Sunday, December 22, 2013

Reactive Stability for the Rotator Cuff

There seems to be a lot of confusion about the rotator cuff and how to train it so this will be part 1 of a two part post on proper rotator cuff training for preventing shoulder injury and improving performance. Today will focus on strength and some time later this week I will address mobility issues. Enjoy

Every joint in the body operates somewhere along a continuum of mobility and stability. Certain joints have limited motion and very high degrees of stability and are therefore more difficult to injure without excessive force or misuse. The knee for example is a very stable joint. It only moves in one plane and requires blunt trauma to cause injury in most cases [1] The hip is slightly more mobile. Think about how it moves in all different directions, allowing you to perform squats, lunges, running and whatever else you do with your hips. It still has some inherent stability because of the location of the femur in the hip socket. 

The shoulder is the least stable joint in the body. Unlike the hip there is very little stability provided by the joint structure, but in exchange we can move the shoulder to extreme ranges not possible in the hips. This is because the femoral head sits just on the surface of the glenoid fossa. Imagine a golf ball sitting on the tee. It's there but as soon as something hits it we could see problems, unless something is holding the ball in place. For this reason stability has to be provided by the muscles and ligaments surrounding the joint rather than the physical structure of the joint itself. 

Ball = humeral head, Tee = glenoid fossa. Analogies are fun!
At this point it should be evident that in order to decrease our likelihood of injury at the shoulder that we need to strengthen the muscles and ligaments holding the humerus in place. Enter the rotator cuff: This collection of four muscles make up a large portion of the surrounding structure to your glenohumeral joint and if trained properly can provide adequate stability to ensure healthy shoulders. 

Look in any anatomy textbook and you will see the actions of each of the muscles:
Infraspinatus and Teres Minor - external rotation
Supraspinatus - abduction
Subscapularis - internal rotation, flexion and abduction [2] 

However there is an extremely important function of all of these muscles that many textbooks will not mention. Every muscle of the rotator cuff provides compression to the joint through varied joint actions and ranges. This compression along with actions from a host of other scapular stabilizers provides shoulder stability. What this means is that we are only training part of the function of our rotator cuff through exercises like these.

In my experience exercises like the one featured above are over-used and over-rated. [3] I am not saying they do not have a place, simply that they are not a comprehensive rotator cuff training program and are often superfluous if your upper body routine is adequately balanced in the first place. (this is increasingly rare, but upper body programming will be a post for next week)

True rotator cuff function involves the shoulder reacting to load and velocity to protect the glenohumeral joint. The rotator cuff responds well to most compound upper body exercises if performed correctly. This includes deadlifts, rows, chin-ups, pushups, single arm pressing activities and even bicep curls. You can also utilize upper body unstable surface training as an addition to the big bang exercises we just covered. In order to get the most out of all of these exercises with regard to rotator cuff strength and function focus needs to be placed on keeping the shoulder "packed". That means retracted and slightly depressed with a neutral spine position. So for the next week try dropping all of your extra shoulder work (side raises, upright rows etc.[4]) and toss in a few extra sets of the big lifts or maybe some of the following reactive stability drills.

Staggered pushups and bearcrawls
Farmers Walks
Bottoms up KB press: Advanced rotator cuff training

Sometimes weak stabilizers are what's holding back your progress in the gym and leading to poor posture and even injury. Try taking a new approach to rotator cuff training and let me know how it goes!

[1] if you are complaining about knee pain unrelated to a traumatic injury it is probably because you've been misusing your body for a very long time
[2] the larger pectorals and latisimuss dorsi are also responsible for internal rotation, a primary reason that most weightlifters are overly internal rotated
[3] anecdotes are a dime a dozen in the fitness industry but I haven't done any direct internal or external rotation work in years and my shoulders are as mobile and strong as they have ever been
[4] i hate these exercises

Monday, December 16, 2013

Practical Applications for Unstable Surface Training

Last post I discussed the proper implementation of functional training for varied populations. In summary, functional training is whatever training allows you to optimally carry out all of the tasks you encounter in a given day. As promised I am going to take some time to analyze the most commonly used and misused functional training modalities and see how effective they actually are and when to apply them to training yourself or others.

Today we will be taking a look at the use of unstable surface training. This includes equipment such as bosu balls, wobble boards, airex pads, gymnast rings or simply adjusting one’s foot or hand position to alter stability in a given exercise. I will start by addressing what these training techniques claim to be effective for.

The general thoughts behind traditional unstable surface training are as follows:

- improving balance on an unstable surface will make balancing on a stable surface easy

- causing the core muculature to fire more during an exercise must improve core strength and therefore create more stability in my other activities [1]

If our goal in training is to improve balance and stability maybe we should define these terms.

Balance – ability to maintain equilibrium in a static or dynamic setting

Stability – the body’s ability to resist acceleration

Balance and stability can both be demonstrated in static and dynamic postures. A static balance test might be the ability to stand on one foot and dynamic balance the ability to land on one foot. Static stability is the ability to hold very still such as in a plank, whereas dynamic stability is seen when carrying a lot of bags of groceries and having to maintain a neutral spine while opening the door with your opposite hand. Dynamic balance and stability are much more applicable to real life scenarios.

