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What the Strength and Conditioning Textbook Never Taught You: The World Isn’t All Concentric

Written on June 29, 2012 at 8:54 am, by Eric Cressey

As a continuation of this week’s series on things you didn’t learn from a textbook, today I’ll be talking about how we’ve misunderstood muscle actions. As we go through anatomy and kinesiology in the typical exercise science degree, we memorize muscle actions.

The quadriceps extend the knee. The biceps flex the elbow. The teres minor and infraspinatus externally rotate the humerus. You get the point.

The point that many folks don’t get is that this is simply a practice of memorizing concentric muscle actions, and the truth is that this is really only one-third of the picture when it comes to how we move. You see, these muscles are also acting isometrically and eccentrically; sometimes the primary goal is not to shorten, but preserve muscle length, or prevent uncontrolled lengthening. This is a crucial understanding for one to acquire, as poor isometric and eccentric control are the culprits in an overwhelming majority of non-contact athletic injuries.

Our shoulder barks at us because our scapular stabilizers and rotator cuff don’t function correctly to prevent, slow, or limit inappropriate movement. An ACL goes because glutes and hamstrings couldn’t control unrestrained knee hyperextension and hip adduction and internal rotation.

To that end, while you might memorize a muscle’s concentric action first, it’s important to infer from that understanding that it has more implications above and below the joint it crosses. At the subtalar joint, pronation kicks off tibial and femoral internal rotation each time we land from taking a step. The gluteus maximus – as a hip external rotator, abductor, and extensor – plays a crucial role in decelerating this internal rotation and the accompanying hip flexion. In other words, your butt is an anti-pronator! Just watch what happens on the way down in a bowler squat and you’ll appreciate pick up what I’m putting down:

When you start looking at all movement like this, it will have a powerful influence on your ability to help people move more efficiently. With that in mind, I’d encourage you to look over the last strength and conditioning program you wrote and try to consider how the exercises you programmed help to prevent or control unrestrained movement, rather than creating movement. My prediction is that you’ll notice several exercises in there that you might not have included if you’d thought about this beforehand.

For more lessons like this, be sure to check out the Building the Efficient Athlete DVD set, on sale for 25% off through this Saturday at midnight.


 

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ACL Grafts: Which is Best? A Strength Coach’s Perspective

Written on November 15, 2010 at 3:53 am, by Eric Cressey

A few weeks ago, I came across this recent study of different ACL grafts.  It found that there was no difference in follow-up success rates at two-year mark between hamstrings and patellar tendon grafts.  The patellar tendon group did, however, exhibit more anterior knee pain – which isn’t a surprise because it’s not uncommon to see longer term tendinosis in athletes with patellar tendon grafts even after their “rehabilitation period” is over.  That said, I would be interested to see what would happen if they:

a) evaluated those patellar tendon graft subjects who received soft tissue treatments as part of their rehabilitation versus those who didn’t (my experience says that the anterior knee pain goes away sooner when manual therapy is present) .

b) evaluated those who went to effective strength and conditioning programs immediately post-rehabilitation versus those who didn’t (my hunch would be that those who continued to activation/strengthen the posterior chain would have experienced less anterior knee pain).

c) looked at performance-based outcomes at ~12-18 months in the hamstrings group, as these folks have more “intereference” with a return to normal training because of the graft site (you want to strengthen the posterior chain, but can’t do that as soon if you are missing a chunk of the hamstrings).  My experience has been that patellar tendon patients can do a lot more with their strength and conditioning program sooner than those who have hamstrings grafts.

It’s not to necessarily say that one is better than the other, as they both have their pros and cons – but I think this study potentially casts patellar tendon grafts in a less favorable light when the truth is that hamstrings grafts can have just as many complications down the road.  Above all else, the best ACL grafts are the ones that the surgeon is the most comfortable using – so pick your surgeon and defer to his expertise.

As an interesting aside to this, I remember Kevin Wilk at an October 2008 seminar saying that 85% of ACL reconstructions in the U.S. are performed by doctors that do fewer than 10 ACL reconstructions per year.  So, don’t just find a surgeon; find a surgeon that does these all the time and has built up a sample size large enough to know which ACL graft site is right for you, should you (unfortunately) ever “kneed” one (terrible pun, I know).

