CategoriesAssessment Corrective Exercise

Tendinitis vs. Tendinosis: Yes, There’s a Difference

Yesterday I had the pleasure of attending the filming of Eric Cressey and  Mike Reinold’s next phase in their Functional Stability Training series, Functional Stability Training – Upper Body.

As an FYI:  the first two modalities, Functional Stability Training – Core, and Functional Stability Training – Lower Body, can be accessed HERE.

Think of the whole shebang as on par with The Dark Knight trilogy.  All stand alone pieces are equally badass in their own right, but as a whole……can be considered mindblowing.

Yesterday entailed the filming of the “hands-on” or lab portion, and Cressnold (as I like to call them) took volunteers from the audience and placed them through a few shoulder screens/assessments to demonstrate that not all shoulders are created equal.

More importantly, they took it as an opportunity to demonstrate to everyone that how “we” approach treating and addressing certain dysfunctions can drastically change from one shoulder to the next.

And, as it happened, I ended up being one of their guinea pigs, as seen below in a “behind the scenes” shot.

Basically, it went down like this:

Mike:  would anyone be willing to take their shirt off?

[dead sprint from my seat]

Me:  Can The Rock smell what’s cookin?  Does a bear shit in the woods?  Does Dolly Parton sleep on her back?  YOU WANT MY PANTS OFF TOO????

I suspect that my 20 minute shirtless cameo will be a huge selling point for Eric and Mike when they finally release this module.

Learn the secrets behind an effective shoulder screen/assessment.  

Find out how both Mike and Eric choose what treatment and corrective exercise progressions come into play based off a thorough shoulder assessment.

Watch Tony squeeze his pecs and turn a piece of coal into a diamond!

Okay, all facetiousness aside, it was a FANTASTIC event and it should come as no surprise that Mike and Eric helped make a lot of people a heckuva lot smarter.

One key point that I want to discuss today which Mike hit on briefly during one of his talks, is the notion of tendinitis and tendinosis.

Many people think the two are one in the same and that both should be lumped together (like Star Wars and Star Trek.  You know, cause both take place in space) with regards to how we go about assessing and addressing each.

This is wrong, and here’s why.

– itis = is the Greek suffix for inflammation.

– osis = is the Greek suffix which denotes actions, conditions, or states. In the context of this conversation it refers to degeneration.

Someone with acute elbow pain or discomfort for example has tendinITIS.  You can palpate the area, the person will say “ow,” tell them to apply ice, take some ibuprofen for a few days, lay low on things that exacerbate symptoms, and they should be fine within a few weeks, if not days.

Conversely, someone with a more chronic, insidious condition has tendinOSIS.  You can palpate the area, the person will probably want to punch you in the face (but it could just as easily be more acute discomfort like the example above), but in this case, despite icing, popping NSAIDS, and rest, the condition, even after six months hasn’t gotten any better.

The problem here is actual degeneration of the joint, and it’s in this scenario we need to look more outside the box.

In keeping with the elbow example, someone with tendinitis will typically – not always – respond well with dedicated manual therapy on the problem area itself alongside your standard ice/rest protocol.

If the issue doesn’t resolve and it continues for months on end (tendinosis), and as Mike pointed out, sometimes you need to look elsewhere along the kinetic chain to see what’s the TRUE culprit.

It’s something he’s routinely referred to as The Kinetic Chain Ripple Effect.

When dealing with a more chronic issue, you still need to look at the affected area (in this case the elbow), but you also need to look at other factors elsewhere.

You can treat the elbow all you want with manual therapy and corrective exercise, but if someone has atrocious T-spine mobility, is overly kyphotic, and has forward head posture, wouldn’t it make sense to address those “red flags?”

Interestingly, Mike worked with someone yesterday during his presentation who had elbow pain, and one of the first things he did was test her grip strength bilaterally.  It should come as no surprise that she was weaker on the side which hurt to squeeze.

After coaching her on her posture – getting the shoulders back and posteriorly tilted, learning to brace the abs and posteriorly tilt the pelvis, and to tuck the chin – he retested her grip and she immediately saw a 16% increase (and it was less painful!).

And all he did was place her into better alignment!

There’s no doubt that she would still need soft tissue work to address her elbow, but many of her symptoms were corrected by taking a closer look at her shoulder and head position!

