Are We Missing the Boat on Core Training?

A lot of attention has been placed on core training over the last several years, both in the rehab and fitness industry.  I recently watched my friend Nick Tumminello’s latest product Core Training: Facts, Fallacies, and Top Techniques and it made me think (more on Nick’s product, which is on sale this week, below).

We’ve made exceptional progress in our understanding of the core and have shifted away from isolated ab training to integrated core training.  My DVD with Eric Cressey on Functional Stability Training for the Core discussed this at length and showed a nice system to effectively train every aspect of the core.

However, the more I read on the internet the more I wonder if we are still missing the boat a little bit.  I’ll chalk this up as a another pendulum swing, but while we have progressed away from isolated abdominal exercises like sit ups, I wonder if we have swung too far to an extreme and started to focus only on isometric anti-movement exercises for the core.

 

Anti-Movement Core Exercises

Realistically the core helps stabilize the body and allow a transfer of energy.

Anti-movement exercises, such as planks for anti-extension, should be the foundation of the basic levels of core training.

Plank - core training

Once your baseline ability to maintain an isometric posture with the core is obtained, the next progression is to control limb movement with a stable core.  This involves combining upper body and lower body movements while maintain a stable core.  An example of this would be an anti-extension drill with TRX Rip Trainer.

However, the core does need to “move” during normal function.  It rotates, bends, flexes, extends, and all of these at once!  Should we train this?

 

Don’t Forget the Trunk is Designed to Move

I would say we should.  I think the difference here is to train these movements within a stable range of motion.  We should be training the body to work within it’s normal mobility, but to stabilize at end range of motion.

We get into problems with core movements, like rotation, when we depend on our static stabilizers, like the joints and ligaments, to control end range instead of our muscular dynamic stabilizers.

Perhaps the goals should be to train to control the core at end range of motion.

 

End Range Core Stability

These types of drills would include chops, lifts, push-pull movements on a cable or Keiser system, and medicine ball drills.  You are probably doing these already, right?

They all involve a transfer of energy from the limbs through the core.  The core needs to move during these exercises, but you are working in the mid ranges of motion and controlling end range.  These should also progress to include functional movements patterns like swings, throws, and kicks.

In the video above, I combine the act of throwing and decelerating in the half kneel position.  This takes the lower half out of it and requires the core to stabilize.

I guess the point is that we shouldn’t be afraid to move the core.  That is not beneficial to teach our patients, clients, and athletes.  Rather, train the core to move and stabilize at end range of motion to take stress off the structures of the spine.

 

Core Training: Facts, Fallacies, and Top Techniques

If you want to learn more about training the core, Nick’s program Core Training: Facts, Fallacies, and Top Techniques is on sale this week.  I watched Nick’s presentation last week and enjoyed it.  Nick does a great job discussing some of these concepts.  Click below for details:

 

Anterior Pelvic Tilt Influences Hip Range of Motion and Impingement

One of the most common postural adaptations that I see on a day to day basis is anterior pelvic tilt.  In fact, it’s getting more rare to find someone that isn’t in a large amount of anterior pelvic tilt.

I blame it on our seated culture.  The human body is excellent at adapting, and the seated posture produces an anterior pelvic tilt.

 

Anterior Pelvic Tilt Influences Hip Range of Motion and Impingement

Anterior Pelvic Tilt Hip Range of Motion ImpingementA recent research study published in the American Journal of Sports Medicine looked at the effect of changes in pelvic tilt on range of motion and impingement of the hip.

The authors looked at CT scans of the hips of  50 subjects with femoroacetabular impingement and simulated range of motion using 3D-generated models.

A 10 degree increase in anterior pelvic tilt, which I would say is something we see clinically, resulted in a significant loss of 6-9 degrees of hip internal rotation and increase in FAI.  This increase in anterior pelvic also resulted in a loss of 10 degrees of hip flexion.  Subsequently, an increase in posterior pelvic tilt resulted in greater hip internal rotation, less impingement, and more hip flexion.

 

Clinical Implications

The results of the study have several implications

  • Assessment of hip ROM should take pelvic position into consideration.
  • FAI symptoms may be reduced by decreasing anterior pelvic tilt.
  • People with limited hip internal rotation or hip flexion may have too much anterior pelvic tilt.  Focus on alignment before starting to torque the joint.  This is a fundamental principle I talk about in Functional Stability Training of the Lower Body.
  • People with poor squat mechanics, especially in the deeper positions, may have an underlying pelvic position issue.  People with excessibve anterior pelvic tilt that are squatting deep maybe impinging and beating up their hips.

