The Importance of Ankle Mobility

Written on December 20, 2009 at 3:38 pm, by Eric Cressey

One of the most common issues we see in both athletes and our general population clients is a lack of ankle mobility – and more specifically, dorsiflexion range-of-motion.

For just about everything in life – from sprinting, to lunging, to squatting – we need a certain amount of dorsiflexion (think of how far the knees can go over the toes, or the positive shin angle one can create without lifting the heel).  If we don’t have it, we have to compensate.

One of the most common things we see in people with a lack of dorsiflexion ROM is an “out-toeing,” as this opens up the ankle and allows for them to get to where they need to be – even if it isn’t the most biomechanically correct way to do so.

This out-toeing may also be caused by hip internal rotation deficit (HIRD), so it’s important to assess both.  Check out this previous video blog for more information on how to assess for HIRD.

In a more “uncompensated” scenario, an athlete with poor ankle mobility may push through the toe instead of the heel – creating a quad-dominant propulsion in a scenario that should have signification contribution from the posterior chain musculature.  In the pictures below, you’ll see that Josh Beckett requires a considerable amount of dorsiflexion range-of-motion to get the job done (push-off without the heel leaving the ground).

This lack of ankle mobility may also negatively affect knee function.  Research has shown that a lack of ankle mobility can increase rotational torque at the knee.  This falls right in line with the joint-by-joint school of thought with respect to training; if you lock up a joint that should be mobile, the body will look elsewhere to create that range-of-motion.

This definitely applies to what happens to the lumbar spine during squatting in a person with an ankle (or hip) mobility deficit.  If someone can’t get sufficient dorsiflexion (or hip flexion and internal rotation), he’ll look to the lumbar spine to get that range of motion by rounding (lumbar flexion).  We know that combining lumbar flexion with compressive loading is a big-time no-no, so it’s important to realize that folks with considerable ankle mobility restrictions may need to modify or eliminate squatting altogether.

Take, for example, Olympic lifters who wear traditional Olympic lifting shoes with big heel lifts.  This artificially created ankle mobility allows them to squat deeper.  While I’m not a huge fan of this footwear for regular folks for squatting, used sparingly, it’s not a big deal.

Other individuals may be better served with hip dominant squat variations (e.g., box squats) that allow them to sit back and not squat quite as deep while they work to improve that ankle mobility and get closer to squatting deeper (with more dorsiflexion).  With these individuals, we supplement the more hip dominant squatting with extra single-leg work and plenty of deadlift variations.

The take-home message is that ankle mobility has some far-reaching implications, and it’s important to be able to assess it to determine if it’s the factor that’s limiting someone’s safe and efficient movement.

For more information on how to evaluate and address ankle mobility, check out Assess and Correct.

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Mobility Exercise of the Week: Wall Hip Flexor Mobilization

Written on November 17, 2009 at 12:21 pm, by Eric Cressey

For more exercises like this, check out the Assess and Correct DVD set.

Random Friday Thoughts: 10/30/09

Written on October 30, 2009 at 5:51 am, by Eric Cressey

1.Just a quick heads-up: today is the last day you can get the new Functional Strength Coach 3 DVD set from Mike Boyle with all the sweet bonuses he’s offered as an introductory special.  Definitely check it out (here).

2. There’s some great new research out in the Journal of Strength and Conditioning Research that compares front and back squats with respect to stress on the knees.  Not surprisingly, you actually see higher compressive forces and knee extensor moments with the back squat – which would imply that the front squat is a safer option for most folks.  This actually isn’t a huge surprise to me, as we’ve integrated front squatting well in advance of back squatting in returning folks with lower extremity issues to “normal training.”  However, there is a bit more.