All of this to say:  if you’re a personal trainer or strength coach and have a client with a nagging injury that hasn’t gotten better with traditional ice, rest, and NSAIDS, it’s a safe bet that it’s not just a simple case of tendinitis, and you’re dealing with something more chronic like a tendinosis (or, actual degeneration of a joint).

Step one would be to refer out to your network and have him or her work with a manual therapist.

Step two, and something which you can take more of the reigns on, would be to keep an eye out for other factors such as posture or any movement dysfunctions who may notice.

More often than we think an “elbow issue” isn’t just something that’s wrong with the elbow. Likewise, a “knee issue” could be something fishy going on elsewhere. We can’t assume it’s solely the knee.

I like to put all the blame on CrossFit….;o)  Just kidding.  Kinda.

What are you thoughts?  Agree?  Disagree?  Tomato? Tomahto?  I’d like to hear everyone else’s thoughts on the matter.

CategoriesAssessment Corrective Exercise Exercise Technique Strength Training

Building a Superhuman Core

Nowadays you seemingly can’t walk more than 15 feet without crossing paths with a CrossFit gym.  Along those same lines, you can’t go more than five clicks (it’s like the internet’s version of the Kevin Bacon game!) before you view some iteration of a “core training” article espousing anything from six-minute abs to improved posture to bringing sexy back.

And guess what?  Today I’m sharing my own iteration of a core training article!!!

Except, you know, mine doesn’t suck.

Core training means different things to different people.

On one end of the spectrum you have those trainers and coaches who feel all you need is to deadlift and squat and you’ll cover all your core-training bases.  I feel this is a bit of a mis-guided POV.  Conversely, on the other end, you have those who will spend half a training session “activating” their TA .

The answer to the riddle, as always, usually lies somewhere in the middle of those two extremes.

I prefer to address core training in a multi-faceted manner where I take each and every individual who walks through our doors at the facility through a litany of assessment protocols to figure out what would be the best approach for him or her.

And it’s with this thought in my mind that I wanted to toss my name into the mix and finally write my treatise on the topic of core training.

It’s pretty good (I think).  You should check it out.

Click Me <—– Careful, I’m Ticklish

CategoriesAssessment Corrective Exercise

How to Hip Hinge Like a Boss

Or, in other words:  Learn how to groove the hip hinge and then be able to train like a boss.

Quick question/observation:  Have you ever wondered why, among other things – like why women tend to make that funny face when applying make-up –  when it comes to American cars, or “Western” cars, the driver’s side is on the left side of the car and not the right (as is the case in the rest of the world)?

It’s something I’ve pondered in the past and up until recently I just kinda shrugged it off as one of those things which had no legitimate rationale other than us Americans are a bunch of pompous a-holes that like to do everything differently than everyone else – analogous to us being the only country not to adopt the metric system of measurement.

As it turns out – there is a reason why the steering wheel is on the left hand side and not the right. And it’s something that makes complete sense.

In the book I’m currently reading, One Summer: America, 1927, author Bill Bryson spends a whole section going into detail about Henry Ford and the Model T car.

Up until the Model T came to fruition every car that was produced in America had the steering wheel on the right hand side so that the driver would have easy access to the side curb, side-walk, or grassy area to easily step out of the car.

Ford then decided that this was a convenience that should be afforded to the “lady of the house,” and thus the Model T was designed to have the steering wheel placed on the left hand side.

So there you go.

Fascinating, right?

Another nugget that blew my mind – albeit in the strength and conditioning realm – was an article I read recently by personal trainer Joy Victoria titled Twerk Your Way to Stronger Lifts, Stronger Abs and Pain-Free Movement in which she offered this train of thought:

“Load is not weight. Load is how your body adapts to carrying the weight. So someone with good alignment can squat 100 lbs and experience an adaptation in their butt and legs, and another person can squat 100lbs and experience an adaptation in their hip flexors and low back muscles (very simplistic example). This is because of how we load our body! You want to load the muscles and joints properly to develop the qualities of strength, power, speed, mobility etc. A lot of pain and what “dysfunctional” movement can be a result of improper loading for your body and structure.”

This summary served as one of a few reasons why I wrote THIS article for T-Nation on why I feel learning to brace and not relying on over-arching or over-extending the lumbar spine (in other words: maintaining ALIGNMENT) is paramount with regards to lifting heavy things. Not only in the context of improved performance in the weight-room, but also as a way to play the house in your favor with relation to long-term health – especially spine health.

