CategoriesExercise Technique Program Design Strength Training

9 Ways to Progress the Landmine Press

At the expense of coming across as the cantankerous, meanie-head strength coach for saying it, I’m going to go a head and say it anyways:

Exercise, for most people, most of the time, should be mind-numbingly monotonous.

Boring.

It should be boring.

Copyright: AlienCat / 123RF Stock Photo

 

I get it: boring isn’t sexy. And it sure as shit doesn’t help sell DVDs or keep people’s attention at 3 o’clock in the morning watching the latest infomercial on how performing 47 different bodyweight calisthenics while juggling two machetes – you know, to keep the body guessing – is the key to your ultimate body.

BONUS: If you order within 30 minutes you’ll also receive a month’s supply of grass-fed acai berries soaked in the belly-button sweat of a Centaur.

Because, why the fuck not? And, science.

People have been sold on the idea of incessant novelty and variety being the determining factor in getting results at the gym.

I disagree.

“The greatest gap in most people’s training isn’t lack of novelty, but rather lack of mastery.”

It’s telling, then, that many of the most popular training programs around and top coaches in the industry often predicate their roots and training around these basic movements: squat, hinge, push, pull, lunge, carry.[footnote]I’d add rotate and bicep curls to the mix. Important stuff.[/footnote] That’s it.

That’s about as un-sexy as it gets.

However, what’s often lost in the age of exercise ADD is that those six categories alone can be broken down into hundreds of iterations when you factor in variances in grip used, stance used, sets/reps, load, tempo, speed of movement, not to mention barbell vs. dumbbell vs. kettlebell vs. bulldozer (depending on how ginormous of a human you are).

There’s more than enough variety to keep even the most strident exercise enthusiast satiated for a fitness lifetime.

To that end, I can see why some people aren’t as enamored with the Landmine Press as others.

Upon first glance it’s the vanilla ice-cream or NASCAR of the strength and conditioning world.

“Oh, you mean, like, you just press the barbell up and down like that? At an angle? Repeatedly?

Cool.”

via GIPHY

It’s nerds like me who can see the bigger picture and can appreciate how valuable of an exercise/drill the Landmine Press is.

I’ve waxed poetic enough in the past on the importance of overhead mobility and people’s lack of ability to do so in a safe and efficient manner.

You can check THIS article out; or THIS one; or THIS one; or not.

I’m cool either way.

In the end, it’s a fantastic, joint-friendly way to perform “fake” overhead pressing for those who lack the requisite range of motion to do so.

Pressing up and down, at an angle, indeed, while seemingly boring, helps keep people out of their “danger zone”…yet still glean an effective training effect that helps build strong shoulders, core, and general levels of badassery.

And as much of a champion of monotony as I am, I can appreciate that, after a certain amount of time, it’s often prudent to up the ante and provide more excitement and, GASP, variety to the movement.

Here Are Some of My Favorite Progressions/Regressions/Lateralizations (Whatever Word Piques Your Interest Most) of the Landmine Press

1) A Quick Primer on Set-Up and Execution

 

In general, much how I program my warm-ups, I prefer to progress my landmine variations from the ground to standing. When you adopt a tall kneeling or half-kneeling stance you take joints out of the equation (ankles, knees, hips, lumbar spine) and provide less of a window for people to default to aberrant movement patterns that can cause injury or exacerbate any painful symptoms they may have.

2) Tall Kneeling 1-Arm Landmine Press

 

I should note there are a handful of tenets with regards to technique across the board:

  1. Abs and glutes engaged. Both will nudge people into a little more posterior pelvic tilt and less likely to crank through their lumbar spine.
  2. If you are performing these 1-arm at a time I like to cue people to make a fist with their free hand to encourage more full-body tension.
  3. The shoulder of the working arm should not “dip” or round forward on the lowering phase.
  4. Keep the chin tucked.
  5. When appropriate, there should be a slight “reach” (or shrug) at the top to more fully engage the upper traps (which play a role in scapular upward rotation).
  6. Also when appropriate, play some Wu-Tang.

3) Half Kneeling 1-Arm Landmine Press

 

This is probably my favorite variation regardless. I like this one because we’re hitting a lot of problematic areas at once: shoulder health (upward rotation), rotary stability, hip flexor length, and glute activation (on kneeling side).

I prefer to coach people to dorsiflex the toes of the back foot (dig them into the ground), but in the end it comes down to whatever feels better for the person.

4) Half Kneeling Sideways Landmine Press

 

This is one I stole from my buddy Dean Somerset.

Here we’re training more in the frontal plane, which is important…cause we should get people out of the sagittal plane once they master it.

NOTE: you could also combine this one into a 1-arm clean-to-press hybrid movement if you wanted.

Honeybadger don’t give a shit.

5) Plain Ol’ Boring Standing 1-Arm Landmine Press

 

You can toss in a few curveballs here. You can adopt a staggered stance (one foot in front of the other), which makes things more challenging due to a narrower base of support.

You can also add bands into the mix.

6) Band Resisted Landmine Press

 

I like adding bands because it provides an added challenge to the anterior core musculature, in addition to forcing the lifter to control the eccentric portion of the lift more.

We can also make the case it “saves” the shoulders even more in that the band automatically decelerates the movement at the top.

Also, on a side note: When the hell are Jon Snow and Daenerys going to hook up on Game of Thrones?

7) Side to Side Landmine Press

 

This is a great option for when you want to be a little more aggressive with loading.

8) 2/1 Technique Landmine Press

 

The 2/1 technique is a concept I picked up from Christian Thibaudeau years ago, and something I’ve used in my own programming and that of my clients ever since.

We all know that we can handle more weight on the yielding (eccentric) portion of any lift compared to the overcoming (concentric).

The 2/1 technique takes this into account.

