CategoriesProgram Design Rehab/Prehab

The Lowdown on Femoral Acetabular Impingement. Trust Me: Not as Geeky as It Sounds.

When I first moved to Boston – roughly seven years ago – I was working at a swanky, fancy-pants commercial gym in the downtown area and I remember on one of my days off Eric Cressey and myself took a little road trip to Worcester, MA to take part in an impromptu and informal workshop that orthopedic surgeon, Dr. Chris Vinton, was doing at the College of the Holy Cross on Femoral Acetabular Impingement (FAI).

Like some of you seeing this for the first time and starring at the screen as if I were saying the alphabet in Klingon, at the time of Dr. Vinton’s talk I had a similar reaction:  Femoral Acetabular Say-What-Now???

Without beating around the bush, in laymen’s terms:  “FAI is a condition of too much friction in the hip joint.  Basically, the ball (femoral head) and socket (acetabulum) rub abnormally creating damage to the hip joint.  The damage can occur to the articular cartilage (smooth white surface of the ball or socket) or the labral cartilage (soft tissue bumper of the socket).”

Resultantly it sucks donkey balls.

Source:  www.hipfai.com (except for that last sentence).

FAI comes in a few flavors.  You have your Cam form which manifests itself as a bony overgrowth on the femoral head itself, and you have your Pincer form which results from a bony overgrowth on the rim of the acetabulum itself. And lastly, for those unfortunate few who can’t seem to make up their mind, you can also have a Mixed form which is a bony overgrowth of the two.

Even then, seven years ago, as I was sitting through the presentation, FAI wasn’t that prevalent in the athletic or fitness community – or, so it seemed.  I couldn’t recall one case of a current or past client who I felt fell under this FAI tree.

Fast forward to today and it seems everyone has FAI.  Hockey players, baseball players, soccer players, the mailman, the woman who does your hair, Batman.  Everyone.

Of Note:  Eric was talking the other day about this and mentioned something about a recent study that came out which showed something like 90% plus of high school hockey players have some degree of FAI.

I’ll have to see if I can ask him to find the study.  Stay tuned……

UPDATE:  Kevin Neeld discusses it HERE.

I don’t feel it’s because of some new pandemic or anything – like we’ve somehow mutated into a bunch of hip impingement ninjas.  Nah – nothing like that.

Well, maybe a little bit.  If I were speak freely I do feel that athletes today – particularly young athletes – fall into two categories:

1. Those who specialize too early and play ONE sport year round without any breaks.  It’s not rocket science to see how someone who plays a rotational sport year round, and develops pattern overload, can run into problems.

2.  Those who make the Tin Man look agile. It’s sad to say, but kids (and adults) just don’t move around as much anymore.  Texting has taken the place of riding a bike.  Call of Duty has trumped pick-up baseball games.  Escalators > stairs.

So I think we have ourselves to blame…..to a degree.  When we take people who have joint restrictions and don’t move well, and then ask them to “do stuff” they aren’t prepared to do. Well…….

But too, I just feel we’ve gotten a heckuva lot better in recent years at screening for FAI and recognizing symptoms.

Before I go on I should state the obvious:  as a strength coach I’m not diagnosing anything.  I can use some rudimentary “screens” (like the one to follow) which will better help me ascertain the situation and provide information on how I’ll go about programming for someone.  But almost always, I’ll be referring someone out to a more qualified fitness professional who can do a more thorough exam and/or possibly order an MRI.

That said if I’m working with an athlete or general population client who’s complaining of consistent and chronic hip pain – especially if they participate in a rotational sport or when squatting, I can do a quick “screen” as follows.

Here, I lie the person on their back and make sure their lumbar spine is flush against the table.  Then I’ll bring the affected limb into flexion, adduction, and internal rotation.

If the person winces or punches you in the face, it’s fair to say that that lit them up, and they may be a candidate for FAI. You can tweak the test by having them brace their abs – which will encourage more posterior pelvic tilt – and if it feels better, you know that’s it’s more of an alignment issue and not a worse case scenario.

No need to send someone for an MRI when all they had to do was posteriorly tilt their pelvis.

But it stands to reason that even with their anterior core engaged, if that still causes discomfort, it’s time to refer out and get them to see a more qualified practitioner to dig a little deeper.  Only through a combination of screens, tests, and possibly an X-ray or MRI can FAI be truly diagnosed.

But What Can You Do In the Meantime?

A lot, actually.  But lets try not to get carried away in thinking we’re going to solve the issue.  This is more about working AROUND the issue and maintaining a training effect than anything else.

FAI is a condition, not a disease. But here’s some food for thought.

1.  Rule numero uno is to nix squatting.  You’re not going to last long as a strength coach or personal trainer if you’re throwing caution to the wind and squatting those who are candidates for FAI.

I will say, though, that I say that with a grain of salt because technically you could still squat someone – albeit NOT BELOW 90 DEGREES OF HIP FLEXION.

If you look at the pictures provided above of the Cam and Pincer lesions, you can see how if someone were to squat below 90 degrees, that that would be, well, dumb.

Depending on symptoms you could get away with staying above 90 degrees, but honestly my rule of thumb is to wait six months before playing with fire.

2.  The good news is that you can still hit the lower body fairly hard.  Things like rack pulls, trap bar deadlifts, or even conventional deadlifts would be fair game given that neither require significant hip flexion.  In addition barbell glute bridges would be a viable option as well.

3.  Surprisingly, single leg work is fair game.  Even things like Bulgarian split squats – as counterintuitive as it sounds given they require deep hip flexion – would be okay.

The thing with single leg work is that the trainee can sort of find his or her “groove” with regards to hip internal and external rotation and be able to find a pain free ROM.

To that end I wouldn’t be apprehensive to crush single-leg training with someone with FAI – although certain things like femoral glide syndrome should be on the radar and may lend itself to making appropriate modifications.

4.  Go read anything and everything by Kevin Neeld on the topic. THIS and THIS would be good starts.

And that’s about it really. I think as strength coaches and personal trainers it IS in our best interests to know when to refer out and understand scope of practice.  But just as equally (if not more) important is to have the ability to assess and screen clients for certain conditions and be able to still garner a training effect and not make them feel like a patient.

Of course there is still a lot that’s unknown about FAI (s0me doctors still fail to admit that it exists!), and this post isn’t meant to serve as a definitive path to address the issue.  If anything I just wanted to throw it out there and hopefully bring forth a little more awareness on the topic.

CategoriesCorrective Exercise Rehab/Prehab

Where Does Unstable Surface Training Fit In? (Weeeeeeeeeeeeeeee)

Q: I’ve frequently read that unstable surface training in a non rehabilitate setting isn’t of that much use, particularly due to the fact that the increased muscle recruitment doesn’t necessarily become functional in other athletic activities.

Im curious where stir the pot comes into all this?

I certainly get great anterior core recruitment but am curious if this will carry over to athletics and other lifts?

What makes the stability ball usage in stir the pot different from that of doing 100 squats on a bosu ball? 

