I’m on vacation this week (don’t worry I didn’t bring my lap top to the beach, I just wrote these posts last week!), so I will keep the posts short, but hopefully you can still something out of them!

About two weeks ago my colleague Kevin Neeld posted a video on how to assess for femoral anteversion and retroversion.  The video why this type of assessment might be very important, especially for hockey players.  Kevin also explains in detail how to assess range of motion at the hips.  If you haven’t seen it on his website already, make sure you watch the video below!

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I wrote on Tuesday that you may not have to stretch your hip flexors, even if they feel “tight”.  I also showed how easy it is to screw up a hip flexor stretch.  If you missed it, make sure to read it HERE.  But how does someone knows if he needs to stretch his hip flexors if we can’t rely on the fact that they feel “tight”?  Those who are familiar with muscle testing a bit will say to use the Thomas test (or one of its variations) to assess hip flexor length.  The Thomas test is a commonly used test among strength coaches, physical therapist and other rehab/training professionals.  Here is what it looks like:

 
By letting one leg hang down, you can usually know if the person has short/stiff hip flexors if the knee of the down leg hangs higher than the hip.  In the case of a shortness in the rectus femoris the knee will also stay extended over 90 degrees of flexion.  A positive Thomas test (knee staying above hip level) usually is good indications that your hip flexors are short or stiff, but as I mentioned before it might mean that the problem is neurological, and stretching your hip flexors won’t solve the problem.  To add to the confusion, a negative Thomas test (knee dropping all the way down) doesn’t mean that your hip flexors aren’t short/stiff.  It could mean that your anterior capsule and ligaments are overstretched.  One way to prevent this is to make sure that you stretch your hip flexors the right way, like I mentioned in my last post.  But how do you know if it’s a capsule/ligaments issue or not?

Using the adduction drop test in conjunction to the Thomas test might be a good option.  Here’s what it looks like:

The adduction drop test is something I picked up from the Postural Restoration Institute.  They commonly use this test to identify what is called a left AIC (Anterior-Interior Chain) pattern, which implicates that most human beings are stuck in external rotation and abduction, and hip flexion in the left hip.  The combination of a positive adduction drop test and a positive Thomas test usually points in the direction of a left AIC pattern because of the lack of hip extension and adduction on the left side.

We can also use the combination of these two tests to identify anterior capsule and/or ligament laxity.  A positive adduction drop test and a negative Thomas test would be indication of anterior laxity in the hip capsule and/or ligaments.

Assessing before you prescribe a hip flexor stretch and making sure it is performed correctly if you need to prescribe it are the two keys here.

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I wrote a little bit in the past how some hip restrictions can come from a structural problem rather than from just a lack of mobility in soft-tissue.  Femoroacetabular impingement (commonly known as CAM and Pincer impingement) can restrict hip flexion range of motion as well as abduction and external rotation.

These structural differences are only present in a very limited number of individual, but it’s really important to assess athletes and clients who present with a lack of mobility and clear out those potential problems before hammering on the soft-tissue and flexibility work.  Trying to force someone in full hip flexion in the presence of a femoroacetabular impingement can have some pretty bad consequences.

Here is a simple test you can use to clear out a femoroacetabular impingement.  The quadruped rock test is very helpful in helping determine if we might or might not be dealing with one of these problems.  Put your client/athlete on all fours and ask him to rock back while maintaining neutral spine.  With a normal hip, no matter the stiffness, the range of motion should improve as the client/athlete rocks back multiple times.  If your client/athlete gets stuck at the exact same spot, even after rocking 15-20 consecutive times, chances are that you might be dealing with a femoroacetabular impingement.

If this is the case and your client/athlete’s quadruped rock doesn’t improve, you should refer them out to a medical professional to have them confirm or clear out the problem. This type of impingement is not very well known in the strength and conditioning community and it’s definitely something we need to be aware of as coaches.

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I read Charlie Weingroff’s blog post 2 days ago that was called Putting Manual Therapy Into Perspective (make sure you read it, as it is one of the most enlightening thing I’ve read recently).  For those who might not know Charlie, he is one of the smartest minds in this business and he has a unique perspective on things (I guess that’s what happens when you put physical therapy, strength and conditioning, powerlifting and manual therapy in the same person!).  That being said, Charlie was discussing different manual therapy options in his blog post and when each one might be appropriate.  The part of his blog post that really caught my attention though is the first part where he explains why we lose mobility in the first place.

