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Over the last couple of years, I have utilized the FMS to screen each of my players prior to the commencement of the season. Having both tracked and treated their injuries year-long, it looks like one of the seven screens may be a powerful predictor of AC joint separations. Traditionally thought of as an injury that occurs due to the physical nature of the sport, AC separations are one of the most common injuries in ice hockey. In fact, shoulder injuries in general consistently rank quite high in epidemiological studies (see studies by Benson and Emery).

As per the FMS manual, “The shoulder mobility screen assesses bilateral shoulder range of motion, combining internal rotation with adduction and extension, and external rotation with abduction and flexion. It also requires normal scapular mobility and thoracic spine extension.” A loss of such normal scapular mobility and thoracic spine extension often results in any of the following presentations: sick scapula, upper crossed syndrome, scapular protraction, etc. And as a result, a shoulder girdle that may be more prone to injury.

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When thinking about AC joint separations, it is important to note that often it is the acromion that translates in a downward fashion rather than the clavicle moving superiorly. In each of the above faulty presentations, it is not uncommon for the acromion to already be trending toward an anterior-inferior position. Now when presented with trauma such as a seemingly benign body check, a protracted shoulder may indeed not be able to “cushion the blow” as well as one that is retracted, and may sustain an AC injury.

At least this is my take on it.

But what can we do to “better position” our players for increased resiliency?

Personally, I prefer dynamic and loaded correctives over manual stretching and therapy. Indeed soft tissue work may be necessary, but experience has demonstrated to me that the following correctives give me a bigger bang for my buck.

Try these out with your 1′s and 2′s and let me know what you think!

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“To Crunch or Not to Crunch”

No if you spend any time on the internet, you’ll know that this paper has been widely discussed. From Mike Robertson’s forum to T-Nation to Strength Coach.

Now I recently shared my two cents on core training through a webinar on Strength and Conditioning Webinars and Sports Rehab Expert but the above specifically discussed crunches.

Naturally, Dr. Stuart McGill recently had a few words to say so may I direct you to Dr. Snell’s awesome site, myrehabexercise.com. And while you’re at it, make sure you sign up for the site and use the referral code - promo46034. Click here for more information why.

Please note that the strength coach, sports rehab expert and strength and conditioning webinars links are of the affiliate variety.

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I studied the HITs system too!

Study Title: Does cervical muscle strength in youth ice hockey players affect head impact biomechanics?

Authors: JP. Mihalik, KM. Guskiewicz, SW. Marshall et al.

Journal: Clinical Journal of Sport Medicine

Date: September 2011

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Summary:

• Some of you are aware that Hockey Canada recently instituted their new Head Contact Rule in an attempt to minimize head and neck injuries, including concussions. While I think this is certainly a giant leap in the right direction, there are also many other factors to consider when it comes to injury prevention. In this particular study, Mihalik and his group of researchers looked at the role of more “internal factors” for head injury prevention, specifically cervical muscle strength. The rationale for this paper was based on the speculation that the neck can be strengthened to reduce the risk of mild traumatic brain injuries by way of tension to withstand and distribute the force of head impact.
• This prospective cohort study utilized AAA hockey players (aged 15 + 1 year) wearing helmets equipped with Head Impact Telemetry to record impact force data (linear, rotational and HIT severity profile) in real-time. Using a handheld dynamometer, body relative cervical muscle strength (as described by Kendall) of the anterior neck flexors, anterolateral neck flexors, cervical rotators, posterolateral neck extensors, and upper trapezius were measured. These results were then used to categorize the players into three groups based on strength (weak, moderate and strong) for the purposes of comparative analysis.
• Of the 7770 total impacts recorded over the course of one season, it was revealed that increased isometric cervical strength did not reduce the severity of head impacts. In fact, those players with weaker upper trapezius muscles experienced lower impact severity scores than those with the strongest recordings.
• Personally, I am not prepared to discredit the role of neck strengthening as a potential protective mechanism but I do think some things (relevant to this aspect of injury prevention) need to be considered. First, I am not quite sure how the results from a shrugging maneuver (as used to test the upper trapezius) can be relevant regardless of the findings. I would put more weight into those results from each of the other testing procedures. Second, I’m more of a quality of muscle activation kind of guy rather than a quantity. Does quantity matter? Of course, but I do think that the ability to reflexively stabilize a joint upon impact is more important than absolute strength. I would liked to have seen Janda’s and Jull’s tests rather than the ones used. Finally, we should remember that the results of this paper are demographic specific. At this age, the players are not only still developing physically, but they are also still learning the art of both rendering and receiving contact. Therefore, I would like to see a similar study performed at higher levels and at the very least, in junior age players.