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Who “Kneeds” Normal Knees?

Written on June 24, 2010 at 7:00 am, by Eric Cressey

Okay, this subject line was undoubtedly the worst of all time, but I promise that the information that follows will be worth reading.

A lot of you were probably hoping that you were out of the woods after I told you how bad your lower backs and shoulders look on diagnostic imaging such as MRIs.  I’m sorry to say that these “normal” structural disasters also apply to the knees.

A 2010 review from Flanigan et al. looked at studies that collectively examined the (1,862) knees of 931 athletes (40% of whom were professional athletes) using MRI and arthroscopy.  They found that 36% of these knees had full-thickness chondral defects, but 14% of these subjects had no symptoms when diagnosed.  The researchers concluded that “Over one-half of asymptomatic athletes have a full-thickness defect.”

chondral-defect

Years earlier, Cook et al. screened 134 elite junior basketball players (268 total knees) for patellar tendinopathy.  At the time, only 19 (7%) of the 268 tendons presented with symptoms (pain) of tendinopathy.  Interestingly, though, under diagnosis with ultrasound, researchers actually found that 26% of all the tendons could be labeled tendinopathy based on the degenerative changes observed.  In other words, for every one that actually presents clinically with symptoms, more than three more go undiagnosed because people either haven’t reached threshold, or they move well enough to keep symptoms at bay.  Or they are Kurt Rambis and can just look so awkward that nobody even pays attention to their knee sleeve.

hh_rambis_19jan2007

On the “move well enough” side of things, check out this study from Edwards et al.  They showed that these athletes with asymptomatic patellar tendinopathy actually land differently – both in terms of muscle recruitment and sequencing – than asymptomatic athletes without tendinopathy.  Fix that movement pattern neurally and strengthen the right muscles, and those issues never reach threshold.  Leave it alone, and they’ll be presenting with knee pain sooner than later.  Mike Robertson does a great job of outlining ways to improve knee health via movement retraining in his Bulletproof Knees Manual.

bpk

This is just the tip of the iceberg.  You’ll see loads of chronic ACL and meniscus tears that folks never realize they have.  I could go on and on. The take-home messages?  Yet again, diagnostic imaging is just one piece of the puzzle, and how you move is far more important.


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Understanding Elbow Pain – Part 5: The Truth About Tennis Elbow

Written on May 25, 2010 at 4:37 am, by Eric Cressey

Author’s note: This is the fifth part of a series specifically devoted to the elbow.  Be sure to check out Part 1 (Functional Anatomy), Part 2 (Pathology), Part 3 (Throwing Injuries), and Part 4 (Protecting Pitchers) if you haven’t done so already.

Today, I’m going to cover a pretty common, yet remarkably stubborn issue we see at the elbow: tennis elbow.

It’s also called lateral epicondylitis, although the -itis ending may not do it justice (as we discussed previously in this series) because it is likely more of a degenerative – and not inflammatory – condition in the overwhelming majority of those who experience it.  To take this naming conundrum a bit further, while the term “tennis elbow” is used to describe pain on the lateral aspect of the upper arm near the elbow, tennis players often experience medial elbow issues as well (golfer’s elbow) secondary to the valgus stress one sees with the forehand and serve.

womanserve2

In a tennis population, “tennis elbow” emerges almost solely from backhands (with the one-handed version logically being much more problematic), which require huge contributions from the extensors of the wrist to not only hold the racket, but stabilize the wrist against the vibrations from the racket as it redirects the ball.  The path of the ball against the racket creates a destabilizing torque that wants to force the wrist into flexion, and it’s the job of these extensors to resist that movement.

The logical question for many is why does the pain occur at the elbow when the forces are applied so much further down the arm?  The answer rests with the zones of convergence topic from Part 1: there are lots of tendons coming together in congested area, creating friction and negatively affecting soft tissue quality.  At the lateral epicondyle, you have the common extensor tendon, which is shared by extensor carpi radialis brevis, extensor carpi ulnaris, supinator, extensor digitorum, and extensor digiti minimi (the extensor carpi radialis longus and brachioradialis attach just superiorly).

lateralepicondyle1

If this doesn’t convince you of both the preventative and rehabilitative role of soft tissue work, then you might as well be living life with a bag over your head.  Yet, it amazes me how many treatment plans for tennis elbow don’t have even the smallest element of hands-on work.  Here’s a little demo from Dr. Nate Tiplady, with Graston and ART.

