Assessments You Might Be Overlooking: Installment 4
Written on March 8, 2014 at 9:21 am, by Eric Cressey
I always tell up-and-comers in the strength and conditioning field, "If you aren't assessing, you're just guessing." It's not as simple as just doing a sit-and-reach test and having someone hop on the scale for you, though. This series is devoted to highlighting some of the most commonly overlooked components of the assessment process – and here are three more evaluations you might be missing:
1. Previous Athletic/Training Workload – If you're trying to help a client get to where they want to be, it's important to realize where they've been. For example, someone who has a history of overworking themselves might respond really well to a lower volume program. Or, an athlete looking to gain muscle mass who has never trained with much lifting volume might be well-served to add some "backoff" sets and additional assistance work.
This is an incredibly important discussion with our professional pitchers, too. Starting pitchers who have a high workload (some in excess of 200 innings pitched in the previous 8-9 months) need to wait longer to start throwing than relief pitchers who may not have thrown more than 40 innings in a season. The former group might not start an off-season throwing program until January 1, whereas the latter group might already have eight weeks of work in by that point.
Discussions of building work capacity get a lot of love in the strength and conditioning field, but I think we often lose sight of the fact that sporting coaches are also looking to build work capacity in the context of the athletes' actual sports. Now, these two things don't have to be mutually exclusive, but if everyone is always pushing high volume all the time, things can go downhill fast.
2. Quad and Adductor Length – Let's face it: a huge chunk of the population doesn't exercise enough, and even most of those who do exercise regularly don't pay attention to mobility needs. As a result, their entire exercise program takes place in a very small amplitude; they never get through significent joint ranges of motion. Two areas in which you see this probably rearing its ugly head the most are quad and adductor length.
Your quads are maximally lengthened when your heel is on your butt. How often do you see someone encounter this position in their daily lives?
Adductors are stretched when the hips are abducted. When was the last time you hit this pose in your daily activities – outside of a fall on the ice?
If you want to do a quick and easy assessment of where you stand on these, try these two (borrowed from Assess and Correct):
Prone Knee Flexion: you should have at least 120 degrees of active knee flexion without the pelvis or lower back moving.
Supine Abduction: you should have at least 45 degrees of abduction without lumbar or pelvis compensation, or any hip rotation.
I generally just check these up on the training table when people get started up, but these should provide good do-it-yourself options for my readers who aren't fitness professionals. Also, if you find that you come up short on these tests, get to work on the two stretches pictures at the start of this bulletpoint.
3. Taking the Shirt Off – This is a tricky one, as you obviously can't do it with female clients, and even when male clients, you have to be sensitize to the fact that it might not be something in which they'd like to partake. That said, you'd be amazed at how many upper extremity dysfunctions can be obscured by a simple t-shirt. As an example, this left-handed pitcher's medial elbow pain was diagnosed with ulnar neuritis, and he was prescribed anti-inflammatories for it and sent on his way without the doctor even having him take his shirt off to evaluate the shoulder and neck.
Needless to say, he sits in heavy scapular depression on the left side, and it wouldn't be a "stretch" (pun intended) at all to suspect that his ulnar nerve symptoms would be originating further up the chain. Take note on how the brachial plexus/ulnar nerve runs right under the clavicle as it courses down toward the elbow.
Crank the scapula and clavicle down, and you can easily compress the nerve (and vascular structures) to wind up with thoracic outlet syndrome, a very common, but under-diagnosed condition in overhead throwing athletes. The more forward-thinking upper extremity orthopedic surgeons are diagnosing this more and more frequently nowadays; elbow problems aren't always elbow problems!
The lesson is that you can see a lot when you take a shirt off. If it's the right fit for your client/athlete, work it in.
I'll be back soon with more commonly overlooked assessments. In the meantime, I want to give you a quick heads-up that to celebrate National Multiple Sclerosis Awareness week and help the cause, Mike Reinold and I have put both Functional Stability Training of the Core and Lower Body on sale for 25% off through tonight (Saturday) at midnight – with 25% of proceeds going to MS charities. Just use the coupon code msawareness to apply the discount at the following link: www.FunctionalStability.com.
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March 8th, 2014 at 10:54 am
How would one correct number 3?