You see, we’ll have people do a box squat variation before going to a front squat.  There is more of a sitting back motion, and a bit less knee flexion, so more of the stress it put back on the posterior chain (glutes, hamstrings) than the quads.  It not only takes the stress off the knees, but also allows folks to maintain a great training effect while they’re on the mend.  And, in reality, it probably helps to address some of their inefficiencies, as a good chunk of folks with knee issues tend to have weak posterior chains and be very quad-dominant.  While the majority of these individuals’ training focuses on deadlifting variations and single-leg work, when the time comes to squat, we’ll first use a front box squat:

From there, we’d go to a back-loaded box squat variation (giant cambered bar, safety squat bar, or straight bar), and then on to regular ol’ front squats.  (FYI, I covered front vs. back squats from a different perspective HERE)

3. When it comes to shoulder health, one thing folks miss out on all the time is the important role of the subscapularis, one of the four muscles of the rotator cuff.  This is a huge mistake if you want healthy shoulders.  Why?  As the picture below shows, this sucker has a big cross-sectional area (CSA).  In fact, according to Bassett et al., its CSA is the second largest (behind only the deltoid) of any muscle crossing the glenohumeral joint.

As an interesting little tag-along to that fact, I recall reading that research has demonstrated that subscapularis cross-sectional area was the only factor that predicted powerlifting performance.  While the primary focus of the subscapularis is dynamic stabilization of the humeral head (and, more specifically, creating anterior stability with its posterior pull), it also assists in internally rotating the humerus, so it’s lumped in as a “bad guy” with the other internal rotators: pectoralis major, latissimus dorsi, anterior deltoid, and teres major.

In reality, in most folks, some subscapularis activation work during the warm-up should be done in conjunction with lengthening drills for the other internal rotators and posterior rotator cuff in order to establish a good shoulder groove before training.  We go into great detail in Assess and Correct with two of our progressions, but to get the ball rolling, try putting your hand behind your back (as if handcuffed) and then lifting off without extending your elbow or flexing your wrist.

If this isn’t happening easily (both getting the arm back there and lifting off), you need to get to work!

4. Speaking of Assess and Correct,  the feedback thus far has been fantastic – and folks haven’t even received the DVDs yet!  Here’s a little sample from some of the emails I’ve received:

“I ordered a copy last night and have been looking over the e-manual this morning and I’ve got to say, it looks awesome! Can’t wait to put it to use.”

“I got it yesterday. It’s awesome and the DVDs haven’t even arrived yet!”

Needless to say, the DVDs alone will be 100% worth the deal, but the in-depth bonuses take things to the next level.  Remember that the one-week only introductory price of $97 expires on Sunday at midnight, so pick up your copy ASAP!

Have a great weekend!

EC

PS – I’m looking for a good trainer/S&C coach in the State College, PA area.  If you are located there or know someone good nearby, please email me ASAP at ec@ericcressey.com.  Thanks!

PPS – I’m doing the Fitcast with Kevin Larrabee this morning.  I’ll get the link posted as soon as it’s available.

Assess and Correct Now Available!

Written on October 26, 2009 at 5:10 am, by Eric Cressey

Today’s a really exciting day for Mike Robertson, Bill Hartman, and I – and hopefully for you, too!

You see, after months of planning, filming, and editing, our new product, Assess and Correct, is now available at www.AssessAndCorrect.com.  And, for the first week ONLY, we’re making the product available for $30 off what will be the normal retail price.

Assess and Correct is the first resource that empowers you with not only a series of self-assessments to identify your own flexibility and stability limitations, but also exercise progressions to correct those inefficiencies.  In the process, you’ll take your athletic performance to all new levels and prevent injuries from creeping up on you – whether you’re a high-level athlete or someone who sits at a desk too much.