A:  That’s actually a really great question, but something I feel doesn’t require a whole lot of explanation.  For starters, for those not in the know, generally speaking, when most people hear the word “unstable surface training” many will quickly defer to your garden variety items such as stability balls, BOSU balls, wobble boards, and other (borderline) nefarious gadgets that are (often, not always) marketed as the panacea of everything awesome.

If you believe the hype, unstable surface training will do everything from helping to improve your balance to increased muscle activation (particularly in your core) to shaving off a few dress sizes to improving whateverthef***.

Just what she needs: more knee valgus! (<— note heavy sarcasm)

About the only thing unstable surface training can’t do is wash the dishes and solve our national debt.

If I had to describe my general thoughts pertaining to unstable surface training I’d more than likely do it in an interpretive fashion like this:

Which isn’t to say that I’ll dismiss it altogether.  There is some efficacy towards its use – and as you noted it’s namely in the rehabilitative setting when we’re working with athletes or clients coming off an injury and we’re trying to reestablish proper motor patterns, work on muscle activation, or otherwise reintroduce (and progress) them to external loading.

Unfortunately, at some point within the last decade (give or take), a bunch of personal trainers and coaches decided it would be a good idea to take data extrapolated from the physical therapy realm – and in particular data used with INJURED patients – and apply it with their healthy clients.  You know, to be functional and stuff.

The end result was (and has been) anything but ho-hum.  Instead of people actually doing something of relevance – like actually being able to do a push-up correctly, or being able to perform a hip hinge or lunge pattern without making my eyes bleed – we have a bunch of people doing things like 1-legged curls on BOSU balls, and trainers – in an effort to look unique and different – wasting people’s time (not to mention money) by doing shit like this:

I’ll concede that it looks impressive, and I’d if I were going to speak candidly I’d probably have a better shot of tossing a touchdown pass to He-Man in the next Super Bowl than being able to do it myself.

But that’s beside the point.  For healthy individuals who are looking to get bigger, faster, stronger, leaner, prevent injuries, increase power, move better, wrestle a grizzly, be able to say the alphabet backwards, or be able to wear white past Labor Day, unstable surface training is not the answer.

My business partner, Eric Cressey, actually wrote an entire book on the topic titled The Truth About Unstable Surface Training, which delves into how its use, application, and efficacy has been overtly saturating the fitness world for the wrong reasons.

Likewise, given the main “argument” for those who advocate unstable surface training is to help improve one’s balance, I’d encourage you to read John Kiefer’s article, Unstable Surface for Stability Training (AKA Clown School).

The fact of the matter is, the floor works just fine….and unstable surface training probably does more for DECREASING athleticism, strength, balance and movement quality than it helps.

Stealing a section from Keifer’s article:

Think about when you step onto an icy or oily surface. You instantly tense up, you almost literally can’t perform certain movements because the nervous system senses the instability of the environment and fires in resistant ways to keep you balanced. In this process, it also shuts down the ability to produce maximum force (your strength, power, hypertrophy and speed all go down the shitter. Think about it, if you start to slip in one direction and your reflexes caused your muscles to fire with maximum force against that motion—a motion that may be inevitable at that point, like falling—then you risk tearing muscle or connective tissue. The body is trying to protect you by making you weaker.

Which brings us to Stir-the-Pot.

This exercise in of itself constitutes as “unstable surface training,” and like I said above….I don’t dismiss it altogether.  We actually do employ a decent amount of this type of training into our programs at Cressey Performance – albeit not in the context that will make you want to punch a hole in the wall.

Since we work with a crap-load of baseball players, one drill we like to use to help increase rotator cuff activation is a bottoms-up 1-arm kettlebell carry:

Since we’re currently on that side of the fence, we incorporate bottoms-up variations with things like DB presses, 1-arm bulgarian split squats, and Turkish get-ups.

Something to consider, however, is this is in conjunction with movements like squats, deadlifts, rows, chin-ups, hip thrusts, and the like which are done on STABLE surfaces and which help to get people strong.

With regards to the stir-the-pot, I simply see this as:

1.  A great way to train the anterior core.

2.  A great way to “progress” the plank. I find it comical that people brag about how long they can hold a plank for – the longest I’ve heard is 17 minutes – when I KNOW that all they’re doing is hanging on their lower back and hip flexors in order to get the job done, which isn’t doing them any favors.

I find a lot of validity with planks and their numerous variations – especially when working with someone with chronic low back issues (as the name of the game is spinal stability/endurance, and teaching neutral spine) – but there comes a point where there’s a rate of diminishing returns, especially when people make them into a dick measuring contest.

I don’t know what the female equivalent would be here:  high-heel measuring contest?????

Either way I’d much rather make planks more challenging than longer, for the sake of making them longer.  Can you think of anything more boring?  I mean, outside of NASCAR is there anything?

And besides, this isn’t the type of exercise that opens itself to “repetition” anyways.  The objective isn’t to do them for “100 reps” as compared to the “100 squats on a BOSU ball” comment from the original question.  Instead, the objective is to learn to recruit and engage the anterior core and RESIST extension.  This is all about QUALITY of movement – and not compensating – than it is about QUANTITY.

To that end, I do feel this is an exercise that will help to improve performance – albeit not under the guise that I feel it’s because you’ve somehow improved your balance or recruitment of anything.

Wrapping Up

Again, this isn’t to insinuate that unstable surface training should be avoided at all costs – there’s ABSOLUTELY a time and place for it’s inclusion in a program.  However, I do feel that it’s WOEFULLY overrated, overused, and quite frankly a waste of time for most healthy individuals who walk into a weight room to get better.

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.

CategoriesExercise Technique Rehab/Prehab

Lift Big by Bracing, Not Arching

As far as current fitness debates are concerned the argument over which is better for long-term progress in the gym – bracing vs. arching – is right on par with people arguing over whether or not a potato is considered “Paleo, (1),” whether or not high- rep Olympic lifting (ALA: CrossFit) has any efficacy (2), or figuring out which is smarter: Tracy Anderson or a ham sandwich (3)?

  1. Um, it’s a freaking potato! It grows in the ground.  Newsflash:  That broccoli you’re eating didn’t exist in the Paleolithic era, and I know for a fact Gronk and his friends didn’t crush “Paleo” chocolate brownies back in the day you uppity douche.
  2. Sorry, but I’d trust a coach who advocates high-rep Olympic lifting about as much as I’d trust Formula One racer you drives a Prius.
  3. Come on, do we really need to debate this one?

Nevertheless, the growing dichotomy between bracing and arching – especially as it relates to hoisting heavy loads and how it parlays into optimal performance – has gained steamed within the last few years.

As a coach and as someone who trains a wide array of athletes and clients for newbie status all the way up into the professional ranks, and as someone who’s job it is to keep people healthy for the long haul, I can say that I tend to lean more towards the camp who advocates bracing.

In my latest article for T-Nation I explain why.

Continue reading you sexy beast you…..

CategoriesExercise Technique Exercises You Should Be Doing Rehab/Prehab

Deadbugs: The What, Why, and How

I know what some of you may be thinking:  “Really, Tony, a post on deadbugs?  What’s next….telling us how much you love Twilight or that you’re adopting another cat?  You haven’t gone soft on us now have you?”

