Month: February 2009

Groin Pain 101: Quadruped Rocking Disclaimer

Sahrmann’s Quadruped Rocking Exercise, that I’ve mentioned a couple times in the last few weeks, can reveal a lot of valuable information about hip flexion range of motion. My interpretation of a conversation I had with Sahrmann is that 8-10 reps of quadruped rocking should loosen up any soft tissue restrictions. If it doesn’t, the range that they’ve consistently shown is likely all their anatomy will allow for.

While I’ve used this test and found it to be very helpful, it’s probably not as straight forward as “if that’s all they’ve got, that’s all they’ll ever have.” There’s one particular incidence that you should consider before you jump to conclusions.

Jump to Conclusions

Tightness of the posterior hip capsule (ligaments connecting the posterior femur to the sacrum and hip) can lead to similar range of motion restrictions as hip impingement. I was talking to Eric Cressey the other day, and he said that, in general, bone will move in the direction opposite of capsular tightness.

Applying that to our hip, that means tightness of the posterior hip capsule will likely result in a forward movement of the femoral head within the acetabulum (“hip socket”). When attempting to enter into hip flexion, this disadvantageous femoral head position, combined with a tightness of the posterior ligaments, can result in both a restricted range of motion with accompanying hip tuck, AND discomfort in the “groin” area.

Luckily, posterior hip capsule tightness IS a modifiable factor and one that should be explored. At the hands of a good manual therapist (I’d recommend an Active Release Techniques practitioner), long-standing posterior capsule tightness can be resolved in a few weeks (sometimes a few visits, and if the therapist is REALLY good, sometimes significant progress can be made in a few minutes).

Remember. Nothing in the human body is as simple as “if you have this, this is why.” Just some food for thought.

Speaking of food…Yesterday was my second ReFeed Day, since starting my calorie restricted diet. I weighed in yesterday morning at 163. After finishing a cottage cheese, ground flax seed, chocolate protein powder, peanut butter, and deluxe mixed nuts concoction in the shower last night, I weighed out at 173. Yes, it was a great day. And yes, I eat in the shower. What do you mean that’s weird? If Kramer can make a salad in the shower, I can eat dessert in the shower…

Kramer Stop

Keep working hard.

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Picking A Protein Supplement

At least once a week I get a question from someone about which supplements to take to get the most out of their efforts. There is no shortage of options-that’s for sure. Unfortunately, MOST supplements aren’t worth your money. As a general statement-the more colorful and flashy the label, the more expensive and worthless the supplement. There are a few supplements that have stood the test of time and proved effective through comprehensive research: Fish oils, creatine monohydrate, and a protein or protein/carbohydrate shake. The next big question is, “Which protein supplement should I take?”

Below is a copy of an email I sent to a student of mine who was looking for the answer to that question for her dad. As an appropriate prequel-I’m not a big muscle milk fan. I know it tastes good-so do cheeseburgers, but I don’t recommend eating those while you lift. There’s one ingredient in Muscle Milk (glycocyamine) that’s been tied in with increasing homocysteine levels, which is a marker for cardiovascular disease. Considering the risk, there is no benefit of taking Muscle Milk over other protein shakes.

“Assuming your dad has now discarded all of his muscle milk and is looking for a new protein supplement, I have some recommendations. Different protein supplements are more ideal for different purposes. If he is drinking it before, during, and/or after working out (before/during AND after is typically best), he should look to get a whey protein supplement. Whey protein is rapidly digested and consequently used wherever needed IMMEDIATELY. This is in contrast to casein protein, which takes longer to be digested and absorbed. Think of casein as a time-release protein-it provides smaller amounts of protein over a longer period of time. I typically have a whey protein supplement AND a casein/whey mix supplement. I take the whey either before or sip on it during my lifts, and then drink a shake after my workouts. I take the casein/whey mix whenever my schedule is too chaotic and my planning too poor to have a whole food protein source and I need a quick source of high quality protein. When looking at protein supplements I typically look for something that has 20-30g of protein per serving. Many supplements will have something like 75g per serving, and use that as a selling point. The amount of protein that can be absorbed at any one time is highly dependent upon the individual and the current status of that individual (immediately after training vs. day off for example), but I can’t imagine anyone using 75g at once. Taking that much just puts a little more stress on their kidney and lets them urinate out their money (pleasant, I know). I don’t recommend taking more than 40g in any one sitting, for anyone. I’ve had success with products from BioTest (Surge for during/immediately after workouts, GROW! for after workouts, Metabolic Drive to fill in for missed real food meals), and Optimum Nutrition’s 100% Whey protein.”