With 27 self-assessments and 78 corresponding exercises, you’ll cover virtually everything you need to feel and perform well. And, you’ll have plenty of variety to use for many years to come!  And, while the DVDs alone are really comprehensive, the bonuses we’ve added to this really sweeten the deal.  Included in this package are:

• DVD #1: Your Comprehensive Guide to Self-Assessment
• DVD #2: Your Individualized Corrective Exercise Progressions
• Bonus #1: The Assess and Correct Assessment E-Manual, which is a guide to which you can refer to in conjunction with DVD #1.
• Bonus #2: The Assess and Correct E-Manual, which includes written cues and photos for each recommended drill in DVD #2 so that you’ll have a resource you can take to the gym with you.
• Bonus #3: “The Great Eight Static Stretches” E-Manual, which shows you eight additional flexibility drills that we use on a regular basis in addition to the drills featured in the DVDs.
• Bonus #4: The “Optimal Self Myofascial Release” E-Manual, which shows you the soft tissue methods and techniques we use with our clients and athletes.
• Bonus #5: “Warm-ups for Every Body” E-Manual, which is a collection of two sample warm-up templates for 19 different sports/scenarios.

Again, this introductory offer will end next Sunday, November 1 at midnight EST.  For now, though, I’d encourage you to head over to www.AssessAndCorrect.com to check out some of the sample videos from the DVDs – including the introduction in which we discuss our rationale for creating the product.

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.

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.

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.

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.

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

Want to Get Strong? Quit Switching Strength Training Programs Every Week.

Written on July 15, 2009 at 10:42 am, by Eric Cressey

Day in and day out, I see loads of athletes and regular fitness enthusiasts who have hit plateaus in their quest to get stronger, bigger, and leaner – or run into injury issues.  Each situation is unique, but one thing that I am always especially attentive to is learning whether someone has recently altogether overhauled their approach to training.

As is the case in so many things in life, “Slow and steady wins the race,” “Rome wasn’t built in a day,” and “Don’t run sideways on treadmills while wearing jeans.”  Actually, that last one wasn’t all that applicable to what I’m getting at, but it’s probably still good advice to heed for some of our easily distracted teenage readers.

I come across a lot of “program hoppers” in what I do.  These are individuals who might do four weeks of Sheiko, four weeks of 5×5 workouts, four weeks of Crossfit, four weeks of German Volume Training, and then four weeks of Tae-Bo DVDs in spandex.  At the end of this five month journey, they are somehow more fit – but literally have no idea what training principles were key in them achieving that end.  Everything was too muddled; they overhauled the entire strength and conditioning program rather than keeping the valuable stuff.

About 8,000 strength coaches before me have used the line, “The best program is the one you aren’t on.”  Well, I would agree with that – unless, of course, it means that this new strength and conditioning program leaves out all the important stuff that you learned from previous training experiences.

I mean, honestly, I’ve heard of guys going to strength training programs where they only squat, bench, and deadlift.  They don’t even do warm-ups;  nothing else stays!  Then, after six weeks of this program, they email me to ask why their shoulders, back, and knees hurt.  Uh, maybe become the only thing they kept from your old program was specificity?  With no single-leg work, no horizontal pulling, and no mobility work, it’s a surprise that they have only been diagnosed with a musculoskeletal injuries – because they probably should have been institutionalized for being so dumb that they’re a harm to those around him.

For instance, rather than tell this individual to stop squatting (he actually kept a pretty good neutral spine on the way down), I’d encourage him to a) get a squat rack, b) get a training partner/spotter, and c) put on some clothes.

Major kudos for rocking “The Final Countdown,” though; seriously.

Where am I going with this, and how does it apply to you?  Well, the message is very simple: never overhaul.  Instead, tinker, fine-tune, adjust, or whatever else your thesaurus recommends as a synonym.  Good strength and conditioning programs all share certain things in common, and anything that deviates from those qualities isn’t worth it.  It’s something that I really tried to take into account when I wrote Show and Go: High Performance Training to Look, Feel, and Move Better.

To take it a step further, I encourage you to be leery of those who encourage you to adapt an entire discipline and change everything that you’re doing.  I find that even in the most injured and hopelessly weak folks that come to me for help, I can always find several things that they’re doing correctly that deserve to stay.  This is something I’ve seen in some of the best physical therapists and strength and conditioning coaches with whom I’ve worked in the past, too.  A good professional should work with athletes and clients to meet halfway on what works, not simply pass judgment on a strength training program and overhaul it altogether.

