Month: November 2010

Groin Strain Case Study: Assessment

Last week I had a Tier I U-18 player stop in at Endeavor so I could have a look at his hip. I tend to do these types of favors for players that have trained with us in the past and/or play for coaches that I know (in this case, Jared, my boss at Endeavor).

In these situations, my first question is always, “Have you seen a physical therapist about this?”

This is an important first question to ask because they may have already received a diagnose and/or treatment strategies that will provide some insight into what’s going on. It also helps protect me professionally from stepping on the toes of a profession that, in general, is better suited to handle sports injuries.

With that said, this player had been to a physical therapist who (in his words) “showed me a few stretches for my groin.” Naturally, these didn’t help.

As you know, I’m almost ALWAYS against stretching a strained muscle. In most cases, I think it will make the injury worse. In general, strains tend to occur in areas that move excessively and in muscles that aren’t strong enough to accommodate the workload. In many cases, the strained muscle simply lost a “stiffness” battle with a synergistic muscle. This means that the synergistic muscle would likely need the stretching and the strained muscle would likely need strengthening.

Moving away from injury generalities and back to the case at hand, I went through the normal process of asking him what happened and how long it’s been bothering him. Not surprisingly, he pointed to the inguinal triangle as his area of pain. Because the adductor longus is the most frequently strained groin muscle, I was expecting this area to be painful.

I did a quick search for “groin pain” pictures and this came up. I’m not sure why exactly, but to find out I will have to personally assess each and every one of them! (…just kidding Emily)

I did a simple prone and supine hip internal and external rotation ROM assessment, and this revealed something interesting. He had great ROM in both directions on his unaffected side. On his affected side, he had slightly less internal rotation than his other side, but SUBSTANTIALLY more external rotation. As a follow up, I did Craig’s Test” on his affected side, a test that assesses for femoral anteversion or retroversion.

Interestingly, he had a positive Craig’s Test (>15 degrees), which typically is accompanied by excessive internal rotation and limited external rotation (quite the opposite of what we found). I also performed a Thomas Test to assess hip extension ROM, which was positive (limited hip extension, indicative of a hip flexor restriction) on his uninjured side, but negative/normal on his injured side. While this could be interpreted as a good thing (how could full hip extension ROM be bad?), putting it within the context of the rest of our findings painted a drastically different picture.

In this case, the full hip extension is indicative of anterior hip capsule laxity. Basically the ligaments have become overstretched, which allows for both full hip extension and excessive external rotation. In light of a damaged anterior hip capsule (which provides a “check” to hip extension and external rotation), it’s of no surprise that the muscles that also provide a “check” to hip extension and external rotation (the hip flexors/adductors/internal rotators) would be overworked, and (almost inevitably) injured.

Stretching these muscles would be exceptionally counterproductive. My approach was:

  1. STOP stretching the adductors
  2. Strengthen the anterior glute medius to help return some muscular support to the anterior hip capsule (a concept from the Postural Restoration Institute)
  3. Seek treatment from a great manual therapist (in this case, Dr. Tancredi in Broomall, PA)

I often hear people make the argument that certain things (notably the above example) are more in the realm of a physical therapist’s job description than a strength coach’s. I don’t disagree. I don’t necessarily view my role as “diagnosing and treating injuries”, but it’s helpful to have an understanding of some of the tests that PTs use so I can get an idea of what is going on with our injured athletes. This doesn’t give me the go-ahead to treat them, but allows me to make the most appropriate referral and clearly communicate the situation with that professional.

As a closing note, if you’re a player, the big take home from this is to get your injuries checked out immediately. This player hasn’t played in a couple weeks now, and this is the season he’s supposed to finalize an agreement with an NCAA D1 team. I understand you’re a hockey player so you’re supposed to be tough and not feel pain and fight through injuries and all that crap. You’re also not supposed to be a moron and miss several weeks/months of a season because of a minor injury that got out of hand as a result of your stubbornness. If your going to fight through injuries, October/November isn’t the time. Save the tough guy mentality for playoffs.

Kevin Neeld

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This Week at Hockey Strength and Conditioning

This was a really cool week at Hockey Strength and Conditioning. Last week I mentioned that the content slowed a bit, at least in the form of programs, articles, and videos, but that I really got a lot out of the forum discussions. This week was almost the exact opposite-TONS of new stuff added.

