CDEC nok De OCC CAC aie Rc ic ne eee hr We ee ae bee iy a BUILDING is all NeW LETE Eric erasser is OECTABuilding the Efficient Athlete Eric Cressey, MA, CSCS Mike Robertson, MS, CSCS, USAW Performance and Heath 1) 1) | eee | i} TRAINING SYSTEMS. Why Are You Here? 1)Learn more ~ become a better trainer 2)Joe and Tim made you! 3)Make more money What This Weekend Will Give You ‘quality assessment tha you can use to soreen individuals before traning (and modify for your own reeds) [An ENHANCED understanding of functional anatomy Real-time experience inthe skis you wil soon be using SoThg abiltyo start thinking “ontne-ty" and apply exteal itunking skits vaining = Tho “Aurays Assessing’ Mindset Ability to borate previous injures with posture What This Weekend WILL NOT Give You - An orthopedic assessment know when to refer = An amazing background of functional anatomy you don't know it, you need to loan! ‘Gould be a whole seminar (or ietime!) = ‘Alesson in stand-up comedy ~ The be-all, end-all of assessments You will be overwhelmed at some point this weekend. Don't worry about it! Goals 2) Be abl to adninitor both tne 1) Beale ceaty examine someone {Leann 8 poINtHUFF FTF F TTF V TTF F VF FV GFF I TTF VIII TGIGGTVIIS Recommended Resources Entry Level + Manual of Susu Kinston ~ Tompson sod Foyt + Kise Antony - Banko + ac Blnechans Hot + Pulsaonal Fins Coach Poa Deson Mant ~ + Ralase Your Pan - Abelson sen Shmpath Ting Anatomy Delavier > AlagrieantMebity (OVD), Cressey and Roberson + snsiiQur OVOMarun! -Robersenatmans + Anyansiatpnsicogy xt Recommended Resources Intermediate Mesil + Ultimate Back Fiinass and Performance ~ McGill + Sports Mechanics for Goachos ~ Carr + Scence and Practice of Strenath Training -Zatsiorsky * Qplimal Muscle Training - Kinakin + Functional Strength Coach (OVD Set) - Boyle + Aimo8t anything by RabertsoniCressey at T-Nation + Low Back Disorder Recommended Resources Advanced + Anatomy Trains - Myers + Binanosis and Treatment of Movement Impairment ‘Syndromes » Sarvmann + Muscles: Testing and Function in Posture and Pain Sh EO, ~ Kendal ela > Neuromechanics of Human Movement - Enka + Suporaining - Sit! + Fundiimentale of Orthopedics ~ Saunders + Bruno's Clinical Kinesiology ~ Smith, eta. Kinesiology — Smih et a Recommended Resources * Miscellaneous + Seminars and lectures + Discussion with colleagues + Journal articles (Pubmed) + raining cients and YOURSELF NON Recommended Resources + Texts that discuss training muscle groups + Opposite end of the spectrum info (too much focus on posture)??? ~+, Resources from those who don't train “themselves Why do we care about posture? The answer is simple: Posture affects everything we do!Improved _ Posture Improved Fewer Improved In essence, it helps us do our jobs better! Performance Injuries Appearance A Performance Example ‘© Basketball player ‘coming off a screen ‘© Now, think of your favorite sport ‘How can proper posture improve your performance? How can improper posture hinder i? A Lifting Example ‘* Poor posture and lifting + Getting glutes involved wth squattingideaditing + Improving T-spine mobltyextension with overly yphotc naiiduals How does posture become flawed? «* Structural/biomechanical ‘© Poor posture throughout the day (creep) ‘© Repetitive movements = Uniateral imbatances/discrepancies * POOR TRAINING! Law of Repetitive Motion Law of Repettive Mation- explains how repetitive injunes occur FIAR # |= Insular tothe issues {N= Number of repeitons +R Force of tension of each repetition as a percent ‘ot maxmum musco strength = A= Amplitude of each repetition + R= Relaxation time between repetitions (lack of pressure or tension onthe issue) How does what we do affect the Law of Repetitive Motion? « Sitting at a computer has a high number of reps (constant activation) with low amplitude and lower relaxation time (vibration is a good example) -* Poor posture produces higher forces with iting tasks (no change in amplitude or relaxation — leads to high insult) ‘¢ How do we minimize "NF" and maximize “AR?” «First, some background. SSS PSSST SI FSIS III IIIIITIIFIIFIIFIIIIIVIVIGIIGSIDIDISIDIFIIIIIIIIIITIDIIIIIIIIIIIIIIIIIIIS What is ideal standing posture? + Looking for 90 degree angles aed straight ines! + Front View (erware a ea Sed + lea antec on + Feshgaltog eon What is ideal standing posture? # Ankles, knees, hips, Shoulders and ears at Inalignment d socket positon), *< Refhambor that posture is Does “perfect” posture exist? litdoes, were yet to see it = Prec ie 3 Prec anhing? ‘+ However, this model should be our goal Conistionspecite Lower Body Functional Anatomy Functional Anatomy Ifl'm a performance coach, trainer, or athlete, why do! need to understand functional anatomy? # Structure dctatos function; funtion Aiciates dystunction 98 Caratgnment G + Funetional anatomy isnt taught in ‘school «© Who super programs (fewer injures, beter performance) ‘+ Tighvovoractive Typical Flawed Lower Body Posture ‘eons : sec ie ico 4 Anter gute madus Buternimie Lub spinal rectors 1 HansragsRectus Femoris «Primary Functions STighine ters >¥/0K utes sas ose ‘ Tensor Fascia Latae (TFL) 0 eae oe ———_ — i Ses one | + TTB nad wins ase | retode (ART: massage liacus ‘© Primary Functions 1 ip tral tain «Implications 1 Terthip flexors Weak ites vey aay? Remember ‘fan of rpative son ‘SRs.aterent rom the Peoae! Psoas Major «Primary Functions oR Standing Psoas Test ‘= Psoasis te only hp fexor that is elective stove 90 degrees oF hip flexion ‘+ Can the individual hold the knee above 80, __ degrees? SS Ungotoralaiscropancios? * Compensation pattems? ‘tan Back = TFEGam, Thomas Test «Easily tests length of all hip flexors Manipulate fiexion/extension at knee joint for desired effectVastus Lateralis + Primary Functions += Knoe extonsion Lateral rotation of flexed knee + Implications ‘ Often tght and/or adhered to 178 4 Contributes to lateral pul of patella The Adductors + Breve, Longus, and Magnus Pamary Functions «Hp saaucton # Hip itera otaion «Hip exion «+ Hip extension (magnus especialy) + impicaione # Contbutes to "knoakcknee appearance The Adductors 1» Adductor magnus ‘2 4° Hamsting © Oversecnuied when utes ‘ate dormant + Adductors and the mole rile ‘© Add. Macrus con substitute forlackof glue max = eanirton Internal stort "Cancelaton Gracilis ‘Primary Functions = ‘Hip adaacion x ip intemal rotation + nplications Anterior Glute Medius Pima Functions sip con 1 Hp abaucton + Sette e Tee + Gites ate “oS peat onerome “pbc leds “Tha bout how be ner nt peter at Gluteus Minimus ‘= Primary Functions plications TAUanirorghie mosus “small therefore doesntPiriformis ‘+ Prmary Functions « nplecations 1 Ercan thins iad fogestor' th an posable Quadratus Lumborum (QL) ‘Primary Functions *« Lateralytoxes spine (Giade Mp) Elovatos samo-ise hip ‘Contbutes to pvc ‘biquity (gh hip) on Signs, ® Lanier tip dominate ostecor npn hip Hanseaness patos canna Nh Lumbar Spinal Erectors ‘= Tiree names Dry resins ieee emp poser an (tas a magnciors Peroneus (Fibularis) Longus ‘= Primary Functions ‘© Eversion (Abduction of the foot) + Plantarlexion « implications = « Tightioveractive long vigastro soleus = Playe a rie in pronation = Mi Gastrocnemius/Soleus + Primary Functions ‘+ Prortatexon 4 Seer ‘Knee fexon(gastoc) ] + lnpcations ‘*Tightoveractve ana orainces a santero) nm ~ calves lead to such a8 Aches tendnose and plantar cites Yenten ‘acon Internal Oblique 1+ Primary Functions + Trunk exon itera) «© Implications weenTransverse Abdominus (TVA) Taina ote ee * Focus WR + Impicaions c iN ith vi Transverse Abdominus (TVA) + From the Internet Seth ug toe 2 ie moe of Multifidi ‘= Primary Functions " Segrria stabizston + Spa peproceston| + Implicavons te? e Gluteus Maximus Peary Futons Posterior Glute Medius «Primary Functions ‘Hip extension 1 Hip enema eaten + tmplicatons Vastus Medialis ‘+ Primary Functions «Implications 1 KEY kno stable rust Dut poate medaty) Soto ane To ~ West gern mo} ‘yey inked dungTibialis Anterior “Er Rectus Abdominus ‘+ Primary Functions 1 Dopresss ib cage ‘Implications en + nay fay The Rectus Abdominus Conundrum # True Role of the Rectus ‘© Again, structure dictates function! ‘* Need stability at the “lumbar spine, and ‘mobility at the hips, External Oblique ‘ Primary Functions runk flexion (bilateral) = Trunk rotation (unilateral wopposite 10) + Posterior Pelvic Tit without a pul onthe ‘iB cage (posterior ‘Semimembranosus ‘Primary Functions ‘Hip exension * Hipinteral otation (Gommemoranosvs! Semencineeus) + Knee texan = tmpigatons 5 9 Tight. duo to APT - * Intemat rotates tonto ominate over exten rotator. thoraciospine, and nies) scapulae, « Implications «How do we ttain it \ thou the rectus an hip foxor amen? Semitendinosus and Biceps Femoris + Top ato nskionos Spenanann— — ad od = — = 2 2 = 2 = = — Upper Body Functional Anatomy Typical Flawed Upper Body Posture ii 2 Dewp neck ers + Gray areas + Tignvoverstve 1 sucepiae Seer 1 Pomc ots * Suoscapans 1 Siraspinstu \ 1 beens + implications Pectoralis Major ‘© Primary Functions + Shouse lagen 1 Howe you siti nit row Pec Minor ‘© Primary Functions 1 Scapulr depreasion ond ounmors raion « Scapulrstabizaton = plications shade (AT, macaage, Anterior Deltoid ‘+ Primary Functions '* Shoulder flexion “+ Horizontal adduction 1 GH internal rotation ‘+ Implications # Tighvoveractive due to raining and posture Upper Traps ‘Primary Functions * Upwerdeaon of scapula «+ implications * owe sre tiong 1+ Uy shut one, bot rotLevator Scapulae Sternocleidomastoid (SCM) ‘+ Primary Functions + Lateral trast ‘nace ede SRE NEER (wc non ‘Impicatons = Chingralon +l hod ato (hod Suboccipitals 4 Sec aniae $ Sinus ter + Binary Functor Seana Jono cain “eats Reet kn ren Teres Major ‘+ Primary Functions Shoulder extension # Horzontal adduction * GH intemal rotation ‘implications # Tighoveractve dus 10 traning and posture = Mica Middle and Lower Traps 1+ Primary Functions ‘Mi: Seaport 5 Nowa Senay ‘= implications ‘ Domiate by woe tap ‘oor Bough oan Wt idee) ~ower Lower aon ‘eres copie wih srs nie and urbe ops \ \ Infraspinatus # Prmary Functions «External miaton of + Suablass GH nt ‘© Implications = aknaere iSSTTTIFETTTTGGIGG Teres Minor ‘Primary Functions ce NZ =~ ~S Deep Neck Flexors eens * plo fson ore ee “a-rnglcations WG sate 3 minenne 4 iw Serratus Anterior pepo > «+ Scapular protein 1 Upward rtaton fps ann * Fauna vin chee 5 5 \ ieee SEs 3 eae Cervical and Thoracic Erectors J+ Primary Functions ‘ Bialerl: Extencion Unilateral: Rotation = implications * Lengineneaiweak due te POSTURE. wend tolose = exténsiblity of thoracic (spine + Kyphotie/Quasi Modo physique Latissimus Dorsi ‘+ Primary Functions += Shoulder extension x + Horizontal adduction + Shoulder intemal rotation Scapular depression Implications Se Tignoveracve duo to Nang and posture '# Chios tain the internal on tre onsen? \ Length Test for the Lats ‘¢ Flatten the lumbar spine © Bend the knees # Can the individual touch the ground overhead?Rhomboids SB} homboid minor SBP Aremvoia & / Rhombord major Lees, aA + Peary Functions 1 Scapular leaton + tneteatone "can be shotant bers 4 fo tlre ut + Mago metower + Senpitedciwars Posterior Deltoid Eee, KAS tno Subscapularis ‘= Primary Functions + Stbizes GH oat prltcounoract gee Fraee