<—– LOL, get it??  I actually put a picture of a “dead bug” here, when I’m actually just referring to the exercise.  High five!

Full confession time.  Okay, I admit it: back in 2008 I read the first Twilight book.  But only because I wanted to see what all the hoopla was about and see for myself why so many people were going bat shit crazy over it.

Well that, and it was a dark period in my life. I was single at the time and was going through some existential phase where I was trying to figure out what everything means.  Vampires wasn’t the answer.

I read it, didn’t care for it, and moved on with my life.

As far as the cat thing.  I plead the 5th…..;o)

With regards to deadbugs, however, in many ways I feel they get a bad rap and that they’re one of the more UNDERrated core exercises out there.  Perhaps a more apropos way to explain things would be that deadbugs are almost universally seen as a “sissy” exercise and a waste of time by many trainees, meatheads, and athletes alike.

I couldn’t disagree more.

I was recently asked by MensHealth.com to provide a “hot list” of some of my favorite go to core exercise that I either use with my athletes and clients, or that I pepper into my own training as well.

While I offered the prerequisite favs like Pallof press variations, stir-the-pot, and carry variations, I purposely OMITTED deadbugs for a few reasons:

1.  I didn’t want the incessant eye rolling pointed in my direction.

2.  Despite their perceived “easiness,” deadbugs are actually an exercise that are absolutely butchered by, well, everybody.

3.  As such, I took the greedy way out, held back, and decided to keep deadbugs to myself and dedicate an entire post on them in an effort to persuade everyone reading that they’re the bees knees (and that they should take the time to pay a little more attention to detail).

Getting the obvious out of the way:  deadbugs are an exercise that, for all intents and purposes, help with motor control and can be seen as a “baseline” exercise to ascertain whether or not someone has any glowing imbalances that need to be addressed.

Let me explain.

While it’s fairly common in the athletic realm, more and more we’re seeing people in the meathead/weekend warrior or what I like to call the “I like to lift heavy things category” present with an overextended posture or anterior pelvic tilt.

While this isn’t necessary anything to write home about – there IS a “range” of acceptable anterior pelvic tilt – it does become problematic when it’s excessive and otherwise leads to other imbalances up and down the kinetic chain.

For starters, those in excessive anterior pelvic tilt will almost always have extension based back pain – where the facet joints, posterior discs, etc are placed in an ungodly amount of stress which can manifest into more profound issues like spondylosis (end plate fracture) down the road.

Mike Robertson has a cool term for this called Flawed Active Stability – whereupon you’re cueing the body to engage the paraspinals and spinal erectors, effectively crushing the spine, in an effort to gain stability.

What’s more, in general, because of the misalignment associated with APT, it’s not uncommon for people to experience chronic pulled hamstrings, anterior knee pain, hip pain, and a myriad of other issues.

All of this to say: it just plain sucks donkey balls and can really mess with one’s training in the long run if not addressed or at least kept under wraps.

But again, I’m just stating the obvious.

Do Your Deadbugs, Yo!

Deadbugs are a fantastic way to teach the body to “encourage” more posterior pelvic tilt while simultaneously enhancing motor control and to engage the lumbo-pelvic-hip stabilizers to do their job.

As note above, most people flat out do a piss poor job when it comes to performing deadbugs correctly.  Here’s a great example.

Upon first glance those don’t look too shabby, right?  Offhand those look pretty good.  But with a closer look we can definitely comb through some common technique flaws that many should be able to appreciate.

1.  Before anyone makes fun of me for tucking my t-shirt into my sweatpants, just know that I did it for a reason. Which was to show how most people perform their deadbugs:  with an excessive arch in their lower back and with their rib cage flared out.

Well that and we had people visiting the facility from Australia yesterday and I didn’t want to make things awkward by walking around with my shirt off.

Admittedly, it’s still hard to see in the video above, but if you were in the video with me (oh, hey, hello!) you would easily be able to fit your hand in between the floor and my lumbar spine.  This shouldn’t happen and essentially defeats the purpose of the entire exercise.

And this is why I tend to lean more towards deadbugs from the get go – rather than birddogs – because the floor provides more stability and kinesthetic feedback to the body.

2. Another mistake is that people tend to rush this exercise.  Many will just haphazardly flail their arms and legs around hightailing it through the set.  While we could make a case that extending the arms and legs may be too much of a progression and we need to REGRESS the exercise – read THIS for more ideas – much of the time it just comes down to slowing people down.

All that said, lets take a look at what PROPER deadbug should look like.

I know it doesn’t look much different than the first video, but I assure you there’s a lot to consider.

1.  My shirt’s still tucked in.

2.  My lower back is flush against the floor – and I’m encouraging more posterior pelvic tilt.

3.  Moreover I’m also taking a massive breath and inhaling THROUGH MY NOSE to focus more on a 360 degree expansion into my torso.  In other words:  I’m not just breathing into my stomach, but also trying to expand sideways and INTO the floor as well as my ribcage (but without allowing it to flare out too much).

4.  From there I lower contralateral limbs – controlled, in an effort to resist extension – while FORCEFULLY exhaling my air through my mouth.  I do this until ALL my air is out.

By doing this a few things happen (and I apologize in advance for all the enumerations in this post):

1. I slow myself down.

2. The diaphragm is better engaged.

3.  Many don’t think of this part, but with all my air exhaled out, I now have nothing to help stabilize my spine except the muscles themselves.

It’s not uncommon for people to literally start shaking as they proceed with their set. This is okay – so long as you maintain proper spinal position – as it just demonstrates that the muscles in the surrounding area are now doing their job more efficiently.

I’ll typically shoot for 2-3 sets of 5-8 repetitions PER SIDE.

And there you have it.  It’s nothing flashy or Earth shattering, but I guarantee that if you go a head and try to perform your deadbugs in this fashion you’ll notice how much MORE challenging they can be, and they’re anything but a sissy exercise.

Give it a try and let me know what you think.

 

 

CategoriesRehab/Prehab

Managing Laxity in Lifters and Athletes – Part 1

Note from TG:  Given the special, niche population we work with at Cressey Performance – baseball players – it’s no coincidence that we deal with many athletes who walk in on day one with a preponderance towards being “lax.”

Too, it’s not uncommon to see this in the general population as well, as we’ve also had our fair share of yoga instructors, dancers, and overall “stretchy” (for lack of a better term) people walk through our doors.

It’s a unique circumstance to put it lightly.  Is laxity bad? Yes and no.  For some, being lax allows them to do what they do – and be successful at it.  While for others it can be the bane of their existence. All told if it’s not approached with delicate hands and some careful thought to programming, as a coach or trainer you could be causing more harm than good.

In this guest post by former Cressey Performance intern (and resident breakdanceologist), Miguel Aragoncillo, he dives into this often overlooked (and under-diagnosed) phenomenon.  It’s a two parter, but it’s chock full of awesome information.

I hope you enjoy it!

My own story of hypermobility begins with breakdancing throughout high school and college, and later dealing with it while taking up the sport of powerlifting, and still managing it to this day. I have quite a bit of congenital laxity – in some ways it helps, other times it hurts.