Webinar: Case Study-Pro Hockey Player from Jim Reeves
Admittedly, I don’t know much about Jim Reeves other than knowing that people I speak very highly of speak very highly of him. This webinar was a great introduction to his experience, philosophies and methodology. He presents Pre- and Post-FMS scores for the same player across two-consecutive off-seasons, details the player’s dysfunctions and impairments, and shows EXACTLY what he did to restore function and rebuild performance. This will be one of those resources that takes me a few viewings to truly let everything sink in. Great stuff!

Video: More Dryland Skating Exercises from Mike Potenza
This has been a popular topic on the site for the last several weeks, and one that I find especially interesting. From a training standpoint, I go back and forth on how important these exercises are. There is a large specificity component to training skating-like movement patterns off the ice; on the other hand, players should be spending time working on these things ON the ice. I don’t think an entire training program should be built around these, but including them as 5% of your program under the umbrella of hip stabilization or work capacity exercises (depending on the exercise and how you implement it) is a great idea. Getting athletes to buy-in to your programs ultimately decides the results they will get. Including exercises that hockey players will clearly see an on-ice translation will help with buy-in. That was a long-winded way to say that I think having a variety of “skating exercises” to pull from will keep things interesting for the players, and Coach Potenza presents a lot of great choices in this video series.

Program: Pre-Game Warm-Up from Sean Skahan
Great dynamic warm-up from Coach Skahan that players of all ages could use to best prepare for their game (or practice for that matter). This is very similar to warm-ups I’ve used in the past with my players. In the accompanying text Coach Skahan mentions that some players that have gone through this with him continue to use the exact same warm-up, despite having moved to a different team. In my opinion, that’s one of the greatest testaments to a quality warm-up (or program), when players continue to do it because they see the benefit, not just because they have to.

Article: RFE Progressions from Devan McConnell
Like we do at Endeavor, Devan uses the “Rear Foot Elevated Split Squat” as a foundational lower body lift for his athletes. This is a great six-step progression for athletes that have trouble mastering the “back squat” bar position right away.

Getting the Most Out of Your Hockey Strength and Conditioning Membership!

By now, you’ve likely experienced the huge benefit to getting access to the information at HockeySC.com every week. In addition, there are two other things you can do to improve your experience:

  1. Network on the site by posting something on the “Introduction” thread on the forum, and by asking well-thought out questions on other forum threads. There are a lot of “big names” in strength and conditioning that check the site regularly. Whether your goals are hockey-specific or not, this is a great place to meet professionals that can help you advance your career.
  2. Check out contributor’s youtube channels. I get a lot of great ideas from watching other coach’s exercise videos. The articles provide a great opportunity to hear the coach’s rational for using certain exercises and learn how they integrate them into their program. Because many of the coaches use youtube as their video hosting platform, you can get access to ALL of their public videos by clicking directly on the video while it’s playing. You’ll be redirected to their youtube channel, which you can then subscribe to. I actually have two youtube channels (“EndeavorPerformance” and “HockeyTrainingCoach”) that I post videos to pretty regularly. I recommend you subscribe to as many quality channels as you can to get new ideas on a regular basis!

Click the link below for more information about Hockey Strength and Conditioning!

To your continued success,

Kevin Neeld

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Random Thoughts Continued

Picking right up where we left off on Monday:

18. These are two interesting abstracts on outcomes of manual therapy in chronic groin pain populations. I think every athlete should get manual therapy work performed on a regular basis, especially once they reach their Junior and Senior years of high school. If you’re in the mid-Atlantic area and need a recommendation, shoot me an email. I have a handful of professionals that I think are top-notch.

Abstract 1: A Manual Therapy Technique for Chronic Adductor-Related Groin Pain in Athletes: A Case Series

Abstract 2: Manual or Exercise Therapy for Long-Standing Adductor-Related Groin Pain: A Randomised Controlled Clinical Trial.

19. I recently started taking girth measurements of a few of our clients at Endeavor to better track their progress. While measuring the arm circumference, one of my clients said “You better call the vet, because these puppies are sick!” as he flexed. I’ll probably never forget that!