Related Posts

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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.

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!

Newsletter 161

Written on June 30, 2009 at 7:24 am, by Eric Cressey

I have the normal weekly newsletter posted below, but first a quick announcement: Mike Robertson, Bill Hartman, and I just filmed a new DVD set!  Those of you who have enjoyed all of our products individually can now see what happens when the three of us collaborate.  For more information, check out today’s blog post: A Sneak Peak at the New Project.

The Law of Repetitive Motion: Part 2

In last week’s newsletter, I talked about the first three component of the law of repetitive motion: “I” (injury/insult), “N” (number of repetitions), and “F” (the force of each repetition, expressed as a percentage of maximal strength).

This week, I’ll discuss the “A” and the “R” of this equation.  To begin, amplitude, stated simply, is range of motion.  If we spend our entire lives in limited ranges of motion, we run into problems.

Obviously, this refers to those who sit too often and too long – particularly in poor postures.  I’m a big believer that the best posture is the one that is constantly changing, so I always encourage people to try to get up and move around every 20-30 minutes whenever possible.  If not, I love the idea of simply “shuffling” positions at your computer.  Complement this constant fluctuation of posture with some good training to open up the hips and thoracic spine, and strengthen the upper back and glutes, and you’ll find that being stuck in a job with a small amplitude is a “manageable” problem.

Amplitude can also refer to only doing certain exercises in the gym, particularly those who exercise through a partial range of motion.  It might be people who simply press too often and pull too infrequently, or those who perform a lot of bilateral exercises, but nothing unilateral.  We aren’t just talking about ranges of motion at the joints; we are also talking about the muscles recruited and type of muscle action – concentric, eccentric, isometric – that takes place.

Lastly, working at a specific task for extended periods of time can be a huge issue for some.  Just ask musicians, factory line workers, and even baseball pitchers.  These issues can all impose huge asymmetries that must be addressed both directly (soft tissue work, flexibility training) and indirectly (training the contralateral side, or just exposing the individual to a broader excursion of movement outside this specific task).

So, all that in mind, improving amplitude is all about increasing range of motion in one’s daily life.  Of course, this must be specific range of motion.  You wouldn’t, for instance, want to increase lumbar spine range of motion in most back pain patients, but you would want to optimize hip and thoracic spine mobility.

Rest, the “R” in our equation, is pretty straight-forward: if a tissue is angry, you need to give it time to settle down.  However, just stopping all exercise isn’t always the best bet.

Often, it’s simply a matter of keeping the stress on the tissue below its capacity for loading.  As a great example, a lot of manual therapists with whom I’ve worked actually like people to go out and lightly load tissues that have just been worked in order to teach the tissue to “deform” properly.  For instance, I got a little “Graston Loving” on my biceps a while back, and spent the rest of the day lightly loading the tissues and doing some prolonged stretching sets.  It worked like a charm.

Taking it a step further, though, much of the time, it’s about redistributing stress.  For instance, someone with anterior knee pain may not be able to do a more quad-dominant squat, but instructing that same lifter to sit back into the glutes and hamstrings more can markedly take down the stress on the anterior knee.  Sure, it changes the muscular recruitment of the exercise, but the lifter derives great benefit and keeps the loading on the affected tissues below capacity.  And, in this particular case, he’s strengthening the posterior chain muscles that almost always help to prevent anterior knee pain in the first place.

That wraps up our look at the law of repetitive motion.  It’s certainly not an exhaustive review, but my hope is that it got you thinking just enough to consider how this law applies to the issues you see on a daily basis, as well as those you want to prevent from ever reaching threshold.  For more information, check out the Building the Efficient Athlete DVD Set.

New Blog Content

Random Friday Thoughts
The Who-What-When-Where-Why of Flexibility Training
In the Presence of Greatness

Have a great week!