Muscles are rarely, if ever, short.  When a muscle feels stiff, it’s not necessarily short and it definitely doesn’t automatically means that you should stretch it.  Stiffness can be created for many different reasons, and sometimes the cause of the problem may be somewhere else. For those who’ve been reading my stuff for a while, you know that I’m a big advocate of stretching, so that might sound confusing coming from me, but bare with me you’ll understand why I’m saying this (because it is not ALWAYS appropriate to stretch).

One other thing to understand is that a muscle that feels tight might be short, or it might actually be long.  This might be a complex thing to understand, but here is a simple example: think about someone in an anterior pelvic tilt.

When your pelvis is tilted forward, your hamstrings are going to be put on a stretch.  Because of that, your hamstrings might feel stiff and if you use a straight leg raise to assess their length, they will most likely test short.  But if you think about it, in this specific example, your pelvic position is what causes your hamstring to test short.  If the pelvis is reposition correctly with appropriate strategies (read: not stretching your hamstrings), your hamstrings will get some slack and they most likely won’t feel stiff anymore (or less stiff).

This is just one example of why muscles that feel stiff might not need to be stretched.  Another reason might be when muscles get stiff as a protective mechanism or a compensation pattern.  Never forget the brain-muscle connection and its importance, especially when it comes down to “stiff” muscles.  Your brain might send the signal to the muscle to stiffen up because there is something going wrong around the area.  This might happen to prevent a muscle to overstretch or that might even prevent you from pulling a hammy or a quad while you sprint or play hockey or whatever else you’re doing.  And when you’re performing a task at high or near-max intensity, your body will always compensate in the easiest way possible.  And unfortunately this is not something we have control over; your brain is the boss and he’s the one sending the signal to the muscles if they should activate, stiffen, shut down, etc.  So you can stretch all you want, but the muscle in question will never loosen up.

This is why assessing and addressing imbalances is key.  It’s really important to address the underlying issues to whatever problem one might have.  If you don’t, you might be studying for the wrong test.  You can stretch a muscle all you want and it’ll always feel tight.

This is really just the tip of the iceberg when talking about short/stiff muscles and the implications of stretching and how the brain has so much control over what’s happening.  And there are so many other things to consider.  Hopefully that opened your eyes a little bit on how stretching stiff muscles might not always be the solution to everything.

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I came across a study yesterday (thanks to my colleague Kevin Neeld) on ice hockey and the relationship of physiological components with actual on-ice performance.  Before discussing the results of the study, what I found especially interesting with this specific study is that they were interested in the actual on-ice performance during games.  Most studies measuring physiological attributes (such as strength, speed, VO2 max, body fat, etc) usually relate these aspects to on-ice performance, but not very often to actual in-game performance; results will most of the time be compared to on-ice skating speed, endurance and the like.

In this study by Peyer et Al., the physiological measures were compared to in-game performance in the form of plus/minus scores.  The characteristics measured were:

• Age
• Height
• Weight
• Body mass
• Body fat %
• VO2 Max
• Repeated off-ice speed test (in the form of 12 x 110 meters sprints)
• Strength tests (in the form of push ups, chin ups, leg press and bench press)
• On-ice speed tests (dot-to-dot, short lightning, and lap sprint)
• Plus/minus on the ice during games

A significant correlation was found between the repeated off-ice sprint test, 3 strength tests (chin ups, leg press and bench press) and the plus/minus scores.  The players who performed the best on the repeated sprint test and the 3 strength tests had a better plus/minus score.  What is equally interesting to me is that body fat percentage and Vo2 max, which are two highly rated and utilized tests in the hockey community, had no relevance whatsoever with actual in-game performance.

Good Predictor of Hockey Performance?

If you’ve been using a no-nonsense approach to training hockey players (prioritizing strength, using an interval-based system for conditioning, etc) you’re probably not very surprised by the results of this study.  It’s interesting to me that the research world is actually coming up with concrete results that support and back some of the stuff we’ve been trying to spread in the strength and conditioning world.