20. I recently had somewhat of a revelation that I needed to find more “balance” in my life. For the last several years, balance meant balancing various parts of work with other parts of work (e.g writing, article reading, DVD watching, coaching, etc.). I say “somewhat of a revelation” because my mom and Chris Boyko have collectively been politely reminding me of this for the last 15 years of my life (originally with hockey, now with strength and conditioning). This Summer I spent most of my weekdays training for 10+ hours; then I’d spend a good chunk of my weekend getting all my writing done.  When the Summer ended, I was ready for a slow time, which to me meant:

  • Writing a comprehensive hockey training book
  • Taking the Postural Restoration Institute’s Myokinetic Restoration Course
  • Taking the Precision Nutrition Certification Exam
  • Developing and implementing a Nutrition Coaching Program at Endeavor
  • Going through Mark Joyner’s Simpleology 101 Course (and reading the accompanying book)
  • Two other HUGE projects for Endeavor that I can’t even talk about yet because their still in their infancy

Not exactly a healthy break in the action. Over the last month, I’ve actively planned time away from anything training related and tried to spend more time doing things I enjoy, despite not having professional benefits.

21. This is the first time I’ve publically mentioned the book that I wrote. I’m more excited about this than I have been about any other project I’ve ever worked on. I’m still not sure if it will get picked up by a publisher or if I’ll self-publish it, but I whole-heartedly believe it will be a game-changer when it comes out.

22. They say behind every good man is a good (or better) woman. Frankly, I don’t know where I’d be without Emily, but I know I wouldn’t be as happy or have as much fun.

From our cruise a couple years ago. (first time I left North America)

I probably don’t thank her enough. I consider myself exceptionally lucky to have a best friend that is supportive when I need her to be, and that drags me away from textbooks when she knows I need her to. As much as I respect her, it’s still embarrassing when she beats me in bowling.

Over the line! Mark it zero dude.

23. Over the last couple years there has been a rapid increase in the number of websites dedicated to hockey development information. The two best FREE resources out there are Kim McCullough’s Total Female Hockey Club (incredible information for MALE hockey players too!) and Maria Mountain’s Hockey Training Pro. The best slightly-less-free resource is Hockey Strength and Conditioning.  If you’re involved in hockey in anyway, check out all three of these resources on a regular basis.

24. Spike…For when coffee feels like Nyquil

25. One of my dreams has always been to get invited to speak on hockey training in Europe. A couple weeks ago I received an email asking if I’d be interested in speaking in Denmark. I don’t know if it’ll work out or not, but I’m pretty psyched about the opportunity.

26. Stephen Covey once said, “We judge others by their behaviors. We judge ourselves by our intentions.” Think about the implications this has regarding our perceptions of EVERY behavior that goes on around us and how our own actions may be perceived by others. This may be the single most profound thing I’ve ever heard.

27. On a similar note, Michael Boyle summed up sports nutrition by paraphrasing someone: “Eat food. Mostly plants and animals. Not too much.” I urge everyone reading this to analyze their diet in that light and see how close they are. Most will find that there is less food, and more “food products” than there should be.

28. This is my new favorite stretch. Great way to improve full-body rotation range of motion.

Brettzel 2.0

29. You make everything I do possible. I’ve politely asked for people to forward my posts/newsletters that they’ve liked to other people. Because of these forwards, I’ve been introduced to a handful of NHL Strength and Conditioning Coaches, a couple of the higher-ups in USA Hockey, and countless other people that are equally important to me. When I started writing online, I made a promise to myself to always put out quality information that will truly benefit the people reading it. Regardless of what I write, it doesn’t matter if no one sees it. Because of your help, quality information is reaching more people. Thank you!

To your continued success,

Kevin Neeld

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Random Thoughts

I’ve had a lot of different things on my mind recently, so I want to break free of the typical “article-style” post and touch on a wide variety of topics, ranging from professional to personal, intellectual to comical. Let me know what you think of these types of posts and I’ll use them more or less in the future. Enjoy!

1. ZMA may be my favorite auxiliary supplement. I wouldn’t put it in my “essentials” list, but as busy/stressed as I get sometimes, nothing helps me sleep better.

2. Eric Cressey’s Show and Go Program is incredible. The entire Endeavor Coaching Staff has been following it for the last two weeks; it’s intense and exceptionally well written. Last week I front squatted 275 for 3 reps and trap bar deadlifted 405 for 5 reps. Nothing to write home about, but pretty good for me.

3. Every time Bon Jovi comes on our satellite radio, my blood pressure skyrockets. There is a time and a place for Bon Jovi. That time is never. That place is nowhere.

4. Last week on my drive to work I noticed that all of traffic slowed to 5 mph below the speed limit, because there was a cop driving in the right lane at that pace. She then proceeded to change lanes without signaling while talking on her cell phone. Nothing like leading by example.