Taking this concept a step further, though, and since this is a fitness blog, lets roll with the talking point of alignment and load and delve into something a bit more practical and relevant to just about everyone reading:

The Hip Hinge

https://www.youtube.com/watch?v=a1Y73sPHKxw

For those unfamiliar and stealing some insight from renowned strength coach Dan John – who’s a mega fan of the hip hinge (and rightfully so), we can introduce the hip hinge as follows:

“It’s the hip snap, the hip slam and all of the various inappropriate terms coaches have used to teach young virgin ninth graders to tackle like NFL linebackers. Just learning the move right can open up hamstring flexibility. Doing it slowly with a massive load can impress your friends for generations. Learning to have symmetry in the movement can jumpstart you to an injury-free career.

And, to do it fast? It’s the one-stop shop to fat loss, power and improved athletic ability. Swings, the top of the food chain in hinge movements, are the most under-appreciated move in life, in sport and in the gym.”

 

In more rudimentary terms the hip hinge involves any flexion/extension originating at the hips that involves a posterior weight shift.

And if we wanted to be super-duper simplistic, and separate ourselves from the notion that a hip hinge is the same thing as a squat pattern – WHICH IT ISN’T! – we can break things down like this:

Hip Hinge = maximal hip bend, minimal knee bend.

Squat = maximal hip bend, maximal knee bend.

*Smoke bomb, smoke bomb, exit stage right*

Moreover, taking the swing out of the equation altogether, I’d argue that nothing has quite as a profound effect on one’s performance in the gym, overall movement quality, addressing pain (especially low back pain), as well as shortening one’s “learning curve” when introducing new exercises than the hip hinge.

About the only thing a properly patterned hip hinge doesn’t help fix is a bad hair day and Justin Bieber’s general level of douchebaggery.

1o points awarded to me for a Biebs burn!

So the question then becomes:  How can we go about grooving a proper hip hinge?

More to the point – when working with athletes or clients who either A) have an extensive injury history, have engrained an aberrant motor pattern, and hence like to “squat” everything or B) are otherwise healthy and still like to “squat” everything……how can we groove the hip hinge pattern we’re looking for and start to teach people how to load their body properly?

Well, I’m glad you asked!

At the lowest level two of the easiest (and effective) ways to begin to pattern the hip hinge are:

1.  The Wall Tap Hip Hinge

The objective here is pretty self-explanatory.  Brace the abs, ensure spinal alignment (move through the hips and NOT the lumbar spine) and then focus on tapping your derriere to the wall.

One cue I like to use is to tell people to chop or “fold” their hips with their hands (you’ll see me do this on like the third or fourth rep).

I’ll start people as close to wall as I need to in order to ensure they’re doing it correctly, and as they become more proficient I’ll move them further and further away.

2.  Dowel Rod Hip Hinge

This too is fairly self-explanatory, so I’ll try not to belabor anything.  I love this variation because it gives the trainee some kinesthetic feedback on spinal positioning.

In short:  there should be three points of contact with the dowel rod – the sacrum, in between the shoulder blades, as well as directly behind the head.  If at any point the dowel rod loses contact with any of those points – whether because the chin isn’t staying tucked or they’re squatting with too much knee bend – that should be considered a fault and corrected immediately.

Upping the ante a bit, here are some more drills that I like to implement.

3.  Rip Trainer Hip Hinge

Taking the dowel rod hip hinge to the next level is the TRX Rip Trainer Hip Hinge, which very much plays into a lot of Gray Cook’s work on loading the hip hinge.

It’s a subtle load – you don’t need to be too aggressive here – but it’s amazing how much technique cleans up when you cue someone to “pull” themselves into the hinge pattern (here the trainee literally has to pull into the hinge).

Much like with the wall tap drill, I’ll tell people to visualize “folding” their hips and to sit back.

4. Sternum Hip Hinge

Place a kettlebell (you could use a plate or DB here) flush against the sternum and try to visualize driving it through your chest.

I can’t really explain why it works so well – most likely because of the anterior load – but it just does, so just do it!  GOSH!

