We were hosting the Myokinematic Restoration course from the Postural Restoration Institute at Endeavor this past weekend. Other than the learning experience in itself, it’s always fun to attend those events to connect with new people and hang out with like-minded people. The added bonus this time, since we were hosting the event, is that there was no traveling!
For those not familiar with the PRI concept, their basic philosophy is that the human body is asymmetrical because we have a heart on the left, liver on the right, larger diaphragm on the right, and more lobes in the right lung than the left, just to name a few things. These characteristics change the orientation of our spine, pelvis, ribcage, as well as our limbs.
I have taken 2 home study course from PRI before, but it was my first time attending a live event. I must say that the live event blows the home study course out of the water! Everything makes a lot more sense, and you have actual lab time to practice the assessments protocols and corrective techniques.
That being said, here are some take home points from the weekend:
- We need to stop thinking of muscles as singular plane movers. Most muscles, especially the ones around the hips, have a tri-planar component. For example, the adductor group has an influence on the hip in the frontal plane (adduction), but also in the sagital plane (flexion and extension), and the transverse plane (medial and lateral rotation). It’s not necessarily a prime mover in all 3 planes, but it clearly has an effect on the hips. It’s the same for many other muscles.
- All corrective strategies in the presence of an imbalance or a limitation start with proper positioning. No matter what the issue is (lack of hip rotation, lack of shoulder rotation, limited t-spine mobility, etc) you can’t know if that is truly the problem until you’ve repositioned your client in a neutral position. For example, the left pelvis could be forwardly rotated, which would restrict the internal rotation of the femur. So if you test the seated IR of your client and it seems restricted you might be tempted to just crank on the stretching. If the client is repositioned in a neutral alignment, and then you re-test him, you might find that the internal rotation deficit just disappeared. This is why repositioning is important before prescribing anything else.
- According to the PRI school of thoughts, everyone is asymmetrically built the same way. That doesn’t mean that everyone should be treated the same way. Why? Because not everybody compensates the same way. Assess, correct, re-assess and see if anything improved. If not, change your corrective strategy.
- The posterior fibers of the glute medius externally rotate the femur. The anterior fibers of the glute medius internally rotate the femur.
- The left AIC (anterior interior chain) is what is referred to as the most common compensation pattern. In a left AIC, the left pelvis is rotated forward, the left femur is externally rotated and abducted, the right femur is internally rotated and adducted, the weight is shifted on the right leg, and the lumbar spine is rotated to the right. Watch for these common findings in clients and athletes.
- The most common injuries in left AIC people that are non-pathological (with no ligament laxity) are: right SI joint pain/strain, hip bursitis, tibial stress fracture and shin splints, hip impingement syndrome (posterior on the left, anterior/medial on the right), pubalgia, hamstring pull (more common on the left), and anterior knee pain (more common on the right).
- The posterior hip capsule (mostly on the left side) often gets very stiff. It might often be problematic when trying to reposition the pelvis. Make sure to include a posterior capsule stretch in the corrective program if that is the case.
- People who live in extension (hyperextended back) have a hard time getting all their air out when breathing. That is mainly because the diaphragm is in a disadvantageous position to eccentrically contract (exhalation phase) properly. When breathing out the ribs should come down to allow optimal eccentric contraction of the diaphragm. With people in hyperextension this just doesn’t happen because their ribs are flared out in the front, and it becomes impossible for them to come down. If you have a hard time understanding what I’m trying to explain, check out the video below, and look at the movement of the diaphragm and the ribs during the exhalation phase.
All in all, this course was really good, and I learned a ton, even after taking the same home study course 2 years ago. I would highly recommend it to anyone involved in training, or rehab. It’s great information that will put you ahead of the curve!
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I’ve had a couple people come up to me recently with a nagging shoulder pain. One of them was one of the baseball pitchers that I train during the summer who’s now in College. He’s had a nagging pain in his throwing shoulder for the past couple of months that’s preventing him from pitching at the same intensity as he used to, and now he’s freaking out because the baseball season is starting in a couple of weeks. The second is a good friend of mine who’s into the Crossfit thing and he was telling me one of his shoulder has been bothering him for a little bit. They both had pain in their shoulder with either the shoulder clearing test from the FMS (baseball player) or the empty can test (Crossfit guy).
The Empty Can Test
A quick assessment of their range of motion around the shoulder showed an internal rotation deficit in the painful shoulder for both of them. Shoulder extension wasn’t too bad in both cases and t-spine ROM was lacking a little bit in the Crossfit guy.