pal) ‘elgpiications Wee ‘ea a Supraspinatus ‘= Primary Functions + Fist 15 degrees of Humeral Abduction + Stablizes GH joint '* Implications + Most commonly {hjured RTC musce ‘= Upper trap substitution Daten Biceps Brachii ‘+ Prmary Functions ‘ow texon oth) 1 Forearm cusnaion Feo aad Cong on Aa sxe Coracobrachialis ‘¢ Primary Functions + Shoulder flexion # Aaduction Horizontal adduction '* Implications, + Insertion on coracoid Bracess: tightness ‘may ead 10 anterior seapuian itSISIFTIFISISIIIIFIIIIIIIIIIIFIIIIIIIIIGIGIIIIISG Anterior Scapular Tilt: The Coracoid Process Muscles © Modifiers: ‘© Etbow Flexion only put biceps brachii on Sack 4 Elbow flexion + slight shoul flexion: put © What's Left Over: Pac Minor Time to Digest — Literally and Figuratively! The Static Assessment Why perform a static assessment? « Structure dictates function; function dictates dysfunction ‘© A btter predictor of dynamic movement that previously thought. « IF you're out of alignment at the start, chances are that you'll be out of alignment when you start tomove. © “Ideab Alignment Facilitates Optimal Movement" - Sahrmann Goals of Assessment Discuss current/past injuries Examine posture (static assessment) for areas of concern * Use dynamic assessment to make correlations and determine compensations ~.* Give us the tools necessary to improve ‘posture and performance via proper programming (short and long term) Static Assessment Rules ‘+ Take pictures + Each picture tells us a story «Allows for progress to be monitored ‘* Examine the BIG PICTURE! ‘© When in doubt, look for the obvious structural flaws Once found, where does it start? ‘© Trust instincts and look fr biggest issues fist ‘© Don'ie biased! Subtle deviations from symmetty are expected but not necessarily pathologiealSIFGIFIFIISIIIIIIIIIIIIIIIIIIIIIIIIGITISGIISS: WANTED: One Subject WANTED Static Assessment: Feet/Calves ° Front View *# Foot position Extemal rotation? internal rotation? « Intine with pateliae? + Excessive pronation? # Cortelate wiLunge, Squat, Single Leg Squat test ‘© Excessive supination? ‘= Correlate wiLunge, Squat, Single Leg Squat test Static Assessment: Knees ‘© Front View ‘Patella position sFowara? * Tumod in? ‘Turned out? + Bow-loggod (genu varus)? ~Se'Knock-kneed (genu valgus)? 1 Corclat wiLunge, Squat, Single Leg Squat test « Intine with feet? Hips? Static Assessment: Hips/Low Back © Front View ‘* Polvic obliquity? «# Correlate wBalance, Side Bridge, Hip Abduction ‘© Pelvic rotation? Static Assessment: Upper Extremity ‘¢ Front Viow ‘Shoulder postion in relation to one another? ‘+ Torso rotation? ‘= Iniemal rotation of humerus? ' Corelate wempty ane Fucan 92 Crock te eeaule! ‘S-Arm postin inrolaton to torso? = Hard Retaion Static Assessment: Neck © Front View © Carried to one side?Static Assessment: Knees © Back View © Genu varus? # Genu valgus? ‘*Corroate wiSquat, Single-Leg Squat, Lunge Static Assessment: Hips/Low Back * Back View '* Pelvic obliquity? * Correlate with side bridge, balance and hip abduction + Pelvic rotation? + Size of erectors; one larger than other by 14 ‘oF more? ‘Correa Ip extension Static Assessment: Upper Extremity © Back Viow + Shoulder postion in relation to one another? ors0 rotation? Itomat rotation of humerus? + Scapulse cownsarly rotated? + Kier goon est (tem of mover Static Assessment: Neck * Back View ‘Carried to one side? Practical Session: Postural Analysis The Dynamic AssessmentWhy use a dynamic assessment? # Doesn't the static assessment tell us, everything we need to know? « Static assessment gives us basic info on where dysfunction may exist, but the dynamic assessment tells us how our body is compensating and gives more reliable information Rules of Dynamic Assessment «© Start with simple, isolated movements that ‘occur in one plane ‘© Progress to muljoint, integrated movernents that occur in multiple planes + Look for correlations to the static, assessment! Dynamic Assessment: Vleeming’s Test [What does integration of Care Hest totus? | abiny to Brace’ and tansfer power [Common | Trunk rotation (weak core) Flaws. Moditers. |Add resistance Ti I Dynamic Assessment: Vieeming's Test Dynamic Assessment: Hip Abduction (What does [Recratrnent patterns during hip test tellus? [abduction [Common [Hip fexioniinternal rotation (overactive Flaws TFL) Hip king (overactive QL) Hip external colation (overactive Ree pirtormis) S\.__|Poor ROM (overactive adductors) Modifiers [Add resistance } Manual Paipation Dynamic Assessment: Hip AbductionDynamic Assessment: Hip Extension fwmat does [Recruitment pattems dung hip test tellus? _| extension [Common | Delayed glute fring (inhibited glutes) Flaws, DDeopening of lordotic (ight erectosinp flexors) knee flesion (overactive hamstrings) Trunk rotation (combination) |Moaifers [Add resistance Dynamic Assessment: Hip Extension Dynamic Assessment: Static Back Extension (Sorenson) [what does Endurance capacly of low back testtat us? | musculature [Gomman | Cannot maintain horizontal (poor Flaws endurance) 4 [Cannot hold for atleast 62 seconds Rodibers [None Dynamic Assessment: Static Back Extension (Sorenson) Dynamic Assessment: Side Bridge [Winat does — [Endurance capacity of ateral core testtel us? |musculatce (Common [Unable thoi for 40 seconds Flaws Correlate whip abduction, posture lanalyets (high hip) Shoulders round Lumbar hyperextension Performed on kneas Dynamic Assessment: Side BridgeDynamic Assessment: Crunch what does Strength of rectusiinternal testiatus? _|obliques to flex trunk [Common | Heels rise off table (ight psoas Faw mayor) Hyperextension of the lumbar spine (ight hip