5.  Behind the Head Hip Hinge

Pigging back off the sternum hip hinge is the behind the head hip hinge, which places the load posteriorly behind the head.  This offers a bit more of a unique challenge in that you have to make sure that you’re bracing your abs HARD so that you don’t compensate and hinge through the lumbar spine.

6.  Band Resisted Hip Hinge

Lastly, the band resisted hip hinge drill is great because it teaches people “terminal hip extension,” to the point where they must finish the movement with their glutes in order to finish the drill.  Moreover, because the band is pulling them back they really have to be more cognizant of bracing their abs, maintaining alignment, and controlling the movement.

What Now?

If or when those drills are mastered THEN it’s time to add appreciable load.  One of my go to exercises is the pull-through.  I find that this is a fantastic exercise to introduce people to loaded hip hinging because, well, I said so!

And because it hammers the posterior chain with minimal spinal loading.

Of course deadlifts and squats will come into the picture, but not until I feel confident that the person I’m working with (especially for those with a vast injury history) can hip hinge properly and disperse the load accordingly.

I can usually coach someone up and get them deadlifting and/or squatting with a good hip hinge pattern within a short amount of time – typically in one session – but not without utilizing some of the drills mentioned above.

CategoriesAssessment Strength Training

My Take on the “Knees Out” Debate

In case you’ve been living in a cave for the past few months or engrossed in the latest season of The Walking Dead, you’ve undoubtedly noticed a hot debate in the fitness and weight-training community surrounding the whole “knees out” technique when performing the squat (or deadlift for that matter).

As far as debates in this industry are concerned, it’s a doozy. I’d put it right up there with other debates which make people go bat-shit crazy with rage such as steady state cardio vs. HIIT, eating every 2-3 hours vs. intermittent fasting, ShakeWeight vs. ThighMaster, or which is the superior late 90s-end-of-the-world-asteroid-slams-into-Earth-disaster-flick:  Deep Impact or Armageddon?

The impetus behind the madness is one Dr. Kelly Starrett, owner of CrossFit San Francisco and author of the New York Times best selling book Becoming a Supple Leopard, who, at least recently, is the prime example of someone who’s championed the “knees out” cue.

Just to be clear though:  he’s not the first (nor will be the last) to use this cue, but writing a national bestseller will pretty much guarantee your name is placed in the spotlight, and open the floodgates to the critics.

Addressing the pink elephant standing in the middle of the room, let me preface all of this by saying that I don’t work with elite level olympic lifters – in fact, I rarely work with anyone who does olympic lifting outside of the occasional college athlete or meathead who wants to learn how to perform a hang clean.

But in a non-explosive reverse bicep curl kind of way.

However the book (and the cue) speaks to more than JUST elite level olympic lifters – and I believe the book was intended for a much broader audience, and was written as such.

Sure there’s sections dedicated towards the Olympic lifts – and CrossFit (for better or worse, mostly worse, but that’s another ball of wax I don’t want to get into right now) – encompasses a large olympic lifting component. But the book as a whole and Kelly’s message throughout is to help people move better and to avoid technique faults or errors – with the squat (and by extension, the deadlift) taking the forefront.

Still, due to the whole phenomena, you’d be hard pressed to find more spit-fire and venom directed towards Kelly within various articles, blogs, and forums. It’s like playing the Six Degrees of Kevin Bacon game, except here the premise is to see how many time you can click your mouse or notebook pad before you come across someone on the internet shitting a kettlebell because Kelly has the audacity to cue people to squat with their knees out.

What an asshole!

And that’s the thing – he doesn’t even subscribe to that “cue” in the first place!  At least not in the literal sense.  He’ll be the first to tell you that squatting with an excessive knees out pattern (or excessive varus, bowing) is a fault and that he would NOT want an athlete or client to do that.  In fact, he uses it as a CUE for when an athlete begins to go into knee valgus when squatting.

But more on that in a second.

Before I continue:  lets take ad hominem jabs out of the picture. I love how a lot (not all) of the arguments against Kelly is that he calls himself a “Dr” (he has a doctorate in Physical Therapy), that just because he treated “x” athlete one time doesn’t mean he trains said athlete, and that CrossFit San Francisco has yet to churn out an elite level CrossFit athlete.

For starters the book is titled Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance.

It’s NOT called The End-All-Be-All Guide to Winning the CrossFit Games:  Go Fuck Yourself, Everybody.

