Home Posts tagged "Anatomy Trains"

What the Strength and Conditioning Textbook Never Taught You: Fascia Exists

It's not uncommon at all to hear recent college graduates in the strength and conditioning field talk about how they encounter a number of things in the "real world" that were never even considered in an exercise science curriculum.  And, while I've previously shared my thoughts on this topic in Is an Exercise Science Degree Worth It? - Part 1 and Part 2, the focus of today's post won't be debating the merits of this degree. Instead, it'll be outlining some of the holes in a typical exercise science curriculum and learning accordingly.  With that in mind, here is my first point that rarely gets consideration in strength and conditioning textbooks:

Fascia actually exists.

Amazingly, I went through an entire undergraduate education of anatomy, physiology, kinesiology, and biomechanics without the word "fascia" being mentioned a single time.  In fact, we didn't even discuss it when I had gross anatomy; the med students cut it away so that we could look at what was deemed "important" stuff: muscles, tendons, bones, ligaments, and organs.  And, when I got to graduate school, fascia really wasn't discussed much in my endocrine-heavy kinesiology curriculum or the graduate level physical therapy courses I took for my electives.

Now, think about why so many personal trainers have never used a foam roller with their clients, or why a physical therapist or doctor might not appreciate how manual therapy could help with everything from anterior knee pain, to hamstrings strains, to ulnar collateral ligament tears.  It's a school of thought on which they may have never been schooled.

Needless to say, "fascial fitness" is extremely important, and you need to understand why as well as how you can achieve it as you identify movement inefficiencies in your clients or athletes.  To that end, here are some recommended reads on this front:

8 Steps to Achieving Fascial Fitness - This was my write-up of a presentation from bodywork expert Thomas Myers back in 2010.

Anatomy Trains - This is Myers' famous book on the topic. 

Muscle Imbalances Revealed - Lower Body - Dean Somerset's presentation on fascia alone was worth the entire price of the product, but you also get the benefit of a bunch of other contributors' information.

I'll be back soon with more lessons the college textbooks never taught you, but in the meantime, get to reading on this topic and you'll quickly separate yourself in the strength and conditioning field - and make a lot of clients and athletes happy with their results in the meantime. 

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Strength Training Programs: Integrating the Functional Back Line for Pelvic Stability and Performance Enhancement

Today's guest blog comes from former Cressey Performance intern Eric Oetter.  Eric was one of the best interns we've ever had, and writing like this is just one example of why. In Thomas Myers’ groundbreaking work Anatomy Trains, several “lines” of fascially connected muscles are presented. Myers denoted these lines as “anatomy trains” (thus giving rise to the title of his now famous book). For those unfamiliar, fascia is a seemingly endless web of connective tissue, which envelops and unites the musculoskeletal, nervous, and circulatory systems of the body. Though manual therapists have treated the fascial system for centuries, Myers has played a pivotal role in introducing the concepts fascia and musculoskeletal tensegrity to the strength and conditioning community.

Tying the bottom of the foot to the scalp through fascial connections up the posterior surface of the body, the superficial back line remains the most referenced of Myers’ anatomy trains. While this line certainly has implications in extension (above the knee), propulsion, and full-body pronation, it’s far from being the only line yielding practical application and solutions for strength and conditioning coaches and movement therapists. Patrick Ward wrote an excellent guest piece on Mike Robertson’s blog last year concerning the deep front line and its effect on diaphragm functionality. I’ll follow suit with some examples of how the functional back line can produce stability across the posterior lumbo-pelvic-femoral complex. Functional Back Line Anatomy Tying one humerus to the contralateral tibia, the two functional back lines take the following path across the dorsal surface of the body:

Shaft of humerus --> Latissimus dorsi --> Lumbodorsal fascia --> Sacral fascia --> Sacrum --> Gluteus maximus --> Shaft of femur --> Vastus lateralis --> Patella --> Subpatellar tendon --> Tuberosity of tibia From behind, the lines look like a giant “X”, intersecting at the pelvis. The two key components in this discussion will be the latissimus dorsi and the glute max, as well as how their muscular actions can affect the sacro-illiac joint. Sacro-Iliac Joint Stability: Form Closure vs. Force Closure The sacro-illiac (SI) joint is comprised of the articulation between the illium and the sacrum and lies right in the middle of both functional back lines, deep to the lumbosacral fascia. Much like a crack in the sidewalk, the joint acts as a predetermined fracture to defer stress across the pelvis. Viewed from the back, the SI joint resembles a key fitting into a lock– the grooves on either side of the posterior illium are congruous with the lateral sacrum. This “lock-and-key” structure can be described as an instance of form closure. Essentially, the innate stability of the joint is provided by bony approximation.

