The All-Knowing DOC

Orthopedic surgeons know what they’re talking about when it comes to the body. . . . . .sometimes!?!?  While I value a Doctor’s opinion when it comes to assessing and diagnosing joint, and tissue injuries I don’t often value their opinion on sports performance. 

Un-explosive movement???

I’ve spoken with a doctor who have said they aren’t taught anything about the physiological effects of training on the body.  In truth, he said he didn’t know much at all about it.   But how many Doctors throw out exercise prescriptions for athletes though. 

Not my area of expertise

I know the ins and outs of the human body fairly well, but I would never take a shot at repairing an ACL tear, or scoping a shoulder.  I may know the anatomy of the joint well but that doesn’t mean I would know what I’m doing on the inside.  It’s not my field and I haven’t studied for years, just as sports performance isn’t their field and they haven’t studied it for years. 

Not our new baseball training

Upon visiting with a respected shoulder specialist about pitchers I was informed that I quite didn’t know what I was doing when it came to their training.  He recommended nothing under 20-25 reps with extremely light weight.  Generally, the goal should be to build endurance.  They also should be working mostly the lower body, with very little  if any upper body included.   He noted to make sure the reps were slow and controlled and nothing explosive.  After all, we do know that the act of pitching is a very slow and controlled movement without any form of elasticity, recoil, or explosive effort.  Who would ever think of actually strengthening a muscle or teaching it to recoil, and fire explosively. 

In a separate example I visited with a spine specialist as I was having some lower back problems at the time.  I brought up Stuart McGill and discussed his beliefs all the while expecting that he knew who Dr. McGill, or at least may have heard his name.  He had never heard of such a fellow, and in the process told me that I should never squat, power clean, or do any type of olympic lift ever again.  The better option would be sticking to the leg press from now on.  So no squatting?!?!?! 

Fundamental movement pattern!!! This is a good squat!

I find it interesting when doctors prescribe no squatting ever again, yet the leg press is a safe alternative.  The squat is a fundamental movement pattern in life.  So how do I use the bathroom, or sit in a chair ever again if I’m not allowed to squat?  I am always amazed at that statement from Doctors, and it happens quite frequently.  

The second thing I didn’t understand is how this certain doctor had never heard of someone so well-respected in the field of spine biomechanics.  Dr. McGIll is considered one the foremost knowledgeable sources on the human spine, and was recently invited to a weekend conference overseas.  The conference was extended to the top 20 authorities in THE WORLD on the spine. 

Don’t get caught up in the myth of the all-knowing doctor.  Of course they obviously are all-knowing in their respective field, but not so much when it comes to the adaptation of the human body to sports performance training.

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The Reverse Hyper

The reverse hyper is good and evil at the same time. One thing we want to make sure we’re always doing is utilizing the glutes for hip extension.  A sign of glute weakness is the knees flexing when performing any type of prone hip extension movement. This is no exception on the reverse hyper either.  A lot of athletes will break at the knees.

Keep the knees straight and emphasize the glutes

Focus on keeping the knees locked out and activating the glutes throughout the entire movement. One way I correct this problem is to execute a pause at the top.  This will help to eliminate momentum throughout the movement as well.  When performing the reverse hyper we want the entire motion to come from hip extension.  Always make sure the lumbar spine is locked into place and we don’t have a sagging or dipping motion as we extend the hips. 

Loaded hyperextension of the spine

Also, I reinforce the need to be up on the elbows with the chest off the pad as per Dr. Stuart McGill.   We want a straight line from the ankles to the shoulders at the top. 

Good techniqe is spine sparing

WE DON”T WANT HYPER-EXTENSION OF THE SPINE.  I would much rather have an athelte stop short of the top then to look like a reverse V-up at the top. 

OUCH!!!

Upper Crossed Syndrome II

With upper crossed syndrome the first thing we need to work on is releasing the over-active area including the pectoralis complex as well as the levator scapula and upper traps.  There are several methods of decreasing the tone in the over-active group.  Soft tissue work is by far my favorite method.  That includes various forms of rolling, as well as massage.  Using a stick is an excellent way to get into the upper traps, and levator scapulae.  They really aren’t accessible with a foam roller and using any type of ball to get into the area is pretty difficult due to lack of pressure.   After soft tissue means, we incorporate stretches to the affected chest and upper traps to reset proper length. 

The opposite end of the spectrum requires strengthening the retractors and depressors of the scapulae, as well as the serratus anterior. 

Using various prone position retraction, and depression exercises will help to strengthen the mid back.  These exercises include Y’s, T’s, Cobra’s, Rows (elbows out), Rows (elbows back), Blackburns, etc.  Making sure athletes maintain proper position during rectraction, and depression exercises is key to strengthening the mid back. 

Are your scaps working?

Creating thoracic extension will go a long way in helping resolve the problem of rounded over shoulders.  Athletes rounded over are at increased risk when performing overhead movements because the sub-acromial space is decreased.  By extending the thoracic spine, we actually open up the front side stretching the chest and rectus abdominus.  As well, we gain activation of the thoracic musculature on the back side. 