So the big question is does unstable surface training (UST) provide an increased ability to perform dynamic balance and stability tasks in real life? In short, the answer is no, but let’s delve a little further into some of the research.

UST causes very different muscle recruitment than traditional ground based training. This is the primary reason for its ineffectiveness. Every action has an agonist and an antagonist movement. The agonist is the prime mover and the antagonist is the opposing muscle, or the decelerator of the movement. When performing on unstable surfaces the antagonist is recruited to a far greater degree. The unstable surface is interpreted as a threat by your body and antagonist muscles are activated as a sort of braking system. Your body knows that if you go full throttle while you are standing on a wobbly surface you are likely to get hurt. Using UST in as little as 2-5% of your training volume can alter muscle recruitment patterns in all activities, leading to decreased force output in other exercises.

Balance on an unstable surface is a very skill specific task and recruits muscles very differently than balance on a stable surface (you know, the type of surface that we walk, run and play on here on earth). Even ice hockey players who operate on an unstable surface in their sport have been shown to receive no additional benefit from unstable surface training compared to traditional strength training without unstable surface training.
Balance is very skill specific. John Wall has tremendous dynamic balance on a basketball court. On the mound...not so much

In life and in sport instability often arises from insult higher up the kinetic chain which the trunk and hips have to respond to. This is why there is some value in UST for the upper extremity. Take the grocery carrying example from before. I am not unstable because the ground was moving beneath me. I was unstable because I was attempting to move while asymmetrically loaded and dealing with a shifting load in my upper extremity. A great way to mimic this real life scenario is with a single arm kettlebell carry.

Or a plank march

We can see a similar story with balance. Dynamic balance challenges in life arise when the body is suddenly forced to shift positions and express force from varied foot positions. Simple locomotive warmup drills similar to what you might see from a track and field athlete are excellent for training dynamic balance. That can eventually be progressed to a more strength based lunge matrix routine and eventually a heavy unilateral exercise selection.

For athletes interested in increasing maximal force output (ie. All healthy athletes) unstable surface training may be detrimental to your performance. The more frequently you do these type of exercises the more the body becomes conditioned to recruit the muscles in this pattern. Bad news for people that want to be strong and fast.

This article would not be complete without addressing the issue of UST in rehabilitation settings. Unstable surface training for the lower body has been shown to decrease the incidence of re-injury in rehabbing athletes. However uninjured athletes do not decrease their likelihood of injury by incorporating this type of training.

I am not here to tell you not to utilize UST in your own programming. I just hope that you can now use it in a way that translates to the needs of you or your clients. Unstable surface training has a use for healthy athletes. Standing on a Bosu ball does not. 

[1] Research has shown increased muscle recruitment of the rectus abdominus during many unstable surface training exercises. The problem with this research, and much research built around EMG activity is that performance is not based solely on muscle force output, but on a coordinated effort of a series of muscles that fire in a specific sequence for optimal performance

Saturday, December 14, 2013

What's Your Function?

There are a handful of buzzwords that have gained a lot of traction in recent years and most of them are being used or applied completely incorrectly by the people who are supposedly experts on the topic. Some of my biggest fitness industry pet peeve buzzwords are “core” “balance” and “coordination”. These are the pillars of the so-called “functional” fitness craze that has completely overtaken the fitness industry in the last decade. So today I want to take a little time to talk about functional training. It’s a broad topic and one that will, in some capacity, be the focus of more than one post. Today I want to take a look at where it came from and how it can be used properly depending on the population applying the concepts.  And as will become customary on this blog I will poke fun at a handful of people who are doing it totally wrong.

Let’s have a brief history lesson. In the 70’s Arnold Schwarzenegger, Joe Weider and the isolationist (ie. Bodybuilding) approach to training heavily influenced the fitness industry. Because of Arnold’s relationship with the Kennedy family he has long been on the board of the Presidential Council on Fitness, Sports and Nutrition, even rising to the position of Chairman for several years in the early 90’s. With a competitive bodybuilder serving as the voice of the nation’s exercise recommendations of course machine based body part training became the exercise mode of choice. As is usually the case the pendulum eventually swung back the other way. However the pendulum appears to have swung to far in many instances

Not sure if I'm more impressed with his exercise selection or his sweet outfit
Functional training not only directly opposes the machine based body part style of training but also mirrors a lot of popular physical therapy modalities[1]. However, there are two key problems with this approach. One is that most physical therapists don’t know what they’re doing. And two is that even the good physical therapists are working towards eliminating pain and minimizing risk of injury. Outside of very specific situations your goal in training is probably not rehabilitation related so why mimic a training style based around that goal.

