Review of Rehab=Training, Training=Rehab: Top 10 Takeaways – Part 2

Written on December 19, 2010 at 4:58 pm, by Eric Cressey

Today, we’ve got a follow-up of my blog from late last week, Rehab=Training, Training=Rehab: Top 10 Takeaways – Part 1.  This mini-series highlights some of the key takeaways from Charlie Weingroff’s great new DVD set, which is on sale at an introductory price through midnight tonight only.  We pick up today with #6.

6. I’ve written a lot in the past about why a hip internal rotation deficit (HIRD) is a huge problem in both athletes and the general population.  Weingroff raises an interesting point in discussing the “Hip Internal Rotation Paradox” that I’d never really considered – probably because nowadays, I really don’t train as many female athletes where we see valgus-initiated knee and lower leg injuries.  In this population, we see lower extremity pathologies largely because a lot of females can’t control femoral/tibial internal rotation and pronation at the subtalar joint (left side in the photo below).

The casual observer to kinesiology might say that a good way to prevent these injuries would be to make sure that athletes have insufficient internal rotation and pronation; if you can’t hit a dangerous end-range, then you can’t tear anything nearly as easily.  Hooray for HIRD then, right?  Wrong.

The problem with this thought process, though, is that it doesn’t appreciate that the hip DOES need full internal rotation for proprioception.  As Charlie puts it, the hip “needs to know it to prevent it.”  If we don’t have adequate proprioception, we can’t get the hip external rotators to turn on to prevent it from becoming excessive.  This is really true of all joints; we must have full mobility so that the mechanoreceptors can tell the brain that a joint can go from point A to point B.  Otherwise, we can’t stabilize naturally and reflexively.

7. Weingroff reaffirmed a great assertion that I remember Bill Hartman making a year or two ago: you only need stability in the presence of mobility.  In other words, “functional” mobility is not just about being capable of adequate stability in wild excursions of joint range of motion – unless that’s what your functional demands are.  In other words, a powerlifter, gymnast, and baseball pitcher would all have different “optimal mobility” schemes, and even within these populations, you’d see different needs for different folks based on body type and the specific activity in question.

This also can influence our training programs.  While exactly simulating the sporting movement will only lead to overuse without enhancing functional mobility, working to improve stability in similar joint alignments and ranges of motion can still have a favorable carryover.  This came to mind the other day when Kansas City Royals prospect Tim Collins was doing some core work at the facility; you just have to consider the movement alongside his functional demands.

8. Charlie also cited some more up-to-date research that shows that problem with lateral knee pain is usually too much femoral internal rotation during closed chain movements (e.g., squatting, lunging), not too much lateral patellar tracking.  So, you think the hundreds of thousands of lateral release surgeries that have been performed in the last decade were a good idea?  A lot of people could have gotten their issues under control the right way by getting the hip under control – because the patella was already where it was supposed to be.

9. I liked the way that Weingroff broke corrective exercise down into three categories: isolated, integrated, and functional movement.

Isolated work might include manual therapy (massage or joint mobilizations) or stretching.  Essentially, this category consists of interventions where the client/patient has little to no active participation (foam rolling would technically be a mild exception, as the client has to actively reposition his/her body for this soft tissue work).  Effectively, these modalities get the ball rolling on undoing a dysfunction that won’t clear up with gross movement because the individual with the problem will simply go to the path of least resistance and feed into that dysfunction.

Integrated work is aimed at tying this new mobility with the core – whether it’s with a more comprehensive mobility drill or stabilization exercise.  Many people can benefit from going directly to integrated work; examples include someone who has always trained on machines, or someone who sits at a desk all day; they simply need to move).

Functional movement is the third piece of the puzzle and involves tying the upper and/or lower extremity to the core.  This is the fun stuff.

10. There is a difference between functional movement and functional exercise.  This might seem like wordplay, but in reality, it’s an important differentiation to make.

Charlie cited the example of a baby going into lumbar flexion when squatting down.  It’s a range-of-motion that a child should have and utilize in normal development and day-to-day living.  That doesn’t, however, mean that it’s a good idea to put 405 on your back and squat through lumbar flexion.

