There is an exciting forum on the website of the American Sports Medicine Institute that has tons of information for both the clinician and the athlete.  For those that are not aware, the American Sports Medicine Institute (ASMI) is the research and education institute of Dr. James Andrews in Birmingham, AL under the direction of Dr. Glenn Fleisig. 

ASMI is one of the world-wide leaders in sports medicine research and education, especially in the field of baseball.  In fact, ASMI was the leading force behind many of the protective guidelines that are now in place in within Little League Baseball and USA Baseball to prevent youth baseball injuries.  I have posted about these guidelines and how they help prevent little league injuries in the past.

I worked at ASMI for years and was a graduate of their Sports Physical Therapy Fellowship program so I know first hand that this is a great forum.  When I offer advice for physical therapy students, one of the first I recommend is to seek out the leaders in the field that you would like to work in one day.  Well, I sought out ASMI.

The forum has frequent posts by Dr. Fleisig and his staff and is a great opportunity to learn, interact, and to ask questions from a variety of sports medicine experts.  Visit the forum today:

ASMI Sports Medicine Forum

The influence of the kinetic chain on the patellofemoral can not be underestimated.  Because the knee is located mid-way through a weightbearing extremity, it is vulnerable to excessive force from biomechanical faults located both proximally and distally to the knee itself.

While forces from the foot and ankle have been associated with patellofemoral pain for some time now, the influence of the hip is becoming more of a hot topic as research has demonstrated significant increases in forces and injuries originating from biomechanical faults associated with the hip.  A particular pioneer in this research has been Dr. Christopher Powers from the University of Southern California.  A Pubmed search on Dr. Powers reveals several significant papers on the topic, specifically one of my favorites from JOSPT on the influence of the kinetic chain on patellofemoral biomechanics.

Examination of the joints proximal and distal to the knee is imperative in the treatment of patellofemoral pain.

I believe a significant reason why “patellofemoral pain” has been such a challenging diagnosis in the past is because we are treating the symptoms, not the cause of the pain, which is many times may be coming from elsewhere within the kinetic chain.

 

The following is part 7 of the series on solving the patellofemoral mystery:

• Part 1: Introduction – Solving the patellofemoral mystery
• Part 2: What causes patellofemoral pain?
• Part 3: Differential diagnosis of patellofemoral pain
• Part 4: Principles of patellofemoral joint rehabilitation
• Part 5: Specific treatment guidelines for patellofemoral pain
• Part 6: Biomechanics of the patellofemoral joint – clinical implications
• Part 7: Understanding the clinical implications of the kinetic chain: The influence of the hip and foot on the patellofemoral joint

 

The Influence of the Hip on Patellofemoral Pain

The influence of the hip on the patellofemoral joint has been well documented over the last decade.  The biomechanical works of Dr. Powers have shown that excessive hip adduction and internal rotation places the patellofemoral joint in a disadvantageous position.

Unfortunately, our population is dominated by sagittal plane strength and weakness in the coronal and transverse planes.  It seems like it is a normal part of daily living now as the majority of our functional tasks take place in the sagittal plane.  Even more unfortunate is the fact that exercises outside of the sagittal plane are often neglected in rehabilitation and strength training programs.  This creates a significant biomechanical disadvantage.

To fully understand the significance of this, imaging the weightbearing knee.  When the hip moves into adduction and internal rotation while the foot is planted, the femur will change position around a relatively stable patella (there is movement, just using this as an example).  It is the reverse concept that is commonly seen in patellofemoral rehabilitation.  The movement, or “tracking” of the patella on the femur is less relevant in this weightbearing position.  It is the movement of the femur on the patella that is significant.  Below is an example of how the femurs moves on the patella in the weightbearing position, note the patella is fairly stable while the femur rotates internally:

 

This is likely the mechanism of patellar subluxations and dislocations and the cause of wear and tear of the joint.  Patients often describe an injury that occurs when planting and pivoting or planting on an unstable surface.  The quadriceps contracts to stabilize the knee while the femur is adducted and internally rotated, resulted in a lateral displacement of the patella in relation to the femur.  This can cause an acute injury as well as degeneration over time.

