Concepts For Mobility

This past week in Boston was one filled with continuing education opportunities and knowledge bombs galore. From Thursday to Sunday in the Boston area you had an opportunity to check out the following….

• 3 Seminars from San Fransisco PT/Crossfitter: Kelly Starrett
• 2 Days of FMS Training with Gray Cook and Lee Burton
• 1 Day of Nutrition Lectures with Robb Wolf

With that being said, if you train people, Boston was the place to be this past weekend as far as continuing education goes. Since I did the FMS seminar last year and I knew that it wasn’t likely that I’d have an opportunity to see someone from the west coast out here again soon I went all in and saw as much of Kelly Starett’s presentations as possible.

I can hear the functional party ranting already…”Pshh a Crossfitter what can you learn from him besides how to injure someone??”

It turns out you can learn a lot…

Kelly Starett is a brilliant physical therapist and owner of San Fransisco Crossfit. He currently maintains a blog entitled www.mobilitywod.com where he posts one mobility video EVERY SINGLE DAY!! (Check this out for serious and practical knowledge bombs daily!) Say what you want about Crossfit, but Kelly and his team do it right out there.

My roommate and fellow MBSC coach Brendon Rearick extended an invitation to Kelly to give an in-service presentation here at MBSC while he was in Boston for two other seminars and he politely obliged . Some great education followed. In addition to giving us nearly 3 hours of an in-service at our gym Kelly extended a free invitation to attend his full day seminars being held in Boston on Saturday and Sunday. 8 hours of free education?!?! You’d better believe I was all over that. So over the weekend a handful of MBSC coaches and I crossed over to Crossfit and attended a kick ass seminar. Here is some of what I picked up.

– Mobilize for specific position not anatomy

• When thinking about mobilizing a joint it is best to think about it in a position specific model rather than an anatomical one. Knowing your anatomy is necessary but it tends to get lost in translation in a practical sense.

Take this for example..

You’re mobilizing your hip externally rotated and flexed. You know that your lacking mobility in hip ER but what is limiting you your piriformis, glute min, med, gemelli, quadratus blah, blah, blah. The point is you don’t really know. So make it simple and mobilize in external rotation. Don’t over think it.

– “Look at the shoulders and hips as analogs of one another.”

• Thinking of the hips and shoulders in this fashion really helped me. I once heard Gray Cook say that the Eastern Cultures referred to the shoulders and hips as “The 4 Knots.” When you think of these joints and how they function best in movement you start to see the patterns appear.

• The shoulder needs external rotation in flexion…think OH pressing/pulling/throwing

• The shoulder needs internal rotation in extension…think Throwing/Swimming.

• The hip needs external rotation in flexion….think squatting

• The hip needs internal rotation in extension…think running/swinging/throwing/the back leg during an SLDL

Thinking of the hip and shoulder in this fashion allows for easy reference when it comes to picking positions for mobilizations. Ask yourself….What positions do you find your joints in during training and competing? Where are you restricted?

-Have a stabilization strategy and enter “the tunnel” in a good position

KStarr had a great metaphor for the proper set-up for exercise. I know this one really stuck with me and the other coaches from MBSC as it has been repeated multiple times since then. He made the analogy of setting up for an exercise as “Entering The Tunnel.”  Simply put, if you intend to exit the tunnel (or execute and finish the exercise) in the proper position you must enter the tunnel (or exercise) in the proper position well. This sounds like common sense but how often do we waste our breath cueing an athlete who is in a bad position while under load??

Picture this…You have an athlete who is doing a heavy front squats with his knees caved and back rounded and you cue him to “get his chest up and get his knees out!!” Do you actually think the athlete is going to be like “Sorry bro” and fix himself half way up with 400lbs with the rack position?!? Of course not. There was something wrong to begin with and they couldn’t handle the load. If we are out of position and we are under load it’s not going to change. Lack of stability in the center won’t allow proper positioning in the periphery.

All of this goes back to something I heard from Charlie Weingroff and was reminded by Kelly this past weekend. “Proximal stability before distal mobility” which means we must have stability in our mid-line structures (proximal stability) before we can maximize our extremity function (distal mobility).