The idea is simple: Press up with both arms (preferably, in an explosive manner) and lower with one under control.

9) Deep Squat 1-Arm Landmine Press (<– Only For Those Who Want to Hate Life)

 

I hate this one so much. And by hate, I mean love.[footnote]But really hate.[/footnote]

Assume a “deep” squat position and press away.

This can also be performed 1-arm at a time.[footnote]But only if you’re standing on a BOSU ball you functional bastard.[/footnote].

10) Z Landmine Press

 

I wasn’t sure where to place this one, so I guess I broke my “from the ground up” rule here.

Whatever, it’s my blog, I can do whatever I want.

Like, yell out “I’m Batman!” or post a picture of a unicorn shitting rainbows and cupcakes.

This one is a doozy and requires someone exhibits sufficient t-spine extension to perform well. Even though it’s a ground-based variation I’d be reticent to place have beginners perform this one.

That’s It, Folks

I hope you learned a few new variations in today’s post. If you have some of your own you’d like to share please feel free to post them in the comments section here or on Facebook.

BONUS Option

Because nine sucks, here’s a 10th variation.

Viking Landmine Press

 

If you have the Viking attachment (which you can purchase HERE) you can add another nice variation, which includes a neutral grip option.

Helmets sold separately.

CategoriesStuff to Read While You're Pretending to Work Uncategorized

Stuff to Read While You’re Pretending to Work: 8/11/17

As you’re reading this I’m likely 35,000 feet in the air making my way back from Florida to Boston. What’s also likely is Lisa and I trying not to destroy the back of our pants juggling a 6-month old lap to lap in an effort to keep him at bay and not terrorize the rest of the passengers.

Knowing today was going to be a wash in terms of productivity I planned a head and prepped this week’s list of stuff to read a day early.

Lets get to it.

Copyright: epokrovsky / 123RF Stock Photo

 

Check This Stuff Out First

1) Complete Shoulder & Hip Blueprint – Orlando

There’s only less than three weeks left to take advantage of the Early Bird rate for Dean Somerset and I’s workshop in Orlando, at Spark Fitness, the weekend of October 21st.

I’ve never been to Orlando. I bet it’s going to be beautiful in October. Yet, there’s no way in hell I’m visiting Disney World.[footnote]They could be giving out free tickets to a Jennifer Lopez wet t-shirt contest and I’d still avoid it like the plague. And yes, it’s not lost on me that Disney World is family friendly and they’d never host a wet t-shirt contest. It’s my fantasy. Shut up.[/footnote]

You can go HERE for more details and to sign up.

HEADS UP: We’ve also added Boston into the mix later this year. Not Burlington Boston or Beverly Boston, two cities that are lovely, albeit not (that) close to Boston.

No, this is IN Boston. In the heart of the city Boston, at AMP Fitness.

Early bird rate is in effect now and if you’re super eager to sign-up you can go HERE.

2) Elite Fitness & Performance Summit – Chicago

 

I’ll be in Chicago this September alongside some other phenomenal speakers for the Elite Fitness & Performance Summit. The cast includes:

  • Nick Tumminello
  • Mark Fisher (if I have to follow him on stage I’m going to be pissed)
  • Josh Henkin
  • Nick Berry
  • Molly Galbraith
  • Krista Scott-Dixon
  • Ryan Ketchum

And many, many more.  It’s one of the most action-packed fitness events of the year, so be sure to reserve your seat ASAP.

Stuff To Read

Precision Nutrition ‘Hot Topic’ Report – John Berardi

I trust the people over at Precision Nutrition implicitly. If there’s ever a topic on nutrition I’m curious about or if a client has questions I almost always defer to them.

Today’s nutrition climate is sooooooo confusing and dichotomous. Who’s right? Who’s wrong? It’s sometimes hard to ascertain if something is BS or legit.

Well, PN (or, more specifically, the legend himself, John Berardi) just released this awesome, FREE, multi-day mini-course covering nutrition “hot topics” like whether grains are good/bad for you, the good and bad detoxes, whether you should be worried about GMOs, the facts about post-workout nutrition, nutrient timing, calorie counting, and, like, do unicorn tears really increase protein synthesis by 119%?

All the important stuff is covered.

The Best Fat Loss Article On the Motherfuckin’ Internet – Aadam Ali

There’s a kid-friendly link somewhere on the internet that refers to this as the “Best Fat Loss Article on the Motherlovin‘ Internet.”

Fuck that.

This.

THIS ladies and gents is what it means to write with infotainment in mind.

Tony Was a Weirdo, So Mark Started a Gym – Pete Dupuis

True story:

Pete sent me an email last night saying:

“You okay with me publishing the following tomorrow? Don’t want to overstep, so asking first.”

I then proceeded to read the greatest piece of literature ever written.[footnote]Only a slight exaggeration. Slight.[/footnote]

I wrote back:

“I got teary eyed reading that. Please, publish that motherfucker.”

Thanks Pete (and Mark). That meant a lot to me.[footnote]Also, “was” a weirdo? Was? I’m still pretty freakin weird, thank you very much[/footnote]

Social Media Shenanigans

Twitter

Instagram

I love this slide on scapular winging. Mostly because I look jacked, but also because it’s a term that’s vomited out there by personal trainers & coaches without much thought. Dr. @quinn.henochdpt notes that while it is a thing (congruence between the rib cage and shoulder blade)…REAL scapular winging is a medical diagnosis where the Long Thoracic Nerve fails at innervating the serratus anterior. Much of the time what’s “diagnosed” as scapular winging isn’t really much of anything and nothing more than a lack of tension and motor control that can be addressed rather easily. In this pic I’m using a ground based movement first, a side lying bottoms up kettlebell swivel and press, to teach context of tension and CONTROL of movement. No scapular winging. Weird. Stop tossing out words and terms that likely don’t mean anything and giving everyone the sense they’re broken. They’re not. They (probably) don’t need 37 different corrective exercises to fix their winging. They just need to learn how to do a push up correctly or something.