lexors/erectors) Total trunk extension vs. flexion (weak rectus abdominus) Dynamic Assessment: Crunch Dynamic Assessment: Leg Lowering Test [What does | Strength of rectus/extermal esttallus? obliques to stabilize/posterior tt [Common [Unable to maintain posterior ttt Flows lumbar spine ied [Varying degrees of diftculy Hold object overhead? Gradualy edhe mais of object Dynamic Assessment: Leg Lowering Test Esa Dynamic Assessment: Adducted Internal/External Rotation [What doos — |Sirongih lvls andi pain is presontin teste us? _|subscapulansteres minor ‘Overactive thomboide? |Overactive posterior deltoid? Weak teres minor and intaspinatus? = ]eemmon [Pain Weakness Faully humeral head mation Fauly scapular motion "Add resistance Moaiore Dynamic Assessment: Adducted Internal/External Rotation eg |Dynamic Assessment: Abducted Internal/External Rotation (What does |Strength levels and if pain is test tell us? | present in 4 isubscapularislinfraspinatus Common |Pain Flaws | weakness Faulty humeral head motion Faulty scapular motion [Modifiers pad resistance Dynamic Assessment: Abducted Internal/External Rotation re Dynamic Assessment: Lift-Off Test [What does [intemal rotation flexibility and i pain test tell us? is present in subscapularis [Common [Pain Flaws Weakness Dynamic Assessment: Lift-Off Test Dynamic Assessment: Scapulohumeral Rhythm [What does |Syrergistc performance of scapular test tell us? | slabizorsiotator cut COTA | Sane ero (OAT NaPS) Flaws Lateral scapuiar rotation (weak thomboids) Trunk side bends (lack of upward . rotaton/nhbited serratus) Downward rotation syndrome (weak lower traps, serratus anterior; OA romboi, Modifiers \ |Add resistanc Dynamic Assessment: Scapulohumeral Rhythm prota ord 100% of go humoral nitty prcleme. The nema shouicer Kineton sed peepee he sur ory. — ums) eb Ate Tracing Fe guscucstlial specalat shou ah Sra tace pons wo have shove pan. On oer pole! separ stoic restore show eter osSIDISIDIFIIIIIIIIIIIIIISIIISIIIGIIIIIIIIIIIIS Dynamic Assessment Scapulohumeral Rhythm Ps Dynamic Assessment: Speed's Test [What doos [Strength levels and if pain is test tell us? | present in long head of the biceps “Mysterious” shoulder injuries [Common [Pain Flaws | Weakness fs | Modiiors |Add rsistonce Dynamic Assessment: Speed's Test Dynamic Assessment: Full Can What does ]Strength levels and if pain is test tell us? | present in supraspinatus Common [Pain Peart Flaws Weakness Modifiers |i negative full can, perform empty can |Add resistance Does the scapular plane reduce pain? Dynamic Assessment Empty Can Dynamic Assessment Neck Flexion [What does | Performance of deep neck Hest tellus? flexors/muscle balance around neck Common Chin protrusion: extension vs. flexion| Flaws (OA SCMisuboccipitals; inhibited neck flexors) ShakingDynamic Assessment: Neck Flexion FE ' 1 one ott, : + ay Dynamic Assessment: Balance [what does [Coordination of glute medius test tellus? | Proprioception [Common |Overeronation (tight calves/weak Flaws |dorsitiexors) “Trunk side bending (overactive ty Hip sagrtaliout (weak glute SO |medius) Moaitiors. [Eyes closed Consider gender ditferences, based on hip width Dynamic Assessment: Balance Dynamic Assessment: Squat What does Lower Body Function est te us? Besa [Common | Knee varatvalau (oh he abloaivaor) Flaws | Heels come of ground (ight gasto-sus ‘or hip flexors) Feet externally rotate (ight gastro-soleus ‘analor peroneais, biceps femons) “Thighs don't reach horizontal quad dominance andlor weakness) Modifiers\. {Overhead Squat Dynamic Assessment: Squat Dynamic Assessment: Lunge What does ]Lower Body Function test tell us? [Common |Lumbar hyperextension (weak glutos, Flaws |tight hip Rexorsierectors) Increased patallo-feroral shear (quad ‘dominanca) She. ‘nee falls in (weak glues, tight ladductors) Hyperpronation (ight clves/peroneals) Coming up onto toes (tight calves, hip exors) Modiiers “Overhead LungeDynamic Assessment: Lunge Dynamic Assessment: Push-Up fwhat does [Upper Body Function test tell us? [Common | Seapuler wining (OA uoper rape and Fiaws |mombods; weak SA) | substantia scaptar ravacon (OA | mambots, weak SA) | Scapular vation (OA upper | apsitevator Poor lumeo-pelvic control (weak core) Dynamic Assessment: Push-Up Dynamic Assessment: Kibler's 3-Position Scap Screen [What does ]Scap Function and predisposition test tellus? |to injury Common [inferior border too lateral/medial Flaws prior to testing . >1 om difference in movement in 2 out of 3 positions Dynamic Assessment: Kibler's 3-Position Scap Screen ; Dynamic Assessment: Prone-to-Side Bridge What does [Rotational Preparedness: Can the test tell us? [individual prevent lumbar rotation? [Common |Lumbar rotation instead of thoracic and Flaws |Rip rotation,—SISIIIIIIIIISIIIIIIIIIIIIIIIIIIIIIIIIIIIISS Dynamic Assessment: Prone-to-Side Bridge Dynamic Assessment: THE BEST Movement Screen [What does [Dynamic fiexibily of virtually test tell us? | every muscle group | Balance/Proprioception Proper movement pattems ‘Weak muscles Tight muscles {Possible areas of injury Dynamic Assessment: THE BEST Movement Screen ‘¢ What is the best ‘movement screen? {A soreen that challenges the athletes in = S1Bynamnic movements* ~SMitiple planes “Mohiple directions" Use Your Imagination and Think Critically! Anything can be a functional assessment if you understand functional anatomy. Practical Session: Dynamic Movement Screen DAY 2The Art of Hardcore Corrective Training Ten Lessons to Keep Athletes Healthy nica tele bree. When | was dong alatera-medial scrape ‘ior eutngSau att ntctta nr dire es nty bord men cen th mycin breton be ibe ats ote eats