Instead of cranking on their range of motion and possibly forcing something that’s not there (and possibly originates somewhere else), I gave them 2 simple breathing exercises that I learned from the Postural Restoration Institute to re-establish proper diaphragm function, as well as ribs, thorax and scapulae positioning. I also gave my Crossfit buddy a t-spine mobility and scapular stabilizer drill do to because his posture was not great.
The positioning of the diaphragm can affect all the surrounding structures
After only 5 minutes, both of them had an increased internal rotation range of motion in the painful shoulder; and I did absolutely no stretching or soft-tissue work whatsoever. And even more importantly, their shoulder pain wasn’t there anymore with neither the FMS shoulder clearing test or the empty can test!
This is how important proper breathing patterns and diaphragm function are. It can affect the way your shoulder, your pelvis and everything around them is positioned. Before forcing range of motion and hammering the soft-tissue work, make sure your athletes and clients are breathing right!
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Everybody makes mistakes. And if you think you’re any different and you don’t make any, you’re really kidding yourself and it’s probably time for a reality check.
We all make mistakes, whether we like to admit it or not; this is human nature. It’s part of the learning process. Strength and conditioning coaches are not different. I’m no different.
This is the time of year where everybody makes resolution for the new year or highlights what they learned or changed in the last year. I’ll give my 2011 review a different flavor by giving you my top 5 mistakes I made in the last year (or the ones that have lasted up to this past year).
1. Recommending minimalist footwear for everyone. I wrote a whole blog post on the subject not too long ago (if you missed it you can check it out HERE). The idea is that for too long we have restrained our feet in footwear with a lot of cushioning, big heel lifts and support all around. That made the feet become lazy, and they stopped doing their job because they didn’t have to anymore. But the thing is that the problem can originate somewhere else; in other words, the feet are not always the source of the problem, but rather the result from a problem originating somewhere else. In our lifestyle in 2012, there is more than just our footwear that’s wrong. Sedentary lifestyles, prolonged sitting, poor posture, long commute in cars, and early development in young athletes who do too much too young are all factors that can wreak havoc on our bodies. Any of these factors (or a combination of) can lead to permanent structural changes on our bodies. Femoroacetabular impingement (FAI), femoral anteversion and retroversion and other hip problems can lead to different feet position and structural variations.
Probably wouldn’t be a good idea to have this guy run in Vibrams…
Before I digress too much, it simply means that not everyone can get away with wearing Vibram Five Fingers or New Balance Minimus all day. I used to blindly recommend those type of shoes without assessing the person. Let’s just say that I’m a lot more careful about it now. As a side note, overweight and poor running mechanics are 2 other factors that would lead me to not recommend a minimalist type of shoes for physical activity.
2. Minimizing the importance of breathing. If you’ve followed my blog for some time, you should know by now the importance I pay to breathing patterns. I’ve blogged about that many times during the last year, and I must say that the more I learn about it, the more I realize how crucial it is with any movement pattern and for proper alignment (as a side note, I can improve your range of motion just by teaching you how to breathe; that’s how powerful it is). The diaphragm muscles (yes, there are 2 of them) have fascial connections with the thoraco-lumbar fascia which in turn connects with the psoas (that attaches on the spine) and the hips.
Because of that, proper diaphragm function and proficient breathing patterns are essential for optimal posture and positioning through various movement patterns. Ineffective use of the diaphragm muscles could lead to hyperextension of the thoraco-lumbar region, faulty positioning of the hips and plenty of other problems all the way up and down the chain. This is something I coach a lot now, and it has made a huge difference on our athletes at Endeavor. If you’re not familiar with proper breathing patterns and diaphragm function, I suggest you take a look at the PRI stuff (Postural Restoration Institute).