While form closure can create stability, it’s not truly authentic. For example, we can create stability in the lumbar spine by shearing it into extension and using bony approximation to prevent movement. I hope all reading agree that such a situation is less than ideal. A superior option would be the force closure of a joint system. As opposed to form closure, where the morphology of the joint system creates stability, force closure entails the surrounding musculature dynamically stabilizing a joint by “pulling it tight”. Relating to our previous example of the SI joint, imagine how much better it would be to stop relying solely on the ligaments that cross the joint andinstead employ the powerful glute max and lat, which cross superficially as part of the functional back line, as both become continuous with the lumbosacral fascia. While using the functional back line to create force closure is useful in cases of general instability, it can be especially valuable in the instance of sacral torsion, where, as shown in the CT scan below, the sacrum rotates one way and creates strain on the contralateral tissues/ligaments as they are pulled taught.

Training this line in isolation can certainly provide benefit, but why not implement a big-bang strength exercise that integrates the entire line at once? Here are two great examples of how to train the functional back line in a more dynamic fashion. Split-Stance Low Cable Row

The split-stance low cable row provides an excellent presentation of shortening the functional line from both ends, thus force closing the SI joint. The latissimus dorsi aids in the horizontal pull while the contralateral glute max stabilizes the pelvis in the transverse plane to fight rotation. (Remember, any unilateral movement is inherently rotational.) Coaching Cues:
  • Place the cable stack with a D-handle attachment at its lowest height.
  • Set up facing the stack with feet about hip width apart. Imagine that you’re standing on railroad tracks – when you take the step back to set up, the only movement should be in the sagittal plane.
  • Pack the chin, brace the core, and then flex the hips to the point that the torso is angled at about 45°. Put most of your weight through the outside of your up-foot heel.
  • Perform a row, holding at the top for a one count.
Potential Corrections:
  • Look for lumbar extension in two places – the initial set-up and as a substitution for scapular retraction. Think “neutral spine” throughout.
  • Scapular elevation and shoulder hyperextension are common compensation patterns during horizontal pulling. Think of rowing “back-and-down” and only to the point that the scapula gets to the thoracic spine.
  • Make sure that you or your client feels the front-leg hip musculature kick on to stabilize – if not, play with the set-up a little until those external rotators are contracted.
The split-stance low cable row can be a great horizontal-pull variation for any client, but especially for those experiencing lumbosacral instability. I’d recommend placing it as an accessory exercise on upper body days – 3-4 sets of 8-10 reps. 1-arm Cable Rotational Row