5. A lot of people in the hockey world say that vision is one of those things a player either has or doesn’t. I couldn’t disagree more. As with any ability, some players will naturally excel in this department more than others, but everyone can improve. The key is to spend time ANALYTICALLY watching the game. It’s helpful to do this by watching players at the same age, but higher skill level, or older players at the same skill level.

6. I’m amazed at the number of parents that come into Endeavor wanting their kids to be faster yesterday. Getting EVERYONE in the fitness industry (fat loss clients, body builders, athletes, etc.) to understand that training is a continuous, progressive process would be the single greatest breakthrough in the history of the industry.

7. A former intern of ours said one of her teachers told her that she’d have to cut all carbs out by 3pm if she wanted to get lean. While I don’t necessarily disagree with the concept, I strongly disagree with the clear-cut dichotomy here. What if she wakes up at noon because of her work? What if she trains at 4pm? What if it’s a cheat meal? Nothing is ever this black and white, in training or nutrition.

8. Last week I met with Shoba Murali and Shaun Gagnon, the CEO & President and VP of Sales for Generation UCAN, respectively. I whole-heartedly endorse their product because it’s the best out there. The carb-only mix is a drastically healthier alternative to the more well-known sugar-laden Gatorade and Powerade alternatives. The protein-carb mix is the perfect post-workout/post-practice/post-game drink. Even more pleasing to me, Shoba and Shaun are both incredible people that really have the athletes’ best interest in mind. This is quite different from the sleezy approach of most supplement companies (e.g. spending all their money to put a colorful label around their shit product, having steroid-enhanced spokespeople make false claims about the effectiveness of their product, etc.).

Enter the code “KNHockey” to get a special discount!

9. Cristi Landrigan wins the hockey parent of the year award. Over the Summer, she drove her kids around 90 minutes to train with us three times a week at 8am! Now, every couple days she’ll email me a great article she found on some aspect of sports performance (training, mentality, etc.). I wish every parent could adopt 10% of her enthusiasm for helping her kids succeed as members of society, and as athletes.

10. For young professionals out there, nothing will help you more than finding a good mentor. Since I was young, I’ve frequently been complimented on my “drive”. I think having that has been an important ingredient in my success so far. With that said, I wouldn’t be anywhere without the guidance of Chris Boyko, Eric Cressey, and Michael Boyle. I’ve learned from a ton of people, but these three mentors have done more for me than I could ever describe.  If you’re looking for internships, look to them first.

11. On internships, if you’re an intern, be realistic about your role. There is nothing more off-putting than hearing an intern talk about “their athletes”. As an intern, you don’t have athletes. You’re implementing someone else’s programs for their athletes. You have a long career to brag about all the great stuff you’re doing with your athletes; now is your time to learn/absorb.

12. I’m pretty good at blocking out distractions. In grad school, I frequently fell asleep with Avenged Sevenfold playing on my laptop next to me. But if there is a single fly in my office, my day is ruined.

Me…not getting any work done.

13. Lingo such as “can I get a spot” and “all you” is typical in the gym, but should not be used in a men’s room.

14. The growing popularity of Facebook continues to amaze me. My “Ultimate Ice Hockey Training” group now has over 4,025 fans!

15. We use the reverse lunge as one of our primary lower body lifts at Endeavor. We try to encourage our athletes to return to the top by “pulling through the heel of their front leg”. Inevitably, when the weights get heavy, there is a stronger push off the back leg. One way to eliminate this altogether is to have them perform the reverse lunge with their back foot on a slideboard. For the scientists out there, it may be interesting to test 3-RMs on ground, and on a slideboard to quantify how much that push/back-leg stability adds to the lift.

16. Speaking of scientists, my colleague Bret Contreras (who I believe has set up an EMG lab in his garage…awesome), mentioned me on his “Best Blogs” list: How I Learn. I’m flattered that someone with Bret’s intelligence would consider my site one of his top resources. I also read on Bret’s site that Jeff Cubos, an incredibly well-read professional from Canada, included this site as one of his go-to’s as well. If you guys are reading this, thank you!

17. In that post, Bret mentions that he wishes I wouldn’t “pigeon-hole” myself so much by just talking about hockey. I write mostly about hockey because that’s what I’m most passionate about, and why I got into training to begin with (to help hockey players develop and fulfill their potential). With that said, many of the training principles I write about in regards to hockey are directly applicable to most team sports and to training in general. My hope is that people that may work with athletes in other sports don’t write off the information simply because my site says ice hockey on it.

Check back in on Wednesday for more musings!

To your continued success,

Kevin Neeld

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