A recent study by Dr. Powers in JOSPT showed that females with patellofemoral pain had greater hip rotation during running, jumping, and stepping down.  This also lead to subsequent decrease in hip strength.  In fact, another study by Dr. Powers’ group published in AJSM demonstrated that patellofemoral pain in women is the results of decreased hip strength not anatomical variations (wider hips, etc.).

Treatment of these patients requires training the hip to abduct and externally rotate.  Also, it is important to train the hip abductors and external rotators to isometrically stabilize the knee during sagittal plane movements and to eccentrically control hip adduction and internal rotation.  A simple test I perform is the step-down exercise.  I am specifically looking for the ability to eccentrically lower the body in the sagittal plane while preventing the hip from dipping into adduction and internal rotation.  This is harder than it looks and will often be an issue in your patients.  But trust me, overtime this will improve, and POOF!  Your patient’s patellofemoral pain while climbing stairs and running will have vanished!  You are a genius now, the last three times she went to rehabilitation elsewhere they perform ultrasound on her knee and had her squeeze a ball between her knees during mini-squats to “strengthen her VMO.”

Which brings up a great topic, do you still want to squeeze that ball between your knees and emphasize hip adduction and internal rotation?  I would actually recommend just the opposite.  I frequently use a piece of Theraband (or even those new knee resistance straps that Theraband just started making) around the patient’s knees during exercise.  This will require the patient to isometrically control the hip from adducting and internally rotating while performing mini-squats, wall squats, leg press, and other sagittal plane exercises

The Influence of the Foot and Ankle of Patellofemoral Pain

Just as forces located proximal to the knee can have a significant impact on the patellofemoral joint, forces distal to the knee may also contribute.  Treatment for patellofemoral patients should include a thorough assessment of the foot and ankle to establish biomechanical factors that need to be addressed.  Orthotic fabrication is often necessary, though off-the-shelf orthotics have had some success in the literature. 

• Pronation.  Excessive pronation of the foot causes a reciprocal internal rotation moment of the tibia.  This turn increases the resultant Q-angle at the knee.  As we previously discussed in our previous post on the biomechanics of the patellofemoral joint, an increased Q-angle will cause a greater amount of force on a more focal portion of the patella.  Furthermore, an internal rotation moment of the tibia also results in internal rotation of the femur and a more laterally displaced patella.  This may be a cause of ELPS as discussed previously when we discussed the differential diagnosis of patellofemoral pain. 
• Leg Length Discrepancy.  I chose to include leg length discrepancy with the group of distal forces as the impact of a longer leg length tends to impact the positioning of the foot and ankle.  The longer leg will tend to have a toe-out and pronated position to compensate for the longer length.
• Supination.  Patients labeled as “pronators” seem to get all the attention, but excessive supination is likely just as bad.  Not only do you diminish the foot’s ability to dissipate force, supination will result in external rotation of the tibia and more force to the patella.

You can see that the position of the foot and ankle when the foot hits the ground is important to evaluate as it will alter the arthrokinematics and patellofemoral joint reaction forces.

It can not be stressed enough that it is imperative that the proximal and distal aspects of the kinetic chain need to be evaluated and treated in patients with patellofemoral pain.  I am sure that your outcomes will begin to improve by not neglecting this important aspect of treatment. 

 

Have We Solved the Patellofemoral Mystery?

Probably not, but although the patellofemoral joint may still be a complicated area of sports medicine, I hope that this series has helped take the some of the mystery out of patellofemoral pain!  Be sure to go back and review if you missed some of the articles in this series on the patellofemoral joint.  In putting the pieces of this series together, remember to:

1. Understand the source of patellofemoral pain and realize it might not be from “chondromalacia.”
2. Perform a thorough examination and attempt to identify a specific diagnosis, lets stop using the term “patellofemoral pain” and describe the actual diagnosis!
3. Consider the basic principles of patellofemoral pain rehabilitation, including understanding the biomechanics of the joint and the biomechanics during exercise.
4. Look proximal and distal within the kinetic chain to identify a potential true “source” of patellofemoral pain and stop treating the “symptoms!”