Creating thoracic extension

Athletes that are at an increased risk for upper crossed syndrome include tennis players, swimmers, and baseball athletes.  I have seen it in swimmers and tennis players most frequently.  These athletes’ main sporting movements involve lots of humeral internal rotation. In the end proper training adaptations must be made to correct the imbalances that occur through sport.  Being conscious of proper posture outside of the sport as well will help to reset the problems associated with upper crossed syndrome. 

Floor Angels

My post today is of our shoulder mobility exercise called floor angels.

Start with the knees bent and the feet flat on the floor. We start the hands at the ears and extend all the way up over the head by reaching out as far as possible. Have the athletes try to keep their arms completely flat on the floor the entire time. This is a great mobility drill for unloaded scapular upward rotation and elevation, and is incredible for stretching the lats. The biggest cue for athletes is to drive the low back into the floor.  When the low back arches off of the ground it is compensation for lat tightness.  The lumbar spine and lats are highly correlated with each other due to the lats origin on the bottom 6 thoracic vertebrae, as well as the 5 lumbar vertebrae.  Any lat tightness will be reflected with arching of the lower back in order to keep the arms on the floor.

Upper Crossed Syndrome I

A few weeks back we took a look at Lower Crossed Syndrome (Part I / Part II) in which the glutes and rectus abdominus are weak and inhibited and the hip flexors, and lumbar erectors are tight and overactive.  Today, we’ll look at that equivalent in the upper body.  Again this is the pioneering work of Vladamir Janda.  He was one of the first therapists to document the compensation patterns, and imbalances that occur in the human body.  

Posture check!

In the upper body version the shoulders become rounded due to lifestyle and/or training habits.  These habits result in continual overuse in isolated areas and weakness in others.  This leads to a perpetual cycle of dysfunction and possible future injury.  

First, our inhibited, lengthened, and weakened group include the rectractors and depressors of the scapulae.  The lower and middle traps, and rhomboids, which I talk about frequently, are very often neglected.  When we sit at our computer for hours throughout the day we lengthen these mid back stabilizers.  Over time these muscles shut down and become inhibited.  Many of our training applications don’t do these muscles any favors either.  I’ve touched on problems associated with this area in several previous posts HERE.  

The serratus anterior also gets lumped into the problem.  The serratus shuts down at the first sign of trouble in the upper body.  Don’t neglect this important muscle.  More about the serratus HERE.

Alongside the retractors and depressors of the scaps are the deep neck flexors.  Again it’s easy to see how these muscles can become lengthened by sitting at a computer all day with the head up and chin out.  This leads to forward head posture.  The position in the end causes neck pain, and even compromises the shoulder.  

Upper Crossed Syndrome

On the flip side of that the pectoralis group including the pec major, and minor become extremely overactive.  It doesn’t take a rocket scientist to understand how this happens in our beach body society.  everyone knows the chest is the most important muscle group not only for sporting performance, but aesthetics as well.  

The backside includes the upper traps and especially the levator scapulae when it comes to tightness.  Again, I’ve recently talked about the problems associated with tightness in the levator scapulae.  Having tightness in this area leads to downward rotation of the scapula, closing the subacromial space, inherently leading to possible impingement, or even worse.  

All of this combined puts a person into a rounded over position with internally rotated shoulders and a forward head posture.  You can probably tell that this ins’t the most efficient position for the scaps to reside in.  As well, the mechanical axis of the gleniod fossa can actually become altered causing increased stress on the shoulder.  Other problems associated with upper crossed syndrome will include headaches, and upper back trigger points.  The thoracic region of the upper back will go into spasm causing pain especially in the upper trapezius region.   Clearing up this postural imbalance isn’t that hard to do but does take a concentrated effort.  In the following days, I’ll post on the procedures taken for correction of upper body crossed syndrome.

Interview

I recently did an interview for Coach Jim Kielbaso on his website Ultimate Challenge Training. If you get a chance go over and check out his site.  There is a lot of good information there.  You can also find the following interview there as well. 

1. Who taught you or mentored you in strength & conditioning?  What things do you do the same as those people?  What do you do differently now?
Rick Perry was my mentor.  Currently, he is the director of strength and conditioning at Central Michigan.  I played football at Southwest Missouri State University, now Missouri State, and he was the head strength coach at the time.  It couldn’t have worked out any better.  At that time, I was studying the same type of training that he believed in.  He helped me to gain my first internship at the University of Washington and then offered me my first job in S&C the following year.  I owe everything to Coach Perry.  He started me on the right path by teaching me the basics to not only programming, but discipline, organization, and mental toughness in the field of strength and conditioning.   

 The other coach who had a huge influence on me was Bill Gillespie, director of strength and conditioning at Liberty University.  I had the privilege to meet Bill while I was at the University of Washington for my internship.  He was a strength coach with the Seattle Seahawks at the time.  Bill’s knowledge in the field is unsurpassed and he was amazing mentor at a time when I was very impressionable in the field of strength and cond.  Not only did he allow me to pick his brain, but he even let me train with him.  It’s very humbling training with an 800+ lbs. bench presser and world record holder.

