Weight Training Programs: Assess, Don’t Assume

Written on May 10, 2011 at 8:06 am, by Eric Cressey

Late last week, my buddy Nick Tumminello made the follow comment that some folks, unfortunately, took out of context:

“Everyone is talking about assessments (and that’s cool). But, no one seems to talking about simply not allowing poor form in training. If you can’t keep good form in a certain exercise (movement pattern), simply don’t do that exercise until you’ve improved the movement or decided that you’re simply not built for it to begin with. Not sure why things need be any more complicated than that!”

For the record, I agree 100% with Nick and understood what he meant, but it would have been easy to assume that he was referring to “trainers train, and therapists assess.”  In other words, many folks assume that as long as you aren’t symptomatic in some way, then you’re safe to start exercising because you can simply “feel” things out as you go and, if something hurts, you don’t do it.

While you obviously shouldn’t do something if it hurts, just because something doesn’t hurt doesn’t mean that it’s not harmful long-term – and to me, that’s the difference between “working someone out” and provided them with an optimal training experience.  As physical therapist Mike Reinold has said, “Assess; don’t assume.”

To illustrate my point, here are a few examples.

Let’s say you have someone with a chronically cranky acromioclavicular joint or osteolysis of the distal clavicle that might only be apparent upon reviewing a health history, palpating the area, or taking someone into full horizontal adduction at the shoulder.  While direct over-pressure on the area (as in a front squat) would surely elicit symptoms, my experience is that most folks won’t notice a significant amount of pain until the next day if the strength exercise selection is inappropriate (e.g., dips, full range-of-motion bench pressing).  You might have avoided what “hurt” during the session (presumably because the individual was warmed up), but you find out after the fact that you just set an individual back weeks in their recovery and fitness program.

How about right scapular winging?  It’s not easily observed if a client has a shirt on, and if you simply throw that individual into a bootcamp with hundreds of push-ups each week, you’re bound to run into trouble.  Here’s the thing, though: even if you observed that winging and wanted to address it in your training, you really have to consider that it can come from one or more of several factors: weak scapular stabilizers, a stiff posterior cuff, insufficient right thoracic rotation, faulty breathing patterns, or poor tissue quality of pec minor, rhomboids, levator scapulae (or any of a number of other muscles/tendons).  Just doing some rows and YTWL circuits will not work.

Also at the shoulder, a baseball pitcher with crazy congenital and acquired shoulder external rotation may have a ton of anterior instability in the “cocking” position of throwing (90 degrees of abduction and external rotation), but be completely asymptomatic.  Back squatting this athlete would exacerbate the problem over the long haul even if he didn’t notice any symptoms acutely.

Finally, in my recent article, Corrective Exercise: Why Stiffness Can Be a Good Thing, I spoke about how someone can have crazy short hip flexors and still manage a perfect squat pattern because his stiffness at adjacent joints is outstanding.  If I don’t assess him in the first place and just assume that he squats well, I’m just waiting for him to strain a rectus femoris during sprinting or any of a number of other activities.  Gross movement in a strength and conditioning program wouldn’t tell me anything about this individual, but targeted assessments would.

The point is that while Nick’s statement is absolutely true – demanding perfect form is corrective in itself – you’ve still got to assess to have a clear picture of where you’re starting.  Otherwise, many cases like this will slip through the cracks.

To that end, I’m happy to announce that my long-time friend and colleague, Mike Robertson, recently released his Bulletproof Knees and Back Seminar DVD Set.  This comprehensive product covers anatomy, assessments, program design, and coaching.  In fact, almost the entire second day is focused on coaching, and that’s an area in which most trainers really do need to improve.  All in all, this isn’t a collection of bits and pieces; it’s Mike’s entire philosophy on training someone who is suffering from knee or low back pain (and how to prevent it in the first place).  Effectively, Mike covers what both Nick and I are getting at in the paragraphs you just read.

Since Mike’s a great friend – and because he and his wife just had a new baby daughter that will surely shop a ton in her teenage years, go to college, and have an expensive wedding – I want to sweeten the deal and help him with sales, especially since this is tremendously valuable information that fitness professionals need to hear.