tne ard conpe by Panto niworal wees in saa lee RAT is Tebwnt teers de tov ot How Would You “Fix” this Athlete? Questions to Consider. © Are you dealing with ATHLETES or PATIENTS? © Can you walk a mile in their shoes? \@) @ Are we doing more harm i than good with modern-day corrective training approaches? Bridging the Gap 1 80% of Americans have lower back pain at some point in their lives; this rate is even higher in athletes. ‘= Add in Shoulders, Elbow, Hips, Knees, Ankles, fic. and virtually everyone is affected! ‘© 26% of patella tendons in basketball players Shave symptomatic (7%) or undiagnosed ~tendinopathy. * We can't send everyone to PT, so trainers and coaches need to pick up tho siack. This Isn't Picking Up the Slack...The Status Quo: Missing the Boat The Inability to Differentiate between Pathology and Inefficiency/lmbalance ‘* Regurgitation rather than Knowledge- based Theory and Practice ‘¢ Overlooking the Important Things: Do “correctly” instead of “differently.” ‘*"Foo-Foo” Programming: Maximal strength can be corrective! The Status Quo: Missing the Boat ‘¢ Trainers/Coaches wiout a Framo of Reference ‘© Criticizing what they don't understand band pressdown example ‘* Often, not much help from the Medical Profession ‘* A General Distrust between Clinicians and those in the Trenches: ‘No squats” Step 1: Functional Anatomy This isn’t a lesson; it’s a prerequisite! ‘¢ Ifyou don't have functional anatomy down cold, learn it ‘* This goes beyond memorizing muscles’ origins, insertions, and actions. -# You need to understand compensation pattems: ‘<8 What happens if a muscle dozsn’ do its job? "What other muscies nave to pick up the slack? '# Can you correlate symptoms with dystunction? Step 2: Prevention Part |: Avoid Cookie Cutter Programs ¢ Most Lack Structural Balance + Don't take into account the training age of the individual + Cannot account for individual injury history # What looks good on paper often hurs in the real word! A Hypothetical Case Study... ‘+ Mike Robertson decides that he's going to retum to his vollayail and basketball glory days by improving his vertical jump. ‘Logically, ne seeks out a pre mede program from one of his favorite onine “gurus.” ‘* Ho nds ono that has him doing:jump squats, vertcal amps, depth jumps, splt-squat jumps, and power cleans ™ amafig others), '* Kooping in mind Mike's RECENT KNEE SURGERY, wat do'you think is going to happen to him? If he’s LUCKY, only this.More than likely, though More meniscus problems Stress fracture Muscle strain Achilles or patellar tendinosis Lesson #1 Fit the program to the liter—not vice versa, The best way to correct. Fy dysfunction is to = prevent it. If you're blindly following cookie-cutter programs, stop. Step 2: Prevention Part I: Learning to Write Programs Factors to Consider Goals ‘Training and Chrenologies! Age * injury History, Existing imbalances, Strctura balance # Sehediling Equipment Avaiabsty Delong {Taming Envkonment ane Patna ‘Nonilly Sof-tssue, Passive Fes, Catcovascuir. and Recovery Werk K Structural Balance Crash Course: The Upper Body a A Structural Balance Crash Course’ The Lower Body A Structural Balance Crash Course: Take Home Points If you're healthy and don't have any imbalances, balance the left and right columns. ‘* Most people need more of the LEFT column exercises. “# Dd more single-leg work.SISISIIIIIG Lesson #2 Learn to program for yourself. Establish a small group of people who will give you honest feedback on your programming ideas, and then use your intuition when it comes to modifying things on the fly. Step 2: Prevention Part Il: Some oxer + Unig Rows Combine maximal intemal ration with Rosato «+ ovemeod pressing in cetsin poputations Risk ncreaes wih ago Acromvon Morphology Srauty Scapular aignment 5 ‘¢ Some athletes’ shoulders are & Ge Ge ‘ready beaten-up enought ory 1s just aren't worth it. Step 2: Prevention Part Il: Some exercises just aren't worth it. © Sttups ‘High compressive forces ‘Encourage lumbar spine ROM when itrealy noods stabilty ++ Hyperexcensions ‘Encourage lumbar spine ROM when realy needs stabilty Lower back” weakness isnt as common as people ‘eeomto thnk Lesson #3 Some exercises just aren't worth it. Don't bother with them; there are better options available to you Step 3: Determining What to Do in the Meantime Part I: Gather all the information. + Aggravating/problematic exercises ‘* Nature of the pain (if any) ‘ History of previous injury ‘Daily activities/ocoupation: what imbalances ‘a6 typical in their sport or occupation? + Any diagnostic testing that's been done ‘© Get them moving in a controlled environment. Lesson #4 You can never have too much information. Ask a lot of questions.Step 3: Fixing What's Wrong Part Il: It's not always what you're doing; it’s often how you're doing it. © Deadiif/Pull-ThroughiBack Extension lockouts Box Squats ‘© Bench Presses This If preventative and corrective. Bad Deadlift Lockout: Lumbar Hyperextension Good Deadlift Lockout: Full Hip Extension/Posterior Pelvic Tilt Bad Box Squat: Quad-Dominant Good Box Squat: Hip-Dominant Bad Box Squat: Incomplete Hip Extension = "GPOCPSPSPCISEPCPPPEPPPPPPEPPISPEDEPSEPSBEGBBBESS Bad Bench Press: Elbows flared, Scapulae Protracted Good Bench Press: Elbows tucked, Scapulae Retracted Lesson #5 Think ‘correct’ before you think “different.” If an exercise causes pain, stop performing it Evaluate technique before moving on, though. If performing the exercise correctly alleviates pain, keop it. Chances are that Brrectly performing the exercise will actually ‘help correct the imbalance. An athlete will be ‘moré:receptive