A post shared by Tony Gentilcore (@tonygentilcore) on

Categoriesmuscle growth

Blood Flow Restriction Training: Real Deal or Are We Wrapped Up in the Latest Trend?

I’m still in Florida enjoying my vacation (and eating copious amounts of carrot cake). Actually, after reading this article myself and looking at all the jackedness, I’m kinda grossed out by how much carrot cake I’ve been ingesting.

Nevertheless, if you’ve ever been curious as to whether or not there’s any validity to blood flow restriction training and whether it’s something that’s a good fit for you today’s guest post by Dr. Nicholas Licameli will help answer those questions.

Enjoy.

Copyright: lyashenko / 123RF Stock Photo

 

NOTE: Be sure to check with a healthcare practitioner before using blood flow restriction, especially those with cardiac or circulatory pathologies.

For a more in depth look at this topic as well as explanations and details of the studies referenced, be sure to check out my podcast HERE.

Blood Flow Restriction Training: Real Deal or Are We Wrapped Up in the Latest Fad?

In order to fully understand the theory behind BFR, it’s important to quickly review how blood flows through the body. This quick review of the circulatory system also appears in my article on compression garments, which can be found right here.

 

“The system is a cycle with the heart at the core.

Oxygenated blood enters the heart and is pumped (with great force) into the arteries. The arteries carry oxygen rich blood to all the tissues of the body, including muscle.

For simplicity, let’s use the biceps as an example.

As the arteries approach the muscle, they become thinner and thinner until they become so thin that the nutrients and oxygen diffuse across its walls and into the tissue. These super thin blood vessels are called capillaries.

After the blood “drops off” its oxygen and nutrients, it is picked up by more capillaries, which feed into larger blood vessels called veins. The veins passively carry the deoxygenated blood back to the heart. Once back at the heart, the deoxygenated blood gets sent to the lungs to get re-oxygenated, sent back to the heart, and is pumped back into the arteries to start the cycle all over again.

So the force from the initial pump from the heart is enough to send the blood from the heart, through the arteries, through the capillaries, into the veins, and back to the heart all while fighting gravity, plaque build up, etc. (pretty amazing huh?).

So it is easy to see that the velocity of blood flow is MUCH greater in the arteries than it is in the veins. Think of pushing a toy car across the floor. The initial push (the heartbeat) gives the car a decent amount of velocity, however as the car travels further and further away, its velocity lessens.”

What Is Blood Flow Restriction Training?

The goal of BFR training, or occlusion training, is to maintain arterial inflow of blood while occluding venous return during exercise: We want to get that nutrient, hormone, and oxygen-rich blood to the muscle, while delaying its escape.

This is accomplished by the application of a blood pressure cuff, knee wrap, or anything that can be tightly secured around the most proximal (closest to the midline of the body) part of a limb. If we use the arm muscles as an example, the wrap would be tightly secured around the upper arm, as close to the shoulder as possible, causing the blood to pool in the arms.

It is thought to have a positive effect on hypertrophy while using much lighter loads than conventional weight training.

How is it possible to restrict venous return without restricting arterial flow?

Let’s think back to our circulatory system review.

The blood in arteries has a much higher velocity and propulsion force than the veins, so in order to occlude arterial blood flow, a much higher pressure is needed. It is easier and requires less pressure to restrict blood flow in the veins because at that point, the flow of blood is not as forceful. Think of in the movies when someone gets an injury and the blood is squirting and pulsing out. The movie is depicting an arterial injury because of the high velocity of blood.

If a vein were injured, the blood would just ooze out.

 

Note From TG: I added this scene from Kill Bill because 1) why not? and 2) it repeatedly shows “arterial injuries” Nick referred to above. Also, 3) it’s badass.

How Does It Work?

The exact mechanism by which BFR works is unclear, however, the most likely and agreed upon theory has to do with greater metabolic stress.

Muscles release growth factors and metabolic by-products, such as lactic acid, into the bloodstream as a result of resistance training. These growth factors and metabolic by-products are washed away with normal blood flow. By restricting venous return and allowing the blood to pool, these growth factors and metabolic by-products remain in the muscle for a longer period of time and therefore have more time to interact with corresponding receptors in muscle tissue.

The accumulation of metabolic by-products, such as lactic, increases intramuscular acidity and may promote hypertrophy as well as the release of growth hormone (although acute increases in growth hormone have not been shown to significantly impact hypertrophy, it is still worth noting).

The increase in acidity and the buildup of lactic acid are responsible for “the burn” that we all know and love.

Even though we love the feeling, our bodies do not.

Our bodies fight tooth and nail to increase oxygen flow to the area in order to decrease the acidity and restore homeostasis. It does this by increasing respiration (increased breathing rate) and increasing arterial/oxygen-rich blood flow (vasodilation…the pump), but it can only fight for so long.

When the body is no longer able to manipulate breathing and blood flow enough to balance the acidity of our tissues, we enter an anaerobic (“no oxygen”) state. As we keep working through the burn, the acidity continues to increase until we reach muscle failure. Type II muscle fibers are recruited during this anaerobic state, which is important because they have the most potential for growth.

Blood flow restriction increases the amount of deoxygenated blood in the area, which helps facilitate the creation of an anaerobic environment. The result? We reach an anaerobic environment faster and for a longer duration.

How Do We Do It? How Tight? What Set & Rep Ranges? How Often?

As mentioned above, apply the wrap at the most proximal area of your arms and legs. It is difficult to establish an optimal tightness of application due to individual factors such as limb circumference, body fat level, skin thickness, etc. Studies seem to agree on is a simple rating of 7/10 self-rated tightness.