Without having the proper stabilization plan first we won’t be able to get into our necessary positions to enter or exit the tunnel properly.

Check out this video where Kelly probably does better job describing “The Tunnel” than me..

– Follow the system

• Kelly presented a great system that can be followed to improve mobility at any joint. The system mirrors much what has been presented by Boyle, Cook and Weingroff in the past but served as a great reminder.

The formula for improving your mobility goes like this.

1). Test Your Range

• We have to know where we are now if we’re going to figure out where we’re going. Find out where you need mobility. Test based on the positions you’re looking to improve. You can use things like table testing, FMS or simply have them squat or reach their arms overhead. Start with what is worst and go from there. 

2). Improve Tissue Quality 

• Perform some sort of release on the tissue to break down the nasty tacked down mess of myofascial net that is preventing you from burying that squat, causing you knee pain etc. Your tool: lacrosse ball, foam roller, softball whatever works really. Just start digging for that restriction in the position you want to improve.  Bottom line is we have to improve the quality of the tissue and it probably isn’t going to feel great.

3). Mobilize 

• After applying some pressure to the tissues via some sort of release tool you’ve got to get that joint moving in the range you desire to improve. It’s more than static stretching, the joints have to move hence the word MOBILITY. Mobilize in the position of restriction. (You see the pattern here)

4). Re-Test 

• After we mobilize it’s important to re-test. How will we know if we improved ROM if we don’t re-test?  Repeat step one and look for improvement. If it doesn’t look better than it’s not. You either need  different mobilization or it’s not a simple mobility problem. This is a simple step that a lot of people miss and it only takes a second so DO IT! Don’t miss this step!

5). Use it before you lose it!

• If you have got new range of motion USE IT!! We’ve heard Gray Cook say this before. “Use it before you lose it ” is true when it comes to mobility. New range of motion at any joint is useless if you don’t strengthen it. Lack of stability in your new found joint freedom will cause you to lose it all over again. Work the new range to hold onto it.

I like systems, they make things simpler. Follow this system and the power will be in your hands to improve your mobility as well as your clients. Credit goes to guys like Boyle, Cook, Weingroff and Starett for dropping this knowledge on me, I’m just relaying the information. I’m truly standing on the shoulders of giants with this one. Now go to www.mobilitywod.com and start mobilizing. 

7 Guidelines For Training Adult Clients

Along with coaching high school and college-aged athletes I also train a number of middle-aged adult clients. In fact, almost half of the hours I spend training people throughout the course of any week is spent training clients who are 40+! So, if I must toot my own horn for a second I think I’ve gotten pretty dam good at training the aging weekend warriors, stay at home house-wives, overweight oldies and every aging adult in between. I feel very confident programming for this demographic and believe I have some great insight when it comes to restoring function and improving long-term quality of life in adult clients. The truth is the rules I follow are not that different from when training young athletic populations. Here are some of the guidelines I follow.

1). Leave No Stone Unturned  in Assessment

This should be a general rule of thumb when it comes to all clients but I find my assessment sheet becomes more cluttered with writing when it comes to my adult “athletes”. Years of wear and tear lead to a number of injuries and pathologies that often go unnoticed or written off as simply a result of “old age.” The fact is nobody should be in pain and everybody’s dysfunction can be resolved either by me or a more skilled clinician.

It seems like every adult client that I get makes me play my least favorite game entitled “Find My Pain and Dysfunction”

It goes like this….The health and injury history form comes back glowing. No history of pain or injury in sight. I say “Wow, no aches, pains or injuries ever!?!? Write down anything you can think of big or small I have to know!” They answer “No, I’m healthy and ready to go!”. Common sense tells me this is next to impossible and  in my head I think “We’ll here we go again…”

More often than not only  about 10 minutes into an assessment I find out about that shoulder injury from high school hockey when you got buried into the boards. To which they often say “Yeah it’s not a big deal, I just can’t lift my arm over my head, I’ve just got a lot of miles”  Either that or it is the chronic low back pain that they didn’t think was worth mentioning. This is why assessment is so important. To them “It’s just old age” to you it’s pain and dysfunction that needs to be dealt with.