Some of the philosophy behind functional training is sound. Let’s make people exercise in a way that will translate to their daily functions while keeping them healthy and injury free. Improving balance and coordination is an admirable goal but if you think standing on a rubber ball while lifting very light weights is the best way to do that you are going to be sorely disappointed with the rest of this article.
Functional fitness should aim to improve your performance in your activities of daily living (ADL). Because everyone’s activities are different functional training can have a huge variance from person to person.

My stepdad lives on a farm in the middle of nowhere and has to spend a lot of his days lifting awkward heavy objects over his head and bending over to pick things up. So a functional training program for him will be designed around allowing him to do these things pain free. The program would be comprised of a lot of soft tissue work and mobility around the shoulders, a lot of hip mobility and bracing techniques and heavy loading for low volume. He is literally lifting things all day so there is no need to spend a lot of time working on weightlifting with him. Just enough to ingrain proper movement patterns and make the rest of the work he does easier.

This is Dan John, an incredible Track and Field and Strength coach. He is most known for his popularization of the goblet squat. The exercise is fantastic for teaching the squat pattern, strengthening and mobilizing the hips and strengthening trunk musculature

My dad is a similar age to my stepdad but would have a totally different program for restoring his function. He spends most of his day sitting, leading to fairy dormant posterior chain musculature (glutes, back extensors, scapular stabilizers etc.)  He wants to be able to do long distance bike rides on the weekend with his friends and be able to throw a football around on the beach with his family. Like almost everyone he has weight around his midsection he would like to lose. So his program will need to include a lot of hip and shoulder mobility but will include a lot more volume at moderate loads to allow strength building but also maintain some level of caloric expenditure. To improve his bike performance a lot of single leg strength will be emphasized (lunges, step ups etc.) Because he is older and still wants to do some agility related activities some ACL prehabilition exercises can be included in the warmup or as fillers between strength sets.[2]

True Function. No wobble board required
When people think of functional they often think of bands and rubber balls. I will address the use of various pieces of equipment in a later post but for now I just want everyone to understand that functional training is not a singular concept, rather it is a reflection of an individuals goals and needs. And almost everyone needs to get stronger and more mobile. Almost no one needs to get better at standing on a flimsy piece of rubber.

[1] My personal opinion is that the isolation based programs led to significant muscular imbalances by neglecting stabilizing groups and proper recruitment patterns, which led to a high incidence of shoulder, knee and low back injuries. In turn the industry as a whole responded by turning to rehabilitative exercise modalities as the main source of exercise instead of just lifting weights correctly. No need to throw out the baby with the bathwater. You can lift heavy weights and build big muscles without herniating a disk or tearing your labrum
[2] The concept of fillers is one I learned from Eric Cressey. He’s a fantastic coach from Massachusetts. Heavy strength exercises require long rest periods to ensure optimal performance on subsequent sets but to be efficient with training time that rest interval can be filled with low intensity rehabilitation exercises or mobility drills

Welcome to the Show

This blog is something I have been contemplating starting for a long time. At the urging of some of my most successful clients (ie. my dad) I finally caved and decided to give it a shot.

In the last couple of years I have worked in a half dozen gyms in multiple states. There were college athletics weight rooms, posh health clubs and everything in between but there were some common patterns that emerged between all of them. Most striking to me was that almost no one knew what they were doing! And this includes the trainers [1]. In most cases it is no one’s fault, people are just basing their own exercise routines off of what they see everyone else doing. And why would they know any better? Quality fitness information is hard to find. Everyone wants to sell something (equipment, supplements, training, whatever) and that usually gets in the way of actually helping people [2]. Thankfully this blog doesn’t sell anything. I just want to help everyone do a better job optimizing their time in the gym so that all of your efforts are actually helping you achieve your goals.

Ever since I began my formal education in exercise science people have assumed that I would have all of the answers to their exercise and fitness questions and they would ask my advice on a host of topics. What should I eat, what are the best exercises, how often should I lift etc. etc. Most of the time I can provide a good answer for people (although it’s not usually what they want to hear) and when I don’t know I can at least point people in the right direction. So with this blog I am hoping to take what I know about exercise and spread it to a wider audience.

My hope is to present everyone who reads this page with the knowledge necessary to handle their own fitness regimen. Along the way I hope to dispel some of the ridiculous ideas about exercise that people get into their heads. There will be a lot of discussion of weightlifting, conditioning, exercise technique and programming and basics of injury prevention. There will be a limited discussion of nutrition and physiology. Most posts will be around 500 words but I have certain topics that I feel strongly about that will warrant a longer look and some things that I find to be very simple and will be much shorter. I hope to write in a style that is both easy to read for people not in the industry and also insightful for other coaches. I appreciate you stopping by this site and hopefully you enjoy the content!

[1] [1] This is inexcusable for trainers but the lack of standards for training and coaching in the industry is a post for another time
[2] [2] I actually had a sales manager tell me that I was teaching my clients too much and that I shouldn’t be so educational because they wouldn’t need me anymore and it would hurt my business. This broke my idealistic little heart because I got into this business to help people. Sadly she was right. The client in question made awesome progress but he quit because he felt that he had learned enough to do it on his own.