When I worked as a personal trainer for a few years after college, I was convinced that the general population displays tightness due to a combination of work demands, poor posture, and a lack of exercise. This would be illustrated through tightness in their hamstrings, back, and pectorals, and that they would usually need to static stretch in order to decrease that tightness.

From my own time spent breakdancing, I was aware that I was fairly flexible, but it wasn’t until I began reading Eric’s and Tony’s blog that perhaps there was some genetic predisposition that allowed me to slip into certain positions without stretching for hours on end. This point was driven home further after completing an internship at CP in the fall/winter of 2012 last year.

While my time in Massachusetts was filled with pitchers with laxity, talks about glenohumeral instability, and deadlifting to techno (<—- Note from TG:  YES!!!!!!), I discovered that there was more to this self-flexibility observation than I had imagined.

Hypermobility or being congenitally lax involves a series of tests that present themselves in various joints and ligaments due to a lack of specific protein called collagen. In fact, I determined that I was indeed hypermobile through a self-adminstered Beighton Laxity Test.

Personal anecdotes aside, hypermobility affects enough of a population to be documented, namely in those who have African, Asian, and Arab origin, along with youth due to growth and structures not fully developing quite yet. (Chaitow & DeLany).

Concepts Behind Congenital Laxity

Namely, as a strength coach and personal trainer, it comes down to managing the effects of laxity, whether it is taking a pro-active approach through exercise selection or referring to further treatments through a physician’s care.

To break it down, joint stability is a combination of passive stability (think ligaments and tendons), and active stability (agonistic and antagonist co-activation). Further…

“Functional joint stability is determined by the interaction of several factors… joint geometry, the friction between the cartilage surfaces, and the load on the joint caused by compression forces resulting from gravity and the muscles acting on the joint. Of all the factors contributing to the functional joint stability, the load imposed on the joint is one of the most important.” (Lephart and Fu, p15)

Theoretical Approach to Joint Instability

If there is a lack of stability within any movement, there could be several reasons for said instability: weakness of a stabilizer, lack of bony congruency, lack of synaptic signaling from the brain to the affected joint, along with a proprioceptive deficit in said joint.

While each case of hypermobility is unique to the individual, there are a few overarching themes that should be reinforced when talking about stability, namely, co-activation of “agonistic and antagonistic muscles to create stability and coordination for functional joint stability” (Lephart and Fu, pg 15)

Putting this into action would involve proper positioning during exercises that you may be familiar with already: planks, push-ups, rows, squats, lunges, and Tony’s fave – deadlifts.

With hypermobile athletes, there are two points to be made: 1. Stopping a joint from reaching full hyperextension and 2  Encouraging a partial range of motion as variations for beginner athletes. By encouraging a safer range of motion, there will be an increase in proprioceptive feedback on top of increased muscular activation in the major stabilizers of the shoulders and hips. With these tools you can create a safer environment for your athletes, along with adding a more varied exercise selection to choose from at the same time.

To use a common ankle sprain as an example, there is a prevalence for inversion of the ankle to occur. Signals from the brain must be sent to the ankle to provide an equal or greater eversion force to prevent an injury from occurring. “The response (of an ankle injury) is still the body’s dynamic response to a potentially dangerous situation, however, and it seems reasonable to assume that the faster the reaction is, the greater the degree of protection achieved.” (Lephart and Fu, p243)

However, there are a few instances which may present themselves, namely the muscles that must be activated through a conscious awareness of a possible injury from occurring due to an over-inversion of the ankle will be insufficient to react in time.

When discussing injury prevention, the discussion for bracing and taping vs zero bracing is brought to mind. The argument for bracing and taping includes providing proprioceptive feedback from the skin’s mechanoreceptors. These receptors can provide proprioceptive information or may facilitate joint proprioception by increasing sensitivity or motoneuron excitability. (Lephart and Fu, pg.306)

So in regards to the extremely lax athlete, there may be some theoretical benefit to wearing a brace, but at the same time there should be a push towards encouraging an increase in joint position sense during both static exercises and dynamic exercises.

So whether you believe in joint centration and encouraging those activation of joint stabilizers after centration, or utilizing bracing to increase proprioceptive feedback, the end goal should be the same – increase proprioception and re-establish proper stabilization of major joints.

I personally would like to have my cake and eat it too, or food analogies aside, I’d love to see training encouraged in a proprioceptive rich environment, sans the bracing, and after training and outside in the regular world, perhaps wear the brace or taping to help in “everyday activities”. After a period of time, retest various movements and joints by using a variety of stabilization tests or assessments and reassess the plan of action.

With athletes who display  Cirque du Soleil-like flexibility, here are a few drills and exercises that may be more beneficial and specific to helping establish this proprioception that I keep on harping on about, particularly reactive, perturbation-like drills, and finding reference centers for the body.

Managing Hypermobility with Exercise Selection

For lower body reactive drills, progressions involve hurdle hops, single leg hurdle hops, all the way to lateral bounds (or heidens) – all involve “sticking” or landing the movement.

Emphasis should be on maintaining tension through the hip external rotators and avoiding a “knees-in” movement during landing. These exercises can serve as a progression for youth athletes and advanced general population clients, as the cause for knee internal rotation during flexion is increased due to structural variances of passive structures in the knee in a hypermobile population. (Lephart and Fu, p60).

Upper body drills involve perturbations during various drills – whether it is during a static movement such as a quadruped med ball perturbation, or a more dynamic movement such as perturbating a side lying windmill, these are all great variations to use to reinforce proper stability of the humerus within the glenoid socket.

Further, after being exposed to the philosophy along with attending a few seminars held by the Postural Restoration Institute, there seems to be a manageable series of movements that will help encourage viable movement within the hypermobile population.

Speaking with several coaches, physical therapists, and fitness professionals, there seems to be a concerted effort to finding “reference centers” within the body for those who may be “floating in space”, a common feeling for those who are affected by hypermobility.

These reference centers are facilitated through various positional breathing techniques, and a few of these breathing exercises have been referenced by Greg Robins and Eric Cressey throughout their blog. Specifically, these “reference centers include the left abdominals, left ischial seat (sit bone), left heel and right arch.” (-3)

A hierarchy for exercise progressions would be first to develop force in a static or isometric fashion, and from there develop the force through dynamic movements to help increase proprioception in specific stabilizers. This in turn will help to create a protective mechanism within the faulty joint for healthy movement – whether in everyday life or on the field.

And that wraps up Part 1.  Tomorrow I’ll delve into some more challenges facing the “lax” athlete, assessment, as well as provide a unique case study.

CategoriesProduct Review Rehab/Prehab

Post Rehab Essentials 2.0: An Inside Look

For most of you who read this blog on a regular basis, I don’t really need to introduce Dean Somerset.  The man is quickly climbing the “kind of a big deal” ladder in the fitness community, and has really gained a reputation for being one of the brightest minds in the industry.

For those who aren’t familiar, here’s a brief introduction:

1.  He’s a strength coach as well as the Medical & Rehabilitation coordinator at World Health, located in Edmonton, Alberta.