3. Mismanaging training volumes and intensities. Whether it is in my own training or the ones of my athletes, I think I have not always been good at managing fatigue and recovery. On paper, training volumes always look well managed, but the reality is that it goes far bey0nd that. For one, if you always go balls to the walls when you train and push yourself the the very limit every training session lifting maximal weights and pushing lactic conditioning ’til you puke, chances are you won’t recover properly even if the planned training volume for the week is moderate. The other thing is that there are a lot of other factors that factors in the equation (quantity and quality of sleep, nutrition, other sports and activities outside of the gym, the party factor, etc). Whether you like it or not, there aren’t that many athletes that won’t take some time to enjoy life during their off-season, which usually means spending a day at the beach not eating too well (or enough) or have a late night and a couple of beers once in a while. In their off-season, athletes not only need a physical break from their sport, but a mental one as well. Nothing wrong with that, as long as they keep it in check and don’t overdo it. It struck me this past summer when we had one of our pro hockey player return to Endeavor after a very long season in which his team ended up winning the Stanley Cup. First of all he came back from his team mid to late June, almost 2 months later than all the other guys, but he was also way more beat up physically and mentally. It was apparent that even after almost 10 days completely off, he just didn’t have the wheels he had the previous off-season (which started in April the year before- that’s a big difference). He took more days off from training than the previous off-season and the number of days he showed up hungry to get after it were definitely not as frequent. The off-season is not only about getting ready for the upcoming season, but also recovering from the previous one, especially if it was a very long and excruciating one. This is where HRV measurement tools are gonna come in handy; it allows you to measure physical and nervous system fatigue and you can manage fatigue and recovery so much better. And that technology is becoming available to us. I blogged about this before.
4. Aerobic training is not the evil I thought it was. I always stood up against aerobic training for team sports because it’s simply not the way most sports are played. After trying to prove my point for years, and I am starting to realize certain things. I still don’t think I was wrong about the fact that long slow pace aerobic training is not specific to sports, but I’m starting to realize that the pendulum may just have swung too far.
The aerobic system plays a huge role in recovery for the lactic and alactic systems and a decent amount of the energy produced in a team sports setting will come from the aerobic system. It still doesn’t mean that you should go for hour long jogs 4-5 times a week to get ready for your hockey season, but there just might be a place for steady state aerobics in a yearly training plan after all.
5. Not enough external rotation based rotator cuff exercises for my baseball players. With the importance of scapular stability, t-spine mobility, breathing patterns and working the rotator cuff in a stability role, I will admit that I neglected external rotation based exercises a little bit last off-season with my baseball players.
Shoulder injury prevention is about much more than just external rotation exercises, but it might have been another pendulum that swung too far for me because I haven’t done much of it with my baseball pitchers last off-season. The reality is that the external rotators of the shoulder still need to decelerate the crazy velocity of internal rotation that occurs at the shoulder in a pitching motion (over 7,000°/sec), so it’s still specific to do direct external rotation work with baseball pitchers, so these muscles become better at decelerating the internal rotation.
Those are the mistakes I’ve made this past year. What are the mistakes you’ve made during the last year?
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Core training is most often referred to as exercises that work your rectus abdominis. Sometimes the concept of core training will go as far as including the external and internal obliques and the lumbar erectors, but it rarely goes past that stage. The term “core” in itself is very loosely used to describe either abs training or stability training, or sometimes both. But the reality is that your core can include every muscle that runs across your hips, spine (including the cervical spine) and shoulders.
And this is only the back view…
So we definitely need to broaden our horizons when we think about core training and realize it’s much more than just the muscles around our belly. Here are some of the most overlooked aspects of core training:
Cervical spine alignment (packing the neck)
Inner core activation (pelvic floor, diaphragm, transverse abdominis and multifidus)
Breathing patterns
These are 3 things that go hand in hand with each other, as well as with traditional core training and in my opinion they’re probably the 3 most overlooked aspects of core training among athletes and regular gym-goers.
The trend since Stuart McGill’s work came out is to use neutral spine whenever we train the core and lift weights. The goal is to reinforce this pattern as much as possible. But we often forget that the neck is part of the spine and that should also be trained to be neutral. There is a much deeper core activation when the neck is packed in a neutral position and it provides for greater stability. The cervical spine often gets into hyperextension when training, especially with posterior chain exercises. The tendency is to keep the eyes up while the angle of the spine gets closer to parallel.
Notice how hyperextended the cervical spine is.
This position puts a lot of strain on the inter-vertebral discs of the cervical spine on top of having sub-optimal spine stability all the way down to the lumbar spine (each segment of the spine interacts with each other). Keeping the neck in a neutral/packed position will facilitate a proper breathing pattern (Try and take a deep breath- without thinking about it- first, in a relaxed position with your neck not in a neutral position, and then try it again in a packed neck position. Notice how the breath with the packed neck position is much more of a belly breath, compared to more of a chest breath without your neck packed). And that in turn will facilitate activation of the inner core muscles.
Why is this the first image that pops up when I google “packed neck position”??