Serving as a progression to the split-stance low cable row described above, the cable rotational row is a fantastic movement to dynamically integrate the functional back line into a more advanced pulling variation with much greater demand placed on the glute max. I view this movement much like the horizontal pull version of a push-press – the lower body drives the action with the upper body coming along for the ride. Coaching Cues:
  • Set up a few feet away and perpendicular to a cable stack with feet about a step outside of hip width. The D-handle should be about waste height.
  • Offset the feet so that the toes of the inside foot (closest to the stack) line up with the middle of the arch on the back foot. This positioning is crucial to maximize external rotation/abduction of the front hip.
  • Grab the D-handle and allow the load to pull you toward the cable stack. Maintain an erect torso and packed chin throughout. You’re allowed to let the back foot toes come up, but keep the front planted in position.
  • Once you’re facing the cable stack with arm outstretched, drive hard through the front heelto extend the front hip/knee while simultaneously pulling the D-handle across your torso.
  • Hold the end position – hip extended/abducted, scapula retracted, and eyes straight ahead – for a count of one before reversing the movement.
Potential Corrections:
  • I find some clients tend to lead the row with cervical rotation, finishing the movement looking away from the cable stack. These biomechanics are sub-optimal, so make sure to cue a packed chin.
  • Rowing from this position can prove awkward, as there is a tendency to try and row around your torso. Fight this urge by keeping the cable close to your body – it should be in contact with your shirt as you finish the row.
  • Achieving full hip extension on the front leg is a must – make sure the movement is initiated by driving the lateral heel into the ground almost as if you were going to step away from the stack.
The benefits of the rotational cable row are numerous, but two stick out in my mind. First, it drives a powerful and dynamic contraction of the functional back line, which as we’ve seen can have ramifications for pelvic/SI stability. Secondly, this variation has huge carryover for some of our rotary sport athletes who rely on the connection between shoulder and contralateral hip to develop force. As mentioned above, use this as a progression to the split-stance low cable row or with some of your athletic clientele – think in the range of 3-4 sets of 6-8 reps per side. Conclusion The functional back lines can be powerful players in creating stability across a region of the body that demands it. In cases of lumbo-pelvic-femoral instability, utilization of these lines can be as crucial for correction as they are for performance enhancement. I hope the two exercises described above help give some practical application for the functional back lines in action – let me know in the comments! About the Author Eric is currently a senior at the University of Georgia majoring in Exercise and Sport Science, with plans to pursue a Doctorate of Physical Therapy. After concluding a Division-1 football career at the Georgia Institute of Technology, Eric has ardently pursued his passion for coaching, garnering experience with clients of all ages and ability levels through internships at both Indianapolis Fitness & Sports Training and Cressey Performance. He can be reached at ecoetter@gmail.com. Sign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
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The Fascial Knock on Distance Running for Pitchers

A while back, I had the privilege to experience Thomas Myers in seminar for the first time.  For those who aren't familiar with Myers, he is the author of Anatomy Trains and a pioneer in the world of bodywork and fascial research.

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There were a wide variety of attendees present, and Myers made dozens of interesting points - so the take-away message could easily have been different for everyone in attendance as they attempted to fit his perspective into their existing schemeta.

While I enjoyed all 150 minutes of his presentations, the portion of Myers' talk that jumped out at me the most was his list of the eight means of improving "fascial fitness:"

1.       Use whole body movements

2.       Use long chain movements

3.       Use movements including a dynamic pre-stretch with proximal initiation

4.       Incorporate vector variation

5.       Use movements that incorporate elastic rebound - this consists of cylic motions of a certain speed (for instance, cycling wouldn't count)

6.       Create a rich proprioceptive environment

7.       Incorporate pauses/rest to optimize hydration status

8.       Be persistent, but gentle (prominent changes can take 18-24 months)

A big overriding them of Myers' lecture was that the role of the fascia - the entire extracellular matrix of the body - is remarkably overlooked when it comes to both posture and the development of pathology.  He remarked that he doesn't feel like we have 600+ muscles in the body; he feels like we have one muscle in 600+ fascial pockets because they are so interdependent.  And, in this fascia, we have nine times as many sensory receptors as we've got in muscles.

Think about what that means when someone has rotator cuff problems - and treatment only consists of ice, stim, NSAIDs, and some foo-foo rotator cuff exercises.  Or, worse yet, they just have a surgical intervention.  It overlooks a big piece of the puzzle - or, I should say, the entire puzzle.

For me, though, these eight factors got me to thinking again about just how atrocious distance running is for pitchers.  I have already ripped on it in the past with my article A New Model for Training Between Starts, but this presentation really turned on a light bulb over my head to rekindle the fire.  Let's examine these eight factors one-by-one:

1.       Use whole body movements - Distance running may involve require contribution from the entire body, but there is not a single joint in the body that goes through an appreciable range of motion.

2.       Use long chain movements - Pitching is a long chain movement.  Jumping is a long chain movement.  The only things that are "long" about distance running are the race distances and the length of the hip replacement rehabilitation process.