2.  He’s a regular contributing author on T-Nation.com, as well as writes a pretty kick-ass blog HERE.

3.  He’s the co-contributor to several DVD compilations such the Muscles Imbalances Revealed series (both the lower and upper body versions), as well as the Spinal Health and Core Training Seminar of which I was part of as well.

4.  He can deadlift in the mid-400s (and 500 is just around the corner).

5.  His wife, Lindsay, is an accomplished tri-athlete and has recently qualified for world competition over in Europe!

6.  He owns two dogs, and loves rainbows.

Okay, I made the rainbow part up. But come on: I had to bust his chops in some way.

Dean just released his brand spankin new product, Post Rehab Essentials 2.o today, and I wanted to give people more of an inside scoop as to what to expect from it.

Unlike most sequels, which suck (yeah, I’m talking to you The Hangover Part II), PRE 2.0 really takes the information offered in the first edition and takes it to another level.

Speaking candidly, I’ve only just started to watch the videos myself, but from what I’ve seen thus far – I’m pumped that this information is going to be making its rounds.  It’s undoubtedly going to make people (and the industry as a whole) better!

I can’t even begin to tell you how much I was nodding my head in agreement as I was watching the first section. It got to the point where I was high-fiving my computer screen.

Nevertheless, below is a candid interview that Dean and I did the other day which, outside of discussing the product itself, is chock full of knowledge bombs in of itself.

Enjoy!

TG: Dean! Okay, lets cut to the chase:  I know you’re an Oilers fan, but they unfortunately didn’t make it to the playoffs.  Are there any teams left on the docket that you’re rooting for?

Side Note for a little TG Trivia: I for one, have never been to an NHL hockey game, and while the Bruins are still in the chase, sadly, the only time I’ve ever stepped foot in TD Garden (where both the Bruins and Celtics play) was for a live Star Wars in Concert event.

Literally there was a live orchestra playing music from Star Wars with a giant screen playing scenes from all the movies in the background.  Upping he geek-factor ante, Anthony Daniels (who plays C3PO in all the films) was there in person narrating the event.

Too, Lisa dressed her hair up in Princess Leia “buns,” and we had our picture taken with a live StormTrooper.

It was pretty much the greatest day in my life. True story.

DS:  Funny enough, I’m probably one of the very few Canadians who not only doesn’t play hockey but never even learned how to skate. I only started watching hockey a few years ago and didn’t even know what offside was until 2010.

That being said, I do watch the Oilers when they play because it gives some good water cooler talk while I’m training clients. Plus, I may or may not be eventually working with them directly in the coming seasons, and recently had a chance to do all the exit testing on the entire team for this current season, which was pretty cool.

I just want a Canadian team to win so that Montreal has something less to cheer about as they were the last Canadian team to win the cup back in 1994 (I think).

TG:  So, I was a huge fan of the first edition of Post Rehab Essentials, and I really felt it was a product that helped me better understand the assessment process as well as hone my programming writing skills. Like a ninja.

First off:  what was the impetus behind releasing a second, more awesomer version?

What does this version contain that the other didn’t?

And Secondly:  what do “we” actually mean when we use the term “post rehab?”

DS: Awesome questions. Much like you, I train people all day long and do things like writing and blogs on the side. I try to stay up on research as much as possible given the number of hours in a day, and try to view my own clientele as a cross section of average people, in which I can test to see if certain things provide better benefits or worse.

If something doesn’t seem to hold up across the board, I toss it out. If it’s something that’s universally effective for the vast majority of my clients, I continue to use it. When I put out the first version, my thinking of how the body worked was in one place. This current version represents the refinement of those thought process and includes a broader implementation of the concepts instead of spending as much time talking about the theory and anatomy.

That’s still there, but I wanted to make this more of a hands-on version.

For your second part, post rehab essentially means once you’ve received medical contact and have been cleared to begin a workout program in a guided setting.

Think of if you go into a chiropractor with a really sore back. They crack you, and send you out. You go into the gym not knowing whether you can do your favourite exercise program of high volume leg presses, stiff leg deadlifts and elbow to knee crunches.

What do you do? You find someone who has gone through Post Rehab Essentials V.2.0 to make sure they have tools to work with that won’t cause them to become a walking bag of fail.

TG:  Since this is a product that’s targeted towards personal trainers and coaches (and for those who are just fitness nerds in general), where do you feel most tend to miss the boat with regards to writing effective programming?

DS: Another great question. I feel that trainers have forgotten how to coach. We’re more concerned with giving the exercise than teaching the client how to do it properly. Stu McGill has said there’s no bad exercise for the spine, just contraindicated ones for the specific individual, and even then every exercise is bad if done incorrectly.

This video series brings back the coaching aspect to training and helps you understand how to get someone out of a poor spinal position with their exercises, how to hip hinge, what it means when their shoulders shrug into their ears, and how to fix that. These simple fixes can represent about 90% of every training program.

Correct exercise is corrective in nature.

TG:  OMG!!  Yes!!!  I couldn’t have said that better myself.  Whenever we start with a new intern class almost always they want to dive into assessment on day #1.  Much like you I’m under the mindset that they need to LEARN HOW TO COACH, and do it well, before we start discussing the finer points like assessing hip IR/ER or discussing the differences between flexion vs. extension based back pain.

One of the main points you covered in PRE 2.0 that really hit home for me is the whole concept of protective tension.  Put another way: people aren’t nearly as “tight” and stiff as they think more as they’re actually just really, and I mean REALLY unstable.

Can you kinda give everyone a Cliff Notes/Laymen’s terms synopsis of this whole phenomena?

DS: Muscles are pretty dumb creatures. They’re the slave of the nervous system, and if the brain says to contract, they will. If it doesn’t say to contract, they won’t. It’s really that simple. If you have a muscle that is constantly “tight” and won’t release no matter how much work you do to it with respect to stretching or SMR work, you may need to ask why it’s tight in the first place. Typically it’s trying to provide some form of stability for another area that isn’t being held tight enough.

Think of the hip flexors as a classic example. I’ve found that when people who have chronically tight hip flexors, they also tend to have very unstable spines coupled with weak abs. The same thing goes for tight posterior hips and lateral core stability.

Note from TG:  For those looking for a cool demonstration of what we’re talking about, I’d HIGHLY encourage you to watch the video below.  It’s eleven or so minutes that will blow your mind.

TG: Breathing and breathing patterns are all the rage in the industry nowadays.  I’ll admit that we use a fair share of them at Cressey Performance and that we find there’s a TON of efficacy for their implementation.

I’ve seen firsthand the kind of voo-doo magic that breathing drills and diaphragmatic correction can have on many common injuries and dysfunctions.  

What do you feel are the major benefits/take-aways that most people can gain from paying more attention to them?

DS: Core stability comes from the interplay of the pelvic floor, diaphragm, obliques, rectus abdominis, and multifidus (plus quadratus lumborum, but who’s counting). When you want to have a stable spine to lift stupidly heavy things, having the ability to squeeze your core tight between these structures is incredibly important. Likewise, recovering from hard workouts comes down to breathing through your entire lung deeply, rather than just shallow breathing through your upper ribs and shoulders.