Here is what I do

• Watch: How do they walk, move, sit, stand etc.. Are they rubbing their shoulder or low back as you go through the movements?
• FMS: This should be the standard of movement for all humans. Follow the formula and stick to principles and it will lead you to your corrections. Remember if there is pain here the score is 0. Refer to a medical professional or go to the SFMA if you are qualified.
• Table Assessments: Go here to help confirm your findings in the former. Check things like hip mobility, ankle mobility, hip strength, shoulder ROM. This can be a great way to clarify some of things you may already think that you are seeing through the screen.
• Have an “Assessment Workout”: After my aforementioned assessments I put all my new clients through a standard “assessment workout.” This works out great as I usually have 30 minutes left  after my initial assessments are done. I use this as an opportunity take another look at all of the major patterns assuming I don’t see a red light somewhere in the FMS. Furthermore, I can see how move through a linear movement warm-up and can get a general idea of their overall fitness level by watching their general fatigue. Now, I can see the clients general coordination and get a glimpse of their conditioning levels in addition to their movement limitations.

Now we know their limitations and where we need to lay some groundwork before we start really training certain patterns. You can see your red, green and yellow lights. Program your corrective work where it’s needed  and start training everything else. If nothing else remember these two things “If it hurts, don’t do it.” and “Pain = Referral”

Just Do It.

2).Full-Out Assault on Soft Tissue Quality

By far the number one need for all adult trainees that I see is improved soft-tissue quality. Everybody that comes in seems to be jacked up somewhere. We do self-myofascial release and mobility work and stretching of some variety everyday. All my clients are familiar with the the roller, lacrosse ball, and tiger tail whether they like it or not. This does not mean dig in every inch of the body. It means tack and dig with purpose. Teach your clients what their problem areas are, how to attack them and why it is important.

I have a confession to make: I still believe in static stretching. Now I know it won’t work in all situations. A lot of people are “locked long” and all the stretching in the world won’t loosen them up. That being said I have a lot of adults who are simply tight. I’ve seen remarkable improvement in hip mobility with a little bit of soft tissue work combined with contract/relax and static stretching. If you know that they are tight and short somewhere then stretch them. See if it helps. If it doesn’t go back to the drawing board. Once again, the FMS should give you the guidelines to figure this out.

In addition to all of this, make sure your clients hydrated. We know hydration improves soft-tissue quality. Keeping proper hydration will ensure that their tissues don’t more matted and nasty than they already are.

It can't hurt to do...well it might hurt a little bit.

3). Explosives and Plyometrics The Right Way

We’ve all heard the research before. As we age beyond our twenties we begin to lose our ability to produce force at an alarming rate. More specifically we see a loss in reactivity as well as the ability to create explosive power. So is it in our best interest in try to promote reactiveness and explosiveness in our aging clients right?!? Well yes, but with the right implements.

We have to think think about “explosiveness and reactivity” in relative terms. What is a plyometric for a 50 year old adult? It might just be a ladder drill  not a continuous 45* bound or depth drop to hurdle jump. You get what I’m saying? They don’t need bounding all over they simply need to be moving reactively and stabilizing their landing as much as THEIR body allows.

As far as building explosive power goes I’m all for KB swings for adult clients who clear the assessments but they probably don’t need to doing olympic lifts. If their patterns don’t clear have them use the shuttle jump or jump squat. My clients do medicine ball throws everyday combined with one of the aforementioned implements. These can lead to a great training effect with far less chance of injury.

I think plyometric and explosive work is necessary for adult personal training clients. We should be training adults to be powerful and reactive so long as we choose the correct means. It comes down to what is explosive in relative terms not absolute terms.

4). Build/Maintain Muscle Mass and Joint Mobility

Everyone knows that as we age we fight the battle against atrophy. As we head north of thirty and beyond it is my belief that we should literally be in a fight to the death to maintain our lean body mass. In addition to muscle atrophy we also tend to see a loss of joint mobility in our joints in which need them most (Big Toe/Ankle/Hip/T-Spine). Our western lifestyle combined with the natural biology of aging makes for double whammy of sorts when it comes to our body breaking down. Failing to battle these two elements will leave us high and dry, making daily function a severe challenge.

Well how do we fight it…??