 

 

Powers CM (2003). The Influence of Altered Lower-Extremity Kinematics on Patellofemoral Joint Dysfunction: A Theoretical Perspective J Orthop Sports Phys Ther DOI: 14669959

As we continue our journey through the diagnosis and treatment of patellofemoral injuries, it is time to shift gears from the basic principles of care and discuss our final two topics – the biomechanics of the patellofemoral joint itself and the biomechanical influence of the kinetic chain on the patellofemoral joint.  To me, these are two extremely important topics that are often not addressed as much as they should.

The following is part 6 of the series on solving the patellofemoral mystery:

• Part 1: Introduction – Solving the patellofemoral mystery
• Part 2: What causes patellofemoral pain?
• Part 3: Differential diagnosis of patellofemoral pain
• Part 4: Principles of patellofemoral joint rehabilitation
• Part 5: Specific treatment guidelines for patellofemoral pain
• Part 6: Biomechanics of the patellofemoral joint – clinical implications
• Part 7: Understanding the clinical implications of the kinetic chain: The influence of the hip and foot on the patellofemoral joint

 

Articulation of the Patellofemoral Joint

The patella really is an amazing bone in our body.  Did you realize that the artiuclar cartilage on the undersurface of the patella is the thickest in the body?  That really is amazing and shows just how much force is applied to the joint.  Take a look at the picture on the right, notice how thick the cartilage is in comparison to the bone?

When rehabilitating a patient with a known lesion of the patellofemoral joint, it its important to understand the joint arthrokinematics. Articulation between the inferior margin of the patella and the femur begins at approximately 10 – 20 degrees of knee flexion.  The patella does not articulate with the trochlea near terminal knee extension.  As the knee proceeds into greater degrees of knee flexion, the contact area of the patellofemoral joint moves proximally along the patella and posterior along the condyles.

This is an important concept to understand and emphasizes the importance of good communication between the physician and rehabilitation specialist.  If we know the specific area of articulation, we can work around that area, otherwise we don’t know when a lesion will articulate and will have to be more conservative.

 

Contact Area of the Patellofemoral Joint

In addition to understanding when the patellofemoral articulates, it is important to discuss the area of contact.  Obviously, contact between the patella and trochlea that covers a larger surface area will distribute the load over a greater area.  This is a driving factor in exercise selection and will be talked about below.  At 30 degrees, the area of patellofemoral contact is approximately 2.0cm². The area of contact gradually increases as the knee is flexed. At 90 degrees of knee flexion contact area triples,  increasing up to 6.0cm².  As you can see, The contact area initially is small and gradually increases as the joint become more congruent.

Alterations in Q-angle are often associated with patellofemoral disorders and may alter the contact areas and thus the amount of joint reaction forces of the patellofemoral joint. Huberti and Hayes examined the in vitro patellofemoral contact pressures at various degrees of knee flexion from 20 – 120 degrees. Maximum contact area occurred at 90 degrees of knee flexion and was estimated to be 6.5 times body weight. A increase or decrease in Q-angle of 10 degrees resulted in increased maximum contact pressure and a smaller total area of contact throughout the range of motion. This information may be applied when prescribing rehabilitation interventions so that exercises are performed in ranges of motion that place minimal strain on damaged structures.

 

Patellofemoral Joint Reaction Forces

Patellofemoral joint reaction forces are observed during all movements of the knee.  Often times, it is the goal of rehabilitation to exercise the lower extremity while minimizing patellofemoral joint reaction forces.  Forces occur from a combination of:

• Articulation and contact area
• Resultant force vector between the quadriceps and patellar tendon
• Muscle contraction

We have already discussed the articulation and contact area.  Again, joint forces are reduced when distributed over a large surface area.  When we discuss lever arms, remember that the patella’s true function is to increase the mechanical advantage of the quadriceps muscle.  Take a look at the diagram below, notice how the resultant force (red arrow) vector increases as the knee flexes and the line of pull from the quadriceps and patellar tendons causes a more compressive force?