to ‘do it this way instead” than fhe willYo “don't do this.” Step 3: Find What You Can Do Part Il: Maintain a Training Effect in Any Way Possible © Limited ROM work (e.9. board presses) « Find challenging substitution exercises « Increase volume of imbalance- correcting exercises @ Train the uninjured limb!!!" # Know when to refer out. 80 as aggressive as possible, but do no harm. Stay in touch with the PT/ATCidoctor. Lesson #6 Make the athlete feel like an athlete ~ not a patient — both physically and psychologically. Tell them what they CAN do. Step 4: Address the Underlying Issue Part I: Start with daily activities. ‘¢ Never alter the training program first ‘* Modify daily activities ‘* Consider the Law of Repetitive Motion # Explains how overuse injuries occur The 23/1 Rule _ BSF fFThe Law of Repetitive Motion 1=NFIAR sully to the tissues ‘= N= Number of repetitions + F = Foroe or tension of each repetition as a percent ‘of maximum muscse srangth ‘© A= Amplitude of each repetition ‘©. = Relaxation time between repetitions (lack of pressure or tension onthe tissue) + Yau vain for one hour per day and have 23 hours to undo the good stl! The Law of Repetitive Motion 1=NF/AR + Poor posture: higher forces with fing tasks (no change in amplitude or relaxation => high incul) * Siting at a computer: high number of reps (constant ‘cbvaton} with low amplitude and lowor relaxation lime. ‘The weaker you are, tne higher the percentage of ‘mapimal strength youl use to accomplish a task ‘+ Resistance traning can be extremely effective in Correcting problems quickly. Otherwise, we'd have to sit with ‘mores than- perfect” posture for an equal amount aftime fo fon things out Lesson #7 Before you go changing what's going on in the gym, figure out what you can do to improve what's going on outside of it Think posture, repetitive motions, sheer lack of movement, sleeping posture, footwear, and even poor diet. Step 4: Address the Underlying Issue Part II: Implement soft-tissue work. * ART®, Foam Rolling, Massage, Graston, The Stick® ‘* Symptomatic relief, but makes other corrective training easier to do ‘the Elastic Band Analogy: Length vs. Quality ‘* Pre-training or separate from training Foam Rolling ‘© Simple, cheap, and effective © Best Bang for the Buck © Quads ‘© tacus/Psoas Major ‘IT BondiTensor Fascia Latae = Hamstrings| ‘© Pexonels, Calves «© Thoracic Extensions Lesson #8 Soft-tissue work serves a valuable role in preventing and correcting imbalances and alleviating symptoms — without making any programming modifications. Foam rolling ig cheap and effective; just do itStep 4: Address the Underlying Issue Part: Implement mobilityldynamic flexibility and activation work to get more out of your warm-up. Complement it with some static ‘stretching, ‘* Dynamic Flexibility: “controlled movement throgh the active range of motion for each joint” ‘© Ativation: target the non-functioning synergists + la muscle s overusedistrained, always look for a dysfunctional synergist. Some Common Examples TiahSiiained | WeatDystuncional Incorporate softiissue and mobiltylexibiliy work for the lef sid and activation work for the right side, Why Dynamic Flexibility? ‘¢ Improves performance and dynamic range of motion, and reduces injury rates when compared to a static stretching program * Passive vs. Active Flexibility ‘* Neural Control = * Stability within a given ROM ‘+ Excessive Passive ROM is actually an injury risk (@.g.gymnastics, ballet) Sample Warm-Up ‘* Foam Rolling ‘+ Non-involved Corrective Static Stretchs (hip flexors, ITB/TFL, Levator Scap/Upper Trap/SCM) * Ground-based MobilityiActivation: Supine Bridge, Birddog, Calf Moblization ‘* Standing: X-Band Walk, Side-to-Side Leg Swings, High Knee Walk, Pull-Back Buttkick, Cradle Walk, Overhead Lunge Walk, Walking Spiderman, Squat {0-Stand, Overhead Broomstick Dislocation, Scap Pushup Some Static Stretching is a good thing! se Transerengeing:ecerocalmnbion Post inure o ert cara, teak Gorman Ae [Lovato ScanusetUeperasSCM tse Pece!Aneror Dats Hp eos Paoas, lacus Reus Feros So |iteree \ascctre canes (Gastro Solus, Peronane) Lesson #9 Implement mobility and activation work in your warm-up, It only takes 5-10 minutes — Which is a lot less time than it takes to recover from an injury. You'll be amazed at what shakes free when you enhance stability through full ranges of motion. Complement this mobility. and activation work with the appropriate static stretching,Step 4: Address the Underlying Issue Part IV: Modify the training program, «This is a last resort — although you'l often use itsimply because you want results fast ‘© The substitute exercises you chose will rarely help to correct the inefficiency. ‘© With the imbalance identified, volume in the ‘opposing direction is your best friend, ‘Restore joint balance * Groove neural pattems Training Modifications ‘¢ Isometric Holds # Shor (e.g. pullthrough lockout «# Long (EQis: eg, splt-squat isometric hold) ‘* Longer Eccentrics * Groove techrique # Build tendon strength ‘* The basics done CORRECTLY are more valuable than you think. Lesson #10 As allast step, modify the training plan — and only on a small-scale, if possible. This is the most “sacret aspect of an athlete's preparation, so ou should “butcher” it as little as ‘possible. The more you screw with things,.the more the athlete is going to feel like a patient. A Programming Example ¢ IT Band Friction Syndrome « Lateral Knee Pain ¢ Contemplating Lateral Release Surgery * Generalized Lower Back Pain ‘Pain free in less than six weeks ’» Now preparing for the NYC marathon (Sept.) A Programming Example: Month 1 ‘= Daily: Supine Bridge Iso Hold, Side Bridges, Birddogs, Siatie Sretching, Foam Rolling # Pre-Training: 2-3 static stetches + mobil * Day 1 Lower: BB Revrse Lange — Fron Saunt Grp (iso \weoks 1-2), Pulthroughs (Iso weeks 1-2), Reverse — "Crunches, ~Rowefte Exiensions + Day2 Lower: Rack Pulls rom Kneeeaps so weeks + 2 Bulgarian SpliSquat Iso (al four waeks), weighted back ‘extensions, side bridges ‘+ Two “corrective” bloodfiow days wilight aerobic sack A Programming Example: Month 2 # Day 1 Lower: Deals from 3° blocks, Barbell Reverse Lunge Iso Holds, Weighted Back Extension, side bridges, suitcase deadiiis + Day 2 Lower: Wide Stance Anderson Squats from Pins (ust above parallel - long eccentric wks 1-2), DB Sieo~ups, Pul-Throughs, Reverse Crunch, ‘Single-leg supine Bridge Iso Hold » Two corrective bloodflow days wilight aorobic work, plus one additional "cardio" sessionA Programming Example: Month 3 ‘* Day 1 Lower: Full ROM Deadlits, D8 Reverse Lunges, Dragon Flags, Pull-Throughs Day 2 Lower: Front Squats (long eccentric), Barbell Step-ups, Mini-band Box Squats, Full Contact Twists ‘¢ Pushed Weight Room Volume Heavily this month ‘* Longer duration corrective bloodflow and aerobic sessions ‘A Programming Example: Month 4 Day 4 Lower: Box Squats (weeks 1-2), Olympic Squais (wooks 3-4), SLDLs, waking DB lunges, bar roots, Supine bridge iso holds Day 2 Lower: Speed Puls, Anderson Front Squats trom Below Parallel, BB Reverse Lunge — Front Squat Grp, Cable Woodchops, Elevated Spit Squat Iso Hold “Three full running sessions (LSD, Threshold, Adierobic Interval) ‘+ Dropped corrective bloodtiow sessions (some ‘elements included in warm-ups) The Overall Approach 1. Prevention i the best form of corrective taining 2, Remove the offending stimulus ~ fx posture in both your ‘ally ife and when sleoping. Watch for repetitive motions, Check ootweer, dict "Oe some symotomaticraet~ especialy in cases =\were pan Is present —to expedite treatment ‘modalties. For the sake of hs discussion, sof tissue ‘work and tac steichng are appropiate The Overall Approach 4. Address the underying problems - inthis case, were {atking about the non-functioning synecgsis (0.9 giles, seapularretractors, extemal rotator): activation Work, 5. Intograte proper rocrutment pattem established with ‘activation patterns into ful ange of motion training Brotogols: body weight as resistance, dynamic flexibly 6. Integrate these recruitment pattors into more complex ‘and loaded mavemenis~ classe resistance training. A Recap: Lessons 1-5 After you've mastered functional anatomy. 1, Fit the program to the lifter — not vice versa 2, Learn to program for yourself. “<3. Some exercises just aren't worth it 4, You can never have too much information. 5, Think “correct” before you think different A Recap: Lessons 6-10 6. Don't make the athiete feet like a patient. 7. Before you go changing what's going on in the gym, figure out what you can do to improve what's going on outside of it 8. Take advantage of soft-tissue work. 2. Implement mobility and activation work in your warm-up. 10>As.@ last step, modify the training plan ~ as litle as possible.SSSIISSIIIDIIIISSIIIIIIAIDIDIDIDIIIIIIIISSSS One Final Note. * Corrective training is always going to be a work in progress ‘Remember that you're dealing with inefficiency and not pathology; know when to refer out. # Knowledge leads to theory, which drives practice. Practice either confirms or refutes theory; you may not get things right on the first try. “Live” Exercise Assessment Exercise Assessment = Squat “= Broak at kneo ‘knock knees «+ Thoracic rounding ‘© Excessive lower back arching, entarior weight bearing «Heels nse + Foot oxtornaly rotate ‘= Lumbar flexion « Incomplete hip extension ‘© No Bal” of ar Exercise Assessment ‘* Front Squats ‘© Cant assume Olympic iter hand position + Eibows point down 1 Same as back squats Exercise Assessment © Box Squats ‘© Koo break (siting down instoad of back) 1 Rock forward off box *# Bouncing off box # Not pushing knees out # No belly full of ar ‘» Etbows not pulled forward Exercise Assessment Deadift Hitch «+ Lumbar hyperextension + Not standing ta (stopping short) * Lumbar flexion # Breaking at knees fist on loweringSISISISISIISIISIISIISGSIISIIIIIGSIIISIIIGIISISGIISS Exercise Assessment «= Trap bar deadlifts «Break atknees: « Hips oo low at start: ite not a squat! Exercise Assessment # Reverse Lunge «+ Front hee its + External rotation of front andlor back foot # Shortstridingt + Excessive hip external olation (step behind) «Lumbar hyperextension 1 Ke falls mexialy ‘* Overpronation + Posterolateral stop Exercise Assessment Stop-ups * Knoes-in # Ontoes © Shortstriaing it ‘ "Pushing’ instead of ‘puling” oneself up onto box. ltting the ig toe Exercise Assessment ‘¢ Mini-band side-steps Hip king «Auction with axon ‘= Poor thoracic and scapular postoning © X-Band Walks: a solution Exercise Assessment ‘* Glute-Ham Raise + Hyperextension Incomplete reps Lumbar flexion Inability to keep hips extendos Exercise Assessment '* Pullthrough + Lumbar hyperextension ‘ Squatting the weightExercise Assessment ‘© Back extensions + Lumbar hyperextension = Lumber fexion «Hamstring dominant (incomplete) hip extension Exercise Assessment «Suitcase Deadiits ' Not bracing + Sidebending Lumbar flexion + Excessive thoracie rounding Exercise Assessment «Side bridges “Hip sag/ lumbar hyperextension Poor thoracic posture «Not bracing Exercise Assessment « Prone bridges «+ Hip s09/lumbar hyperextension «Scapular winging Exercise Assessment ‘¢ Reverse Crunches * Hip flexion takeover + Rocking « Insufficient knee