Enter Dan John, Legend.

The need to battle this loss of function in aging populations was something grealty reinforced to me by Dan John when he came to speak at MBSC for our winter seminar. Dan stressed that the battle against aging is won by increasing lean body mass combined with increasing mobility in the proper places.

Dan brought attention to Janda’s Upper and Lower Crossed Syndromes, as it should be a basis for training everybody.

In summary, we have “tonic” muscles that are generally prone to tightness and shortness and are in need of flexibility and mobility in their associated joint as well as “phasic” muscles that are often weak and inhibited and need activation, strength and hypertrophy to provide stability. Lets take a look at  some of the list.

Phasic

• Rhomboids
• Lower Trapezius
• Gluteus Maximus, Medius, Minimus (Dan said the best sign of virtility is a muscular butt!)
• Deep Neck Flexors

Tonic

• TFL/ITB
• Pectoralis Major/Minor
• Upper Trapezius
• Rectus Femoris
• Quadratus Luborum

This is not all of them but you get the point. Stretch what needs to be stretched and get more mobile. Strengthen what needs to be strengthened and build some lean body mass. Increased mobility means more functional range of motion during daily life an probably less pain. Increased LBM usually means faster metabolism, less body fat and improved visual appearance. Ask yourself, “What middle aged person doesn’t need all of these things?”

Would you rather look like this....

or like this???

5). Locomotion

As far as goals concerning body composition and truly functional core strength I don’t think you get more bang for your buck out of any exercise than you do with carry variations. ( I know this is also Dan John inspired. What can I say he is a legend.)Once we progress to carries from exercises like planks and pressouts I  like to program them as much as possible for a couple reasons.

1. They provide a great demand in core strength combined with locomotion making them a metabolic challenge in addition to a core exercise.
2. For the average person back injury comes from picking up, putting things down and carrying things improperly. Carry variations teach you how to do all three of those things correctly if you coach them right. They provide a core demand that these adult athletes can carry over more conciously to daily life.

Along with providing a truly “functional”(there is that dirty words again) core demand these exercises provide full-body engagement during locomotion. So not only do we engage the correct muscles to fire in the right places but we get actual movement at the same time. This is a win-win for gaining muscle mass, burning fat and fighting the upper-lower crossed.  Programming carries CORRECTLY provides for a full body muscle builder, fat burner and posture improver all in one.

6). Single Leg Work

Single leg work is my predominate mechanism for training the lower body in my adult PT clients. The ability to spare the back and train the legs is priceless when working with aging clients since the majority of which have some history of low pack pain.

Rear-Foot Elevated Split Squats, Single Leg Squats, Single Leg Deadlift and Skater Squats are my primary lower body lifts of choice. They allow me to train the posterior and anterior musculature of the lower body effectively with0ut increasing the chance for low back injury.

With that being said I have not totally abandoned bi-lateral lower body strength work with my adult clients. All my clients learn to BW/Goblet Squat properly as well perform the hip hinge in some capacity provided they clear the screen. Those without a history of chronic back pain who show me they have the prerequisite stability and mobility to deadlift, will do so. I think the squat and hip hinge is crucial pattern that needs to be trained if we have the ability to do so.

A middle-aged athlete doing a single leg squat

7). Condition, Condition, Condition

Since the number one goal of all my adult clientele is living longer, healthier lives improvement of cardiovascular health and body composition is paramount. There is not a day that goes by when my adults come into train that we don’t get some form of high-intensity work in through some medium. Here are some of the different apprpoaches I take to conditioning a during the last half of our work out…

Metabolic Circuits for time or reps: 30 on/30 or 10 reps of each or something similar.

1. Goblet Squat
2. Farmer Carry
3. Push-Up
4. TRX Row
5. DB Curl and Press

Heavy Partner Sled Pushes:

• Partner 1- 20 yards down/Partner 2- 20 yards back for 6-10 reps

Airdyne Bike Rides

• Time Intervals: 15/45, 20/40, 30/30: 6-10x
• Distance Sprints: .2 miles, .3 miles, .5 miles: For multiple reps
• Long Distance Rides: 3-5 miles: For best time possible

Nothing strikes more fear into the hearts of my clients..