…but I have to say that his form is pretty impressive
The bottom line is that everything in your core is interrelated together and when everything is indeed coordinated, you gain amazing stability that you wouldn’t have otherwise. That’s why it’s so important to train your inner core, your breathing patterns and your packed neck position. From an injury prevention and a strength gain standpoint it can make all the difference.
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There are 2 coaching cues that I’ve become more aware of lately that slipped under my radar for quite some time. I didn’t realize the importance they had on efficient movement patterns and how they could impact they way the athlete moves.
1- Neck position. By reading Weingroff’s stuff as well as watching his DVD set and seeing him speak, this is a big take home that I got from his message: you need to coach neck position. It is part of the spine and has an important impact on inner core function. This is something I feel like too many coaches would say “why the hell does it matter? It’s not a big deal”. Well, in fact, IT IS a big deal! When you deadlift, when you do chin ups, when you do lunges, and when you do any core exercises, the position of your neck affects how your whole body will react. The goal is to get efficient at joint centration and therefore the body can maximize stability and power production. The joint centration concept that Weingroff tallks about refers to your joints being in “optimal”, neutral and stable positions for the body to function and move as efficiently as possible. The position of the neck is a big part of this joint centration concept. Look carefully at your athletes and clients next time they lift; most of them naturally tend to compensate by reaching with their neck in many different positions. Coaching athletes and clients to pack in their neck is of utmost importance and I’ve been guilty of overlooking this coaching cue for way too long. I realize now it is as important as keeping a neutral spine, or keeping your shoulder blades back, etc.
2- Breathing. We’ve all heard this before at some point in our lives: while lifting, you want to inhale on the eccentric phase and exhale on the concentric phase of any given movement. Many of us have ditched this concept because we know that it is far from optimal when trying to move big weights and it is pretty inefficient strategy to create stability. Although I still believe this last theory, I’ve been more aware of the importance of breathing and how it affects your body, just not in the old fashion exhale while you push way. After taking the postural respiration home study course from the Postural Restoration Institute this past weekend, I realize how important breathing patterns really are.
It affects the position of your spine, your thorax and your ribs on both sides. Most people have ribs flaring out on the left side and are not very efficient at using their right diaphragm (more on this in an upcoming blog post); because of that the whole orientation of the spine, the thorax and the ribs are affected; which in turn affect neck and shoulder muscle function. Without going into too much details right now, breathing really does have a profound effect on how we move and position our body. I’m still not going to tell my athletes to exhale on the way up on a heavy set of deadlift because they need stiffness, which they couldn’t get that way, but there are ways to incorporate breathing patterns into training. Coaching effective breathing patterns is another often overlooked coaching cue that deserve more attention than it has had recently.
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Sometimes we get too caught up in looking at the shoulder itself only and we forget what’s happening around and further down the chain. We all know that soft-tissue work, internal rotation ROM, scapular stability and flexibility are all important factors in shoulder health. But in my experience, the thoracic spine is by far the most overlooked aspect of shoulder health. It usually affects everything around. If you take the joint-by-joint approach to training, one general take-away you can get is that a lack of mobility at one joint (or lack of stability, if we’re considering a stable joint) will generally affect it’s neighbor joint (i.e. the one closer up or down the chain) in an unfavorable way.
The Joint-by-Joint Approach
Using this approach, every joint has a neighbor up the chain and one neighbor down the chain (e.g. the hip joint is connected with the lumbar region above it and the knee below it). When taking the thoracic spine and taking this approach one step further, we realize that the t-spine, as opposed to most other joints, has 4 neighbors instead of just 2. In fact, the t-spine is directly linked to:
the lumbar region
the cervical region
the scapula (and the clavicle)
the ribcage
Because of this, the implication of the thoracic spine are major ones, as it can affect scapular positioning and stability, gleno-humeral positioning and range of motion, breathing pattern, lumbar stability and neck function. And guess what? all of these things affect your shoulder’s function and health in general!
A lot of people will benefit greatly from t-spine mobility drills to improve extension and rotation ROM, especially people with kyphotic posture because they are stuck in thoracic flexion and it will affect the whole shoulder position and how the humeral head sits in the glenoid fossa.
Many times just incorporating t-spine mobility drills will greatly improve your shoulder function and health. I’ve seen this happen on multiple occasion with someone with shoulder pain, where incorporating a couple t-spine mobility drills in his program got rid of his pain in a matter of 1-2 weeks.