Soft tissue treatments, flexibility work, and progressive strengthening exercises for these degenerative tissues get the ball rolling – and you can find thousands of foo-foo forearm exercises and stretches online.  Additionally, as Mike Reinold has reported, there is some research to suggest that elbow straps are slightly effective in expediting the process.

tenniselbowstrap

And, eccentric exercise for the wrist extensors tends to show the most promise for tissue-specific return to function. This is all well and good – but I think it sometimes overlooks a big fat white elephant in the room.

I worked at a tennis club for eight summers when I was growing up, doing everything from court maintenance, to racket stringing, to lessons, to scheduling court time.  Toward the end of my eight-year tenure (around the time that I started getting involved with the fitness industry), I started to notice some interesting patterns.

When I looked out on the courts, about 1/3 of the participants were rocking tennis elbow straps (the research actually shows that about 40-50% of recreational tennis players get tennis elbow).  Yet, when I was in the office with some professional tennis match on TV in the background, I NEVER – and I really mean that I can’t remember a single time – heard of a professional tennis player missing time because of tennis elbow.  How in the world would a pro – who might spend about 5-6 hours a day on the court – not break down faster than an elderly woman who plays a) 5-6 hours a week, b) at a slower pace, c) predominantly in doubles matches (1/2 as many ball contacts), and d) against competition that hits the ball much more softly than a professional opponent?  It really didn’t make sense – until I got involved with exercise physiology.  Why?

1. The members were largely over the age of 40 – meaning that they were obviously as an increased risk of degenerative issues like tennis elbow, especially in light of their activity patterns.

2. The pros were also younger, and the two-handed backhand is markedly more common in the newer generation of players.  The one-handed backhand still predominates in the “old guard.”  Research has demonstrated markedly more complexity in the swing kinetics for the one-handed backhand – so there are more ways for things to go wrong in this older population.

federerbackhand

3. This is the biggest one: the pros usually had a solid foundation of conditioning, meaning that they had the strength, power, coordination, footwork, and technical mastery to hit the ball in a biomechanically safe position.  Novice players with poor technique often hit the hit the ball with the wrists flexed and not neutral; in other words, they lead with the elbow instead of the racket, taking the wrist extensors outside of their ideal length-tension relationship.

In a non-tennis population, lateral elbow pain is almost always a function of overusing the grip and having some really nasty, fibrotic soft tissue accumulations at the lateral epicondyle.  In a tennis population, it isn’t just an elbow problem; it’s something that speaks to a lack of preparedness of the entire body, both physically and in the context of insufficient technical mastery.

In my eyes, tennis elbow rehabilitation should be treated much like a return to throwing program for a baseball pitcher.  The injured individual should take care of the soft tissue, flexibility, and strength issues at the elbow, but he/she should also get involved in a strength and conditioning program to improve ankle, hip, and thoracic spine mobility; core and scapular stability; and strength and power of the larger muscle groups at the hips and shoulders that should be creating the power instead of the smaller muscles acting at the wrist and elbow.

Layout 1

If you’re slow to rotate your hips, you’re going to hit the ball late (wrist flexed).  If you lack hip mobility to rotate to the ball, you’re going to hit the ball late (or chew up your lower back).  If you lack core stability to transfer force from the hips, you’re going to hit the ball late.  If you lack scapular stability or rotator cuff strength, you’re going to hit the ball late.  Does anyone see a pattern?  This is about everything BUT the elbow!

Instead, what have we done?  We’ve done exactly what lazy people always does: created gadgets to avoid actually having to work hard!

In the 1990s, racket companies introduced oversized rackets, which have a larger surface area to minimize mishits (which increase vibrational stress) and increase power (at the expense of control).  Screw getting better at tennis or improving your physical fitness; we’ll just make tennis easier!  As an interesting aside to this, strings break more frequently on oversized rackets as well – meaning that companies make more long-term on follow-up string purchases. This sucker is 125 square inches (as a frame of reference, Pete Sampras played with a 85-square-inch racket):

wilsontriad

Also in the 1990s, the titanium tennis racket was introduced.  These things are insanely lightweight – to the point that it requires very little physical exertion to swing if you are a 60-year-old woman in a doubles match.  So much for exercise!