Photo Credit: John Rusin

Perform 3-5 sets to failure with 20-50% of 1 rep max with the muscle occluded the entire time. Rest periods should be 30-60 seconds between sets. After the final set, remove the wraps and restore blood flow to the muscle.

As far as how often BFR should be used, it is my personal opinion that BFR should be used like any other intensity technique that aims to increase metabolic stress, such as rest pause, drop sets, etc.

Is BFR Better Than Just Lifting Weights? I Mean, People Have Been Lifting Heavy Things and Getting Bigger and Stronger for Centuries…

Keep in mind that research only points us in the right direction for further study and isn’t meant to be the end-all be-all.

Research gives us trends and averages, however we each are n=1.

That being said…

Research shows that BFR training may be more effective for hypertrophy than conventional hypertrophy training with matched loads and just as effective as conventional training with unmatched loads.

This means that BFR causes the same amount of hypertrophy as conventional training while using significantly lighter loads. BFR training has been shown to enhance hypertrophy with weights of about 20-30% of 1 rep max, which is significantly lighter than what is typically required for conventional training.

When comparing BFR training to conventional strength training, research has shown BFR and conventional training to have a similar effect on strength with unmatched loads. This means that lifting lighter loads with BFR can increase strength just as much as conventional training with heavy loads.

When loads were matched (both groups lifting the same weight), BFR was shown to improve strength to a greater degree than conventional training.

That being said, there are studies that show BFR to be inferior to conventional heavy training to improve strength. Research supports that, when it comes to strength, specificity of training is key.

What’s the take home regarding strength? As the saying goes, “If you want to lift heavy things, you have to lift heavy things.”

BFR has also shown some promising results in physical therapy and rehabilitation.

Research has shown that subjects experienced increased serum growth hormone, thigh muscle size, and 1 rep max isometric strength just by walking on a treadmill with BFR applied to the legs.

Research also shows that when BFR was applied to the legs following ACL reconstruction surgery, subjects experienced more strength retention and less atrophy when compared to a control.   Strength retention and less atrophy were also observed using BFR following a period of ankle immobilization and a non-weight bearing protocol.

It seems BFR may be quite an effective tool with a wide variety of implications. Variables such as power, speed, endurance, etc. still require further investigation at this time.

Is It Safe?

Be sure to check with a qualified [footnote]

Here is a test to find a qualified healthcare practitioner:

How to spot an unqualified healthcare practitioner:

-You: Hello Dr. So-and-so. I am a weightlifter/bodybuilder and have been noticing that my knee hurts when I squat and my back hurts when I deadlift.

-Dr. So-and-so: Hmmm. Ok. You need to stop squatting and deadlifting, we’ll take some X-rays, take this anti-inflammatory, and come back in 4 weeks. NEXT PATIENT!

-5 minutes later, he’s out of the room faster than the Kool-Aid man.

How to spot a qualified healthcare practitioner:

-You: Hello Dr. So-and-so. I am a weightlifter/bodybuilder and have been noticing that my knee hurts when I squat and my back hurts when I deadlift.

-Dr. So-and-so: Hmmm. Ok. Let’s start by taking a look at your squat and hip hinge, this way we can…

BINGO! Now we’re talking![/footnote]healthcare practitioner before adding BFR to your training toolbox.

Contraindications to blood flow restriction training include a history of deep-vein thrombosis, pregnancy, varicose veins, high blood pressure and cardiac disease.

Excessive pressure and prolonged ischemia (decreased blood flow) can lead to necrosis of tissues (cell death). Even though the BFR guidelines outlined in this article do not use excessive pressure and are not being applied for long periods, caution should always be taken.

Stop use immediately and consult a qualified healthcare practitioner if you experience severe pain, dizziness, nausea, or numbness/tingling.

Keep in mind that every time you enter the gym, you are taking a risk. If not respected or properly executed, anything can be harmful. Even with perfect form, injury is a risk.

What’s the Take Home?

  • With BFR, the goal is to induce fatigue, blood pooling, and muscle burning quicker and withless weight/work.
  • Wrap at the most proximal area of your arms and legs (under your shoulder and high on your inner thigh) with a 7/10 self-rated tightness.
  • Perform 3-5 sets to muscular failure using 20-50% of your 1 rep max with the muscle occluded the entire time.
  • Rest periods should be 30-60 seconds between sets.
  • After the final set remove the wraps and restore blood flow to the muscle.
  • While BFR has been shown to enhance hypertrophy and strength, it seems to have more of a positive impact on hypertrophy than strength. For strength, it may be more beneficial to stick to traditional heavy training.
  • BFR seems to be safe, however a qualified1 healthcare practitioner should be consulted prior to implementing BFR.

Don’t forget… For a more in depth look at this topic as well as explanations and specifics of the studies referenced, be sure to check out my podcast right here. 

About the Author

Dr. Nicholas M. Licameli, PT, DPT

NGA Pro Bodybuilder/Doctor of Physical Therapy

Every single thing he does, Nick believes in giving himself to others in an attempt to make the world a happier, healthier, and more loving place. He wants to give people the power to change their lives. Bodybuilding and physical therapy serve as ways to carry out that cause. His knowledge of sport and exercise biomechanics, movement quality, and the practical application of research combined with personal experience in bodybuilding and nutrition allows him to help people in truly unique ways. Love. Passion. Respect. Humility.  Never an expert. Always a student. Love your journey.

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References

In addition to the references listed below, please be sure to check out the work of Jeremy Loenneke on BFR as well as StrengthandConditioningResearch.com.

Abe T, Kearns C, and Sato Y. (2006) Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. J Appl Physiol 100: 1460–1466.