I wish it were that simple and we could say that joint reaction forces are always highest as the knee flexes.  Unfortunately, we have to take muscle contraction into consideration as well.  The quadriceps is designed to cause compression of the patellofemoral joint.  The force of the quadriceps is greatest at terminal knee extension, that is why patients with patellectomies have such a difficult time extending their knees, they lost the biomechanical advantage of the patella and can not produce enough quadriceps force to fully extend the knee.

Now put the contact area together with the quadriceps force.  The quadriceps provides the greatest compressive force near extension when the contact area of the patellofemoral joint is smallest.  Thus, a high force on a small area produces considerable patellofemoral joint reaction forces.

To demonstrate just how significant these forces are, take a look at the below table that I put together from various sources for a 200 pound person.  Notice how deep squatting applies close to 4000 lbs of force to the patellofemoral joint (still want to squat?).

Activity	Force	% Body Weight	Pounds of Force
Walking	850 N	1/2 x BW	100 lbs
Bike	850 N	1/2 x BW	100 lbs
Stair Ascend	1500 N	3.3 x BW	660 lbs
Stair Descend	4000 N	5 x BW	1000 lbs
Jogging	5000 N	7 x BW	1400 lbs
Squatting	5000 N	7 x BW	1400 lbs
Deep Squatting	15000 N	20 x BW	4000 lbs

 

Biomechanics of Rehabilitation Exercises

The effectiveness and safety of open kinetic chain (OKC) and closed kinetic chain (CKC) exercises have been heavily scrutinized in recent years. While CKC exercises replicate functional activities such as ascending and descending stairs, OKC exercises are often desired for isolated muscle strengthening when specific muscle weakness is present.

Steinkamp et al analyzed the patellofemoral joint biomechanics during the leg press and extension exercises in 20 normal subjects. Patellofemoral joint reaction force, stress, and moments were calculated during both exercises. From 0 – 46 degrees of knee flexion, patellofemoral joint reaction force was less during the CKC leg press. Conversely, from 50 – 90 degrees of knee flexion, joint reaction forces were lower during the OKC knee extension exercise. Joint reaction forces were minimal at 90 degrees of knee flexion during the knee extension exercise.

Escamilla et al observed the patellofemoral compressive forces during OKC knee extension and CKC leg press and vertical squat. Results were similar to the findings of Steinkamp et al; OKC knee extension produced significantly greater forces at angles less than 57 degrees if knee flexion while both CKC activities produced significantly greater forces at knee angles greater than 85 degrees.

When analyzing the biomechanics of the OKC knee extension, remember the concept from above regarding the quadriceps force near extension.  Grood et al reported that quadriceps force was greatest near full knee extension and increased with the addition of external loading. The small patellofemoral contact area observed near full extension, as previously discussed, and the increased amount of quadriceps force generated at these angles may make the patellofemoral more susceptible to injury. At a lower range of motion, the large magnitude of quadriceps is focused onto a more condensed location on the patella.

My friend Rafael Escamilla has published a few new studies on patellofemoral joint forces during the lunge and squatting exercises.  The first study, published in Clinical Biomechanics, demonstrated that the front and side lunge exercises showed the same pattern of force as the squatting and leg press, with more force the deeper the lunge.  Interestingly, performing the lunge from a split-stance position (not actually striding to perform the lunge) also showed a decrease in force and should be used initially.  His follow-up study demonstrated that a longer stride has less force than a shorter stride during the forward lunge.

Escamilla also analyzed the patellofemoral joint reaction forces between the wall squat (performed with feet close to wall and far away from wall) and the single leg squat.  Results indicate that the closer your feet are to the wall, the greater the force during the wall squat exercise.  At deeper angles > 60 degrees, the wall squat produced greater force than the one legged squat.  Interesting results that should be applied to our exercise prescription.