We’ve handed out tennis elbow straps like candy so that people can get back out to play as quickly as possible rather than getting their bodies right and then practicing with a qualified professional who can instruct them on proper technique as part of a return-to-hitting plan.  The straps can be very valuable if used appropriately – but not if used as a crutch to “get by” with poor movement patterns and a lack of physical preparation.

Is anyone else shocked at how comparable the rushed and careless return to action in adult tennis players is to what we see with young athletes trying to come back too quickly from ACL tears, rotator cuff strains, or stress fractures?  They say retirement is the second childhood; I guess they’re right!

So, here are some take-home points on tennis elbow:

1. Take care of tissue quality at the lateral epicondyle alongside any flexibility and resistance training exercises for the muscles of the forearm.

2. Condition the entire body as part of rehabilitation.

3. Ease back into tennis participation, and do so under the supervision of someone who can correct the faulty mechanics in your backhand. Along those same lines, consider switching to a two-handed backhand if you have a history of tennis elbow.

Stay tuned for Part 6 to wrap up this series.


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Stuff You Should Read: 4/20/10

Written on April 20, 2010 at 12:00 am, by Eric Cressey

A few tips on items to check out this week:

5 Sneaky Tricks to Triple Fat Loss Results – This is a 27-page report from Joel Marion that he’s made available for free for the next three days.  It’s got some good stuff in there, and it’s also pretty darn entertaining!

ACL Graft Options: Allograft or Autograft - Here’s a great blog post from Mike Reinold highlighting the research on different graft options for ACL reconstructions as well as their clinical significance.  I liked it so much that I actually posted a comment on it outlining my perspective as a strength and conditioning coach.

I’ve got a great interview lined up for this week, and Part 1 will run tomorrow.  Be sure to check back for it!


Why President Obama Throws Like a Girl

Written on April 7, 2010 at 8:13 am, by Eric Cressey

Many baseball fans thought that it was a bit inappropriate of President Obama to wear a Chicago White Sox hat as he threw out the opening pitching at the Washington Nationals game on Monday.  However, many others – including those of us on the baseball development side of things – overlooked this fashion faux pas, and instead pointed out that the commander-in-chief’s throwing mechanics closely paralleled those of an 11-year-old girl.

Now that I’ve irritated both my Democrat and female readership, let me explain.

We are all born with a certain amount of humeral retroversion.  For the lay population out there, think of retroversion as a bony positioning that allows for more shoulder external rotation.  As we age, we actually gradually lose retroversion (gain anteversion); as I recall, this process moves the most quickly from ages 8-13, which isn’t surprising, as this is when kids rapidly become more skeletally mature.  It’s why we see more torn ACLs than broken bones in the late teenage years; the bones are no longer the path of least resistance.

However, we actually see something different in kids who are involved in overhead throwing sports during this crucial developmental period.  They don’t gain anteversion as quickly in their throwing shoulder; in other words, they preserve at lot of the bony positioning that gives rise to external rotation (the lay-back position), which in itself is a predictive factor for throwing velocity.  Very simply, it’s easier for them to get their arm back to throw because the bones (specifically, the proximal humeral epiphysis) have morphed to allow for it.  There’s even a theory out there that this bony positioning actually spares the anterior-inferior glenohumeral ligaments from excessive stress during external rotation, but that’s a topic for another day (and president?).

How much of a difference are we talking?  Well, in a study of 54 college pitchers, Reagan et al. found that had 36.6° of humeral retroversion, as compared with just 26° in non-dominant shoulders.  Here’s our fearless leader throwing a cream puff from a different angle at last year’s All-Star Game;you’ll notice that he leads with the elbow and his arm doesn’t “lay back” – a technique we’ve come to term “throwing like a girl,” as politically incorrect as it is. Think he could use an additional 10° of shoulder external rotation?

The good news, however, is that he’s in good company; Mariah Carey has sold over 175 million albums and rocks a 12-foot palmball, too.