3.       Use movements including a dynamic pre-stretch with proximal initiation - This simply means that the muscles of the trunk and hips predominate in initiating the movement.  While the hips are certainly important in running, the fundamental issue is that there isn't a dynamic pre-stretch.  This would be a dynamic pre-stretch with proximal initiation:

4.       Incorporate vector variation - A vector is anything that has both force and direction.  Manual therapists vary the force they apply to tissues and the directions in which they apply them.  There are obviously vectors present in exercise as well.  Here are 30,000 or so people, and pretty much just one vector for hours: forward (to really simplify things):

Incorporating vector variation into programs is easy; it just takes more time and effort than just telling someone to "run poles."  Take 8-10 exercises from our Assess and Correct DVD set and you've got a perfect circuit ready to roll.

5.       Use movements that incorporate elastic rebound - Sorry, folks, but even though the stretch-shortening cycle is involved with jogging, its contribution diminishes markedly as duration of exercise increases.  And, frankly, I have a hard time justifying bored pitchers running laps as "elasticity."

6.       Create a rich proprioceptive environment - There is nothing proprioceptively rich about doing the same thing over and over again.  They call it pattern overload for a reason.  Pitchers get enough of that!

7.       Incorporate pauses/rest to optimize hydration status - Myers didn't seem to have specific recommendations to make regarding work: rest ratios that are optimal for improving fascial fitness, but I have to think that something more "sporadic" in nature - whether we are talking sprinting, agility work, weight training, or dynamic flexibility circuits - would be more appropriate than a continuous modality like jogging.  This is true not just because of duration, but because of the increased vector variation potential I outlined earlier.

8.       Be persistent, but gentle - This one really hit home for me.  Significant fascial changes take 18-24 months to really set in. I am convinced that the overwhelming majority of injuries I see in mature pitchers are largely the result of mismanagement - whether it's overuse, poor physical conditioning, or improper mechanics - at the youth levels.  Poor management takes time to reach the threshold needed to cause symptoms.  In other words, coaches who mismanage their players over the course of the few months or years they coach them may never actually appreciate the physical changes - positively or negatively - that are being set into action.

stressfracture

Distance running might seem fine in the short-term.  Overweight kids might drop some body fat, and it might make the practice plan easier to just have 'em run.  Kids might not lose velocity, as they can compensate and throw harder with the upper extremity as their lower bodies get less and less powerful and flexible.

However, it's my firm belief that having pitchers run distances not only impedes long-term development, but also directly increases injury risk.  Folks just don't see it because they aren't looking far enough ahead.

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The Lucky 13: Cressey’s Top Reading Recommendations

A few months ago, I gave a two-day seminar to just over 80 fitness professionals and strength and conditioning coaches.  Even with a seminar this long, I can never cover everything I'd like to cover - and it's generally because much of what I'd like to address relies on some prerequisite knowledge that the attendees may not possess.

seminar

With that in mind, at the attendees' request, I sent a follow up email to all of them with a list of some of the best resources - books/manuals and DVDs - that I've encountered along my journey of self-education. Please keep in mind that this is not an exhaustive list, by any means, but it does cover what I'd consider requisite reading to get a good foundation in a lot of the concepts I covered last weekend. 1.  Any anatomy text will do, but I prefer texts that speak more to functional anatomy.  Netter's Atlas of Human Anatomy is very good, and I know of many physical therapists in the US who keep a copy of this book on hand for patient education.  Kinetic Anatomy is also a solid text that speaks to functional anatomy, and I believe the newer version comes with a tag-along DVD.  Lastly, our Building the Efficient Athlete DVD set was created in part to educate folks on the functional anatomy side of things that they may miss during a conventional college curriculum.  I know of several facilities in the US that use it extensively for staff training. 2. Anything from Stuart McGill - While there are several schools of thought with respect to low back function and rehabilitation (and I'd encourage you to check out each of them), McGill is the one that resonates with me the most.  You can find a lot of his research on Pubmed, but he also has several books (and a DVD) available that I'd highly recommend.  For those of you who are interested in some science and some applied, go with Ultimate Back Fitness and Performance.