Secondly, the man has run his own successful gym (for nine years) and clinic (for six) and he and his staff have logged over 100,000 athlete sessions during that time.

100,000!!!!

I’m sorry but as someone who’s been coaching for a while and who co-founded one of the more reputable strength training facilities in the country, that number HAS to be respected.

That is a crap ton of sessions.

So lets just take a chill pill and respect the fact that Kelly probably knows a thing or two about training people, Mmmmkay.

So Back to This While Cueing Thing

As Kelly notes in THIS video series he posted on his MobilityWOD.com website were he defends his stance and tries to clear up any miscalculation on his message regarding the “knees out” debate:

“A cue is a relationship between a coach and an athlete specific to that moment for something that’s going on. Ie: trying to solve a specific problem.”

What other cue (key word: CUE!!!!) is supposed to be used to prevent the knees from collapsing in?

“Hey, hey, hey, HEY!!  Stop doing that thing you’re doing!!!!”

Or, as Kelly and his staff jokingly state:

“Knees not in.”

They coach people to squat with flat feet, cueing an external rotation torque (rotating femurs?) to create more stability in the hips and lower back. During the descent and ascent out of the hole, the knees should track in the same path.

Starrett even notes, “if you push out too far and your knees bow out into excessive varus, and your foot comes off the floor, that’s an error.”

How this has somehow been lost in translation is beyond me.  I don’t know of ANY strength coach – and I know a lot of very smart strength coaches – who would disagree with this assertion.

Knees collapsing into valgus when squatting is unacceptable, and I don’t know of ANY coach who doesn’t use the knees out CUE.

For 99.99% of people out there who aren’t elite level OLY lifters this is a bang on cue and helps to significantly improve technique.

[I recognize that many elite level OLY lifters will go into excessive valgus on the catch to explode out of the hole.  Okay, cool.  They’re ELITE.  They’ve perfected technique to the point where if they do get into a compromising position, when the shit hits the fan, they’re less likely to injure themselves.  This doesn’t mean Dave from accounting, on his first day of training, should be held to the same standard.]

Which then begs the question:  what if someone can’t squat well?  To perform a “deep” squat you need adequate hip internal rotation.  If you don’t have it, the default isn’t quite so much knees caving in (that much), but more so someone leaning forward too much.  Either way it’s a faulty pattern.

Likewise for those who lack ample ankle dorsiflexion, the typical default pattern will end up being a collapsed arch in the foot with subsequent knee valgus.

And all of this doesn’t take into consideration one’s hip or bony structure.  As Dean Somerset has touched on recently:  genetics do come into play.  Depending on one’s body (hip) structure, this may dictate how well they’re able to handle heavy loads and/or even which squat or deadlift variation is most suitable for them.

As well, you have to take into consideration one’s current (and past) injury history, soft tissue restrictions, posture, experience, and ability level.

In short:  everything’s a little more complicated than nitpicking over semantics, and toy actually should assess your athletes and clients.  And I have to assume that Kelly along with his staff would agree with this.

But I can’t think of one coach who would advocate nor tolerate someone squatting with the knees caving in.  By that token, the cue “knees out” is the universal go to.  All that’s being asked is to create peak torsion to create the system for stability in the hip and back. No one is asking for someone to stand there, perform a squat, and then push the knees out so far that they’re hanging on the end of their joint capsule.

I could be wrong, but I have yet to interpret anything Kelly has said or written to think otherwise. I don’t doubt that there are some coaches or CrossFit affiliates out there who may be coaching their squats in this fashion, and if so, they’re wrong.  Direct your hate towards them.

Or, you could actually go coach someone before you start throwing darts.  Just sayin…..

CategoriesAssessment Corrective Exercise Program Design Rehab/Prehab

So Your Shoulders Are Depressed (So Sad)

Depressed man with hand on forehead over gray

So Your Shoulders Are Depressed (S0 Sad)

Despite the cheekiness nature of the title, you can relax: I’m not suggesting that your shoulders are “depressed” in the literal sense of the word.

I mean, it’s not as if they just got word they contracted ebola or that their heart just got ripped out by some uppity bitch who left them for some toolbag named Cliff who goes to Harvard and rows Crew.  Or worse, they’re a Celtics fan (<—- they’re really bad this year).

