Home Posts tagged "Stretches"

Coaching Cues to Make Your Strength and Conditioning Programs More Effective – Installment 6

It's been a while since I published a new installment in my "Coaching Cues" series, so here are three new ones you can put into action.

1. "Imagine I have a rope around your waist and pull it back."

It goes without saying that teaching a proper hip hinge is essential to get the correct posterior weight shift we need for good deadlifting and squatting patterns.  Unfortunately, it can sometimes be much easier said than done, as lifters with poor kinesthetic awareness and body control might not even know what it feels like.  Take, for instance, this example from my 15 Static Stretching Mistakes article; he has so much congenital laxity (loose joints) that he can perform an "extreme" toe touch without any posterior weight shift.

Just because he can do it doesn't mean that he should do it, though. Just saying "sit back" or "hips back" doesn't always correct this, though. I've spoken about the "touch your butt to an imaginary wall behind you" external focus cue here, but I also like the idea of telling folks to pretend like I'm tugging them backward with a rope, as this fits the correction into a scenario with which they're familiar.

2. "Ribs down, scaps up."

We work with a lot of athletes who have a heavily extended posture, and their overhead movements often look like this:

Essentially, they will substitute lumbar extension (arched lower back) in place of keeping a stable core so that the scapula (and, in turn, humerus) can move appropriately with respect to the rib cage.  Most of these athletes lack scapular upward rotation, so we need to help them to get the scapula moving a bit while keeping the ribs down.  Here's a great exercise for which this cue would be appropriate:

In other words, you can use this cue with your core stability exercises and shoulder mobility drills in this population. Keep in mind, though, that this cue probably won't be appropriate for folks who sit at desks all day and are really kyphotic.

3. "Push yourself away from the bar."

One of the biggest bench press technique problems you'll see is that folks lose their "tightness" at the top of the rep by protracting the shoulder blades too much.  This sets you up for problems - both in terms of shoulder health and strength - on sets with more than one rep. 

With that in mind, one of the easiest ways to coach folks out of this bench press technique problem is to think about pushing themselves away from the bar, as opposed to pushing the bar away from them. It gets them into the "ground yourself" frame of mind and ensures that the upper back is a stable platform from which to press. It's not uncommon at all to see larger than normal dropoffs from 1-rep max loads to what you see on multiple-rep sets, and I firmly believe it's because a lot of lifters lose their tightness on the subsequent reps.  So, if you find that you can bench 315 for one rep, but only 265 for three reps, this cue could very well be a solution for you.

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15 Static Stretching Mistakes

One of the most debated topics in the strength and conditioning world in recent years has been whether or not static stretching is necessary and, if so, when it should be implemented.  While I don't think everyone needs it, and that there are certainly are times when it is a bad idea to utilize, I'm still of the mindset that it can have some solid benefits when implemented properly. 

Unfortunately, like all training initiatives, some people do it all wrong. To that end, I wanted to devote today's article to covering the top 15 static stretching mistakes I encounter.

Mistake #1: Stretching through extreme laxity.

This is the most important and prevalent one of all, so it comes first.  When I see someone doing this, this is pretty much how I feel:

We're all have a different amount of congenital laxity.  Basically, this refers to how much "give" our ligaments have.  Some folks have naturally stiff joints, and others have very loose joints.  This excessively joint laxity is obviously much higher in females and younger populations, but, as Leon Chaitow and Judith DeLany discuss in Clinical Applications of Neuromuscular Techniques: Volume 1, it is also much higher in folks of African, Asian, and Arab origin.

When you take someone who is really lax and implement aggressive static stretching, it's on par with having someone with a headache bang his/her head against a wall.  It makes things worse.

This is a tricky thing to understand, though, because many of these "loose" individuals will comment on how they feel "tight."  Usually that tightness is just them laying down trigger points as a way for the body to create stability in areas where they are chronically unstable.  They'd be better off working on stability training to get back to efficient movement.

I think yoga has a tremendous amount of applications and we borrow from the discipline all the time, but I think this is where many modern yoga classes fall short; they have everyone in the class go to the same end-range on certain exercises. Folks with serious joint laxity should not only contraindicate certain yoga poses, but also modify others so that they're training stability short of the true end-range of their joints. Unfortunately, most of the people you'll see in yoga classes are hypermobile women; you see, they like to do the things they're good at doing, not necessarily what they need to do.

How do you know if you're lax, though? I like to use the Beighton hypermobility scale to assess for both generalized congenital laxity and specific laxity at a joint. The screen consists of five tests (four of which are unilateral), and is scored out of 9:

1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees

Beighton_Score

One of the biggest problems I see in today's strength and conditioning world is that we assume all "big, strong" athletes are tight and need aggressive stretching.  As an example, take a look at this high Beighton score in a 6-3, 240-pound athlete.  We do very little static stretching with him - and absolutely none in the upper body.