It is obvious that there is a need for more research to be done on physiological components and their relation to in-game performance, as this study (like any study out there) has its flaws.  The first one is the fact that the study has been done on only one college hockey team (NCAA D-1), so only 24 players were part of the study.  In an ideal world we would want a bigger sample of players to contribute to the results.  Also, the in-game measure that was used was the plus/minus score of each player.  Although the plus/minus score gives a good idea about a player’s offensive and defensive abilities and reflects on-ice performance decently, there are other factors that affect this score.  For example, the goalie’s performance can positively or negatively affect the outcome of one player’s plus/minus; if the goalie is really good and allows very few goals during games, even when he faces a lot of shots, it can positively affect a player’s plus/minus score.  And the opposite is also true if the goalie is terrible and allows many goals, the plus/minus score will be affected negatively.

In conclusion, this study gives us a good lead on what might be more appropriate tests that actually co-relate to in-game performance and what physiological attributes might be more relevant for hockey players to focus on.

References

Peyer KL, Pivarnik JM, Eisenmann JC, Vorkapich M. (2011). Physiological characteristics of national collegiate athletic association division I ice hockey players and their relation to game performance.  Journal of Strength and Conditioning Research, 25(5):1183-92.

I recently interviewed Mike Robertson on the release of his new product: Bulletproof Knees and Back Seminar.  For those who might not know Mike, he’s a brilliant strength coach who has been in the trenches for many years.  He has helped clients and athletes from all walks of life achieve their physique and sports performance goals.

His new product is an depth resource about injury prevention for the knees and lower back. It’s no secret that knee and lower back pain and injuries are becoming a plague among athletes and in society in general.  Mike goes into great detail on how to address these issues; understanding of the functional anatomy, complete assessment protocols, corrective exercise protocols and how to efficiently coach clients and athletes, and much more.  Mike was kind enough to give us a couple minutes out of his busy schedule to answer my questions on his new product.

DL: Mike, thanks for the taking the time to be with us today.  You recently launched your new product called The Bulletproof Knees and Back Seminar.  It’s a 6-disc DVD set that covers everything you need to know about the knees and back.  It’s definitely a great resource, but let’s face it: it’s not the first knees and back injury prevention resource out there.  What do you feel differentiate this one from the other knee and back resources out there?

MR: There are a couple of reasons I feel this piece is different:

1 – I blend research and in-the-trenches information. Some resources are great with regards to their literature review, but the people haven’t spent a ton of time actually training clients and athletes.  In contrast, other people may have spent the time in the trenches, but their methods are misguided because they haven’t done their homework when it comes to the research.

I do my best to blend the two to get maximal results.

2 – This is VERY complete.  In this product I cover everything from functional anatomy, to the assessments we use, to program design, to proper and effective coaching. I literally take you step-by-step through the entire process, so that you’re a much better coach when you come out on the back end.

DL: This is definitely true!  When buying the product you get a 6-disc DVD set and 10 different bonuses, so it is indeed very complete! Mike, who is this resource for?

MR: My target audience is obviously coaches and trainers, but the industry has changed so much that I absolutely have to include the broad term of “fitness enthusiasts” as well. After all, there are people who read my site daily that are wicked smart, yet their day job is managing hedge funds or selling Blackberries!

Bottom line – if you are serious about learning more about knee and back training, you’ll really enjoy the DVD series.
DL: It’s been somewhere over 3 years since you launched the Bulletproof Knees manual.  Has your view and the way you deal with knee pain has changed ever since? If yes, how?

MR: You know, it hasn’t changed as much as might think!

I’m always striving to improve, but at the end of the day, the hips and the ankles are still critical in knee health. If I’ve changed anything, or improved upon anything, I think now I’m much more cognizant of the roles of hip and core stability in knee health.  If your core and/or hips are unstable, again, the knees will take a beating.

But overall, I haven’t really changed that much – just refined more than anything else.

DL:  Mike, as you already know, trainers and coaches alike have to deal with a lot of knee and back pain (amongst other injuries) with their clients.  Some do too little to help them get better, but some others try and do too much, and sometimes cross some boundaries (i.e. doing a physical therapist’s job, per se).  When do we need to refer out? and how important do you think it is to have a good network of professionals around you?