flexion «+ increase in lumbar lordote curve Exercise Assessment ‘¢ Woodchops ‘© Leaning (hip falout) ‘+ Rotation in lumbar spine ws. sine «Hyperextension «© Puling too much withthe armsPRR REESE EEE EE EES EE EEE EEE EEE EEE EEE EEE Exercise Assessment # Band External Rotation ~ Arm Adducted ‘Abduction compensation «= Rhomboids take over ‘Leaning «Hip or lumbar rotation Curing” t Extending’ it Exercise Assessment * Pulldowns ' Inability to get ul ROM «© Swinging: lumbar and hip Nexion and extension Exercise Assessment '* Seated row ‘Scapular elevatonthumeral extension compensation ‘© Elbow flexion and chin protrusion compensation + Lack ofravaction with depression ‘Hip anc lumbar fexioniexcension Exercise Assessment ‘© One-arm row ‘© Rowing tothe armpit (upper trap dominance) '* Elbow flexion instead of retraction ‘+ Excessive rotation ‘© Waiting fr bar to reach chest - Go gett! lanoring the upper back “ancy feet 's Feat on bench: not reat rom a shoulder health standpoint ‘ole Teor presses ae an exception die the ited ROK Exercise Assessment Exercise Assessment # Bench + overproracton * Prone Trap Reise + Bows fared + Flexing of elbows to achieve ROM «Lats take over (extension!norizontal abduction in lieu Cf what should actually be lexorvabauction to ‘accompany upward rotation)Exercise Assessment ‘¢ Rear Delt Fly + Floxing of elbows to achieve ROM + Lats take over (extensioniorizontal abduction + shrugging ‘= bow crop Exercise Assessment # Prone Cobras *# No longor performed on floor # Do them on a bench! # Dont encourage lumbar hyperextension: fie the glues! Exercise Assessment '* Face pulls # Etbows crop « "Thrusting” the weight ‘© Chin protrusion ‘© Scapular elevation “shnugging® it Exercise Assessment ‘* DB Cuban Press, + Excessive elbow flexion (makes exercise easier by bringing resistance closer to axis of rat ‘¢ Momentum: ths isrita snatch! “+ Upright rowing too high Exercise Assessment ‘© Scapular Wall Slides "Shoulders round «# Excossive iow back arching # Not keeping hands on the wal Exercise Assessment # Overhead Pressing * Pressing fomard * Arching backward * Modifications: seated or spli-stanceSISGISISISISISGIIIDIIIIIAIIDIDIIAAAIDIADAECEDESD Exercise Assessment «Elevated Push-up Iso Hold «Not tucking the elbows. # Not bracing ne core (lumbar hyperextension) + Pressing withthe pecs instead of stretching them Exercise Assessment ‘* Bulgarian Spli-Squat Isometric Hold # “Dogging” it you want maximal recrutment «Not activating the back lag gute + Not “arpping’ the floor with the front leg © Short-stricing it # Quad dominance = Too wide a sot up Neanderthal No More Revisited Neanderthal No More Revisited Dav 151) Supine Bridges '82) Viamor Lunge Stretch 81) Srateh Grip Deacits 882) 1T Band Stoteh 15 seconds per sie ©) Berbel tep-Ups 1) Dead Bug Twists DB} Side Hip Tauste Neanderthal No More Revisited pav2 [At) Pronated, Medium Grip Row 12) Pox sretch 81) Face Pale 12) Decine Bartel Extensions C1) Rear Det Fiy 2) Low Pusey External Rotatons 2) dip Srugs ‘)Hgh-o-Low Catie Woedehops Neanderthal No More Revisited vaya At) Heol Elevated Front Squats 1) Waking Linges| 2)(T Band Stretch ©) DB Spit Squat Ea! (BR Puldown Abs 1} DB Dorsitexon 2} Cal SetonSCPC POOCPEPEPPEOIDAADEDIDAIIADIAADIAIIDIAIAAIDIAIDIIIEOSES Neanderthal No More Revisited pay 11) Decine Close Grip Boneh 22) Chest Suppeted T-Bar Rowe '93) SC Upper Trap ans SubeccpalLevator Seapulne Stretches 81) Single Arm Low Pulley Cable 2} Por Sete 15 seconds (C1) DB Extema: Rotations {G2} One-rm Prone Lower Trap Raises 1D) Saton Side Bence Neanderthal No More Revisited 5) Theraband Extemal Rotations arm accucted () Prone Cobras 1) Sngle-og knee to chest on foam role ) Supino Bridges F) Prone Bridges, 6) Sito Brges H) Scap Pushups TpApplable Static Stetenes (as noted above) Thank You! ww RobertsonTrainingSystems.com \wiwEricCressey.comEric Cressey Ciao RN western eee Sy Roem cu cinerea reece sR ea ‘Connecticut Department of Kinesiology. At UCONN, Eric was involved in Re trae ea eens area cc Taboratary. Previously, Eric graduated from the University of New England with a double major in Exercise Science and Sports and Fitness ore ‘An accomplished author, Cressey is a regular contributor to Testosterone CeCe ea Ree See ca Sec ey LOG one thre Otte ce miata re SOC ee ecu cg ina) ‘As a compelitive powerliter, Eric holds several state, national, and world Pee oO ee usta ne ORDER en lass, Cressey is rapidly approaching Elite status with competition bests ‘of540 Squat, 375 bench, 617 deadlift, and 1632 total in the 165-pound weight class. @eeeeeeegege Enic has helped athletes at all levels - fram youth sports to the professional and Olympic ranks - achieve their highest levels of performance in a variety of sports, Although prepared in a variety of (ree tice reece eco Cece) eeu Sie ee ec Mee we maximal relative strength development, and athletic performance Crates ue ae cage MSR TID athletes alike, and presently trains athletes at Excel Sport and Fitness Training (www. ExcelStrength.com) in Waltham, Massachusetts. ee ec ieere ay Roo ere eee ary LKaaaakhn Mike Robertson Mike Robertson, MS.,C.S.C.S., U.S.AW., has helped clients and CeCe lee Otice eek uri eee Nore MLC Pe are ae ce um ny ee OI ecu kenya umes a his Master's Degree in Sports Biomechanics from the world-renowned Giga Cen el ema oy COCR ee Cin We ttriecieiii ice cnet e ican ‘ateas of strength and power development in athletes. Mike is also an Se ee ae ea a ny coached at the World level. Mike resides in Indianapolis , Indiana, where (OG USgr er ig euler Seog Cae Sica eee MT acer Se Ls lena eRe) Pe Ne MOUNSTEWRCEUREOEE