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Mihalik, JP et al. (2011). Does cervical muscle strength in youth ice hockey players affect head impact biomechanics? Clinical Journal of Sport Medicine, vol 21(5); 416-421
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2. Looking at the Literature: Respiratory Evaluation and Training as an Adjunct to Manual Therapy McLaughlin, L. et al. (2011). Breathing evaluation and retraining as...
3. Looking at the Literature: Reinjury Following Acute Hamstring Strains in Track & Field Malliaropolous N et al. (2011). Reinjury after acute posterior thigh...

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Lindsay is now a chiropractic student and by the end of this weekend, will be an ART practitioner.

Anyway. She introduced me to a tool originating from Italy that I, myself, need to look into further. It may fit in and it may not. But I need to research it.

Because we first have Movement.

Functional Movement Screen

Y Balance Test

Got it? Good.

Now what about Performance?

Well she introduced me to the Optogait and the Optojump. And I think it might fit in. It might not. But then again it might. I just need to look into it further.

What do you think?

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www.functionalmovement.com

www.sfma.com

www.ybalancetest.com

Note: If any of you are unfamiliar with any of the above systems, may I first suggest that you check out the links above.

Having integrated their systems into both athletic and clinical practice over the past several years, I felt it was necessary for me to attend the internship to fully understand the goals of the “system”, particularly since one of my objectives is to perform risk identification research here at the University of Alberta in the near future.

While this was certainly a comprehensive internship, my goal here is to provide you with a brief review of my internship experience.

To start off, I will first admit that while I have been using the SFMA for quite some time, there have been many instances where I have “broken the rules”. So one of my objectives coming into the internship was to truly understand when breaking such rules is ok and when doing so may be a bad idea. Take for example the treatment-based classification for low back pain. Research has demonstrated that there may be instances where manipulation, stabilization exercises, and other treatment strategies are appropriate for patients presenting with low back pain. Now if you’re familiar with the SFMA, you’ll understand that often your assessment will lead you to areas away from the region of pain for the purposes of correction and treatment. So taking both of these into account, should we indeed be breaking the rules and adhering to the TBC or should we strictly follow the SFMA. Well based on our discussions during the internship, it basically comes down to this:

“The rules are there to keep you safe when you don’t know what you don’t know…that ultimately, you just need to know why you got to where you got”

Many of you who FMS trained will know that the FMS is a tool used to aid in predicting injury prior to participation in athletic activities. You will also know that the objective of the FMS is to identify movement pattern dysfunctions that may lead to injury through identifying an athlete’s (in)ability to perform 7 specific movements. What you will also know however, is that the FMS has come under intense scrutiny in recent years not only due to a misunderstanding of its role in clinical scenarios, but also due to its use for anything other than its true objective. Specifically, it has been criticized to lack both a measure rotational competency as well as end-range, dynamic stability and as a result, many professionals simply aren’t convinced. Ultimately, my goal here is not to change one’s mind but simply to introduce the Y Balance Test.