If someone is really lax, nix the static stretching and instead spend more time on stabilization work.  If they still feel like they need to "loosen up," tell them to do some extra foam rolling.  They'll transiently reduce some of the stiffness they're feeling, but they won't be working through harmful end-range joint range-of-motion in the process.

Mistake #2. Substituting knee hyperextension for hip flexion in hamstrings stretches.

This comment piggybacks a little bit on mistake #1, as lax individuals (who probably shouldn't be stretching their hamstrings, anyway) are the most likely to have problems with this.  Because the hamstrings are two-joint muscles (knee and hip), folks will often allow the knee to "give" extra because they are subconsciously trying to avoid an uncomfortable stretch at the hip - or they simply aren't paying attention.  These are the same folks who have terrible hip hinges on toe touch tests, yet can touch their toes without a problem; they just go to knee hyperextension to make it happen.  As an example, this particular athlete scores really high on the Beighton hypermobility score, and he can actually put his palms flat on the floor with little to no posterior weight shift (the wall blocks him). 

How does he do it? Knee hyperextension. 

We'd much rather get a good hip hinge without resorting to excessive joint range of motion at the knee. You get good at what you train, so if you're always doing your static stretching in a bad position, you're going to be more likely to wind up in knee hyperextension on the field - and that's where ACL injuries occur.

Mistake #3: Not creating stiffness at adjacent joints.

In a previous post, I talked about why stiffness can be a good thing, in spite of the negative connotation of the word.  Stiffness is a crucial part of keeping us healthy and enhancing athleticism.  "Good" stiffness allows us to overpower "bad" stiffness that's occurring in the wrong places, and it helps to transfer force as part of the kinetic chain.  Static stretching can either be an opportunity to foster good stiffness or develop bad habits.

You see, we static stretch to transiently reduce stiffness (or true tissue shortness).  However, if we don't stabilize (stiffen up) adjacent joints, it defeats the purpose. Let me give you an example.

Let's say that I want to stretch my hamstrings in the supine position with not just a neutral position (center), but also a bias toward internal rotation/adduction (left) and external rotation/abduction (right).


 



 

 

Now, let's see what happens to these stretches if one doesn't engage the lateral core to prevent the pelvis from rolling toward the direction of the stretch on the ones that go out to the sides.

Mistake #4: Irritating the medial aspect of the knee with 90/90 hip stretches.

Most folks are familiar with doing 90/90 hip stretches or cradle walks as a way to improve hip external rotation in a position of hip flexion.  This is the position I commonly see people using at the point of maximal stretch:

The problem is that many folks crank excessively on the medial aspect of the knee by rotating the tibia (lower leg) instead of the femur (upper leg).  This actually parallels what happens during a McMurray's Test for medial meniscus pathology:

It's a pretty safe bet that static stretching into a position that replicates a provocative test is never a good idea - and it's one reason we use 90/90 stretches very sparingly.  If you are going to use this stretch, however, I recommend that individuals grab the quadriceps on the stretching side to ensure that the majority of the pull into external rotation and flexion comes from the femur and not the tibia.  The opposite hand is simply there to support the weight of the lower leg.

Mistake #5: Substituting valgus stress at the knee for hip adduction/internal rotation stretching.

It's really important than folks have adequate hip internal rotation, as a loss of hip internal rotation has been correlated with low back pain, and it can certainly predispose individuals to hip and knee issues as well. The knee-to-knee stretch is a popular approach for maintaining and improving hip internal rotation, and it's also my chosen method for demonstrating how incomplete my goatee was at the time of this picture.  

lyingkneetoknee

As you can see from the picture, this position can also impose some valgus stress at the knees if it isn't coached/cued properly.  So, instead of thinking of letting the knees fall in, I tell athletes to actively internally rotate the femurs (upper leg).  The stretch should occur at the hips, not the knees.

In folks with a history of medial knee issues, we won't use this static stretch.  Rather, we'll use a kneeling glute stretch, which still gets a bit of stretch into adduction, which will still stretch several of the hip external rotators indirectly.

Lastly, keep in mind that the knee-to-knee isn't a stretch most females will ever have to utilize because of their tendency toward a knock-knee posture (wider hips = greater Q-angle) at rest.

Mistake #6: Not monitoring neutral spine during hip stretching.

This point really works hand-in-hand with #3 from above, which talked about establishing stiffness at adjacent joints.  Certainly, maintaining neutral spine falls under the category of "good stiffness," but because it's such a common mistake, it deserves attention of its own.  When the hip flexes, you shouldn't go through lumbar flexion. For this split-stance kneeling adductor stretch, notice the correct on the left and the incorrect on the right:

And, when it extends, you shouldn't go through lumbar extension.  Again, the correct is on the left, and incorrect (hyperextended) is on the right:

Mistake #7: Not monitoring neutral spine during standing stretches.