We can’t fault these folks (well, maybe for their attire, but that, too, is another blog post), as females traditionally haven’t had exposure to baseball at young ages in order to develop these osseous (bony) adaptations that favor throwing hard.  And, with just a little reconnaissance work on President Obama, I quickly came across this quote from him in the NY Daily News last year: “”I did not play organized baseball when I was a kid, and so, you know, I think some of these natural moves aren’t so natural to me.”  There’s your answer.

Contrast his delivery with that of George W. Bush, who not only played baseball as a kid, but actually owned the Texas Rangers for a while, and you’ll see what a few years in Little League will do for a shoulder.

Interestingly, the Iraqi journalist who threw his shoes at Bush actually displayed some decent lay-back, too.  It makes me wonder if he was born with some congenital laxity, played cricket or tennis, or just practiced a ton for his first international shoe-throwing appearance (cap?).

As an interesting little aside, in our Optimal Shoulder Performance DVD set, Boston Red Sox Head Athletic Trainer and Rehabilitation Coordinator Mike Reinold talks about how European soccer players have actually served as the control group against which we can compare overhead throwing shoulders in research, as these athletes are the same age and gender as baseball pitchers, but rarely participate in overhead throwing sports.  So, perhaps we should say “throw like a European soccer player” instead of “throw like a girl” – particularly since more and more female athletes have started participating in overhead throwing sports at a younger age!

shoulder-performance-dvdcover

However, in the interim, what can President Obama do to get over this hurdle?  It goes without saying that it’s too late to get that retroversion, as he’s already skeletally mature.  However, there is research out there that shows that pitchers gain external rotation over the course of a competitive season – so President Obama would be wise to get out in the rose garden and play some catch because, you know, presidents have plenty of time to do that!

Likewise, as I outlined in Lay Back to Throw Gas, there are several things he could do to improve his pitching-specific flexibility.  The most important thing is to avoid spending so much time hunched over a desk watching NBA TV writing legislation and the like, as being stuck in this position will shorten the pectoralis major and minor, lats, subscapularis, and several other small muscles that need adequate length and tissue quality to get the arm “back” via good humeral external rotation, scapular retraction/depression, and thoracic spine extension/rotation.  To keep it simple, I’d probably just have him do a lot of the side-lying extension-rotation drill:

In terms of volume prescriptions, I’d just have him do one rep for each time Nancy Pelosi blinks in a day (which, coincidentally, is 570 million reps daily):

Of course, there’s a lot more to it than just this, but these quick modifications would be a good start.  For more information, check out our new Optimal Shoulder Performance DVD set.


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Strength and Conditioning Programs: Acts of Commission vs. Omission

Written on March 4, 2010 at 6:57 am, by Eric Cressey

At the last Winter Olympics, Dutch speedskater Sven Kramer missed out on a gold medal because his coach, Gerard Kemkers, directed him into the wrong lane part way through the race.  Kramer finished the race with an Olympic record time – four seconds ahead of his nearest competitor – but was immediately disqualified because of an incorrect lane change with eight laps remaining on his long-time coach’s cue.

In the aftermath of the disqualification, Kemkers obviously came under a ton of scrutiny.  After all, he committed a pretty big coaching mistake – and it’ll probably become a huge part of his legacy, as unfortunate as it is.

sven-kramer_1585448c

Here is a guy who has likely helped thousands of speed skaters over the years, presumably devoting countless hours to research, coaching, and becoming the best he could be – both as a coach and an athlete (he won a bronze medal at the 1988 Olympics).  And, as Kramer noted, it is hard to argue with the success Kemkers helped him achieve:  “Three times world champion, four times European champion, so many World Cups and Olympic gold in the 5,000 meters.” In the process, Kemkers had to have omitted little to nothing; otherwise, he wouldn’t have been coaching at such a high level.

Had Kemkers never endeavored to get to a high level – or taken shortcuts to get there – there would have been countless omissions along the way: gaps in his knowledge, an inability to befriend athletes, and a fundamental misappreciation for what it takes to compete at a high level.  He would have been mediocre at best.

kemkers

Kemkers’ mistake was an act of commission, not omission.