The Y Balance test was covered heavily in this internship and since I was relatively unaware of its role in the overall system, I can honestly say that learning this test has really opened my eyes and mind to the role it plays in the identification of injury risk. Incorporating both an upper and lower quarter component to end-range, dynamic stability testing, this test now occupies a large space in my shed. Through its combination with the original FMS, as well as the software by move2perform, I really and truly think that this system holds a lot of power in identifying an athlete’s future risk of injury. To put it simply, the Y Balance Test seems to be an excellent predictor of risk (at least in the current literature) while the Functional Movement Screen tells us why and how.  Now combine this with a previous history of injury, the athlete’s sport and age and boom…you have an excellent algorithm for risk identification. Oh wait, this already exists with the move2perform software!

One of the highlights of the internship was an evening kettlebell session with Paul Gorman, ATC, RKC, CSCS. As someone who uses kettlebells but has never been formally trained, this was an excellent learning opportunity for me to truly understand its role in the rehabilitation setting. Paul spent plenty of time teaching us methods for progressing the Deadlift, Swing, Turkish Get Up, and Goblet Squat. Specifically, he broke each of these movements down to their component parts and really elaborated on what we should be focusing on when working with our clients and athletes. I can provide you with all the specific details here but I truly believe that formal training is a more responsible form of learning that a simple blog post. What you should note however, is that adherence to proper progressions is the key to kettlebell training. That said, here are some images and videos from this KB session.

Taking things back to the FMS, another highlight of this internship was a conference call / webinar with Rob Butler of Duke University. Rob has been heavily involved in FMS research as of late so this was an excellent way for each of us to truly understand the literature behind their system. Aside from providing us with a comprehensive review of the current literature as well as studies in progress, Rob also provided us with some notable quotes that really shed some light into what we are dealing with.

“MDs want and MRI…I want an FMS, SFMA, and Y Balance”

“Why is a dysfunctional deep squat a medical emergency at 2 years old but not at 14 years?”

“Can we upload a better motor program?”

“We need to clear fundamental movement…’but it hasn’t been shown in research’…ya, but what else has?”

“FMS & Y Balance, the portable gait lab”

“When you screen someone, you’re telling them something they already know…but now you’re objectifying and quantifying it”

“Y Balance – to test for if…FMS – to test for why“

Another significant component to this internship was the application of the system into our everyday practices, be it the athletic or clinical setting. Each delegate was to present a case study where the group was to both critique and provide recommendations to enhance our learning. Interestingly, Kyle also provided us with a rounds type of case presentation that to our benefit, resulted in the incorporation of dry needling in treatment. One of the delegates was a therapist from kinetacare, so he was kind enough to demonstrate the use of needling in a live scenario. The video below is not of the actual case but of another delegate receiving treatment for a neck complaint.

Overall, this internship was a success for me as a practitioner at this current stage in my career. Again, my objectives for this course was not only to truly understand the system in its entirety, but also to solidify my understanding of patient management based on my current knowledge of the existing research as relates specifically to the functional movement system  as well as sport medicine in general. Most certainly, one can hold a successful practice without ever taking any of these courses, however, for me, any opportunity to further myself as a clinician is just icing on the cake.

If you’re interested in specific details of information that really resonated with me over the week or simply want more information of any component of the functional movement system, you’re more than welcome to use the comments section below.

Apparently women don't like the SFMA?

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July 22 – 23, 2011

Click here to register.

For more information on the Functional Movement Screen, go to www.functionalmovement.com

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“We’re having a injury-ridden season this year, and we’ve been trying to determine why. We do see very common trends among the men, and we believe it’s the guys’ lack of scapular stability and endurance in the stabilizer muscles, and general thoracic cage stability…We see a lot of mid-back injury and especially rib injuries, and very commonly rib stress-fractures.

Now, these guys have the best Strength and Conditioning team around, however the medical team feels that they’re…not getting enough stability and shoulder blade mobility exercises (they basically need to improve the stability of the scap to work in a large range of motion).