 

Clinical Implications

When applying the results of Steinkamp(38), Escamilla(39), and Grood(40), it appears that during OKC knee extension, as the contact area of the patellofemoral joint decreases the force of quadriceps pull subsequently increases, resulting in a large magnitude of patellofemoral contact stress being applied to a focal point on the patella. In contrast, during CKC exercises, the quadriceps force increases as the knee continues into flexion. However, the area of patellofemoral contact also increases as the knee flexes leading to a wider dissipation of contact stress over a larger surface area.

Recently, Witvrouw et al (41) prospectively studied the efficacy of open and closed kinetic chain exercises during non-operative patellofemoral rehabilitation. 60 patients were participated in a 5-week exercise program consisting of either open or closed kinetic chain exercises. Subjective pain scores, functional ability, quadriceps and hamstring peak torque, and hamstring, quadriceps, and gastrocnemius flexibility were all recorded prior to and following rehabilitation as well as at 3 months proceeding. Both treatment groups reported a significant decrease in pain, increase in muscle strength, and increase in functional performance at 3 months following intervention.

Thus it appears that the use of both open and closed kinetic chain exercises may be used to maximize outcomes for patellofemoral patients if performed within a safe range of motion. I prescribe the form of exercise based on the clinical assessment. If CKC exercises are less painful than OKC exercises, than that form of muscular training is encouraged. Additionally, in postoperative patients, regions of articular cartilage wear is carefully considered before an exercise program is designed. Most frequently, I’ll allow open kinetic exercises such as knee extension from 90 – 40 degrees of knee flexion. This range of motion provides the lowest amount patellofemoral joint reaction forces while exhibiting the greatest amount of patellofemoral contact area. Closed kinetic chain exercises such as the leg press, vertical squats, lateral step-ups, and wall squats (slides) are performed initially from 0 to 30 degrees and then progressed to 0 to 60 degrees where patellofemoral joint reaction forces are lowered. As patient symptoms subside, the ranges of motion that are performed are progressed to allow greater muscle strengthening in larger ranges. Exercises are progressed based on the patient’s subjective reports of symptoms and the clinical assessment of swelling, painful crepitus, and discomfort.

Continue on to Part 7: Understanding the clinical implications of the kinetic chain: The influence of the hip and foot on the patellofemoral joint

 

 

 

ESCAMILLA, R., ZHENG, N., MACLEOD, T., EDWARDS, W., HRELJAC, A., FLEISIG, G., WILK, K., MOORMANIII, C., & IMAMURA, R. (2008). Patellofemoral compressive force and stress during the forward and side lunges with and without a stride Clinical Biomechanics, 23 (8), 1026-1037 DOI: 10.1016/j.clinbiomech.2008.05.002

I have an interesting question for all my readers, what is your favorite new “medical” book that you would recommend everyone to read?  I say “medical” because I am sure you enjoyed Twilight or the new Harry Potter books, but I want to hear what new rehab, physical therapy, athletic training, massage, manual therapy, orthopedic, sports medicine, strength and conditioning, and any other medical book you would recommend from the last couple of years.

I am wrapping up the last couple of posts for patellofemoral pain series and preparing for my next series on my “essential reading list.”  I want to hear your contributions.

I will include a “reader’s choice” list of essential books in this series so please do reply to this post with your suggestion.  Thanks!

 

 

Photo by juhansonin

It is with great pleasure that Strength and Conditioning Guru Michael Boyle has allowed me to reprint his magnificent article “25 Mistakes in 25 Years.”  I remember reading this when it was first published and being blown away.  I recently stumbled upon it again when I was browsing through Michael’s website StrengthCoach.com (which, if you haven’t checked out yet could possible be one of the best websites available on Strength and Conditioning). 

This is probably a timely reprint of the post as Michael has just release a DVD of a presentation of the material in this article, called “Evolution of a Strength Coach,” available through Perform Better.