The shoulders hang off the ribs. If there’s any issue with the ribs, the shoulders will be directly involved, meaning potential shoulder issues could have their roots in faulty breathing mechanics. People with low back pain breathe in a very guarded manner, which affects their core stability in a negative way. People with hip issues tend to be back breathers, forgetting how to get their diaphragm going. You picking up what I’m putting down yet??

Endurance athletes benefit the most from breathing work as that’s their gas tank. If I can get a runner to do a breathing exercise and it means their threshold speed goes up by a half mile an hour (true story) with no other intervention, it’s pretty important. I’ve had people breathe for 5 minutes and double their squat depth.

Breathing effects everything you try to affect.

TG: You also cover core training and what that actually means.  So, what does the word “core” mean to you?

DS: You mean teh abz?? In reality, core training is pretty simple. Make the core reactive so that it can contract really hard and make the spine stiff and strong, and then train it to pulse on and off.

Think of a baseball pitch.

The windup really doesn’t involve a lot of max core contraction. But at a certain point, the core has to brace incredibly tight, incredibly quick, and then turn down the tension at another point of the follow through so as to generate a whip effect. If the core was simply tense the entire time, you wouldn’t get any whip, and you would most likely throw molases off the mound instead of heat.

Likewise, with people who have a history of back pain, they has a defect in the ability to generate tension through their core and brace their spine, and then create a hip movement or a shoulder movement to propel stuff into or through other stuff. They tend to either hold on to tension too long or not generate tension quick enough to get stabile to control the spine during movement. It’s sort of like watching Lindsay Lohan walk down the street.

Core training typically involves learning how to brace the core in a neutral spine position, then getting them to control that neutral spine while either creating movement in other joints or resisting forces being applied to their body that try to push them out of neutral spine. Once they can do that, we can start looking to hit up things like heavy deadlifts, backflips, and cutting off that truck full of gun lovers on the free way.

The End

And there you have it folks. Post Rehab Essentials v. 2.0 is on sale for this week only!  The entire set is shot in HD, and you’ll get immediate access once you purchase.  If you’re a fitness professional or just someone who loves learning about the human body and performance, I can’t recommend this one enough.  It’s a game changer for sure.

===> Post Rehab Essentials 2.0 <===

 

CategoriesMotivational Rehab/Prehab

Don’t Let That Injury Derail You

Today’s guest post comes from a former distance coaching of mine, Australian strength coach Shannan Maciejewski. Shannan started working with me when he was coming of a pretty serious ankle injury, and he hired me to help him sift through the program design process as he worked his way back to playing competitive rugby.

As a funny aside, speaking of contact sports, I had a very brief history playing football back in the day.  I tried out for the football team in 7th grade and lasted a week.

After getting crushed for five straight days I handed in my helmet and pads and decided I’d rather collect baseball cards and play wiffleball in my backyard.

Nonetheless, Shannan offered to write a guest post and thought the theme he came up with was spot on to a lot of what I write about on this site.  Which is:  yeah, you’re hurt.  But that doesn’t mean you still can’t train.  Learn to make lemonade out of lemons!

Enjoy!

It’s 3.45pm and you receive a call.

Client

“I am just calling to let you know that I got crunched at training last night and am only just able to walk. I am going to have to cancel todays session at 4”

A few things go through your head…

-Is this just a cop out?

-Hmmmm, it is lower body day? I’ll go to hell if he doesn’t deadlift.

Your response

“That’s ok mate, come on in I will tweak the session for you”.

Being able to adjust on the fly or even plan in and around injuries is an extremely important aspect of a coach’s job. Tony has brought it up before on here, and I am going to shed some further light into creating a positive training response while recovering or dealing with the mud that life throws at you.

As with the above example, to have the session off and do nothing would rarely be the best option.

Life is going to get in your way.

I don’t have much energy today, My car broke down, My knee hurts, My nose is snuffly, I am still sore from Monday, My Doctor said to rest, my mum said I’m special, I think I’m coming down with something, I finished work at 5.10 instead of 5, I think I slept on my arm weird, my neck hurts……………And it goes on..

I think we all can relate to something above, I know I can. Mainly the special one!

Each and every individual is unique in what they present, and that is how programming should be approached.

Now just so you know upfront, I am not a physical therapist or a physio and therefore do not treat pain. I work with other professionals to get the best outcome for everyone we have contact with. It is always best to understand what the actual injury is, or what the limitation is before you start tinkering with exercises. So if in doubt seek professional advice initially and build from there.

What I can do is shed some light on is how to incorporate smart training and programming while you feel all busted up and helpless or just in need of some immediate action points that you can incorporate to keep progressing and moving forward.

Quick Story of a client of mine.

-Debilitating and season ending low back injury from over arching and sharp movement of throwing a football.

(Not quite the same throw in, but amusing anyway)

There wasn’t much initially that didn’t hurt. Bending, leaning, twisting, running all aggravated and stopped him from playing.

12 months later he is 10kg heavier, broad jump and vertical jump has increased, deadlifting and squatting is completely pain free and now a dominant figure sitting smack bam in the mid field. Cutting, turning, jumping, sprinting is all fair game.

Below I will outline some tips for you not just in how I approached the above client, but how you can do so with yourself and your injury/mishap.

Because, as Tony always says, you can ALWAYS train around an injury.  Always

Whatever you do it must be pain free

I think this goes without saying, but it does warrant a mention. I have heard it time and time again, and I will also say it.

IF IT HURTS, DON’T DO IT…

It does not matter if it is the number 1 exercise that your specialist or favourite guru said you should be doing. If it causes you pain or discomfort, stop it….Now!

There is always an alternative.

It won’t put you right off track if you need to sub in some Barbell hip bridges instead of your beloved deadlifts. If it means pain free, and creates a positive effect, well I am all for it.

For example do lunges hurt your knee? First off: try doing them properly. That’s a novel idea, right?

A lot of the time this alleviates some issues. I won’t go into correct form in this post, but it’s safe to say that there is a ton of info on this site that you can go back through.

Note from TG:  In fact, you can always perfect your RDL….(hint, hint).

If that’s still no good, go through a pain free range. Or as an example try these Low Co-Contraction Lunges with Anterior Pull. These allow you to feel more controlled and keep more of a vertical tibia therefore performing the exercise more effectively.

Start Point: With your right hand on Vastus Medialis (teardrop shaped muscle) and left hand on your glute and your right butt cheek squeezed hard, lift yourself off the ground a few cm.

Mid Point-End Point: Raise up stopping shy of lock out. This will keep tension throughout and reduce the range. Be prepared for the burns, and an intense stretch through your trail leg. This is fantastic to engrain 90/90 position and give instant feedback on what muscles should be working.

The point is even if it’s a magic exercise, it’s not magic for you if it hurts or aggravates an issue.

Focus on what can do, rather then what you can’t

This piggy backs on the above, but it definitely is worth mentioning.

Accept that you may not be able to perform your heavy squatting pattern for the time being, and focus on what movement you can do to create a training effect.