Anyway, I was wondering what you thought were the best couple of exercises for scap stability and serratus anterior activation. Now these guys are elite athletes, they’re amazing machines actually, so they can probably do some advanced stuff, but I think we need some activation exercise, and then followed by integrating this into some advanced functional movements!”

Admittedly, I have never worked with a rower in my life. However, having examined some of the current literature (Vinther et al, Warden et al) it seems as though the exact causal mechanism for such injury is not clear cut. That said, first things first.

Stress Fractures = Bone Resporption > Bone Repair

(at sites of microfractures secondary to repetitive loading)

While certainly stress fractures may be associated with abnormal (low) levels of bone mineral density and its associated factors, several causal mechanisms have been proposed to describe its etiology. Namely:

• Sheer forces resulting from co-contraction of the serratus anterior and external oblique
• Increased co-contraction levels of the serratus anterior and lower trapezius
• Poor eccentric control of shoulder flexion
• Faulty motor patterning (timing) between the lower body and the upper body
• Inadequate knee-extension strength to elbow-flexion strength ratios

From a training and periodization standpoint, it is quite easy for those on the outside to immediately suggest that such athletes are “doing too much too soon”. However, seeing that such fractures are quite common regardless of the level of athlete, we cannot simply point the finger at loading parameters. Anything and everything from biomechanics and motor control to poor nutrition to improper rest is fair game. Certainly a thorough assessment must take precedence but with respect to the above question posed, here are some recommendations for simultaneously improving scapular mobility and stability.

Scapular Mobility:

(I really like this video)

Assisted Push Pull / Twister (sorry, I couldn’t find a video on youtube)

Scapular Stability/Eccentric Shoulder Flexion:

With respect to motor patterning between the lower and upper of the body, I would consider utilizing such exercises as deadlift and jump squat variations, however, I will leave this for another post. Hopefully some of the above strategies will prove useful when incorporated into the overall training programs of these athletes. Certainly several of the exercises above are anterior chain dominant however, these athletes are exceptionally strong posteriorly and so ensuring balance between the two seems prudent. They are by no means definitive, but when indicated for the right individual, I think they can be helpful. What are your suggestions?

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You walk into a specialty store dedicated to running. For the Canadians, you know which one I’m talking about. You’re a relatively fit individual looking to run your first half marathon or are someone new to the fitness industry and would like to run to get into shape. A store employee asks how he or she can help you and you inform them of your intentions. “Great” he or she says and proceeds to ask you to remove your shoes and socks so that he or she can take a look at your feet.

“Since we all have different types of feet and walk/run uniquely, then it’s important that you wear sneakers best suited to your running style,” he or she says.

You’re excited.

You quickly remove your footwear and the employee then checks your shoe wear-pattern, looks at your arches, and watches you walk.

“Great. You need a stability shoe!”

Does this sound familiar? Good. Because for some reason, everyone and their mother seems to require a “stability” shoe.

It really amazes me that some retailers go through all the trouble of looking at your arch and asking you to walk when all they will do is recommend the exact same sneaker to 95% of individuals every time.

Selling tactic? Maybe.

Time waster? Probably.

Something important? You be the judge. Have a look at this paper, published in the American Journal of Sports Medicine last year and ask yourself that question again.

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Now if they suggest a motion control shoe, run away. Far far away. Even if you’re running barefoot, just keep running. You’ll likely suffer from less pain running barefoot than you will with a “motion control” shoe. In reality, you’ll probably be fine with a neutral or stability shoe but this randomized controlled trial by Ryan et al, demonstrated that motion control shoes are NOT the way to go!

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Now what about my arches?

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The Solution

Below you will find several links to posts throughout this site to help facilitate “stability” and “motion control“. There are certainly no shortage of options so rather than giving you a generic solution, I have decided to provide you with a list of links that may assist in adding to the strategies that you may already employ.

• The Short Foot
• Ankle Dorsiflexion
• Frontal Plane Instability
• The Glutes
• Low Level Stretch Shortening
• The Glutes…again
• The Hip
• and finally, the core
• And the core some more!