Thank you Michael for allowing me to share this with my readers, I know that this will be a valuable benefit for us all and if you’ve been living under a rock for the last 25 years, be sure to follow the links to learn more from Michael.  Strength and conditioning concepts are extremely valuable for rehabilitation specialists.

 

25 Mistakes in 25 Years – The Evolution of a Strength Coach

Michael Boyle, MS, ATC

This year I'll enter my twenty-fifth year as a strength and conditioning coach. Last month I watched Barbara Walters celebrate her thirtieth year with a special called "30 Mistakes in 30 Years." I'm going to celebrate my twenty-fifth anniversary by telling you my top twenty-five mistakes. Hopefully I'll save you some time, pain, and injury. Experience is a wonderful but impatient teacher. And unfortunately, our experiences in strength and conditioning sometimes hurt people besides us.

Mistake #1: Knowing it all

I love Oscar Wilde's quote, "I'm much too old to know everything." Omniscience is reserved for the young. As the old saying goes, you have one mouth and two ears for a reason. I'd take it a step further and say the ratio is four to one: two eyes, two ears, and one mouth.

To continue down the cliché road, how about this one: "It's what you learn after you know it all that counts." When I was young I had many answers and few questions. I knew the best way to do everything. Now that I'm older I'm not sure if I even know a good way to do anything.

Mistake #2: Not taking interns sooner

I was so smart that no one was smart enough to help me. (See mistake number one.) My productivity increased drastically when I began to take interns.

Note: Interns aren't janitors, laundry workers, or slaves. They're generally young people who look up to you and expect to learn. Take your responsibility seriously. Remember the golden rule.

Mistake #3: Not visiting other coaches

God, it seems everything goes back to number one! I was too busy running the perfect program to attempt to go learn from someone else. Plus, when you know it all, how much can you learn?

Find the good coaches or trainers in your area (or in any area you visit) and arrange to meet them or just watch them work. I often will just sit with a notebook and try to see what they do better than I do.

I can remember current San Francisco 49'ers strength and conditioning coach Johnny Parker allowing us to visit when he was with the New England Patriots and then asking us questions about what we saw and what we thought he could do better. Coach Parker is a humble man who always provided a great example of the type of coach and person I wanted to be.

Mistake #4: Putting square pegs in round holes

The bottom line is that not everyone is made to squat or to clean. I rarely squatted with my basketball players as many found squatting uncomfortable for their backs and knees.

It killed me to stop because the squat is a lift I fundamentally believed in, but athletes with long femurs will be poor squatters. It's physics. It took me a while to realize that a good lift isn't good for everybody.

Mistake #5: Not attending the United States Weightlifting Championships sooner

My only visit as a spectator to an Olympic lifting meet made me realize that Olympic lifts produced great athletes. I know this will piss off the powerlifters, but those Olympic lifters looked so much more athletic.

I remember being at the Senior's when they were held in Massachusetts in the early eighties and walking away thinking, "This is what I want my athletes to look like." Understand, at that time I was a competitive powerlifter and my programs reflected that.

Mistake #6: Being a strength coach

How can that be a mistake? Let's look at the evolution of the job. When I started, I was often referred to as the "weight coach." As the profession evolved, we became strength coaches, then strength and conditioning coaches, and today many refer to themselves as "performance enhancement specialists."

All these names reflect the changes in our job. For too many years, I was a strength coach. Eventually I realized that I knew more about conditioning than the sport coaches did, so we took on that responsibility. Later, I realized that I often knew more about movement than the sport coaches too, so we began to teach movement skills. This process took close to eighteen of my twenty-five years. I wish it had been faster.

Mistake #7: Adding without subtracting

Over the years we've continued to add more and more CNS intensive training techniques to our arsenal. Squatting, Olympic lifting, sprinting, pulling sleds, and jumping all are (or can be) CNS intensive.

I think I do too much CNS intensive work, and intend to change that. My thanks go out to Jason Ferrugia for pointing out this one.