EC

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The Law of Repetitive Motion

Written on June 25, 2009 at 8:11 pm, by Eric Cressey

Back in early May, I published a newsletter discussing some alternatives I’ve used as replacements for traditional interval training.  Basically, the goal was to show that one can work to address inefficiencies while still getting some good energy systems development training.

One of the key concepts I briefly outlined in this newsletter – and also thoroughly in Mike Robertson and my Building the Efficient Athlete DVD Set – is the Law of Repetitive Motion.  This law is expressed as the equation I=NF/AR.  In this equation, injury equals the number of repetitions multiplied by the frequency of those repetitions, divided by the amplitude of each repetition times the rest interval.

Looking at this equation and understanding each of these factors sheds some light not only on how we can prevent injuries, but also address these issues once they reach threshold.  Truth be told, as I related in another previous newsletter, I’m a firm believer that we’re always just see-sawing back and forth, getting closer to threshold when tissues are loaded in excess of their capacity.

Providing adequate stability, mobility, recruitment patterns, and tissue quality with the appropriate training loads and recovery measures ensures that we stay below this threshold.  All of these issues are covered in one way or another by the equation from above.

“I” is the injury, or insult to the tissues.  In the active restraints – muscles and tendons – this may present in the form of soft tissue restrictions that can be addressed with manual therapy and foam rolling.  In other words, sometimes simply doing some soft tissue work can bring someone back below threshold (one reason why I refuse to refer any athletes or clients to physical therapists who do not put their hands on patients, but that is a whole other newsletter altogether).

“N” is the number of repetitions imposed on the tissues.  This may be working on a factory line doing the same motion over and over again.  It may also be simply sitting with poor posture, which is the equivalent of a high number of reps (constant activation). Or, it could come from doing as many chin-ups as possible simply because your business partner told you that he didn’t think you could do it – and the Mudvayne in the background motivated you to action (but I wouldn’t know anything about that).

With respect to “N,” the general assumption is that simply reducing the number of repetitions is what it takes to reduce insult to the tissues.  That’s absolutely true, but not exhaustively true.

Take someone who bench presses with the elbows flared, and teach them to tuck the elbows and activate the upper back and scapular stabilizers.  You may instantly relieve their pain without altering the number of repetitions; you’re just redistributing the load.

The same is true of someone with anterior knee pain who has pain with forward lunging, but not with reverse lunges.  So, the lesson to be learned isn’t just to modify the number of repetitions, but also the manner in which those repetitions are performed.

“F” is the force of each repetition, and it’s important to remember that this force is expressed as a function of maximum muscular strength.  So, in other words, the “F” figure will be higher – and more injurious – on a weak tissue.  This is one reason why resistance training is a big portion of modern physical therapy – including physical therapy that the brighter minds in the PT community wouldn’t consider “comprehensive” or “good.”

Here’s an example.   Average Joe gets anterior knee pain and, of course, he gets diagnosed with patellar tendinitis when it’s really more of a tendinosis (but I won’t digress on that).  He spends six weeks in PT to really “build up his quads.”  It’s obvious that the patellar tendon was just weak and inflamed, so strengthening it and knocking back NSAIDs like candy will fix everything.  Riiiiight.

Chances are that the patellar tendon was just overused because Joe had no hamstrings or glutes.  Getting the quads strong just reduces the “F” figure in the equation above.  They push him away from threshold, but not as far as he’d have gone if they’d also worked on recruiting glutes and hamstrings better, optimizing hip and ankle mobility, or performing soft tissue work.  Or, maybe he just got better because they reduced the “N” we discussed above by resting the knee.  Regardless, Joe’s not in the clear and very well might be back in PT in a few months if he doesn’t address the other issues in the equation.

And, with that in mind, I’ll get to the final two components of the Law of Repetitive Motion in my next newsletter.  In the meantime, check out the Building the Efficient Athlete DVD Set for more details.

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