Meanwhile, millions of “armchair” quarterbacks around the world will criticize him for being an idiot, when in reality, the opportunity to make this mistake might never have come along if he hadn’t spent so much time preparing to not be an idiot.

Speedskating isn’t really our thing here in the United States, so let’s apply this to something that better fits our existing schema: ACL injuries in female athletes.  We know ACL tears are extremely common in female athletes, particularly those participating in basketball, gymnastics, and soccer.  I actually recall reading that the average NCAA women’s soccer team has one ACL tear every year, and that typically, 1 in 50 female NCAA basketball players will blow out an ACL in a given season.  These numbers may be a bit dated now, but you get the point: if you don’t train to prevent these injuries, you’re omitting an insanely valuable initiative that protects your athletes…and mascots.

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Now, we need to see another “ACL Injury Prevention Protocol” on Pubmed like I need to experience another Tony Gentilcore Techno Hour.  In other words, there are plenty of them out there, and we know what kind of strength and conditioning programs work; it is just about execution.

So, let’s take your typical strength and conditioning coach who puts his female athletes through everything he should to protect them from ACL injuries – but one girl drops a weight on her foot and breaks a toe to miss the rest of the season.

Had he omitted external loading from his strength training program, this never would have happened – but he probably would have had four times as many ACL tears as broken toes and his athletes wouldn’t have performed as well.  Here, an act of omission would have been far worse than an act of commission – just like we saw with Kemkers.  This isn’t always the case, but it’s important to realize that two kinds of mistakes occur, and sometimes you’re better being proactive and making a mistake than you are ignoring a responsibility and just keeping your fingers crossed.

It’s been said before that strength and conditioning programs are both a science and an art – and the art is interpreting what to leave out and what to include in light of risk-reward for each unique athlete.  For instance, a front squat is a fantastic exercise from a scientific standpoint, but on the art side of things, it may not be appropriate for an athlete whose spine doesn’t like axial loading.  Or, it may be a problem if an athlete hasn’t been front squatting, and introducing it right before competition would cause soreness that might be counterproductive to performance.

Think about how this applies to the next strength and conditioning program you write, and the next client/athlete you coach.

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Random Friday Thoughts: 9/11/09

Written on September 11, 2009 at 6:38 am, by Eric Cressey

1. First off, I hope everyone takes a moment our of their day today to remember all those who lost their lives in 2001.

2. I’d encourage you guys to check out a great article from Chris Shugart at T-Muscle on the topic of Vitamin D:

“D” is for Doping

A lot of you know that I’ve been a huge advocate of supplemental Vitamin D for about two years now, and this article outlines a lot of reasons why I’m such a fan.

3. It was a great night in Double A playoffs for a few CP athletes last night. Huntsville Star Steffan Wilson – just one day after a call-up from High A – hit a game-winning 3-run homerun in the opener of a five-game playoff series.  Steffan is a corner infielder in the Brewers System.

At the same time, CP athlete and San Antonio (Padres AA) pitcher Will Inman picked up the win to even up their playoff series at 1-1.

4. Along those same lines, here are a few recent articles about some CP athletes:

Quinn Begins Southern Quest

Size Doesn’t Matter: A Conversation with Blue Jays Pitching Prospect Tim Collins

5. Check out this study, which reported a markedly different neuromuscular pattern in those athletes who ruptured ACLs as compared to those who didn’t.

In a nutshell, at pre-screening, prior to a cutting maneuver, all five players who went on to rupture ACLs actually recruited more vastus lateralis (quads) and less semitendinosis (hamstrings).  It isn’t surprising that this would be an injury predisposition, as the hamstrings work synergistically with the ACL.  Reduce hamstrings activity, and the ACL has to take on more of the stress.  It’s the same old Active vs. Passive Restraints discussion we’ve had in the past.

The bigger question, in my eyes, is why certain individuals showed this tendencies.  Was it their builds (greater Q angles)?  Prior training programs that may have omitted things?  A combination of the two?

Interested in learning more?  I highly recommend checking out Bulletproof Knees; Mike Robertson did a fantastic job with it.

bpk

Have a great weekend!


Training Males and Females: Similar, but Different

Written on August 11, 2009 at 8:23 pm, by Eric Cressey

Males and Females: Similar, but Different

During my weekly Pubmed scan, I came across this study the other day:

The Core and Hip in Soccer Athletes Compared by Gender

It seemed like a good fit for this week’s newsletter for a few reasons.