 2. Do you place a strong emphasis on hard work in your programs?  Why or why not?

Every program should be based on hard work and effort.  If you don’t have it, you have nothing.  A perfectly put together program on paper is useless without the drive and determination to work your ass off at it.  I’ll take a sub-par program with blood and guts, than a superior program done by ninny’s any day.   

3. What are some of the hardest things you’ve ever had your athletes do?  How did they respond?  Will you do it again?
We have a series of challenges in the middle of our off-season training.  Each one is designed to last from 60 sec to 150 sec.  If you’ve ever done anything as hard as you can for 2 minutes then you’ll know what I’m talking about.  These challenges are done to separate the men from the boys.  They are used with odd objects, strongman equipment, med balls, etc.  We use 200 # chains, manskill sleds, slosh pipes, sprint sleds, football dummies, you name it and we’ve used it.  The kids are put into teams and scored.   At the end of the six weeks, we crown a team and an individual champion.  It’s the hardest six weeks that any of my programs have ever done. 

Our other mental toughness training consists of the Javorek Complex I and II.  We perform these in the off-season as well.  Our kids are all forced to count out the reps together, and if something isn’t done correctly, or someone isn’t counting, we start over.  These are no joke with 1 min rest between sets.  Our kids will work up to 6 sets at the end of a training session, barring no mistakes along the way. 

Surprisingly, our athletes’ response to not only the competition but the complexes is very positive.  Because we make it into a competition it fuels everyone’s drive to win no matter how difficult the task at hand.  The complexes are a favorite because of the extreme pump our kids get to be honest.   It makes them feel indestructible.  They beg to do complexes year round, but we have to eliminate them at various portions of the year, especially in-season. 

I will always continue to implement mental toughness into our training at various points throughout the year.  I will always believe much more can be learned in the weight room than how to lift a dumbbell or barbell x amount of times. 

 4. In regards to exercise technique, at the end of a hard set, how sloppy is too sloppy for you?  You may respond differently for different exercises.  And, what do you do when technique starts to break down during a set?
Generally I don’t let much become sloppy in the weight room, especially when it comes to our main strength movements such as squat, bench, cleans, etc.  We want clean movement at all times, and no breakdowns.  I don’t want to reinforce more dysfunction than we already have in our movements.   Now, at the end of our complexes, or other mental toughness training we allow for some breakdowns with technique.   By the sixth set, some of our freshmen struggle to even hold the bar.  I let this go to some extent because it does build mental toughness, and team togetherness.  As long as I feel the athlete isn’t putting himself in harms way, we’ll finish the set.

Sleeper Stretch

Many of the athletes associated with throwing sports have experience with the sleeper stretch.  The sleeper stretch is for those with glenohumeral internal rotation deficits commonly known as GIRD.  This problem occurs most often in overhead throwing athletes.  Every time an athlete throws a ball there are huge distraction forces that occur at the release of the ball.  This repetitive stress causes the posterior capsule of the shoulder to tighten and a loss of internal rotation occurs.  When this deficit becomes too large the risk of injury increases.  Eliminating this deficit is very important when we do find one.  Properly teaching the sleeper stretch is by far the most important aspect.

1. Set the scaps first and foremost
Too many athletes perform the stretch incorrectly.   The most important aspect of correctly performing the sleeper stretch is making sure the scapulae are retracted and depressed throughout the movement.  Stabilizing the shoulder blades allows for the stretch on the external rotators.  Without keeping tight, the stretch becomes ineffective and can actually cause problems a host of other problems to the shoulder capsule.

Depress and retract the scaps

2. Stack the shoulders. 
From that stabilized position we roll up onto the shoulder making sure to keep the scaps drawn back and down.  Keeping the scaps stabilized means we need to keep the shoulders stacked on top of each other when we roll on to the shoulder.  When the shoulders don’t stay stacked and we have an angled slope from our top shoulder down to the bottom, the scapula isn’t stabilized. 

Stack the shoulders
Good setup! Shoulders stacked.

3. Light stretch
This should be a relatively light stretch and not to the point that it causes pain.  With this setup placing a foam roller under the head would be ideal.  Many times athletes won’t always have access to a foam roller to keep the cervical spine in a neutral position.   Athletes should take note of when they’re doing the stretch wrong because they shouldn’t be able to get anywhere close to the ground with the forearm.  Most athletes won’t get to a 45 degree angle even.  If you’re athletes can get to the ground, check their scaps.  The range of motion is gained through the moving scapula. 

Keep shoulder down on the ground

 Here’s a quick example of not keeping the scaps retracted and depressed with the shoulders stacked.  You’ll notice the angle from the top shoulder to the bottom.  Also, take note that the posterior aspect of the shoulder is coming off the ground.  That’s a sure sign that the scapula is moving.  In this picture it appears that this person has a good degree of internal rotation.  Remember, I said most athletes won’t even get to 45 deg. in this stretch.  He really doesn’t have as much motion as it appears.  If he were to stabilize his scaps he would have considerably less motion.  The scapula compensates for lack of motion giving the appearance of a big stretch. 

Improper position