Boucourt, B., Bouhaddi, M., Mourot, L., Tordi, N., & Ménétrier, A. (2014). Changes in tissue oxygen saturation with calf compression sleeves-before, during and after a cycling exercise. The Journal of sports medicine and physical fitness. 55(12):1497-501

Egerton, T., Beardsley, C. Blood Flow Restriction Training. Strength and Conditioning Research. Retrieved on 7/21/16 from https://www.strengthandconditioningresearch.com/blood-flow-restriction-training-bfr

Kubota, A., Sakuraba, K., Sawaki, K., Sumide, T. & Tumara, Y. (2008). Prevention of disuse muscular weakness by restriction of blood flow. Medicine and Science in Sports and Exercise, 40(3), 529-34. [

Loenneke JP and Pujol TJ. (2009). The Use of Occlusion Training to Produce Muscle Hypertrophy. Strength & Conditioning Journal. 31(3): 77-84.

Menetrier, A., Mourot, L., Bouhaddi, M., Regnard, J., & Tordi, N. (2011). Compression sleeves increase tissue oxygen saturation but not running performance. Int J Sports Med, 32(11), 864-868.

Takarada Y, Takazawa H, and Ishii N. (2000). Application of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc 32: 2035–2039.

CategoriesAssessment Corrective Exercise

The 411 On Plantar Fasciitis and How to Make It Vanish

I’m currently with my family taking a little vacation down in Florida.[footnote]Holy fuckballs Florida is hot in August.[/footnote] I’ll be checking in at some point this week with some content, but on the meantime I’ve got some awesome people pinch-writing for me this week.

Today’s post is written by physical therapist Dr. Michael Infantino on a topic that’s a pain in the ass foot for a lot of people: plantar fasciitis.

Enjoy.

Copyright: sdecoret / 123RF Stock Photo

The 411 On Plantar Fasciitis & How to Make It Vanish

Lets set the scene: It’s a little after 5:00 am. As you open your eyes the sun is just starting to peak through your window. To your right, your husband; to your left, the band Maroon 5 casually playing an old hit. “Sunday morning rain is falling, steal some covers share some skin….”.

Just kidding it’s Sunday morning, rain is falling and you are dead set on getting that five-mile run in.

As you take the first step out of bed, the pain in your heel makes you rethink this whole running idea.

Unknowingly to your heel, your mind knows your day is going to drag if you don’t accomplish this feat.

I know the “drive” that runners possess.

The word “drive” and addictive personality disorder can sometimes be inter-changed, but that’s neither here nor there. This post is going to give you the 411 on everything plantar fasciitis is in as concise of a fashion as possible.

To make life easier we will just say heel pain.

Quick Rundown Of Todays Topics:

  • WHO is more susceptible to developing plantar fasciitis?
  • WHAT is plantar fasciitis? [Sounds like a skin eating disease.]
  • WHAT can I do to treat this damn pain? [I know, I put “WHAT” twice. I wasn’t an English Major.]
  • WHY am I not seeing progress?

 WHO Is More Susceptible To Plantar Fasciitis?

Straight from the Journal of Orthopaedic & Sports Physical Therapy Guidelines for Plantar Fasciitis.

  1. Overweight & Un-Athletic

I know, I know. This sounds awful. No one wants to be called overweight. More than that they don’t want to believe they fall into the un-athletic category.

Prime example: My dad (I love you dad). He has gained some lbs. over the years, and I wouldn’t classify him as an athlete by any means at this stage in his life. Despite my opinion, he still thinks he is SUPER.

His workouts usually come few and far in between. To my surprise, he can never quite understand why his body hurts after his impromptu 3-mile sprint (he calls it a jog) once every 3 months.

  1. Runners

Yay runners! You made it into the JOSPT Guidelines. Victory! Wear this as a badge of honor… I think?

  1. Workers That Spend Increased Time On Their Feet (i.e. factory workers)

  2. Fearful Avoiders

No one wants to admit this characteristic. Regardless, it exists. Many people who actually develop chronic pain fall into this category. Your worries about causing more “damage” to your body often make you think bed rest is still a reasonable option.

I am sorry to say that it is not.

Runners, don’t smirk. You fall into the “overboard” category where your “driven” personality encourages you to push through pain. Because it is weakness leaving the body! Sometimes… not always.

The big takeaway here is to accept the fact that your job, your hobby or your current weight just makes this injury more likely. Knowing that this injury comes with the territory allows you to switch your focus to PREVENTION.

Give Me The Low Down On Plantar Fasciitis.

Research has continuously stated that your heel pain isn’t typically an “iitis,” or inflammation.

Ultrasound actually reveals increased thickening of the fascia near the insertion on the heel (Fabrikant, 2011). This sort of debunks the old “RICE” concept when trying to manage this injury.

It is safer to say plantar fasciopathy.

This could mean either an inflammatory or a degenerative process. Degenerative sounds scary. It isn’t. Changes in tissue quality are normal, not everyone has pain with these changes. [This one’s for you Fear Avoiders].

Diagnosing TRUE Plantar Fasciitis, Or “Fasciopathy.”

  1. 1st step in the morning reproduces heel pain
  2. Tenderness to touch at the insertion of the fascia on the heel

“Both were positive! Am I sentenced to months of night splints, orthotics and stretching?”

Not necessarily. If it is a true plantar fasciitis the research shows that these things can help. They may diminish symptoms, but it’s a Band-Aid.

JOSPT Guidelines

We need to be careful here. Some studies also showed that increased arch height was a predictive factor for pain. Your best bet is to have someone perform a running analysis to see what your foot is doing during the loading phase of running (preferably someone with a ton of knowledge about the human body).

If you don’t display “excessive pronation” or actually lack adequate pronation, an orthotic may not be a good fit. Excessive supination (opposite of pronation) while the foot is in contact with the ground during running or walking could actually be exaggerated with an orthotic.