 

I talk a lot about reverse posturing, my terminology for focusing on reversing the posture that you assume for the majority of your day.  But there is a big difference between reducing static anterior pelvic tilt posture and dynamic anterior pelvic tilt control.  You have to emphasize both with dynamic control being arguably more important.

Keep these findings in mind next time you see someone with a large amount of anterior pelvic tilt.

If you are interested in learning more about how I work with anterior pelvic tilt, I recently outlining my integrated system of manual therapy and corrective exercise in my Inner Circle webinar on Strategies to Reduce Anterior Pelvic Tilt.

 

 

A New Exercise for Strength and Stability of the Shoulder

The PronatorThere is not doubt that we need a strong and stable shoulder to maximize performance.  I recently started playing with a new device called The Pronator.  It’s a device designed to strengthen the forearm musculature.  Honestly, this little thing is a fantastic device for grip and forearm strength, but I also started using it with my shoulder exercises and think this may be a game changer!

Take a look at the video below.

YouTube Preview Image

I see this very similar to performing bottom-up kettlebell exercises.  By having an offset weight, you need to work the shoulder in 3D to stabilize and move at the same time.  Pretty cool.  It essentially allows you to:

  • Develop stability in one plane of motion and strength in another
  • Train the cuff to fire and stabilize while moving the scapula

The product is brand new and very affordable at only $55.   I don’t often tell my audience that they need to buy a product, but I really think everyone should have this one.  I like it that much!

 

Is Perfect Squat Form a Myth?

Over the years I have helped 1000’s of people squat better.  As a physical therapist, my career has evolved over the years from working with injured people to working with healthy people looking to optimize their body and maximize their performance.  In fact, I’m starting to refer to it more as “performance therapy” than “physical therapy.”

Lately, I’ve seen more and more people come to me to learn how to improve their squat.  Often times it’s one of two reasons why they can’t quite get find perfect squat form:

  • Something hurts when I squat
  • I can’t squat with perfect form

After going through a full body assessment, I always assess their squat form.  I don’t mean a rigid deep squat test, such as the one within the FMS of SFMA assessments, but an actual loaded squat.  I don’t say a word, I just observe.  Well, I actually record a video of it, but the point is I don’t want to cue the squat at all so I can see how the set up and how they perform their squat without my coaching.

What I often find is that many people are trying to squat with perfect form, or least what they believe is “perfect form.”  Perhaps they just picked up a copy of Starting Strength, or just attended their level 1 weekend certification, or just went through a foundations course at their box.  The quest for “perfect squat form” probably isn’t that simple.

I’m starting to wonder if there really is a such thing as perfect squat form.

 

Is Perfect Squat Form a Myth?

Don’t get me wrong, you have to start somewhere.  I personally recommend people read Mike Robertson’s article on How to Squat and the book Starting Strength is worth every penny.  My point isn’t that you should throw away any attempt to squat with perfect form, there are good ways and bad ways to squat, you have to start somewhere.

But I almost feel like we are over-coaching and using the same coaching cues during the squat with everyone.  Yes, there are many faults the can occur during squatting that should be avoided.  Bret Contreras has a nice article about solving 7 squat dilemmas.    But there is a big difference between correcting faults and overcorrecting people without faults.

Here is a good example, imagine you are squatting with your knees caving in towards each other, or tracking medially into a valgus knee position.  This would be a great time to cue someone to force their knees out.  However, it is possible to force your knees out too far and I’m not sure I want to cue someone that is squatting with decent form to aggressively force their knees out.  It’s a good thought to prevent knee cave in, but don’t go too far in the opposite direction.

But more importantly, I’m not sure there is a textbook way to squat, simply because we are all built different and have different daily habits.  There is a textbook perfect squat form for YOUR body, but it may be different for the person next to you.

This is why proper coaching and an individualized program built for you is the best way to succeed at perfecting your squat form.  There are several limitations that we all have that may be limiting our ability to achieve a perfect squat form.

 

Anatomical Limitations

The first thing we need to understand is that everyone’s anatomy is unique.  Bret Contreras does a nice job discussing our how our anatomical differences impact our squat mechanics and Ryan DeBall has a great article as well.  In fact, our pelvis and femurs are completely and vastly unique.