mcgill

For those of you who are a bit geekier and want to learn a lot more about the clinical side of things, check out Low Back Disorders.  If you are going to train clients or athletes, you need to understand back pain. 3. Diagnosis and Treatment of Movement Impairment Syndromes by Shirley Sahrmann is probably the book that has influenced me more than any other in my career.  It's worth every penny.

sahrmann

4. For shoulder stuff, I think that The Athlete's Shoulder is a great resource.  It is written by physical therapists and surgeons, though, so it can get very clinical at times.  Those of you who are more interested in actual practical applications would be more interested in our new Optimal Shoulder Performance DVD set, which is the video of a seminar I did with Mike Reinold, who is actually one of the co-authors of The Athlete's Shoulder.  If you enter the coupon code "reinold200osp" today only at checkout HERE, you can get the DVD set with free shipping today as part of Mike's "sale week" to celebrate his 200th post.

shoulder-performance-dvdcover

5. Muscles: Testing and Function with Posture and Pain - This is a newer version of Kendall's classic text, and it's an incredibly detailed resource that you'll find yourself referring back to time and time again.  Several of the screens we use in our everyday assessments with clients and athletes were influenced in part or entirely by Kendall's text. 6. Gray Cook's work is fantastic.  If you want quick, practical tips, check out Secrets of the Hip and Knee and Secrets of the Shoulder.  Both DVDs give you some tips that you can immediately put into practice. 7. Anatomy Trains by Thomas Myers is an excellent read to get you thinking more and more about the role of the fascial system.  I saw Thomas speak this past weekend in Providence, and he was absolutely fantastic - so excellent, in fact, that I'll probably write up a blog with some quick notes from his lecture.  And, I'll be reading this for the third time this week, too!

anatomy-trains

8. Bulletproof Knees - Mike Robertson wrote this manual and I can honestly say that I haven't seen a better product on the market with respect to information that can be quickly applied to clients with knee pain - both in terms of understanding it and correcting it.

bpk

9. Mike Boyle has some excellent products - including all the Functional Strength Coach DVDs (#3 was the most recent).  You can always find some good reading at StrengthCoach.com.  I believe they still have the 14 days for $1 trial period, and as part of that, you get his Designing Resistance Training Programs and Facilities book for free. 10. Anatomy of Breathing - I think it's valuable to appreciate the muscles involved in respiration and start to put them into your functional anatomy framework as soon as possible.  This book is a very quick read, but you'll get that foundational knowledge and start to think about how all this stuff lines up.

anatomyofbreathing

11. 2008 Indianapolis Performance Enhancement DVD set - This is a product that has largely flown under the radar because it was overshadowed by several other products that were launched around the same time.  However, the short vs. stiff discussion that Bill Hartman presented as part of it is well worth the cost of the entire DVD set. 12. Clinical Applications of Neuromuscular Techniques (Part 1 and 2) - These books read like stereo instructions, but they are insanely thorough.  I recommend them to anyone who is really dorky like I am.  They will definitely help you to collaborate with manual therapists and physiotherapists a lot more effectively. 13. Assess and Correct - Shameless self-promotion here, but I'm extremely proud of this product.  It's a DVD set and four accompanying manuals that cover 27 assessments and 78 corrective exercises we use with our clients and athletes.  If I had to recommend one of our products to a trainer, this would be it.  Stuart McGill have us some extremely flattering reviews on Assess and Correct as part of his new DVD.

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I should note that the countless journal articles I've read over the years are noticeably absent from this list, but you can easily access the abstracts of those pieces at www.pubmed.com if you search by whatever keyword relates to your area of interest.  I find myself using it daily, and I'll generally follow up on these abstracts by getting the full-text articles.  Also, in addition to the few resources I note below, you can find a more extensive collection of recommended readings on my resources page. This includes a collection of links to free blogs that I read daily.  Many of my blog readers don't know that, in addition to this blog, I have a free newsletter where readers get exclusive content and early notice on things - so you'll definitely want to sign up HERE if you haven't already. It's also been a matter of interacting with as many smart folks as possible, just making (and documenting) observations with our clients/athletes, and going to seminars.  This list should get you started, though!
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