Mistake #8: Listening to track coaches

Please don't get me wrong. Some of the people who were most influential in my professional development were track coaches. I learned volumes from guys like Don Chu, Vern Gambetta, Charlie Francis, and Brent McFarland.

However, it took me too long to realize that they coached people who ran upright almost all the time and never had to stop or to change direction. The old joke in track coaching is that it really comes down to "run fast and lean left."

Mistake #9: Not meeting Mark Verstegen sooner

Mark may be the most misunderstood guy in our field. He's a great coach and a better friend. About ten years ago a friend brought me a magazine article about Mark Verstegen. The article demonstrated some interesting drills that I'd never seen. I decided my next vacation would be to Florida's Gulf Coast as Mark was then in Bradenton, Florida.

I was lucky enough to know Darryl Eto, a genius in his own right, who was a co-worker of Mark's. In the small world category, Darryl's college coach was the legendary Don Chu.

Darryl arranged for me to observe some training sessions in Bradenton. I sat fascinated for hours as I watched great young coaches work. Mark was one of the first to break out of the track mold we were all stuck in and teach lateral and multi-directional movement with the same skill that the track coaches taught linear movement. This process was a quantum leap for me and became a quantum leap for my athletes.

This was my step from strength and conditioning coach to performance enhancement specialist (although I never refer to myself as the latter). The key to this process was accepting the fact that Mark and his co-workers were far ahead of me in this critical area.

Mistake #10: Copying plyometric programs

This goes back to the track coach thing. I believe I injured a few athletes in my career by simply taking what I was told and attempting to do it with my athletes. I've since learned to filter information better, but the way I learned was through trial and error... and the error probably resulted in sore knees or sore backs for my athletes.

Track jumpers are unique and clearly are involved in track and field because they're suited for it. What's good for a long jumper is probably not good for a football lineman. It took me too long to realize this.

Mistake #11: Copying any programs

Luckily for me, I rarely copied strength programs when training my athletes. This mistake might be beyond the statute of limitations as it was more than twenty-five years ago.

I think copying the training programs of great powerlifters like George Frenn and Roger Estep left me with the sore back and bad shoulders I've carried around for the last twenty-five years. What works for the genetically gifted probably won't work for the genetically average.

Mistake #12: Not teaching my athletes to snatch sooner

We've done snatches for probably the last seven or eight years. The snatch is a great lift that's easier to learn than the clean and has greater athletic carryover. Take the time to try it and study it. You'll thank me.

Mistake #13: Starting to teach snatches with a snatch grip

When I realized that snatches would be a great lift for my athletes I began to implement them into my programs. Within a week some athletes complained of shoulder pain. In two weeks, so many complained that I took snatches out of the program. It wasn't until I revisited the snatch with a clean grip that I truly began to see the benefits.

Just remember, the only reason Olympic lifters use a wide snatch grip is so that they can reduce the distance the bar travels and as a result lift more weight. Close-grip snatches markedly decrease the external rotation component and also increase the distance traveled. The result is a better lift, but less weight.

Mistake #14: Confusing disagree with dislike

I think it's great to disagree. The field would be boring if we all agreed. What I realize now is that I've met very few people in this field I don't like and many I disagree with. I probably enjoy life more now that I don't feel compelled to ignore those who don't agree with me.

Mistake #15: Confusing reading with believing

This concept came to me by way of strength coach Martin Rooney. It's great to read. We just need to remember that in spite of the best efforts of editors, what we read may not always be true.

If the book is more than two years old, there's a good chance even the author no longer agrees with all the information in it. Read often, but read analytically.

Mistake #16: Listening to paid experts

Early on, many of us were duped by the people from companies like Cybex or Nautilus. Their experts proclaimed their systems to be the future, but now the cam and isokinetics are the past. Just as in any other field, people will say things for money.

Mistake #17: Not attending one seminar per year just as a participant

I speak approximately twenty times a year. Most times I stay and listen to the other speakers. If you don't do continuing education, start. If you work in the continuing education field, go to at least one seminar given by an expert in your field as a participant.