First, we always hear that men and women should train exactly the same.  While there are certainly a lot of similarities between how I personally approach the training of men and women, as I noted in a previous newsletter, there are also a lot of important considerations specific to females.  This study highlights on such consideration: increased hip internal rotation as compared with their male counterparts.

Ask anyone who has ever trained male soccer or hockey players or powerlifters, and if they know anything about assessment, they’ll tell you that a hip internal rotation deficit (HIRD) is a huge problem.  It can lead to knee, hip, or lower back pain and have a markedly negative impact on movement.  Improving length of the hip external rotators – with flexibility drills like the knee-to-knee stretch – is of paramount importance.

lyingknee-to-kneestretch

Well, those exact same drills would actually increase the typical female’s injury risk.  Excessive hip internal rotation and knee valgus are just a few of the many reasons (also including the hip abductor and core control weaknesses outlined in this study) that most females have more anterior cruciate ligament injuries than males.

q-angle-female-male

The lesson could end there – but it won’t. Why?

I had a female distance runner in for an evaluation on Saturday, and she had very poor hip internal rotation.  A flexibility drill that would be inappropriate for the female “masses” is a great fit for her.  Cases like this make it very clear that it’s important to assess and not just assume.

This is why I’m so excited about the impending release of our new product, which outlines a series of self-assessments and corrective exercises one can use to pinpoint these issues and address them in a targeted fashion.  Keep an eye out for an announcement on its release in the weeks to come.

Feedback on Maximum Strength

“This program took me to the next level of performance with my lifting. After using a variety of programs focusing on fat-loss and hypertrophy and having limited results from them it was great to see such solid increases in strength and physique changes from the program.  In addition, the program focus on dynamic flexibility and foam rolling has resulted in an injury free training cycle and major flexibility and posture improvements.  I would highly recommend this program and book to anyone wanting to make real progress with strength, performance and body composition.”

Dan Hibbert – Calgary, Alberta

Increased body weight by 14 pounds, broad jump by seven inches, box squat by 80 pounds, bench press by 30 pounds, deadlift by 70 pounds, and 3-rep max chin-up by 27.5 pounds.

Cressey_9781600940576.indd

Check out Maximum Strength for yourself!

New Blog Content

Random Friday Thoughts

Shoulder Range-of-Motion Norms

Stuff You Should Read

Tips for a Bigger Bench

Have a great week!

EC


Random Friday Thoughts: 7/3/09

Written on July 3, 2009 at 4:27 am, by Eric Cressey

1. First off, I want to wish everyone a Happy 4th of July!  Of course, that doesn’t mean much for the 36% of this blog’s readers from other countries.  So, to you, I’ll simply say “HA!  You have to work today!  Don’t you wish you were American?”

Oh, wait; I’m seeing 30+ athletes today before heading north for the holiday.  I guess the joke is on me.

2. The wedding is set for October 3, 2010.  I have put it on my calendar for my fiancee to remind me about it on October 1, 2010 in case I get preoccupied, as I’ve been known to do.  Just kidding, honey!

3. THIS might be the coolest study I’ve ever seen.  Basically, it said that male patient visits to the emergency room decline immediately prior to, during, and after major sporting events.  And you thought being a soccer hooligan was bad for your health!

4. Keeping with the study theme, check out this study that looked at how fatigue impacted single-leg landings.  Basically, researchers single-leg squatted athletes until the cows came home, inducing fatigue on ONE SIDE – which, obviously, negatively affected landing strategies.  Interestingly, though, they noticed that landings on the OPPOSITE side were also negatively impacted.  In other words, we aren’t just talking about muscular fatigue; central fatigue is also hugely important.  Kind of makes you wonder why more people don’t drill landing mechanics hard on the UNINJURED side in post-ACL reconstruction patients, huh?

For more on testing with fatigue in mind, check out this blog post from Bill Hartman.  And, for more on ACL injury prevention strategies, check out Bulletproof Knees.

bpk

5. Different project, but more filming next weekend.  I’m going to enjoy the holiday and then get back to work…lots of work.

Have a great weekend!


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