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www.fics-sport.org

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Aside from the fact that this symposium will be held in Brazil…

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…yours truly will be presenting a lecture on “Functional Return to Sport: Bridging the Gap between the Clinician and the Strength Coach”.

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For the entire program, please click here.

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Authors: N Malliaropolous, T Isinkaye, K Tsitas & N Maffulli

Journal: American Journal of Sports Medicine

Date: February 2011

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Summary:

• Through one simple omission, this article provides little value. As you may be aware, the biarticular nature of the hamstrings seems to put this muscle group at higher risk of strain than monoarticular musculature. Since previous research has demonstrated reinjury rates as high as 34%, the objective of this cohort study was to determine whether a specific clinical assessment may be able to provide indicative factors of possible reinjury following an acute hamstring strain. 165 elite track and field athletes with first-time strains were evaluated in this prospective study. The specific clinical assessment utilized was a 4-grade classification system of hamstring injury based on active range of motion (AROM) – the greater the AROM deficit, the greater the severity of injury. Interesting classification system if you ask me! All athletes followed the same standardized plan of management following their injuries although the rehabilitation protocol was not described. Based on this classification system, it was revealed that athletes who suffered a grade II hamstring strain demonstrated a significantly higher risk of reinjury than those who suffered a grade I, III, and IV injury.

• Unfortunately, the results from this study mean very little to me since the rehabilitation protocol administered was not provided. One of the highest risk factors for reinjury is previous injury so it is clear that in non-contact sports, many rehabilitation and sport conditioning professionals are missing the boat when it comes to return to play. Therefore, in my opinion, a grading system based on AROM has little value compared to a well designed return to play rehabilitation and conditioning strategy as it pertains to minimizing the risk of reinjury following acute hamstring strains in elite track and field athletes.

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Malliaropolous N et al. (2011). Reinjury after acute posterior thigh muscle injuries in elite track and field athletes. American Journal of Sports Medicine, 39(2); 304-310

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Authors: DW Creighton, I Shrier, R Shultz, WH Meeuwisse & GO Matheson

Journal: Clinical Journal of Sport Medicine

Date: September 2010

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Summary:

• For those of you involved in sport medicine, here is an excellent example of scientific insight into the factors that may influence and determine Return to Play decision making.  This paper, authored by individuals at Stanford University, McGill University and the University of Calgary, details the all important, multifactorial decision making process of allowing an athlete to return to “full participation in sport without restriction”.  Through a literature synthesis, a model that included the Evaluation of Health Status, Evaluation of Participation Risk, and Decision Modification was proposed.  While the authors noted that the ability to quantify several decision elements may be limited, they suggested that decision modification must only be considered once participation risk is determined.

• Although seemingly short and straightforward, this paper provides comprehensive insight into the variables that must be considered by those in a priviledged position to determine whether or not an athlete is permitted, let alone mentally and/or physically capable of, returning to sport.

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Complete resolution of symptoms “cannot be considered in isolation” when determining return to play

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Creighton DW, Shrier I, Shultz R, Meeuwisse WH & Matheson GO. (2010). Return-to-play in sport: A decision-based model. Clinical Journal of Sport Medicine, 20(5); 379-385

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Prior to reading the following, I kindly ask that you take two things into consideration:

• The notes were subject to my interpretation and therefore may not be 100% accurate
• All statements made have context. There are no absolutes and the suggestions presented depend on the context upon which each statement was made

Enjoy!