Again, this is another point that piggybacks off of establishing good stiffness, but I see a lot of people doing upper extremity stretches - overhead triceps, lats, pecs - in terrible spine posture.  Perhaps the best example is the overhead triceps stretch with the lumbar spine in hyperextension, plus forward head posture further up.

Mistake #8: Stretching your lower back.

There may be times when a qualified manual therapist might want to do some mobilizations on your lower back. The rest of you really shouldn't be stretching your spine out. Stretch your hips, and mobilize your thoracic spine (upper back), where it's much safer for you to move. Focus on building up some core stability.

Mistake #9: Stretching your calves – and then wearing high heels the rest of the day.

There's nothing wrong with the "stretching your calves" part; it's the high heels part that makes me want to bang my head against the wall. Talk about a dog chasing its tail!

Mistake #10: Stretching a throwing shoulder into extension and/or external rotation (and creating valgus stress at the elbow in the process).

I devoted an entire video to this topic last week in my baseball-specific newsletter:

Mistake #11: Stretching through pain or neurological symptoms.

I honestly can't think of a single reason why anyone should ever stretch oneself through pain. Sure, there may be times when physical therapists may push a post-operative joint through some uncomfortable ranges of motion, but that's a trained professional making a educated decision.  You stretching yourself through pain is just throwing a bunch of s**t on the wall to see what sticks.  Don't do it.

Sometimes, an indirect approach is better.  As an example, there is research demonstrating that core stability exercises can transiently and chronically improve hip internal rotation - even without stretching the joint.  If you're hurting while stretching, see a qualified medical professional to help you devise a plan to work around the issue while reducing your symptoms.

On the topic of neurological symptoms, as an example, intervertebral disc issues with radicular symptoms into the legs may be exacerbated by stretching the hamstrings.  Similar issues can come about if folks with thoracic outlet syndrome perform aggressive upper body stretching. If nerves aren't gliding the way that they need to be, the last thing you want to do is yank on them.

Mistake #12: Not tightening the glutes during hip flexor stretches.

I've written previously at length about how anterior (front) hip irritation is often caused the head of the femur (ball) gliding forward in the acetabulum (socket) during hip extension.  This femoral anterior glide syndrome (described in detail here), was originally introduced by physical therapist Shirley Sahrmann.  Effectively, the hamstrings have a "gross" hip extension pull - meaning that they don't have a whole lot of control over the head of the femur.  Therefore, we need to have great gluteus maximus contribution to hip extension, as the glute max posteriorly pulls the femoral head back during hip extension so that the anterior hip capsule doesn't get irritated.

What we don't consider, however, is that if we stretch a hip into hip extension (osteokinematics), we also need that glute contribution to control the glide (arthrokinematics) of the femoral head.  This is a definite parallel to what I described earlier with respect to stretching a throwing shoulder into extension or external rotation; you don't just want to do it carelessly. As such, whenever you stretch the hip into extension, make sure that you tighten up the glute:

Mistake #13: Stretching into a bony block.

There are a lot of things that may limit range of motion at a joint.  It could be muscular shortness/stiffness, capsular tightness, muscular bulk, swelling, or guarding due to injury.  In many cases, though, it simply has to do with the congruency of the bones (or lack thereof) at a joint.

In the case of a "fresh" bone spur or loose body at the posterior aspect of the elbow, aggressively stretching into extension could easily provoke symptoms.  Conversely, I've seen some elbows with flexion contractures that are a combination of bony blocks and subsequent tissue shortening and capsular tightening that can be stretched until the cows come home with no problem. 

Each case is unique - but at the end of the day, remember that you're better off being too tight than too loose.  In other words, if you're unsure about something, don't stretch it.

Beyond just reactive changes like bone spurs and loose bodies, we also have folks who simply have different congenital or acquired bone structures.  Many individuals have retroverted (externally rotated) or anteverted (internally rotated) femoral carrying angles.  Those in retroversion will lack hip internal rotation no matter how much you stretch them, and those in anteversion aren't going to be gaining external rotation no matter what you do.  Trying to power through these bony blocks will likely create hip discomfort as well.

We also see retroversion as an adaptation in throwing shoulders, where bones "warp" to allow for more lay-back during the extreme cocking phase of throwing.  This is why most throwers will have significantly less internal rotation on the throwing shoulder than on the non-throwing shoulder in-spite of the fact that they have symmetrical total motion (IR + ER) from side to side; they simply shift their arc.

Before you stretch, you better find out if it's bone or soft tissue that is limiting you at end-range.  If it's bone, you're better off leaving things alone.

Mistake #14: Putting the band behind your head during hamstrings stretching.