Nope, we can hold off on the Zoloft, Haagen Dazs and Bridget Jone’s Diary marathon for now.  That’s NOT the depression I’m referring to.

When it comes to shoulders and the numerous dysfunctions and pathologies that can manifest in that region, generally speaking we tend to give much more credence to anterior/posterior imbalances like a gummed up pec (major or minor) or weak scapular retractors.

Rarely, if ever, do we point the spotlight on superior/inferior imbalances.

Translated into English, yes the rotator cuff is important, but we also have to be cognizant of the interplay between upward and downward rotation. More and more (especially with our baseball guys, but even in the general population as well) we’re seeing guys walk in with overly depressed shoulders.

For the more visual learners in the crowd here’s a picture that will help:

It should be readily apparent that 1) that’s a sick t-shirt and 2) there’s a downward slope of the shoulders, yes?

Hint:  yes.

This can spell trouble for those whose livelihood revolve around the ability to get their arms over their head (baseball players) as the downward rotators of the scapulae (levator, rhomboids, and especially the lats) are kicking into overdrive and really messing with the congruency and synergy between the scapulae, humeral head, glenoid fossa, and acromion process.

And this doesn’t just pertain to overhead athletes either.

We’re seeing this quite a bit in the general population as well, particularly with meatheads (those who like to lift heavy stuff), as we’ve (i.e: fitness professionals) done a great job of shoving down people’s throats ”shoulder blades down and together” for years now, emphasizing what I like to call reverse posturing.

Likewise, much of what many meatheads do (deadlifts, shrugs, farmer carries, pull-ups, rows, fist pumps, etc) promote more of what renowned physical therapist, Shirley Sahrmann, has deemed downward rotation syndrome.

Putting our geek hats on for a brief minute, statically, it’s easy to spot this with someone’s posture.  For starters, you’ll see more of a downward slope of the shoulder girdle (see pic above).  Additionally, you can look at the medial (and inferior) border of the scapulae and observe its relationship with the spine and ascertain whether someone is more adducted (retracted) or abducted (protracted).

Many trainees, unless engaged in regular exercise or sporting activity, have a slightly protracted scapulae (kyphotic posture) due to the unfortunate nature of modern society where many are forced to stare at a computer screen for hours on end.

If someone’s rhomboids and lats are overactive, however  – which is fairly common with meatheads – they’re going to superimpose a stronger retraction and downward pull of the shoulder blade, which in turn will result in a more adducted position.  In short:  the shoulder blade(s) will “crowd” the spine.

All of this to say: things are effed up, and are going to wreck havoc on shoulder kinematics and affect one’s ability to upwardly rotate the scapulae.

So, hopefully you can see how this would be problematic for those who A) need to throw a baseball for a living or B) would like to do anything with their arms above their head.

With special attention to the latter, if someone is aggressively downwardly rotated, the congruency of the joint is such that the humeral head is going to superiorly migrate, which will then compromise the subacromial space (making it even narrower) leading to any number of shoulder ouchies.

Throwing more fuel into the fire, because the lats are stiff/short, shoulder flexion is going to be limited and compensation patterns will then manifest itself in other areas as well – particularly forward head posture and lumbar hyperextension.

Which, of course, makes doing the Dougie a little tricker.

Okay, with all of that out of the way what can be done to help alleviate the situation.  Luckily the answer isn’t as complicated as it may seem, and I don’t need to resort to bells, whistles, and smoke machines or take a page out of Professor Dumbledore’s Magic Book of Bedazzling Hexes and Awesome Shoulder Remedies (on sale now through Amazon!) to point you in the right direction.

But make no mistake about it:  you WILL have to pay some attention to detail.

Lets get the contraindicated stuff out of the way first.

Basically it would bode in your favor to OMIT anything which is going to promote MORE scapular depression – at least for the time being (not forever).

Things To Avoid

To that end, things to avoid would be the following:

– Deadlifts

– Pull-Up/Chin-Up Variations (even those these may “feel” good, they’re just going to result in feeding into the dysfunction)

– Suitcase Farmer Carries (again, these are just going to pull you down more).

– Anything where you’re holding DBs to your side (think:  walking lunges, reverse lunges, etc).

– And we may even need to toss in aggressive horizontal row variations if someone presents with an overtly adducted posture.