This is exactly the process that I went through when I broke my fibula and dislocated my ankle being tackled. Write down a list of movements that can be done pain free, and focus on these.

Can’t squat/deadlift/lunge due to injured/stiff/recovering ankle: Maybe it’s a time to hammer on your glutes and hamstrings through various supine based exercises. Lean on the cautious side and build up.

I recently just had a client who outstretched to catch a ball and his ankle blew up to balloon status. We had sumo deadlifts programmed, but ended up starting out with plenty of upper body as well as quadruped glute work, glute bridges, single leg glute work, strap leg curls and went up from there.

After a few weeks we worked up to barbell glute bridges, and now as ankle mobility has nearly been regained I am confident, as he is to slowly incorporate some standing work.

Here he is with some warm up sets on the BB glute bridge.

Try incorporating some DB pressing variations and a lot of pushup progressions, while hammering and bringing up your back strength. There is hyuuuggeee variety to use.

For example we have successfully regressed back to single arm fat grip floor presses with a neutral grip (mouthful I know) pain free. This still lends itself to some heavy lifting, while respecting the body.

Pushup variations allowing the scapula to freely move are an integral part of a complete program as well. You won’t die if some extra pushups are programmed. You may actually feel better.

It never hurts to incorporate more back/upper back work into the mix all year round too. A 2:1, sometimes a 3:1 ratio of pulling to pushing can help regain some normality in your posture and any strength deficits you may have.

Some pressing variations that tend to give the shoulders a bit more room to breathe and be a bit more joint friendly are DB floor pressing variations, Tucked neutral grip pressing exercises, ½ kneeling cable/band presses, standing split stance cable/band presses, ½ or tall kneeling corner presses. There’s more this just gets you to think outside the norm.

This variation is great as the resistance is low on the shoulder, and it is an angled press. So therefore we get a fatter grip, neutral hand position and varying resistance all while the glute is on and we get a bit of anti-extension throughout. Perfecto!

Don’t forget the other limb

There are times when being couch or bed ridden is unavoidable. Although when you are able to be up and moving around, there is then also the chance to begin to start the process in moving forward.

When we injure ourselves, or something doesn’t go quite as planned we can feel quite defeated and mentally drained.

With my ankle injury I wasn’t going to let both my legs turn to jelly and lose everything I had gained. Having 3 surgerys over a 12 month period I needed some avenues to keep me mentally and physically on top of things.

The results of the carry over were positive. Training the other limb has a slight carry over in strength and muscle control.

Choose exercises you can do, and do so with a slowly progressing volume. Most exercises can be done single side loaded or off set loaded.

On a note on stretching here is a hip flexor stretch I had to use when I couldn’t put pressure on my left foot. It worked a treat, and I used it frequently.

(All the pressure is taken off the front foot).

 

Hit the other half of your body hard

If you are someone who trains 4-6 times per week and can’t bare the thought of missing scheduled training sessions, then don’t.

What we can forget is that although we are injured, and recovery is number one at times, we still have 80-90% of our body to train. That’s a big chunk to me. Don’t let 10-20%  get you right off track with everything.

Get your meathead on and add in a varying upper body session. Alter the rep ranges, and go for it. Maybe even add some arms in there. I won’t judge.

If it’s your upper body, add in a lower body conditioning session, or some extra lower bodyweight exercises.

If your ankle/knee is playing up and you can’t join in team training sessions, try incorporating some battle rope conditioning sessions to jack the heart rate, and minimise joint stress.

Try these battle rope variations to keep it interesting and challenging. Not all will be able to used if you can’t walk forward or backwards but you get the idea.

Check List to kick A#*when injured and recovering

I wanted to provide you with a list to go over and sift through, and take note of what you are doing/can do/and will do to make the transition from where you currently are, to where you want to be.

– When in doubt, seek professional advice and determine your injury/restriction

– Focus on what you can do, what you can’t is not important and irrelevant

-List movements you can do pain free. Think in terms of horizontal push/pull, vertical push/pull, squat, hinge, isolation.

-What would you like to achieve in the next 2,4,8,24,52 weeks that you may be recovering etc

-Do you have any weaknesses/imbalances that you can work on and bring up?

-How many days per week do you want to train/ or can train?

-Do you have some opposite limb exercises to perform to carry over to the injured side?

-Omit the days of your current program that you can’t do, or tweak the exercises so you can do them

-Add in some pain free conditioning/metabolic methods to utilise if this is what is needed

-Surround yourself with positive people, and a powerful network that can help you when necessary

-Remain positive and know that this is short term and you can get back to your normal regime when it’s time.

Being injured and recovering takes a new skill set and different approach to training and lifestyle. Some small tweaks to your current plan, and you can remain on track, keep some normality and sanity and in general feel good that you are doing something to benefit not hinder the process.

If you have any questions, pop them below.

About the Author

Shannan Maciejewski is a strength coach from Australia and the founder of Raw Fitness and Sports Training located in Ballina NSW.

He has a strong passion for developing on and off field performance for football(soccer)players, and his no-nonsense approach and methods  produce long lasting results for many regular joes, individuals, athletes, and teams he works alongside.

He does not share the same passion for Star Wars as Tony though. Sorry!

Be sure to follow him on:

Website www.shannanmaciejewski.com

Facebook www.facebook.com/shannanmaciejewski

Football Specific Page www.facebook.com/footballperformancesystem

 

 

CategoriesRehab/Prehab Strength Training

Deadlift Cueing and Fixes

A few weeks ago I received an email from a DPT student in central Florida detailing a research project that he’s doing alongside a fellow student (as well as with one of the faculty at his school) looking at ways to use the deadlift pattern to treat patients with low back pain in a therapy setting.

He asked if I’d be willing to provide some common cues I use given certain “issues” people have when trying to deadlift which would aid in correcting their technique.

[Places finger over said student’s mouth]

Shhhhhhhh, you had me at deadlift.

What follows below is a candid/informal list I sent back highlighting my thoughts on more of the cueing side of things rather than the actual “correctives” (Ie: mobility drills, soft tissue restriction, chewing with your mouth closed, etc).

At the very least I figured it was something that could potentially help out others who may be looking to clean up their own technique.

And if it doesn’t, my bad.  I tried.

Lumbar Kyphosis

Depending on one’s kinesthetic awareness, this one can be tricky.  For those completely unaware of what their body is doing in space I’ll most likely take a more “hands-on,” non-Creepy McCreepypants approach – akin to what I call Play-Doh coaching.

Lets just say I’ve seen some trainers and coaches get a little too hands-on, if you’re catching my drift.

More often than one would think, you’re going to tell someone to “arch their back,” and then they’re going to look back at

you as if you’re speaking Klingon or have an extra nipple or something.  Not that you’d be showing off your nipples or anything, hence the whole creepy comment above, but I’m just trying to make a point.

They’ll literally have no idea or differentiation between lumbar flexion and what it means to arch their back.

One trick I like to use is to place them on the floor in the quadruped position and have them perform the cat-camel.  I’ll have them round their back as much as possible and tell them that’s what I DO NOT want.

