrective exercise quickly becomes a lot easier.
3. Soft tissue work is effective.
Here's what I know: people feel better after they foam roll, and their range of motion improves. Additionally, soft tissue treatments have been around for thousands of years for one reason: they work!
For some reason, though, every 4-6 months, somebody with a blog claims that foam rolling is the devil and doesn't work, and then dozens of people blow up my email address with questions about whether the world is going to end.
The truth is that we know very little about why various soft tissue approaches work. I recall a seminar with bodywork expert and fascial researcher Thomas Myers from a few year back, and he commented that we "know about 25% of what we need to know about the fascial system." If Myers doesn't have all the answers, then Johnny Raincloud, CPT probably hasn't found the secrets during his long-term stay in his parents' basement.
With that in mind, I do think it's safe to say that not all people respond the same to soft tissue work, and certainly not all soft tissue approaches are created equal. Foam rolling doesn't deliver the same results as an instrument-assisted approach, and dry needling likely works through dramatically different physiological avenues than cupping. As a result, we're left asking the client: "does it make you feel and move better?" If the answer continues to be "yes," then I'll keep recommending various soft tissue treatments - including foam rolling - until someone gives me a convincing contrarian argument with anecdotal evidence.
4. Strength can be corrective.
Ever had a friend with anterior knee pain (patellar tendinopathy) who went to physical therapy, did a bunch of leg extensions, and somehow managed to leave asymptomatic? It was brutally "non-functional" and short-sighted rehab, but it worked. Why?
Very simply, the affected (degenerative or inflamed) tissues had an opportunity to rest, and they came back stronger than previously. A stronger tissue is less likely to become degenerative or inflamed as it takes on life's demands.
Good rehab would have obviously focused on redistributing stress throughout the body so that this one tissue wouldn't get overloaded moving forward. In the patellar tendon example, developing better ankle and hip mobility would be key, and strength and motor control at the hip and lumbar spine would be huge as well. Certainly, cleaning up tissue quality would be a great addition, too. However, that doesn't diminish the fact that a stronger tissue is a healthier tissue.
This also extends to the concept of relative stiffness. As an example, a stronger lower trapezius can help to overcome the stiffness in the latissimus dorsi during various upper extremity tasks.
And, a stronger anterior core can ensure corrective spine and rib positioning during overhead reaching - again, to overcome stiff lats.
Don't ever forget that it's your job to make people stronger. If you get too "corrective" in your mindset, pretty soon, you've got clients who just come in and foam roll and stretch for 60 minutes, then leave without actually sweating. You still have to deliver a training effect!
5. Minimalist sneakers might be your worst nightmare if you have high arches.
I love minimalist sneakers for my sprint and change-of-direction work. I don't, however, love to wear them on hard floors for 8-10 hours a day. I'm part of the small percentage of the population that has super high arches and doesn't decelerate very well, so cushioning is my best friend. Throwing in a $2 "cut-to-fit" padding in my sneakers has done wonders for my knees over the years, and I'll actually wear through them every 4-6 weeks.
The New Balance Minimus 00 is a sneaker I've been wearing recently to overcome this. It's a zero drop shoe (no slope down from the heel to the toe), and while lightweight, it offers a bit more cushioning (and lateral support, for change of direction) than typical minimal options.
All that said, just don't force a round peg in a square hole with respect to footwear. Some people just aren't ready for minimalist footwear - and even if they are ready to try them out, make sure you integrate usage gradually.
6. The pendulum needs to swing back to center with respect to thoracic spine mobilizations. - Thoracic spine mobility deficits are a big problem in the general population, given the number of people who spend too much time sitting at a computer. Athletes are a bit of a different situation, though, as some actually have flat (excessively extended) thoracic spines and don't need more mobility. As an example, check out the top of this yoga push-up before we corrected it.
This athlete has a flat thoracic spine, limited shoulder flexion, and insufficient scapular upward rotation. So, he'll logically go to the path of least resistance: excessive thoracic motion (as evidenced by the "arch" in his upper back). The shoulder blades don't rotate up sufficiently, and he's also "riding" on the superior aspect of his glenohumeral (shoulder ball-and-socket) joint. Here is it, "mostly" corrected a few seconds later:
By getting him to "fill up" the space between his shoulder blades with his rib cage (encouraging more thoracic flexion) and cueing better upward rotation of his scapula, we can quickly recognize how limited his shoulder flexion is. In the first photo, he's forcing shoulder ROM that isn't there, whereas in the second one, he's working within the context of his current mobility limitations.
If we just feed into his thoracic spine hypermobility with more mobilizations, we'll just be teaching him to move even worse.
7. You'll never address movement impairments optimally unless nutrition and supplementation are spot on. - It never ceases to amaze me how many athletes will bust their butts in the gym and in rehab, following those programs to a "T" - but supplement that work with a steady diet of energy drinks and crappy food. I'm not talking about debating whether grains and dairy are bad, and whether "paleo" is too extreme for an athlete; those are calculus questions when we should be talking about basic math. A lot of athletes literally don't eat vegetables or drink enough water. That's as basic as it comes. Movement quality will never improve optimally unless you're healthy on the inside, too.
This article was actually a lot of fun to write, so I'll probably turn it into a series for a bit down the road. In the meantime, though, I'd encourage you to check out Dean Somerset's Post-Rehab Essentials resource to learn more in this regard. I don't hesitate to endorse this comprehensive corrective exercise resource, as the content is fantastic, Dean is an excellent teacher, and the product provides some continuing education credits. The $50 off just sweetens the deal. Check it out HERE.
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