Leading to ankle sprains.

JOSPT Guidelines

In my experience, night splints are hit or miss. With a true plantar fasciitis it could be a big hit. As I mentioned earlier, it is not actually fixing the source of the problem (the way you move, strength deficits, poor pacing etc). Before you sentence yourself to months of night splinting try to push the RESET button first.

Lets Get Started! Address Limitations In Ankle Mobility First.

1. Trigger Points

Work out those nasty tender points in your calves and the bottom of your feet. Calf trigger points can cause referral pain to the heel and bottom of the foot. Mimicking plantar fasciitis. Trigger points are responsible for reduced mobility, strength and timing of muscles! (Lucas, 2004)

 

BONUS: Self Instrument Assisted Soft Tissue Treatment (better than the roller stick… in my opinion.)

This is more of a soft tissue mobilization than trigger point treatment. It can actually be a great lead in to trigger point treatment. It helps reduce tone in the muscles. It is also a quick way to scan for areas that are more “stiff” and more irritated (increased trigger points local to that tissue). This is why I prefer it to the roller stick.

 

2. Stretch The Calves and Foot Musculature

Stretching feels good and it can help restore motion. BUT do not neglect the importance of strength and endurance at the shin musculature when looking to maintain that new length.

Performing strengthening drills, like the Shuffle Walk (courtesy of The Gait Guys) demonstrated in the video below will prevent increased tone in the calves from returning.

Prescription:

To make this more effective, actively pull the forefoot and toes up as you are stretching.

Pull the toes and forefoot up for 10 seconds (keep the heel down) followed by a 30 second stretch (work into it slow to get the desired effect). Repeat for 3 minutes.

Renan-Ordine R, 2011

3. Attack The Joints

Get the joints in your ankles and feet moving more freely. Don’t forget about motion at that BIG TOE. Without proper extension at the big toe you can forget about actually accessing that new ankle motion.

This means you can’t access that hip extension while running. This equals poor gluteal function. It all goes down hill after that…

  • 1st Toe Mobilization + Shuffle Walks

 

  • Banded Ankle Mobilization With Active Dorsiflexion

 

This one is all over the Internet. From personal experience, having someone mobilize the ankle for you ends up being way more effective. But better than nothing!

  • Self Ankle Manipulation

Great way to get some quick improvements. Combine with the other techniques!

 

Gave It A Go For A Couple Weeks And Still No Change?

The loss of considerable amounts of body fat obviously doesn’t occur overnight. Stick with a guided nutrition plan and exercise routine to work on weight loss without further aggravating any painful regions. This may require modifications in exercise choices for the time being.

If You Are An Avid Runner Or Stand A Lot For Your Job Consider The Following:

  1. Regular Shoe Rotation was found to be helpful in workers that spent more time on their feet. (Werner, 2010)

Your shoes really tell a story. Excessive pronation and supination start to wear down parts of the shoe. This exaggerates pronation and supination at the foot leading to increases in the speed at which these motions occur. Potentially leading to increased risk of injury.

  1. Orthotics/Taping

We discussed this earlier. Orthotics don’t always fix the problem, sometimes they can worsen it. Taping to support the foot or promote increase stability at the foot could be a safer and cheaper 1st step.

  1. Strengthening

The focus is typically on reducing “pronatory tendencies” at the foot. Sounds promiscuous, grrrrr! Tony can help you with that one.

Your ability to land in a good position during the loading phase of running, and continually do that over the course of a run is the primary goal; despite the addition of weight (maybe a ruck sack), speed or exertion.

Running is not an innate ability.

Strangely, I find joy in watching people run. It is easy to tell which people skipped some developmental milestones growing up or didn’t take part in too many athletic events. If you fall into one of those categories I would definitely recommend some training to improve your running mechanics.

  1. Leg Length Discrepancy (LLD)

I was hesitant to mention this because of how common LLD is in symptomatic and asymptomatic populations. However, it is mentioned in one study in the Plantar Fasciitis Guidelines (Mahmood, 2010). In various studies, a LLD of as little as 4-6 mm is considered clinically significant. In rehabilitation and the fitness world neuroscience is getting a lot attention; often disregarding biomechanics. It is probably in our best interest not to sweep this under the rug if we aren’t seeing progress. LLD will have an impact on your mechanics when walking and running.

Lets Wrap This Up!

The important thing to remember is that the recommendations made today are just guidelines based on an overwhelming amount of research. If you are in pain let these tips guide you. Don’t grasp on to them like they are the word of God, Buddha or The Dos Equis Guy. Accept the fact that your job, hobby, weight or lack of athletic ability make you more susceptible to this injury.

Fix the things you can, accept the things you can’t. There is no harm in trying out a cheap orthotic or heel pad for a little relief. If you want to take it a step further see a professional trained in running evaluations to determine needed changes in running mechanics, programming, proper shoe fit and/or orthotic fit. Knowledge is potential power. Go forth and conquer!

About the Author

Dr. Michael Infantino is a physical therapist who works with active military members in the DMV region. You can find more articles by Michael HERE.

References

Cotchett MP, Landorf KB, Munteanu SE. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. J Foot Ankle Res. 2010;3:18. http:// dx.doi.org/10.1186/1757-1146-3-18

Eftekharsadat, B., Babaei-Ghazani, A., & Zeinolabedinzadeh, V. (2016). Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Medical Journal Of The Islamic Republic Of Iran, 30401.

Fabrikant JM, Park TS. Plantar fasciitis (fasciosis) treatment outcome study: Plantar fascia thickness measured by ultrasound and correlated with patient self-reported improvement. Foot (Edinb) 2011;21:79–83.  [PubMed]

Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93:234-237.