With that said, anyone who purchases the Bulletproof Knees and Back Seminar DVD Set by this Friday (5/13) at midnight will receive a free 37-minute upper extremity assessment video I recently filmed for my staff in-service and uploaded to the web.  In other words, Mike covers the back and lower extremity and I cover the upper extremity, meaning you’ve got a head-to-toe resource at your fingertips.  Just forward your receipt to me at ec@ericcressey.com and I’ll send it along this weekend.

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Getting Geeky with AC Joint Injuries

Written on September 2, 2009 at 6:39 am, by Eric Cressey

Getting Geeky with AC Joint Injuries

Lately, I’ve gotten quite a few in-person evaluations and emails relating to acromioclavicular (AC) joint issues.  As such, I figured I’d devote a newsletter to talking about why these injuries are such a pain in the butt, what to do to train around them, and how to prevent them in the first place (or address the issue once it’s in place).

First off, there is a little bit about the joint that you ought to know.  While the glenohumeral joint (ball-and-socket) is stabilized by a combination of ligamentous and muscular (rotator cuff) restraints, the AC joint doesn’t really have the benefit of muscles directly crossing the joint to stabilize it.  As such, it has to rely on ligaments almost exclusively to prevent against “shifting.”

As you can imagine, then, a traumatic injury or a significant dysfunction that affects clavicle positioning can easily make that joint chronically hypermobile.  This is why many significant traumatic injuries may require surgery.  While almost all Grade 4-6 separations are treated surgically, Grades 1-2 separations are generally left alone to heal – with Grade 3 surgeries going in either direction.

In many cases, you’ll actually see a “piano key sign,” which occurs when the separation allows the clavicle to ride up higher relative to the acromion.  Here’s one I saw last year that was completely asymptomatic after conservative treatment.  It won’t win him any beauty contests, and it may become arthritic way down the road, but for now, it’s no problem.

Now that I’ve grossed you out, let’s talk about how an AC joint gets injured.  First, we’ve got traumatic (contact) injuries, and we can also see it in people who bench like this:

Actually, that’s probably a fractured sternum, but you can probably get the takeaway point: don’t bounce the bar off your chest, you weenie.  But I digress…

Insidious (gradual) onset injuries occur just as frequently, and even moreso in a lifting population.  Most of the insidious onset AC joint problems I’ve encountered have been individuals with glaring scapular instability.  With lower trapezius and serratus anterior weakness in combination with shortness of pec minor, the scapula anteriorly tilts and abducts (wings out) – and you’ll see that this leads to a more inferior (lower) resting posture.

In the process, the interaction between the acromion (part of the scapula) and clavicle can go a little haywire.  The acromion and clavicle can get pulled apart slightly, or the entire complex can get pulled downward a bit.  In this latter situation, you can also see thoracic outlet syndrome (several important nerves track under the clavicle) and sternoclavicular joint issues in addition to the AC joint problems we’re discussing.

As such, regardless of whether we’re dealing with a chronic or insidious onset AC joint issue, it’s imperative to implement a good scapular stabilization program focusing on lower trapezius and serratus anterior to get the acromion “back in line” with the clavicle.  Likewise, soft tissue and flexibility work for the pec minor can also help the cause tremendously.

Anecdotally, a good chunk of the insidious onset AC joint problems I’ve seen have been individuals with significant glenohumeral internal rotation deficits (GIRD).  The images below demonstrate a 34-degree GIRD on the right side.

It isn’t hard to understand why, either; if you lack internal rotation, you’ll substitute scapular anterior tilt and abduction as a compensation pattern – whether you’re lifting heavy stuff or just reaching for something.  And, as I discussed in the paragraph above, a scapular dyskinesis can definitely have a negative effect on the AC joint.

Lastly, you can’t ever overlook the role of thoracic spine mobility.  If your thoracic spine doesn’t move, you’ll get hypermobile at the scapulae as a compensation – and we already know that’s not good.  And, as Bill Hartman discussed previously, simply mobilizing the thoracic spine can actually improve glenohumeral rotation range-of-motion, particularly in internal rotation.  Inside-Out is a fantastic resource in this regard – and is on sale this week, conveniently!

So, as you can see, everything is interconnected!  In part 2 of this series, I’ll discuss training modifications to work around acromioclavicular joint problems and progress back to more “normal” training programs.

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All the Best,

EC

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