– Overhead pressing.  Listen, if you can’t get your arms above your head without compensating, you have no business doing push presses, or snatches, or whatever it is you’re thinking about doing.  Stop being stupid.

– Sticking your finger in an electrical socket.  That’s just common sense.

Things To Do Instead

– In lieu of the deadlifts, if you have access to them, utilizing speciality bars like a GCB bar or Safety Squat bar would be awesome.  Learn to make lemonade out of lemons: why not emphasize your squat for the time being?

And because I know I just ruined someone’s world out there by telling them not to deadlift, because you’re going to deadlift anyways, at the very least, limit yourself to ONE day per week.

– You can still hit up a lot of carry variations, just not the suitcase variety.  At Cressey Performance we HAMMER a lot of bottoms-up kettlebell carries because they offer a lot of benefits – especially for those in downward rotation.

Moreover, we can also toss in some GOBLET carries like so:

http:////www.youtube.com/v/90mxsAsOKwQ

– You can still implement a wide variety of single leg work using DBs, but I’d defer again to utilizing GOBLET variations only.

In this way you’re not feeding into the dysfunction by holding the DBs to your side (and pulling you into downward rotation.

With regards to overhead pressing, I’m not a fan for most people.  I’ve said it before, and it bears repeating here:  you need to earn the right to overhead press.

That said I do love LANDMINE presses which tend to offer a more “user friendly” way of “introducing” overhead pressing into the mix.  Check my THIS article on T-Nation I wrote a few months ago, which offers more of a rationale as well as landmine variations to implement.

And the Boring Stuff (<— The Stuff You’re Going to Skip, But I’ll Talk About Anyways)

From a corrective exercise standpoint it’s important that we stress the upper traps to help nudge or encourage us into more upward rotation.

And by “upper traps,” I AM NOT referring to the most meatheaded of meathead exercises – the barbell shrug.

These wouldn’t be useful because there’s no “real” scapular upward rotation involved, and you’re doing nothing but encouraging more depression anyways.

Instead incorporating activation drills like forearm wall slides and back to wall shoulder flexion – both of which encourage upper trap activation, WITH upward rotation – would be ideal:

Forearm Wall Slides w/ OH Shrug

Back to Wall Shoulder Flexion w/ OH Shrug

NOTE:  something to consider would be how you actually go about cuing the shrug portion.  We like to tell people to begin the shrug pattern once your elbows reach shoulder height.  Meaning, it’s not as if you’re going elevate your arms up and THEN shrug.  Rather you want to combine the two.

Another important corrective modality to consider would be something to address the lats.  In this regard my go to exercise would be the bench t-spine mobilization

Bench T-Spine Mobilization

And while I could sit here and pepper you with a deluge of other “correctives,” I think by now you get the point and those three should be more than enough to get the ball rolling in the right direction.

Those combined with the programming modifications suggested above should definitely help to that shoulder frown upside down. <—  HA – see what I just did there?

That’s some wordsmith magic right there.

CategoriesAssessment

Squat Assessment: Is It a Mobility or Stability Issue?

Assessing someone’s squat pattern offers a gulf of information – everything from any muscular imbalances or dysfunctions that may exist, to soft tissue restrictions, movement quality, and one’s overall general level of awesomeness.

There are a few factors (and to a larger extent, progressions) that I use when I assess someone’s squat pattern, and it’s not uncommon for me to poke and prod and otherwise tinker around to find out what the root cause may be when someone’s performance is less than exemplary.

Far too often I find that people “assume” a client’s or athlete’s poor squat performance is due to mobility restrictions. Or maybe they just woke up on the wrong side of the bed.  Who knows?

As result, many coaches are left barking up the wrong tree when attempting to address the issue(s), with little to no improvement to show for their efforts. Sometimes weeks or even months after the fact.

In the short video clip below, I discuss one aspect that I find gets glossed over by many trainers and coaches and also provide a way to differentiate between something being a MOBILITY issue or a STABILITY issue.

Hope it helps!

CategoriesAssessment Corrective Exercise Exercise Technique

The Perfect Assessment Tool?

Lets be clear from the start: there’s really no such thing as a “perfect” assessment. I’ve seen coaches and trainers spend as little as ten minutes assessing their clients, as well as those who take roughly the same time it would take to read the Harry Potter series, and both have been equally as successful with getting results.