(Note: Mistakes 18-25 are more personal than professional, but keep reading!)

Mistake #18: Not taking enough vacation time

When I first worked at Boston University we were allowed two weeks paid vacation. For the first ten years I never took more than one.

Usually I took off the week between Christmas and New Years. This is an expensive week to vacation, but it meant that I'd miss the least number of workouts since most of my athletes were home at this time. I think the first time I took a week off in the summer was about four years ago. My rationale? Summer is peak training time. Can't miss one of those weeks.

I think there's a thin line between dedication and stupidity, and I often crossed it. I think in my early years I was more disappointed that the whole program hadn't collapsed during any of my brief absences. I felt less valuable when I returned from a seminar and realized that everything had gone great.

Stephen Covey refers to it as "sharpening the saw." Take the time to vacation. You'll be better for it.

Mistake #19: Neglecting your own health

This is an embarrassing story, but this article is all about helping others to not repeat my errors. Every year in February I'd find myself in the doctor's office with a different complaint: gastro-intestinal problems, headaches, flu-type illnesses, etc. I had a wonderful general practitioner who took a great interest in his patients. His response year after year was the same: slow down. You can't work 60-80 hours a week and be healthy.

Like a fool I yessed him to death and went back to my schedule. After about the fifth year of this process my doctor said, "I need to refer you to a specialist who can help you with this problem" and he handed me a card. I was expecting an allergist or perhaps some type of holistic stress expert. Instead I found myself holding a card for a psychiatrist.

My doctor's response was simple. I can't help you. You need to figure out why you continue to do this to yourself year in and year out. I went outside and called my wife. I told her it was a "good news-bad news" scenario. I wasn't seriously ill, but I might be crazy. Unfortunately, she already knew this.

Mistake #20: Not recognizing stress

Again I remember talking to a nurse who was treating me for a gastrointestinal problem. I seemed to have chronic heartburn. Her first question was, "Are you under any stress?" My response was the usual. Me? Stress? I have the greatest job in the world. I love going to work every day!

Do you know what her response was? She said, "Remember, stress isn't always negative." It was the first time I'd really thought about that. My job was stressful. Long days, weekend travel, too many late nights celebrating victories or drowning sorrows. A part-time job to make extra money meant working at a bar on Friday and Saturday until 2 AM, and that was often followed by drinks until 4 AM.

Sounds like fun, but it added up to stress. The lesson: stress doesn't have to be negative. Stress can just be from volume.

Mistake #21: Not having kids sooner

As a typical type-A asshole know-it-all, I was way too busy to be bothered with kids. They would simply be little people who got in the way of my plans to change the world of strength and conditioning. I regret that I probably won't live to 100. If I did I'd get to spend another 53 years with my kids.

Mistake #22: Neglecting my wife

See above. It wasn't until I had children that I truly realized how my obsession with work caused me to neglect my wife. I have often apologized to her, but probably not often enough.

Mistake #23: Not taking naps

Do you see the pattern here? Whether we're personal trainers or strength and conditioning coaches, the badge of honor is often lack of sleep. How often have you heard someone say, "I only need five hours a night!"

In the last few years I've tried to take a nap every day I'm able. As we age we sleep less at night and get up earlier. I'm not sure if this is a good thing. I know when I'm well-rested I'm a better husband and father than when I'm exhausted at the end of a day that might have begun at 4:45 AM.

There's no shame in sleep, although I think many would try to make us believe there is.

Mistake #24: Not giving enough to charity

Most of us are lucky. Try to think of those who have less than you. I'm not a religious person, but I've been blessed with a great life. I try every day to "pay it forward." If you haven't seen the movie, rent it. The more you give, the more you get.

Mistake #25: Reading an article like this and thinking it doesn't apply to you

Trust me, denial is our biggest problem.

 

 

For more information, please visit the below sites:

• Michael Boyle’s StrengthCoach.com Website
• Evolution of a Strength Coach DVD
• The original 25 Mistakes in 25 Years article