Sometimes, depending on the severity, I’ll place my hands on my head, scream as loud as I can “no no no no no no NO!” and then jump through a pane glass window.

You know, for a little more effect. That’ll get their attention…..;o)

Back in reality, though, I’ll then have them bring their spine back to neutral and tell them that’s what I’m looking for.  I’ll have them perform a few rounds of this just so that they’ll get a feel for what I want and who I’ll want them to set up to deadlift.

It’s pretty effective, and will work for most trainees.

Another one I’ll use is to tell them to emulate what a basketball player does on the court when he’s tired (bends over and places his hands on his knees). Almost always, they’ll drop right into a neutral spine position and then I’ll be like, “there!”  Now, keep that same spinal position and grab the bar.

Another thing to consider is just using a deadlift variation which allows them to be successful. I’ve long championed that what makes the deadlift so awesome is that it can be so easily catered to the lifter, and not vice versa.

This is a huge reason why I love the trap (hex) bar so much, as it lends itself to be a bit more user friendly compared to other deadlift variations.  This is especially true for those who lack ample ankle, hip, and t-spine mobility to get into proper position in the first place.

With the elevated handles (and the fact that their center of gravity is inside the bar), the trap lends itself very appropriately to beginners or those with postural limitations.

Anterior Weight Shift

The main culprit here is people wearing those cement blocks that they call shoes.  Many have a significant heel lift which shifts the body anteriorly and makes it much harder to engage the posterior chain (glutes and hamstrings).

In addition, wearing shoes also increases the distance the bar has to travel, so it bodes in one’s favor to just ditch them altogether.

If for some reason they train at a gym that sucks and won’t let them deadift barefoot, I’d highly recommend things like Chuck Taylor’s or the New Balance Minimus (which, as the name implies, is more of a “minimalist shoe).

Outside of that, much of the resolution here is engaging a proper hip hinge pattern.

Having the ability to break with the hips and engage a hip hinge pattern – without losing spinal position – is HUGE in this context.

My go-to drill is hinging with the dowel rod.  We’re looking for three points of contact – back of the head, in between the shoulder blades, and the sacrum.

If at any point the dowel rod loses contact with the body, you’re doing it wrong.

I may have them perform a set of 8-10 reps with the dowel rod, and then immediately have them walk over to the bar and try to emulate that same motion. We need to CEMENT the pattern with strength training.

Along those same lines, another drill I use sporadically is where I tell them to pretend I have a rope tied around their waist and that I’m standing behind them and when they start their descent to imagine that I’m pulling their hips back with the rope.

It sounds weird and far too simple – but it works.

Limited Dorsifexion

This is an often overlooked limitation, as you need roughly 15-20 degrees of ankle dorsiflexion in order to perform a squat, lunge, and deadlift pattern without any major compensation up the kinetic chain.

Your garden variety ankle mobility drills are going to work wonders here.

Knee Break Ankle Mobs:

Wall Ankle Mobs:

Band Hip IR/ER with Ankle Mob (kill two birds with one stone here):


Some other things to consider, however:

1.  We live in PLANTAR flexion. Think about all the women who wear high-heels day in and day out, not to mention the aforementioned “cement shoes” that a lot guys opt to wear.  I love high-heels as much as the next guy (looking at them, not wearing them.  Just wanted to clarify).

Oh……my……..god…..I love them so much…

…..but I can’t even begin to describe how much of a train wreck they are in terms of the compensation patterns they elicit. Everything from chronic low back pain to plantar fasciitis to bone spurs.

It’s pretty telling how much they mess women up, and I’m often advocating for most, when they can, to ditch the high heels in light of wearing a flatter shoe.

Likewise, for dudes, purchasing a more minimalist shoe will work wonders in the long run.

2.  Dedicated stretches for the gastrocs and soleus muscles are going to be imperative here as well.  Standing around in plantar flexion all day is going to light these muscles up, so taking some time to do some simple stretches would be advantageous.

3. On that same note, I’m willing to bet that most even sleep in plantar flexion!  It sounds excessive, but even something like utilizing a Strassburg Sock – which encourages more DORSIflexion while you sleep – pays huge dividends in the grand scheme of things.

As an aside, I’d also gravitate more towards trap bar and sumo variations for those with limited ankle dorsiflexion and those will be less problematic postions to get into.

Limited Glute Activation/Weakness

This one is pretty easy. I’ll often defer to my good friend, the glute-master himself, Bret Contreras and place a premium on glute activation drills prior to training whether it’s supine bridge variations, single-leg variations, etc.

In my mind, glute activation drills is something that most people can’t get enough of so I have no qualms telling people to do them every day, several times throughout the day.

The key, of course, is to ensure that they’re doing them correctly.  Again, proper coaching comes into play here.

Moreover, in the context of deadlift technique, you have to be cognizant of a few things as you’ll inevitably come across two common errors.

1.  Incomplete or no hip extension what-so-ever.

Note:  for some reason I didn’t have a video available for the DL, but Eric does a good job of showing incomplete hip extension with this squat variation.

2. Excessive HYPERextension (essentially using lumbar hyperextension for hip extension)

In both cases proper cueing is going to be paramount.

For the former I’ll typically tell them to “finish with glutes” or “hump the bar,” which usually gets the job done.  Also, depending my rapport with the client, I’ll literally place my hands around their pelvis and try to encourage more posterior pelvic tilt.  Too, I may gently tap their glutes to help them fire.

In the case of the latter it’s a bit trickier, but I like to tell them to “finish tall,” and again, depending on the rapport, I’ll place my hands around their pelvis to help them but on the brakes (and prevent them from going into too much hyperextension).

Thoracic Kyphosis (keep in mind we’re just using the movement to influence lumbosacral movement, not trying to lift maximal weight)

Honestly, the dowel rod drill from above is going to be great here.  As well, I’ll cue guys to make sure they stick their chest out upon the initial set-up which will encourage a bit more t-spine extension

I pretty much shot from the hip on all of these, but hopefully they all made some sense and help a few people out.

Seriously though, I love high heels.

CategoriesRehab/Prehab Strength Training

Why Shoulder Injury Prevention Programs Are Failing

I recently had the opportunity to write an article for Stack Magazine, which is an online resource for high-school athletes and coaches.

When I was originally contacted and asked if I’d be interested I wasn’t really sure what I wanted to write about.  Then it hit me:  Um, dude – you work with a crap ton of baseball players, why not start there?

Seemed like a logical course to take, and that’s exactly what I did.

Now understandably, not everyone who reads this site is interested in throwing a baseball 90 MPH and could probably care less about “arm care.”

Besides chicks dig the long ball, right?

But I’d venture a guess that even though this article is geared towards baseball players, there are some universal nuggets dealing with shoulder health that has a lot of applicability towards the general population as well – especially with regards to the “true” function of the rotator cuff (and how to train it) and how the anterior core enters the equation.

That said, I want to demonstrate to Stack Magazine that the TonyGentilcore.com entourage can reach P-Diddy levels.

I’d really love for everyone to check out the article, give any feedback (positive or negative; hopefully mostly positive), and if you feel so inclined, “Like” it and share it on Facebook and Twitter.

Snuggles!

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