Page 1

• Range of motion and strength do not necessarily correlate with recovery
• Achieving new range of motion (stretching) does not necessarily change movement patterns
• Evidence on the Transversus Abdominis is dying out
• Find motions, postures, and loads that make the individual worse. Then take it away and check again

“Build capacity within tolerance within an injury mechanism that is part of their sport”

• Injury = Load > Tolerance
• The culminating event is rarely ever the cause of a back injury
• Very rarely is a max 1-RM lift a mechanism of injury
• It’s not the load that causes the injury, it’s the amount of strain
• Tolerance – the amount of load a tissue can take right now
• Capacity – the sum of the work that they can do before they break into pain. Train within the capacity every day with enough rest and the capacity will increase

“The Lats activate natures ‘back belt’”

• Longissimus Thoracis – The biggest back extensor is a thoracic muscle
• Most patients hurt their back in shear before they do in compression
• Fatigue is a killer of protective movement patterns. Just because they move well, it doesn’t mean they will

“Scientists set up experiments in order to find what they’re looking for”

• The contribution of the Rectus to flexor torques is between 10-15%
• The Rectus is not designed to change length
• Sit ups are designed to use the obliques
• Core elasticity – short range stiffness to allow the extremities to fly
• Psoas not only acts as a hip flexor but also to lock the pelvis to the lumbar spine
• Spinal Manipulative Therapy – to reset the neural system via the intertransversarii & small rotators. These are the proprioceptors as they are the most spindle rich muscle fibers
• On neuromobilization and nerve flossing – it is important that we get the bulge down prior to flossing

“The squat is a hamstring exercise until you get halfway down. Then it hits the glutes”

• The upper and lower glutes have different neuromuscular components. The lower fibers are active with a deep squat and the upper fibers with an external rotation load.
• Bent knee sit ups – 3400 N of compressive load vs. Straight leg sit ups – 3200 N of compressive load (NIOSH limit = 3400 N)
• Dr. McGill is less worried about the differences between the bent knee and the straight leg sit ups. His concern:

“What a stupid exercise!”

• Always start a painful low back in the sagittal plane to build tolerance. Then progress to the frontal and finally to the transverse plane.
• It is not only about muscle activation but also the corresponding load on the low back.

“The orientation of interspinous ligaments are backwards in English anatomy texts”

• Latissimus dorsi is important for stabilizing the upper lumbar spine
• Compressive load generally stays the same while shear loads decrease with a neutral spine
• Muscles create force linearly with neural drive
• Muscles create stiffness asymptotically (stiffness always stabilizes the spine)
• Symmetry of stiffness is important
• Stiffness can be created at relatively minimal forces in order to create co-contraction. Too much force is detrimental
• The risk of injury is present at very low and very high levels of activation…depending on the activity
• On the use of ultrasound – there is no relationship between the amount of muscle thickness and electrical activity. Muscles are found in layers, some muscles just go along for the ride
• Extending the hip with hamstrings jams the head of the femur anteriorly into the labrum. The glutes pull the femoral head posteriorly

“Building strength too soon may keep people chronic”

• There is no best stabilizer muscle. It changes all the time.
• What is a good stability exercise? Anything that creates a movement engram / pattern that creates stability…with decreased spine loading and sufficient muscle activation

“Abdominal hollowing is pathological”

• The pelvic floor and the abdominal wall have an inverse relationship. Stop a fart, create a fart
• We must divorce the diaphragm from the stabilizers. We must be able to breathe through the brace. (note: the diaphragm has two functions, respiration and posture/stability. In the presence of fatigue, respiration will always win)
• “I’m a marathon runner”…”Well good for you, because you’re not a good athlete”. A good athlete is someone who can be dexterous while sparing their joints
• Intervertebral discs really do not compress very much. They push on the end plate and as a result, the trabeculae compresses.
• Endplate disruption is of the transverse trabeculae
• Schmorls Nodes – are actually endplate compression fractures
• Posture will make your spine stronger by 30%. If you want to hurt your back, break form!