Lucas KR, Polus BI, Rich PS. Latent myofascial trigger points: their effects on muscle activation and movement efficiency. J Bodyw Mov Ther. 2004;8:160-166

Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., & McDonough, C. M. (2014). Heel pain-plantar fasciitis: revision 2014. The Journal Of Orthopaedic And Sports Physical Therapy, 44(11), A1-A33. doi:10.2519/jospt.2014.0303

Mahmood S, Huffman LK, Harris JG. Limb-length discrepancy as a cause of plantar fasciitis. J Am Podiatr Med Assoc. 2010;100:452-455. http:// dx.doi.org/10.7547/1000452

Renan-Ordine R, Alburquerque-Sendín F, de Souza DP, Cleland JA, Fernán- dez-de-las-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management
of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41:43-50. http://dx.doi.org/10.2519/jospt.2011.3504

Werner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk factors for plantar fasciitis among assembly plant workers. PM R. 2010;2:110-116. http://dx.doi.org/10.1016/j.pmrj.2009.11.012

CategoriesStuff to Read While You're Pretending to Work

Stuff to Read While You’re Pretending to Work: 8/3/17

Hey, hey, hey it’s Friday.

I’m excited because Lisa and I are hosting our Strong Body-Strong Mind workshop here in Boston tomorrow and we’re expecting 30 fitness pros to attend and get their nerd on discussing things like the Transtheorhetical Model of Change, intrinsic vs. extrinsic motivation, how to build competency & autonomy, and, you know, deadlifts.[footnote]If you’re interested in hosting Lisa and I for this workshop we’re not afraid to travel…;o) I can say unequivocally there’s no workshop like it around for fitness professionals.[/footnote]

Because I’m a big jerk and always wait till the last minute to get things done, I’ve still got a few things to tweak on my presentation and need to hightail it out of here to get that done.[footnote]As my friend, Ben Bruno, always says “If you wait till the last minute, it only takes a minute.[/footnote]

Have a splendid weekend everyone.

Copyright: vimvertigo / 123RF Stock Photo

CHECK THIS STUFF OUT FIRST

1) Complete Shoulder & Hip Blueprint – Orlando

Our Vancouver shindig in April sold out, but Dean and I have recently announced a stop in Orlando, FL later this year, October 21-22nd at Spark Fitness.

I’ve never been to Orlando. There’s no way in hell I’m visiting Disney World.

You can go HERE for more details and to sign up.

HEADS UP: We’ve also added Boston into the mix later this year. Not Burlington Boston or Beverly Boston, two cities that are lovely, but not that close to Boston.

No, this is IN Boston…in the heart of the city Boston, at AMP Fitness.

If you’re super excited and want to sign-up early you can go HERE.

2) Lisa on the Lift the Bar Podcast

Lisa was invited onto the Life the Bar Podcast recently discussing what she discusses best…the psychology behind personal training.

You can download on iTunes HERE.

Or, if you prefer, the direct link is HERE.

3) Women’s Health Asked How I Train

Women’s Health reached out and asked me what my workout would look like if I only had 30 minutes to train.

Easy: Wu-Tang, inject caffeine directly into my left ventricle, grab a barbell and lift it off the ground repeatedly, repeat.

Kidding. HERE’s what I really said.

Stuff to Read

Scapular Upward Rotation – Julie Read

I couldn’t use an actual image from Julie’s post because it’s a PDF and I want to encourage you to check it out for yourself. She’s very talented and has an uncanny ability to draw awesome pics of anatomy peppered with witty commentary.

For those who are more visual learners this is for you.

Science is Self Correcting: The Case of the Hip Thrust and Its Effects On Speed – Bret Contreras

What a treat to see someone of Bret’s stature and expertise to write something so honest and transparent.

Sabotaging Your Sales Pitch: 4 Mistakes to Avoid – Pete Dupuis

This one resonated with me, especially now that I’m out on my own and oftentimes have people stop by unannounced or randomly and I may need to “temper” my sales pitch.

Pete nails this one, as usual.

Social Media Shenanigans

Twitter

Instagram

Things got serious towards the end of this workout. As you can see….💪

A post shared by Tony Gentilcore (@tonygentilcore) on

Categoriescoaching Exercise Technique

Why I Love These 2 Simple Cues to Clean Up the Front Squat

There was a time in my training career when I despised front squats. I hated them in fact. They never felt good.

Copyright: gekaskr / 123RF Stock Photo

 

But when does any form of squatting feel “good?”

I mean, that’s the last adjective I’d use to describe them. A back massage feels good. Hitting a walk-off home-run feels good. Hell, I’d argue getting kicked in the balls feels good compared to a heavy set of front squats.

The set-up is kinda wonky and you’re always at the risk of suffocating yourself – not the greatest feeling in the world when you’re trying to lift heavy things. Then there’s that annoying part where the barbell inevitably starts to roll off the shoulders.

Each repetition is a battle against gravity (and patience).

It sucks.

The front squat JUST SUCKS.

That said, I’d be remiss to ignore the front squat is still a staple exercise I prefer to incorporate myself and something I have most of my clients perform as well.

Why?

  • They’re joint friendly – almost always a better option for those with a history of lower back and knee pain.
  • They allow most people to attain a deeper depth.
  • They’re (arguably) easier to perform compared to back squats. They allow a more upright torso (which plays into the deeper depth thing), and for anyone who lacks the requisite upper back and/or shoulder mobility (abduction/external rotation, T-spine extension) front squats are a superb option.
  • They help build a monster set of legs, help bulletproof the core, and turn your back into the size of Rhode Island.

I’d go into more of the particulars but 1) I’m lazy and 2) my good buddy, Eric Bach, already did and wrote an excellent article on the front squat HERE that I could’t possibly top.

Go read it, seriously.

Anyways, as much as I tend to belly-ache about how much the front squat makes me want to slam my face into a brick wall, I do prefer performing them over back squats.