Although, in the case of the latter, I’d argue that some fitness professionals spend an inordinate amount of time assessing things that don’t really matter and/or are outside their scope of practice in the first place.  Big toe dorsiflexion?  Really?

The person standing in front of you is 25 lbs overweight and moves about as well as a one-legged pirate.  It’s not rocket science. Get them moving.  End of story.

Nevertheless when it comes to assessment I’ve always lived by the mantra of “different strokes for different folks.”  As an example, at Cressey Performance, we work with a metric boat load of baseball players which is a unique population with regards to the demands placed on their body.  Much of what we look at with them – comparing total glenohumeral ROM between dominant and non-dominant sides, for instance – may not be relevant to someone that walks into the facility who’s just looking to get a little stronger, fix their nagging lower back pain, or not be embarrassed to take their clothes off with the lights on.

That said, how we go about assessing our athletes and clients at Cressey Performance suits our needs, our facility layout, and our business model.

Put another way:  how we go about doing things isn’t to say that we’re right and everyone else is wrong; nor is it to imply that our way is the end-all-be-all of assessment; nor is it suggest that everyone should kneel before us General Zod style:

It all mounts down to what we’ve found works for us. It’s as simple as that.

However, I will say that I do (and always will) feel the push-up is an unsurpassed assessment tool that should be a staple in most assessment protocols.

Not many “tools” can give as much information and feedback to the fitness practitioner than the push-up, and it behooves anyone to dismiss it.

Did you hear me?  I said it behooves you!  I’m bringing back old-English people, so you know I mean business.  You’re just lucky I didn’t grab a white glove, slap you across the face, and challenge you to an old-fashioned bare knuckled boxing match.

Taking actual technique out of the equation (it amazes me how many guys come in to see us with cranky shoulders, only to have some of the worst push-up technique this side of Charlize Theron in the movie Prometheus), the push-up assessment parlays very well to a variety of populations.

With our baseball guys – and even our general population clientele – it gives a good scope to see how well their scapular stabilizers (particularly the lower traps and serratus anterior) are working – if one or both are weak, the scapulae will be more anteriorly tilted and abducted (not “hugged” against the rib cage) which can result in compromised stability.

Too, and an often overlooked component, is anterior humeral glide.  You can see this in someone’s standing posture very easily, but it also becomes very pronounced when you watch someone perform push-ups, or just hold the push-up position isometrically.

This can be detrimental in that if it’s not corrected or just left to it’s own vices can lead to increased anterior instability of the shoulder, which as we all know, not only kills baby seals, but also makes your shoulder hate you.

Using a more glaring and obvious anecdote, push-ups are also a fantastic assessment tool because they make it abundantly clear where someone’s weak points are.  And almost always, many are going have weak lumbo-pelvic-hip control – to the point where they’ll be hanging on their lumbar spine as well as rocking a nasty forward head posture.

On the flip-side many may also demonstrate a dominant rectus abdominus pattern, which typically means their external obliques are non-existent and they probably spend way too much time in front of a computer stalking people on Facebook.

Again, in both scenarios it’s just valuable feedback for you which will dictate that person’s programming moving forward.

Another dimension of the push-up assessment that I never really thought of before – and something I stole from Mike Robertson – is the concept of ‘core delay.’

In short, instead of starting someone in the standard push-up position – away from the floor with arms fully extended – you start from the floor.

In this way you can see whether or not someone has adequate stability or if there’s a delay in firing, and the hips come up first.

The key is to make sure that whoever it is you’re testing is completely relaxed on the floor, and then you just observe and make a judgement call from there.

The first rep would be considered a “passable” rep and shows that the person (me) has good core stability.  They (me) were able to keep the spine in a “neutral” position and everything seemed to fire simultaneously.

And, not to mention their (um, me) triceps were gunny as shit……;o)

With the second rep, though, there was a little wackiness, and you’ll notice how my hips shoot up first and my lumbar spine goes into immediate hyperextension.  This shows a ‘core delay,’ which is just a fancy way of saying “dude needs to work on getting his glutes to fire to posteriorily tilt the pelvis more, along with the external/internal obliques and RA.”

In the end I just feel utilizing the bottoms-up push-up is another great way to evaluate clients and to better ascertain where their weaknesses lie and how their programming may manifest moving forward.

Agree?  Disagree? Tell me more below.