I don’t usually like to make blanket statements like this, but frankly-if you aren’t taking a protein supplement, you aren’t serious about your training. Don’t take my word for it. Pick up some Surge and Metabolic Drive from BioTest. Try it for yourself. When you start to notice that you’re progressing faster and feel better, send me a thank you email.

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The Best Exercise Ever?

The question is often thrown around:

“If you could only do one exercise, what would it be?”

My Answer: The Deadlift!

An argument could be made that the deadlift is the best

exercise around. This argument is often made for the

squat, which I circumstantially disagree with.

Reasons why the deadlift is better than the squat:

1) Gross amount of muscle mass used

If you’ve ever deadlifted relatively heavy, you know that

the deadlift is one of the most taxing exercises out there.

Specifically, the deadlift works muscles from your calves

through your forearms, including the hamstrings, glutes,

Latissimus dorsi, and posterior shoulder muscles. No

wonder a few heavy reps are so tiring! While the squat

uses a significant amount of musculature as well, it

involves few working muscles in the upper body. Why is

this important? The deadlift is a frequently overlooked

exercise. If you want to put on muscle, performing an

exercise that works a significant amount of muscle groups

and can be loaded heavy is a great way to go about it. If

you want to lose fat, performing an exercise that utilizes

more muscle mass burns a significant amount of calories and

creates a great metabolic disturbance.

2) The specific muscle mass used

The anterior side of the body is too frequently stressed in

many programs. Think about what you see in the gym: Leg

Press, Squats, Bench Press, Biceps Curls, and Crunches.

What do all of these exercises have in common? They all

work muscle groups that can be seen by standing in front of

the mirror! The less respected back-side of the body is

extremely important for athletic performance and daily

functioning. A program focusing on what I like to call

‘Beach Muscles’ (especially in those that spend a

significant amount of time in the car or in front of a

computer) can lead to the shortening of these muscles,

creating a hunched over posture. Furthermore, these types

of programs create a total body imbalance that will

inevitably manifest itself as pain somewhere. Why is the

deadlift different? While some quadriceps work is evident

in the deadlift, the majority of the movement is produced

by movements on the posterior side of the body.

Strengthening these muscles will help begin to correct any

imbalances, allowing you to feel better and play better.

3) Development of force from a standstill

Most exercises involve an eccentric contraction preceding a

concentric contraction. In other words, the ‘negative’

precedes the ‘positive.’ Think of the squat and bench

press. You start at the top, lower the bar under control,

and then explode up. Exercises that work in this fashion

allow for a quick stretch at the bottom of the exercise,

allowing the lifter to take advantage of the elastic

properties of muscle and the stretch reflex (the nervous

system’s response to a quick stretch). This is not the

case in a deadlift. The bar is on the floor and is not

preceded by any loaded negative contraction. This forces

the lifter to produce force at a rapid rate. A slow

production of force will result in a tired lifter and a

sleeping bar! Rate of force development is important for

all athletes and for activities of daily living (walking up

stairs, getting out of a chair, etc.).

4) Core Strength!

Core strength is essential for proper deadlifting. The

majority of the muscles producing the movement force are in

the lower body. The bar is held by the upper body; the

upper body muscles are mostly worked through isometric

contractions(no change in total muscle length). If force

isn’t effectively transferred from the lower body through

the core (all muscles that attach to the pelvis or spine)

to the hands, the bar doesn’t move. Included in these

important core muscles are the spinal stabilizers, which

are often neglected due to the majority of the exercises

being performed sitting or lying down. Lock your back into

a flat position with your shoulder blades pinned back, take

a deep breath in through your belly, squeeze your core, and

pull hard!

If you aren’t deadlifting, consider adding it into your

program. In fact, try replacing the squat with the

deadlift for a few weeks. You may find when you return to

squatting that your strength has improved! The old adage

of your only as strong as your weakest link holds true with

lifting and athletic performance. Strengthen your weakest

link and everything else improves as well!

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Groin Pain 101: How’s Your Range of Motion?

The next step in analyzing groin pain and hip pain is to take a look at the range of motion around the hip. The four primary ranges of motion you want to concern yourself with are hip flexion, hip extension, hip internal rotation, and hip external rotation.

A couple important notes:

While it’s best if you use a goniometer, or some sort of other device, a less accurate “eyeballing” can still give you a lot of valuable information about your athlete.
Check hip internal and external rotation in both a hip flexed (to 90 degrees) and hip extended position. In the hip extended position the hip capsule is taut, so it’s important to look for similarities or differences in range of motion in the two positions as it will provide some insight as to whether the restriction is hip joint position specific, and whether it may be due to bony, capsular, or soft-tissue restrictions.