This one drives me bonkers.  It screams "I know stretching isn't hard to do, but I'm still too lazy to put any semblance of effort into doing it correctly."  Why create forward head posture and neck stress when stretching the hamstrings?

Mistake #15: Not monitoring your breathing.

Nowadays, I'd say that we do just as much "positional breathing drills" as we do actual stretches. The more I learn (particularly from the Postural Restoration Institute school of thought), the more I realize that breathing in specific positions can have a dramatic effect on reducing tissue stiffness. For instance, here is one that many of our right-handed pitchers do. 

The left femur is internally rotated and adducted, the left rib flare is "tucked," right thoracic rotation is encouraged, the lumbar spine is flat, and the right shoulder blade is fully upwardly rotated with a bit of upper trap activation. We cue the athlete to inhale through the nose without allowing the rib cage to "fly up," and then encourage him to exhale fully, allowing the ribs to "come down."

We stretch to reduce tone, not increase it - and most athletes are in a constant state of inhalation, which corresponds to a big anterior pelvic tilt and lordotic curve. 

APT-250x300

When the rib cage flies up like this, we lose our Zone of Apposition (ZOA), a term the PRI folks have coined to describe the region into which our diaphragm must expand to function.

Zone-of-Apposition-300x220

In this extended posture, rather than effectively use their diaphragm, athletes will overuse supplemental respiratory muscles like lats, sternocleidomastoid, scalenes, and pec minor - and these are all areas where we're always trying to reduce tone.

Teaching athletes how to control their breathing during stretching - and paying particular attention to fully exhaling on each breath - goes a long way to help reduce sympathetic nervous system stimulation, get rid of unwanted tone in the wrong places, effective favorable changes to posture, and make the most of the stretches you're prescribing.  I think the folks in the yoga and Pilates worlds have done a good job of drawing attention to the importance of breathing, and we should appreciate that with respect to how static stretching and dynamic flexibility drills are implemented.

Conclusion

There are really only 15 mistakes that were right on the tip of my tongue - to the tune of 2,800 words!  To reiterate, I have a lot of clients/athletes who do absolutely no static stretching, but that's not to say that it can't be of benefit to a good chunk of the population.  Just remember that each body is unique, so no two static stretching programs should be alike in terms of exercise selection and coaching cues. 

If you benefited from this article, please share it via Facebook or Twitter, as this is a very misunderstood topic in the world of health and human performance.  Thanks for your support!

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A Great Assess and Correct Review

I'm not back from Florida until Tuesday, but in the meantime, I just wanted to give you a quick heads-up on a thorough review Laree Draper just did on Assess and Correct: Breaking Barriers to Unlock Performance.  If you're on the fence about picking up a copy, you won't want to miss this, as it'll answer a lot of your potential questions.  You can check it out HERE.

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Getting Geeky with AC Joint Injuries

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."

ac-joint

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.

pianokeysign

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.

scapanteriortilt

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.

gird1gird2

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. New Blog Content Birddogs, Continuing Education, and Terrible Journalism Stuff You Should Read Exercise of the Week: Dumbbell Reverse Lunge Random Friday Thoughts It's All About Specialization All the Best, EC Sign-up Today for our FREE Baseball Newsletter and Receive a Copy of the Exact Stretches used by Cressey Performance Pitchers after they Throw!
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Random Friday Thoughts: 7/10/09

Here I sit at my desk on a Friday morning in an empty, 100% quiet Cressey Performance.  I'm not sure that's ever happened before - and it won't last long, as clients start rolling in about 23 minutes from now.  In other words, there goes my opportunity to create a well thought-out, organized, and relevant blog post.  Let the randomness begin. 1. Here's an interesting journal article looking at those with functional ankle instability also presented with delayed trunk reflexes.  In other words, if you've had an ankle sprain without thorough rehabilitation, it relates to a later onset of trunk muscle activation.  This closely parallels a lot of the stuff I covered in The Truth About Unstable Surface Training E-Book, as unstable surface training has been tremendously effective in correcting the proprioceptive delay we see in the peroneals following ankle sprains.

cressey-blog

I guess you could say that this is one more "yea" vote in favor of the whole kinetic chain concept.  Mess up an ankle and you very might be dealing with a knee, hip, or lower back issue sooner than later.

2. For the second year in a row, I'll be speaking at Fantasy Day at Fenway Park.  If you're looking for a good time to benefit a great cause (The Jimmy Fund), click here for more information.  The event is July 18. 3. Random fact: when preparing for the new DVD, Mike Robertson and I realized that Magnificent Mobility has sold in over 50 countries.  Apparently, the Norwegians and Indonesians really dig Mike's smooth Midwestern drawl. 4.  Speaking of Mike, check out this great blog post from him: The Starving Artist That's all for this week.  Have a great weekend!
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