Mainly because, and I can’t believe I’m about to say this…

I’m 40 now, not 25.

It’s not lost on me that my 25 year old self would Sparta kick my 40 year old self in the pancreas for uttering the “I’m 40 now” line.[footnote]Hey 25 year old self, you also thought Applebee’s counted as a romantic date night. So, STFU.[/footnote]

However, while I don’t expect my N=1 anecdote to reflect everyone else’s experience, if I were a betting man I’d put everything on black that a vast majority of people reading feel the same way.

Stuff just feels different at 40 compared to 25.

Relax internet, I still back squat.

But not as much as I used to, and not nearly as heavy. If I were to be honest, I back squat juuuuuuust enough to maintain a decent enough number in addition to having enough of a carry over to my deadlift. After that I don’t give a shit.

I’m not a powerlifter, so who cares?

Besides I DO feel I get more out of the front squat (see reasons above), and more importantly it just feels better and doesn’t beat me up as much. And while I’m not winning any internet dick measuring contests by posting this, I have worked up to a 300+ lb front squat which is nothing to sneeze at.

My 2 Favorite Front Squat Cues

The biggest issues I find with most trainees with regards to the front squat is bar placement on the shoulders and the fact the bar has a tendency to roll off the shoulders. Both are annoying, but both have a simple solution.

Check out this video below – it’s short – to find out my two “go to” cues for cleaning up front squat technique. I hope it helps.

NOTE: T-shirt game is on point.

Categoriespersonal training

A Look Behind the Curtain: The Line and Relationships We Have With Clients

In today’s guest post by Shane McLean he touches on a topic that affects every fitness professional: the “line” or boundary that exists between trainer and client.

What the boundary is and how far a coach/trainer is willing to go to cross it is every individual’s personal choice. It’s an important topic and I’m glad Shane took the initiative to discuss his own experiences.

Copyright: nexusplexus / 123RF Stock Photo

 

A Look Behind the Curtain

I’m going to pull back the curtain on training clients in a one-on-one environment. There’s a lot more to personal training than designing programs, counting sets and reps and wearing tracksuit pants. Sometimes the professional/personal line that exists between coach and client gets crossed.

Let me explain. Since being a personal trainer, I’ve had

  • Three clients pass away
  • Three who have beaten cancer
  • One who’s got dementia
  • Several clients who have had their joints replaced and gone through painful rehabilitation

When studying to become a trainer, these situations never came up in any of my textbooks because nothing prepares you for things like that.

Only life can.

When dealing one-on-one with these clients while they’re suffering, the professional boundaries that trainers should have with their clients gets blurry.

How can it not? Trainers are not robots.

 

Although my (and most) personal training clients come to the gym to forget their problems, sometimes the burden they carry is too heavy and they need someone to talk to. All a trainer can do is lend a sympathetic ear much like your hairdresser or local bartender.

And for most personal trainers (myself included), personal training is much more than a pay check or a business transaction. It’s a real opportunity to make a difference in the lives of their clients whether they’re fighting fit or not.

Trainers share in their clients’ successes, failures and heart aches. Often exercise is the easy part of the equation during a session but the mindset or ‘getting into the mood’ can be more difficult.

Trying to get clients into the right frame of mind when they are in pain takes this mindset thing to a different level. Because let’s face it, exercise can be hard enough even when we’re healthy, let alone sick.

Over two years ago I was hired to work privately with an elderly couple in their home. Both had their share of health problems but the male was in bad shape. He was unable to perform simple self-care duties and found walking extremely difficult.

He and his wife performed simple balance and mobility exercises and fundamental human movements once or twice a week. Even at their advanced age, they were looking to improve their quality of life.

Both were so sweet to me that it was difficult not to get close to them. I would often stay after our sessions to hear their stories and join them for lunch. They welcomed me into their home like I was a part of their family.

However, the male’s health took a turn for the worst a few months into our time together and a few weeks later he passed away peacefully.

It was one of the saddest situations I’ve ever witnessed and made me feel very fortunate that I got to spend time sometime with him and his wife. I’ll cherish the stories they told me forever.

Earlier this year, I was rocked by the death of former client who was taken from this earth because of pancreatic cancer. When we worked together, over two years ago now, he had turned his life and health around.

He was fit, strong and full of life and then cancer robbed him of this. He fought to the end with humor, grace and dignity. I still miss him to this day.

Both of these situations provided a challenging conundrum for one who’s business is personal. When does professional become personal? When is it ever okay for professional/personal boundaries to be crossed?

Most of us know it’s not okay for a trainer to sleep with their client and for a teacher to get sexually involved with a student.

That’s clearly crossing the line.

However, on the other hand, is it okay to visit a client who’s on life support in hospital and to be there for support? Is it crossing the line to go out to lunch with a client and share personal stories?

Like some laws are meant to be broken, some boundaries (I think) need to be crossed, especially when it’s a matter of life and death. However, there is some inherent risk involved here.

When putting yourself out there and crossing boundaries your feelings or the client’s feelings may get hurt. Your wallet may suffer, and if you ever witness sickness or death it’s going to be painful for all involved.

I made a judgement call (and will continue to make it) that I’m going to be there for clients when it comes to life, death and sickness. Am I crossing the line?

You can be the judge.

However, I feel in matters of the heart, you should follow the heart more often than not and the boundaries that exist between a service provider/client should be tossed away.

Wrapping Up

Personal and professional boundaries exist for a reason. It can stop laws and feelings from being broken. However, when suffering and death happens and you’re in the middle of it, lines will get crossed.

About the Author

Shane “The Balance Guy” McLean, is an A.C.E Certified Personal Trainer working deep in the heart of Texas. Shane believes in balancing exercise with life while putting the fun back into both.

After all, we’re only human.