If you find that your athlete has significantly more hip internal range of motion than external range of motion in both the hip flexed and hip extended position, it’s likely that your athlete has hip or femoral anteversion, which is an anatomical characteristic of the hip that CANNOT be adapted through training. In other words, they will ALWAYS have more internal than external rotation, are probably significant limited in external rotation.

For those with groin pain and hip pain, I also lie them on their back and slowly move their hip into flexion, adduction, and internal rotation (think of pushing their knee toward their opposite shoulder). This is the provocative test for CAM impingement. If this is painful and or extremely restricted, it’s likely that they have some sort of hip impingement issues, which are typically accompanied by hip labral tears. Again, you aren’t diagnosing anyone here, just getting an idea of what the problem is to understand your training limitations and what to communicate to an athletic trainer, physical therapist, physician, etc.

To test hip extension range of motion, lie them on a table so that their knees can drape off the end. Have them pull both of their knees to their chest, then straighten one leg out and lower it as low as possible.

If the back of their thigh stays above the table, they likely have a shortened iliopsoas complex. If the back of their thigh touches the table, but their knee doesn’t bend very far, they likely have a shortened rectus femoris (one of the quadriceps muscles that acts to flex the hip AND extend the knee). If their thigh seems to pull out to the side, they likely have a shortened tensor fascia latae (TFL). It’s not always this straight forward, but understanding these things is a good starting point. Typically these “restrictions” adapt to a well-structured flexibility/mobility routine after a few weeks.

Lastly, to assess hip flexion range of motion, have them perform quadruped rocking. Set them up with their knees on the ground immediately below their hips, with their hands on the ground immediately below their shoulders. They should have a neutral lumbar spine and their eyes should be looking straight down on the floor. Have them use their arms to provide a slight push as they shift their hips straight back to “sit on their heels” while MAINTAINING A NEUTRAL LUMBAR SPINE! All caps for emphasis. Note the hip flexion angle that their lumbar spine begins to move. Have them perform 8-10 reps and see if they get more range of motion. According to a conversation I had with Shirley Sahrmann a few months back, if they meet restriction at the same point in the range after 8-10 reps, it’s likely that it’s a joint structure limitation and not adaptable through training, meaning that’s all the range they have, and will ever have.

Now you should have an idea of the nature of their injury, their posture, and their hip range of motion. We’re starting to make some progress!

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Groin Pain 101: Posture Analysis

Continuing on yesterday’s discussion on the groin injuries that plague hockey and soccer players…The second step in analyzing an athlete’s groin pain is to do a crude posture analysis. I don’t advocate strength coaches or sport coaches pretending to be physical therapists, but there are some pretty basic posture assessments that sometimes provide a lot of insight into the nature of groin pain (and other hip and knee pain for that matter).

It’s usually best if you can just snap a few photos and do this analysis at home to avoid the awkwardness of staring at your athletes intently while they stare back at you impatiently. But if you can’t do that, have your athlete stand BAREFOOT in front of you. It’s VERY important that they are barefoot as shoes can have a profound effect on posture. You’re going to want to look at them from the front, each side, and the back.

The two primary things you’re looking for are hip and knee position. Look for an anterior pelvic tilt (top of hips forward compared to bottom). This is usually accompanied by an increased curvature of the lower back. You’ll also want to note any rotation, meaning if one side of the hip seems to be in front of the other, or lateral tilt, meaning one side is higher than the other. Of course, it’s important to make sure their feet are aligned evenly to avoid faulty foot positioning throwing off your analysis.

The next thing to look for as femur positioning. Because this is difficult to do, a reasonable estimate of femoral rotation can be obtained by looking at the knee. While it’s possible that your athlete has externally rotated femurs (compared to a ‘neutral’ position), that’s not usually the case. Typically athletes, especially females, will have noticeably internally rotated femurs, meaning their knee caps will appear to point in. I’ve found it’s easiest to pick this up from the back. As a word of caution, sometimes this doesn’t mean they have internally rotated femurs. It’s also possible they have excessive antetorsion of the femur (the bone itself is twisted-think of grabbing the top and bottom of the femur and twisting in opposite directions). There are many potential causes of this, that are well beyond what we need to go into today, but I thought I’d let you know about it so you weren’t too quick to jump to conclusions.

It’s also worth checking out your athletes shoes (which they shouldn’t be wearing) and/or the bottoms of their feet. Extra wear on the inside of their shoe/foot (think big toe area) may indicate that they over-pronate (think foot rolling in too far), which can be related to excessive femoral internal rotation.

That’s it for today. The best way to familiarize yourself with these things is to practice. Scan all your athletes for these things and see if you can start to pick up on subtle (or not so subtle) posture faults.

The next stages of groin pain assessment get a little more interesting…I promise.

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