Look at these photos of several different pelvis and femur bones by Paul Grilley:

Femur neck variations

Femur Torsion Variations

Acetabular pelvic bone variations

Looking at these photos, it is striking how different we all really are on the inside.  The angles of how the femur bone forms as well as how it sits in the socket can be dramatically different between people.

This is what I find to be the biggest factor impacting why people can’t perform a squat with perfect form.  How can you say there is one way to squat when you look at these photos?  The spectrum of variation is so wide.

Unfortunately there isn’t a quick fix for anatomical limitations.  Rather, a detailed biomechanical assessment can be used to determine what may be the best squat mechanics based on your anatomy.  Sometimes this means that you will need to limit depth.  People never want to hear this, but sometimes you just simple run out of anatomy and can’t physically flex your hips enough to achieve deep squat form, at least without significant low back compensation.

 

Mobility Limitations

Luckily, not everyone has significant underlying anatomical variations.  Some just have mobility restrictions of their joint capsules and muscle tissue.  This is common in the person that assumes a frequent postural position over several years, such as sitting.  Most adults will have postural and mobility limitations that can be improved and subsequently improve their squat performance.

So, keep this in mind if you are a coach at a gym with adult fitness clients that are looking to start squatting.  Chances are they won’t be immediately able to perform a squat well until you clean up some of their movement patterns.  Rushing this process is how newbie adult fitness clients tend to hurt themselves while squatting.  They don’t have the mobility to squat with proper mechanics, and without this mobility, you are just going to compensate and put extra stress somewhere else, like this guy, who probably doesn’t have the mobility to be squatting:

YouTube Preview Image

 

A detailed assessment process can accurately determine if you have an anatomical or simple mobility limitation.

I also want to briefly comment on squatting like a baby.  I know many people have commented that if babies can squat perfectly, why can’t adults?  Dean Somerset wrote about this recently, but this concept is really ridiculous.  There are many factors that make babies able to squat well, including their head to body size ratio, femur height, acetabular position, but most importantly the simple fact that their bones aren’t fused!  Adults will never have the mobility of a baby, this has nothing to do with motor control.

 

Motor Control Limitations

perfect squat formAnother possible area of limitation that can be negatively impacting your squat performance is poor motor control.  I again tend to see this in adults that have been sitting for the majority of the day the last 10-30 years.  When you sit all day, you don’t need abdominal control, lumbopelvic control, or posterior chain activity.  The chair simply does all of this for you.  You essentially learn how to turn all of these off!

This can be seen in someone that has poor movement patterns, however during my clinical assessment have no real mobility restrictions of their joints or muscles.

Sadly, however, I also see this often in my younger athletes.  I’m amazed at how poor our high school students move.  I blame it on sitting and staring at the TV, Xbox, or iPhone all day, but kids can’t even touch their toes anymore!

We have close to 100 high school athletes training with us at Champion Physical Therapy and Performance, and a large portion of them are performing corrective exercises and goblet squats until their motor control improves!

 

Your Perfect Squat Form

It’s always going to be in your best interest to work on your mobility and motor control limitations to improve your squat form.  However, realize that we all have different anatomical factors that may also be limiting your squat form.  This is why getting a proper assessment and individualized program is important if you are serious about enhancing your squat performance and reducing your chance for beating yourself up.

A custom program of mobility drills, corrective exercises, and individualized squat mechanics can really help you.   Sometimes you have to work within your own unique anatomical limitations.  Perhaps you just need to toe out a little more or widen your stance by an inch.  That may mean that you don’t perform the textbook perfect squat mechanics, but that may be OK, it’s your perfect squat form.

 

5 Tips for Treating Scapular Winging

The latest Inner Circle webinar recording on the 5 Tips for Treating Scapular Winging is now available.

5 Tips for Treating Scapular Winging

5 Tips for Treating Scapular WingingLast month’s Inner Circle webinar was on 5 Tips for Treating Scapular Winging.

In this presentation, I discuss how I treat some of the difficult patients with scapular winging.  I’ll overview 5 tips I use to facilitate better scapular movement and reduce winging.  These are great tips that really work when you have a significant amount of winging.