“The spine will break at 18% less load in the morning”

• Endplate fractures – decrease the space between the vertebrae and increase the load between the facets. This results in extension intolerance

“Stop treating your spine like a ball and socket joint”

• Degenerative disc disease vs endplate fractures. DDD never occurs at a single joint segment, you’re more than likely seeing an endplate fracture so find the mechanism of injury
• Provocative testing will show you where you can and can’t take loads
• From Noyes’ research – ligaments avulse under slow load and tear at the midsubstance with high/rapid loads
• Disc injuries are a result of delamination. Fatigue injuries vs torn collagen. “Nuclear worms” work their way between layers over time resulting from a very specific movement pattern – repetitive flexion / extension under load

Pages 16 & 17

• “Nuclear worms” respond well to McKenzie techniques…if there is adequate disc height left
• Radial herniations are a result of flexion + torsion
• Limacon-shaped discs are sagittally strong – have very focal injuries
• Ovoid-shaped discs are rotationally competent – have diffuse pattern injuries

“Patterns of herniation are patterns of repeated stresses which are patterns of movement patterns”

• Sloppy pushups work…but only if they have 70% of their disc height left (for a hydraulic effect). Unfortunately, they also traumatize the facets
• Sitting is ok for the virgin spine. But not ok to a spine that has even a little bit of an injury

“There is no bad exercise…just bad form and inappropriate loading parameters”

“Do you know one world class athlete who does crossfit? I don’t, because training to failure repeatedly outpaces the opportunity for repair”

• Remove the cause of their trouble before you recommend therapeutic exercise
• We must identify what is tolerating, exacerbating, and relieving
• There may be a correlation between a sports hernia and the inability to hold a side bridge for > 70 seconds
• Poor side bridge performance predicts one’s sitting posture
• Instability “catches” disappear with exercise therapy and motor training
• The presence of a lumbar spine hinge often demonstrates a necessity for the latissimus to contribute to stability
• Weakness vs lack of motor control – if the brain can clean it up, it’s likely a motor control issue
• Use the quadruped rockback to find out how wide you need to be to squat, get out of a toilet, etc
• Scottish hips – have a deep socket but a prominent rim
• Ukrainian hips – have a shallow socket and round hips

“The best QL training is to go for a walk”

• If you can get a nerve to floss, it will find its own pathway (but remember, we must first remove the cause of irritation
• The fundamental emphasis of the Glutes is not extension but external rotation
• Manual biofeedback - to stimulate muscle contraction, brush lightly against the grain of hair
• Know the following characteristics of pain: skin, bone, nerve, ligament, muscle, fascia, peritoneum
• The Internal Oblique and the Transversus Abdominis are twins – they almost always work together
• What is a stabilization exercise? – Anything that grooves motor patterns to ensure sufficient stability

“Follow the endurance pathway”

• The cat/camel is a mobility exercise, not a stretch. Optimal number of cycles: 6-7
• When performing the curl-up, the cue is to “unweight the head, neck and shoulders to make the scale weigh 0″. Don’t forget to dissociate breathing

“The curl-up really isn’t a curl-up”

• The highest level of clinical vigilance will get you better. It’s not just the exercise, it’s owning the exercise
• In the presence of a diastasis recti, play with the pushup progressions
• Sweeing the floor in the bird dog induces new blood perfusion
• The most difficult patient won’t fit in a traditional category. Therefore we must only add one new challenge at a time in order to identify what gets the better or makes them worse
• When qualifying an athlete for training – know their demands, capacities, deficits, and special risk of injuries

“Don’t train the failed tests, train the reason why they’re failing”

• Everyone has a limited capacity…use it wisely
• Stretching prior to performance – in some instances we may want to inhibit specific muscles
• The bench press – a grinding exercise that teaches neural capacity. Use the brain to get through sticking points

“Core strength makes the impossible, possible”

• The best spine challenging and sparing exercise for the anterior chain is a staggered pushup
• Spine Power = P = F x V. Always keep one of these at zero
• Speed comes from relaxation – you get quick by relaxing muscles
• Bracing needs to act like a dimmer switch – to tune and be ready at 20-30% MVC
• < 20 % MVC – won’t get enough elasticity
• > 30 % MVC – will be too stiff and will not be able to get springy

Page 32

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