March 8th, 2014 at 12:39 pm
Pitcher Josh Becket (Dodgers) suffered through TOS last year & had surgery to repair & relieve his pain. There’s even a Facebook page devoted to this syndrome.
https://m.facebook.com/TOS.Awareness?id=257447734292841&refsrc=https%253A%252F%252Fwww.facebook.com%252FTOS.Awareness
March 8th, 2014 at 12:53 pm
Jesse,
Beckett’s not the only one…Shaun Marcum, Matt Harrison, Serena Williams, Aaron Cook, Daniel Bard, and several others are examples of those who have dealt with it as well. It’s much more prevalent than we previously thought.
March 8th, 2014 at 12:55 pm
Chuts,
Working in some wall slides would be a good start:
http://www.youtube.com/watch?v=rftFxHSgRmA
http://www.youtube.com/watch?v=W4h4DuUxaQs
March 8th, 2014 at 2:16 pm
Hi Eric, I had a brachial plexus neuritis and as a result I have a winging scapula due to damage of long thoracic nerve (diagnosed by emg). I had this 5 months ago and I think that my situation is slowly improving but I still can’t lift my hand above 90 degrees. Any advice how to do progression excercises? Should I be doing exercises at all or should I wait and pray for a nerve to heal. Would be thankful for your advice and hope to see you on the seminar in Slovenia.
Thank you, Tomaz Hocevar
March 8th, 2014 at 2:30 pm
Eric,
Just curious if a dumbbell 1 arm shrug would help the pitcher with unilateral scapular depression?
March 8th, 2014 at 2:53 pm
In regards to the wall slides, how do you know which one to choose? Is one of those a progression you build to – start with one and later go on to another or are they both for different reasons?
March 8th, 2014 at 7:44 pm
Maybe work on neutral scapular posture retraining (improving scapula elevation alignment) maybe check out the pec minor mobility.
March 9th, 2014 at 12:10 am
Eric, why is the right foot always forward in wall slides?
March 9th, 2014 at 8:47 am
Mike,
We often prioritize left stance because our normal daily activities – and our anatomy – shift us toward right stance. This is a central piece to the left AIC/right BC presentation, as per the Postural Restoration Institute. Check out their site and read a bit about it, then head over to YouTube and search for their drills.
That said, give this a read, as it’ll discuss the common presentation a bit more:
http://ecressey.wpengine.com/5-
March 9th, 2014 at 8:48 am
Dave,
I like wall slides at 135 for those with scapular anterior tilt, and wall slides w/upward rotation for those who need more upward rotation.
March 9th, 2014 at 8:48 am
Patrick,
I don’t think so. I think it’s important to drive scapular upward rotation, and you don’t get that with the arm at the side. You want elevation WITH upward rotation, not elevation in isolation.
March 9th, 2014 at 8:51 am
Hi Tomaz,
Really hard to say without seeing you in person, but one thing I’d just emphasize is making sure that you don’t lose ROM. Even if you can’t actively get overhead, do your best to maintain it passively so that as things slowly improve, you can work to build stability in the ROM you have. Hope to see you in Slovenia!
March 9th, 2014 at 10:30 am
Hi Eric,
These are some good assessments to look at. I am a trainer and always enjoy reading and learning from your work, blog posts etc. High performance handbook is a great resource, I loved the program.
I was curious to know what your thoughts were on Greg Roskopfs Muscle activation technique MAT. Do you think it is an effective tool to have when dealing with individuals with dysfunctions that are affecting there physical performance?
I would appreciate any feedback you have.
Thank you,
Robert
March 11th, 2014 at 9:09 am
Don’t write off the scapula/clavicle assessment with women. You can tell them when you set up appointment (or for next session) that you want to assess their shoulder blade and collar bone position and function. Ask them to please wear a close fitting tank top like they would for a yoga class. Most women who are comfortable working with a male trainer would be fine with that and understand. An athletic tank top will mostly uncover the anatomy you need to assess.
March 11th, 2014 at 12:01 pm
Eric,
What if the 1 arm dumbbell shrug were performed with the bell starting at the side of the hip and then rotated to the front of the hip during the rep?
March 11th, 2014 at 1:15 pm
Patrick,
Wouldn’t make a difference. Scapula is still not upwardly rotating.
March 18th, 2014 at 7:06 pm
Hi Robert,
Thanks for your kind words. Admittedly, I have little experience with MAT. I know of quite a few people who use it heavily in their everyday practice, though, so it’s certainly worth looking into.