That wraps up my not-so-quick recap of Rehab=Training, Training=Rehab.  To be honest, I could have written another dozen blog posts just like this on all the other stuff – both “big picture” points and finer subtleties – that I picked up from Charlie’s presentation.  That, however, is best left to Charlie – which is why I’d strongly encourage you to pick up a copy of the DVD set yourself, especially since it is on sale at the introductory price ($50 off) through Monday 12/20 at midnight.  You won’t regret it:

Rehab=Training, Training=Rehab

Stuff You Should Read: 3/9/10

Written on March 9, 2010 at 12:38 pm, by Eric Cressey

I just got back from speaking at the NSCA Personal Trainers Conference in Las Vegas, so I’m a bit short on content as I play catch-up now that I’m back in Boston.  Luckily, Bill Hartman put together an excellent two-part series on femoral anteversion as it relates to hip mobility.  Check them out:

Hip Mobility: Femoral Anteversion – Part I

Hip Mobility: Femoral Anteversion – Part II

Along similar lines, this old video blog of mine might interest you:

Measuring Hip Internal Rotation

The Best of 2009: Videos

Written on January 6, 2010 at 11:23 am, by Eric Cressey

This week, we’ve already covered the most popular articles and product reviews from EricCressey.com in 2009.  Next up are the popular videos.

One of my goals for 2009 with this site was to include a lot more video content – whether it was “built in” to the text, or serving as a stand-alone content source in itself.  Here were some of the most popular ones for the year:

Correct Push-up Technique – This one got over 9,000 views in spite of the fact that I never even included it in a blog post (that I can remember).  I guess my theory that most people really need to learn how to do good push-ups was right on the money.

My 660 Deadlift – I guess lifting heavy stuff is only about 89% as cool as body weight push-ups.

Tim Collins Can Jump – Great guy, stud athlete, bright future.  Gotta’ love him.

16×16 Sled Madness – This sled masochism was popular among our staff early in the year.  There is more info on it HERE.

Rollouts: Friend or Foe – This video went hand-in-hand with this newsletter.

Anterior Core Progressions – This video was a follow-up to the previous one, and was found in this newsletter.

Measuring Hip Internal Rotation – This video was featured as part of this newsletter.

Lastly, there were a few newsletters that included a ton of video content.  Here’s my personal favorite, a follow-up from Mike Reinold and my shoulder seminar (available soon on DVD): Recap: Testing, Treating, and Training the Shoulder.

Tomorrow, we’ll cover the top guest submissions for the year at EricCressey.com.

The Best of 2009: Articles

Written on January 3, 2010 at 10:00 am, by Eric Cressey

In place of “Stuff You Should Read” this week, I thought it might be cool to direct you to our most popular pages and videos for 2009, according to our website statistics.  Presumably, these are the ones that people forwarded to friends the most, and/or the ones that caught the most people’s eyes.  This excludes pages like the homepage, baseball content, products, etc.  Here we go:

Medicine Ball Madness – This piece outlined some of the medicine ball work I do with both my baseball guys and the rest of our clients.  It was so popular that it actually led to me deciding to cover this topic at my Perform Better talks for 2010.

Hip Internal Rotation Deficit: Causes and Fixes – This Q&A on what the lying knee-to-knee stretch does actually led to a discussion of the who, what, when, where, why, and how.

Front vs. Back Squats – This is a different kind of discussion on a debate that’s been going on for years.

Crossfit for Baseball – Controversial?  Yup.  I got a little hate mail for this one, but on the whole, I think I was pretty fair with how I approached it.

“Quad Pulls” and Sprinting Warm-ups – This article discusses how the term “quad pull” might not be the most accurate one out there – and, more importantly, how to avoid them.

A Common Cause of Hip Pain in Athletes – This piece discusses femoral anterior glide syndrome, a term coined by Shirley Sahrmann.

Next, we’ll feature the most popular product reviews of 2009.

Measuring Hip Internal Rotation

Written on November 23, 2009 at 11:07 am, by Eric Cressey

Q: Inspired by your articles on T-Nation, I’ve started to measure IR/ER/Total shoulder rotation deficits using a goniometer.  I did have another question, however: you mentioned in an article that Hip Internal Rotation Deficit (HIRD) is a serious problem among baseball pitchers and hitters due to the asymmetrical front leg blocking in both mechanics. I absolutely agree, and I use corrective exercises and stretches to help alleviate these problems. However, I lack a good way to test for this; do you have any suggestions?

A: We check hip internal rotation in the seated position.  Basically, you just have the individual sit up tall at the end of a table, and position the hips and knees at 90 degrees.  Then, without allowing the hip to hike, you internally rotate the femur. This is one of the many assessments on our new DVD set, Assess and Correct, and it’s featured on page 50 of the tag-along e-manual.  Check it out:

For more information on how to correct the problem – and assess for other issues like this, check out www.AssessandCorrect.com.

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