MR: As I’ve mentioned before, there are three times when I ALWAYS refer out:

• Neck injury
• Low back injury with radicular signs
• Acute injury

Let’s be honest – I’m not a physical therapist, chiro, or sports med professional. It’s not my job to diagnose new injuries and give them a treatment plan. This is why you need a great PT, massage therapist, chiro, etc. on your team or in your network. You refer them out, get them right, and then they come back to you ready to train.

What I can do is get them moving and feeling better on the back-end. A lot of people don’t have “knee pain,” so much as they have movement patterns and muscle imbalances that hurt their knees! If you squat knees way forward, your knees are going to hurt. If you only train quads and no hamstrings, your knees are going to hurt.

So much of what we do is really simple, it doesn’t take a rocket scientist to get people feeling better!

DL: Mike, thank you so much for your time!  All the best with your future projects!

To purchase Mike’s Bulletproof Knees and Back, click HERE.

My colleague Kevin Neeld was having a phone conversation with a fellow strength and conditioning coach on the phone yesterday, and since we share the same office I couldn’t help but hear everything he was saying.

Sharing an office with Kevin is sooooo much fun

He was talking about the way we do things at Endeavor and how it might be different for other coaches in different settings.  That got me thinking on how important it is to take your setting into consideration with the way you do assessments, write programs, coach your athletes, etc.

At Endeavor, we are training mostly hockey players, which means that we are super busy during the summer months (May through August) which is the hockey off-season and the rest of the year during the hockey season things are slower and we train some athletes from other sports that are in their off-season (mostly baseball, soccer and lacrosse).  The athletes we train from those other sports also happen to be much younger than the college/pro hockey players we train in the summer; most of them are 16 and under.  We do mostly small group training and the time we spend with our athletes every week is not a lot.  In that type of setting, we do things differently than we would with a professional team or in a college setting for example.

Doesn’t exactly look like Endeavor!

It might come as a big surprise to many that we currently don’t have an assessment or testing protocol with our new athletes.  Some may argue that testing and assessing every new athlete that walks through your door is of utmost importance, and they might be right.  But again it comes down to the fact that you need to do what’s best in your own situation.  With the little time we see our athletes, we can’t afford to waste our time with things that are not going to be top priorities.  And the truth is that we used to have an assessment protocol which was basically the FMS (functional movement screen) and some goniometer measurements, but we realized after using that protocol for a while that it didn’t change the way we were writing programs anyway.

Hurdle step test from the FMS

So why do it in the first place?  Even athletes playing the same sports will need to be trained pretty much the same way, but I will admit that there might be some individual differences between athletes playing the same sport.  But the thing that we found out is that we can always identify the problems just by observing our athletes move during the warm up and the rest of the training.  If you’ve been around long enough, major dysfunctions are easily identifiable and adjustments on the programs can be made on the fly.  We also have a high number of younger athletes, and they definitely don’t present with as many restrictions (if any) as some of the older athletes will.  We’ve been quite successful with that approach, both from a time management and injury prevention standpoint.

A similar situation presents itself with performance testing; most of our athletes (for the older ones at least) get tested by their own team at the end of the season and at the beginning of training camp.  So where’s the need for performance testing really when they provide us with all the data they/we need anyway twice a year, sometimes more.

There are many factors that will determine how you implement your system and the way you work with your athletes.  These include, but are not limited to:

- Number of athletes per group

- Sports the athletes play (do all athlete within a group play the same sport?)

- Age of the athletes and training experience

- Number of coach-to-athlete ratio

- Time available with athletes every session and every week

- Equipment available

- Setting of your facility (how your facility is divided and if you can keep an eye on everyone all the time)

- Experience

- Etc.

As you can see it leaves a lot of possibilities depending on many different factors.  You can’t judge what someone does until you’ve seen what their situation is.  Every good strength coach or trainer out there does things differently because they are in a different setting.  Eric Cressey assesses and writes an individual program for every client and athlete that trains at his facility.  Mike Boyle, who’s an equally good and successful coach doesn’t assess anyone and have all his athletes from the same sport on the same program.  Who’s right and who’s wrong? Again, I think they’re both right because they do what’s best for their own situation.

All in all, it’s very important to be able to adapt.  In my opinion, it might be what distinguishes the great coaches for the good ones.  Analyze, apply and adjust things in order to be as efficient as possible in your situation and to get the best results possible for your athletes.