How to Cue the Scapula During Shoulder Exercises

In today’s video, I share my thoughts on the common cue of retracting your scapulae together while performing shoulder exercises.  I’m not sure this is the most advantageous cue, despite it’s popularity.  Instead, I focus on facilitating normal scapulohumeral motion.  I don’t want to restrict the scapula while moving the arm.

Learn more about how to cue the scapula during shoulder exercises in the video below.

 

How to Cue the Scapula During Shoulder Exercises

YouTube Preview Image

Learn How I Evaluate and Treat the Shoulder

Want to learn exactly how I evaluate and treat the shoulder?  My 8-week online seminar at ShoulderSeminar.com covers everything you need to know from evaluation, to manual dynamic stabilization drills, to manual therapy of the shoulder, to specific rehab for stiff shoulders, instability, SLAP tears, and rotator cuff injuries.

ShoulderSeminar.com is on sale this month for $150 off.  This huge sale goes until the end of October 31st at midnight EST.  Sign up today and also get access to RehabWebinars.com for free for 1-month.  Click here to enroll in the program today, the sale ends at the end of the month!

ShoulderSeminar.com

The Influence of Pain on Shoulder Biomechanics

The influence of pain on how well the shoulder moves and functions has been researched several times in the past.  It is often though that impaired movement patterns may lead to pain the shoulder.

A recent two part study published in JOSPT analyzed the biomechanics of the shoulder, scapula, and clavicle in people with and without shoulder pain to determine in differences existed between the groups.  Part one assessed the scapula and clavicle.  Part two assess the shoulder.

The subjects with pain were not in acute pain, but rather had chronic issues with their shoulders for an average of 10 years.  The authors used electromagnetic sensors that were rigidly fixed to transcortical bone screws and inserted into each of the bones to accurately track motion analysis.

The studies were interesting and worth a full read, but I wanted to discuss some of the highlights.

 

The Influence of Pain on Shoulder Biomechanics

In regard to the scapula, the authors found:

  • Upward rotation of the scapula less in subjects with pain
  • This decrease in upward rotation was present at lower angles of elevation, not in the overhead position

It is important to assess scapular upward rotation in people with shoulder pain, particularly emphasizing the beginning of motion.  Realize that no differences were observed in upward rotation past 60 degrees of elevation, implying that the symptomatic group’s upward rotation caught up to the asymptomatic group.  This may imply that there is a timing issue, more than a true lack of scapular upward elevation issue.  They are upwardly rotating, but perhaps just too late?

The study also found the following in regard to shoulder motion:

  • Shoulder elevation was greater in subjects with pain
  • This increase in shoulder elevation was present at lower angles of elevation, not in the overhead position

Noticed how I intentionally presented it similar to the scapula findings?  if you put the two finings together, it appears that people with shoulder pain have a higher ratio of shoulder movement in comparison to scapular movement at the beginning of arm elevation.  The shoulder caught up again overhead, so it appears that the timing between shoulder and scapular movement may have an impact.

The Influence of Pain on Shoulder Mechanics

As you can see, it is important to assess both shoulder and scapular movement together, and not in isolation, as movement impairments at one join likely influence the other.  The brain is exceptionally good at getting from point A to point B and finding the path of least resistance to get there.

I should note that in studies like this, it is impossible to tell if the pain caused the movement changes or the movement changes caused the pain.  So keep that in mind.  Regardless of causation, our treatment programs should be designed with these findings in mind.

There are so many other great findings in the study that I encourage everyone to explore these further, but I thought these findings were worth discussing.  Based on these findings, it appears worthwhile to assess the relative contribution of scapular and shoulder movement during the initial phases of shoulder elevation.

Interested in advancing your understanding of the shoulder?  My extensive online program teaching you exactly how I evaluate and treat the shoulder at ShoulderSeminar.com is on sale now for $150 off!  That is a huge discount that you don’t want to miss!  Click here to enroll in the program today, the sale ends at the end of the month!

ShoulderSeminar.com

 

 

 

Integrating Manual Therapy Techniques

The latest Inner Circle webinar recording on the Integrating Manual Therapy Techniques is now available.

Integrating Manual Therapy Techniques

Integrated Manual Therapy TechniquesThis month’s Inner Circle webinar was on Integrating Manual Therapy Techniques.  This is essentially my manual therapy system.

In this presentation, I overview how I integrate different manual therapy techniques to provide consistent and predictable results.  By combining several different techniques in a logical and sequential order, you can make rapid results with your clients.