Here are 2 of my favorites:
Seated T-Spine Rotation:
Prayer Position T-Spine Rotation
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The neck is a very particular area on the human body. In athletic development, we pay little to no attention to neck training. Some sports like football and wrestling will sometimes devote time to neck training, but that is pretty much it. And the way they do it is usually not only far from optimal, it’s just flat out dangerous. But I digress, as this could be an entirely different blog post. The truth is, even if we don’t train it specifically, the neck muscles still receive stimuli from conventional strength training. At the same time, I feel strength coaches and trainers alike (me included) do not know nearly enough about how the neck works, how we should deal with it and when we should refer out. Because let’s face it: the neck is a very sensitive area (with the numerous muscles and nerves that pass through it) that should be handled with care at all time.
I watched Charlie Weingroff‘s Training = Rehab DVD set over the last week, and I must say before anything else that it is an incredible resource for any physical therapist, strength coach or trainer out there. Throughout his presentation, Charlie highlights the importance of taking the neck into consideration in training, as well as in rehab, no matter what you are addressing.
Here are a couple of things you should know when dealing with the neck. But before I go any further, the most important thing to remember about the neck is that if you’re a coach or trainer and are dealing with a neck dysfunction or neck pain in a client, REFER OUT! We are not qualified for this type of work by any means, we shouldn’t deal with that.
1. The neck muscles, especially the deep neck flexors are a very important, yet totally forgotten, part of the core. The deep neck flexors are part of the inner core, with the diaphragm, the pelvic floor, the TVA and the multifidus.
Deep Neck Flexors
Inner Core
If you’re not familiar with the inner core, make sure you check out my blog post I wrote a while ago (The Inner Core). The inner core muscles are very important spine stabilizers, and so are the deep neck flexors. A tucked chin or neutral cervical position will always make your spine more stable because it prevents unwanted cervical movement during heavy lifting. Also, the neutral cervical position that the deep neck flexors are able to maintain are going to have a big impact further down the spine; which leads me to my next point.
2. The position of the cervical spine can influence what happens at the lumbar spine. When you create extension at the cervical spine, you have more chances to create extension at the lumbar spine, which we try to avoid when we use heavy loads because of all the shear forces that are going to be applied to the spine. When deadlifting for example, starting with the neck extended (when your eyes are looking straight ahead) will put a lot more stress on the cervical spine, and on top of that, it will increase the extension shear forces on the lumbar spine.
Cervical Hyperextension = Big No No
This happens for 2 reasons; for one, as I mentioned earlier, the deep neck flexors are part of the inner core, and the inner core needs to be activated to optimally stabilize the spine. If you’re looking up, the deep flexors are not activated and the inner core will not stabilize as efficiently. Second, the cervical and lumbar segments of the spine are both inwardly curved (“lordotic”), which causes them to react similarly; if one goes into extension, more often than not, the other one will try to get into extension as well.
3. Coaching and cueing neck position during training is very important. If you’ve read the 2 last points, this might seem pretty obvious, but we want to keep a tucked and neutral chin during everything we do in training.
This might seem a little retarded, but it really is the optimal neck position to lift with!
When you start noticing the position of your neck and the ones of your athletes during a training session, you’ll realize that the neck tends to go in a less than desirable position (read: too much extension) with many, and I mean MANY exercises: lunges, squats, deadlifts, seated rowing, chin ups, push ups and almost every core exercise possible! You will honestly be shocked at how much people go into an extended neck position on so many exercises, and most of the time they don’t even notice it. Notice how much more difficult a simple plank is when you force your chin to stay tucked back.
4. The tucked chin position facilitates efficient breathing. Being aware of the importance of efficient breathing has been a topic that has grown in importance among the strength and conditioning community lately. Breathing through your belly instead of through your chest improves diaphragm function and puts less stress on the already overactive neck muscles scalenes and sternocleidomastoid. Many coaches try to cue breathing through different techniques and exercises to reinforce good breathing patterns. But the truth is that when you get in a tucked chin position, with your neck packed back, you don’t even need to cue anything; it just happens. If you’re not convinced, try it yourself: stand up, get our head in a forward position (chin protruded), put one hand on your chest, one hand on your belly and try to take a deep breath. Now do the exact same thing, but with your chin in a tucked back position (as in the picture above) and take a deep breath. You’ll notice that, when in a tucked back position, without even thinking about it you’ll breathe through your belly much more easily. So instead of cueing breathing techniques, why not just cue good neck position?
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