Groin Pain 101: Testing Muscle Function

Coming down the home stretch of the groin/hip pain analysis…

A couple simple tests I’ve borrowed from Shirley Sahrmann and Stuart McGill to assess hip and “core” strength: The Seated Psoas Test, Lying Hip Abduction Test, Front Plank Endurance Test, and Side Plank Endurance Test.

The Seated Psoas Test involves testing the strength and function of the psoas major, the muscle that contributes the most force to hip flexion above 90 degrees. Have your athlete sit down with their feet flat on the ground so that their hip is flexed to 90 degrees and their upper body is perfectly upright (tell them to “sit tall”). Have them lift one foot off the ground and hold it there. If they can do that, add a little pressure to the top of their knee and see if they can resist it. Do this on both sides. Note inabilities to perform this movement at all, compensatory movement patterns, weakness, range of motion, and side to side differences.

The Lying Hip Abduction Test: Have your athlete lie on their side with their bottom hip flexed to 90 degrees and their top hip extended fully. Have them place a hand on their hip and tell them not to let that move at all. Then have them lift their top leg as high as they can (without their hip or lumbar spine moving). If they can handle that, apply a little pressure to their foot and see how well they’re able to resist it. Repeat on the other side. Note inabilities to perform this movement at all, compensatory movement patterns, weakness, range of motion, and side to side differences.

The Front Plank Endurance Test is really straight forward. Have your athlete set up in a front plank position (similar to a push-up position but on their forearms with their elbows directly under their shoulders with their hips even with their shoulders). Have them hold this position for time. As soon as form starts to break down, the test is over. In general, you want them to be able to hold the position for at least 60 seconds.

The Side Plank Endurance Test is very similar. Have your athlete set up in a side plank position (elbow under shoulder, hips stacked and raised off the ground). Record the amount of time your athlete is able to hold this position with perfect form. Give them a couple minutes to rest then repeat on the other side. In general, you want them to be able to hold this position for at least 45s and there should be less than a 10% difference in side to side times.

I think it’s extremely important to make sure your athletes have proper gluteus maximus (read: butt) function, but I don’t test for it. Frankly, I’m not sure there’s an athlete in the world that can’t benefit from glute bridges/glute bridge holds, quadruped hip extensions, bird dogs, etc. Because I know I’m going to program that stuff in anyway, I don’t test it. I will ask athletes if they feel like they have trouble contracting one or both sides while they do some of the dynamic assessments though, just to get a crude idea of any side-to-side differences.

That concludes the static assessments. All that’s left is a few dynamic movements to assess movement abnormalities/deficiencies and putting all this together to see if/how we can address the pain and get athletes back to a healthy status. Stay tuned…

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Fat Loss Program: Week 5 Results

5 weeks of relatively severe calorie restriction and intense training…

On Thursday I was down almost 20 pounds from when I started. Lucky for me, it was time for my second schedule refeed day, which I celebrated with, among other things, a Trader Joe’s Pizza for breakfast and a hefty dinner at P.F. Chang’s with my girlfriend Emily. The two of us took down what looked like a 2 pound piece of chocolate cake, a la mode of course, in about 3 minutes. I guess you could say we’re growing kids. Replenishing all my carb stores and with the accompanying water, I put on 10 pounds that day! I’ve been riding the extra energy wave ever since. It feels great!

I’m ending this twisted experiment after this week. That’ll be 6 weeks since I started. At the end of this week, I’ll stick with a similar diet, tons of high quality protein and fat and essentially NO carbohydrates from sources other than fruits and vegetables, but I’ll be upping my caloric intake considerably. I’m also starting to add in some regular conditioning, which should help maintain the fat loss I’ve experienced in the last few weeks despite eating more. I have to go get ready for a hockey game. This week’s training program below for those of you that are interested. Enjoy your weekend.

Feb 2, 2009
A1) Back Squat: 3s Negative: 135 x 5; 225 x 3: 315 x 2: 335 x 2: 345 x 4 sets of 2
A2) Bird Dog Hold: 3 x 15s each
B1) Stiff-Legged Deadlift: 225 x 4; 315 x 4; 325 x 4; 335 x 4; 345 x 4
B2) Front Plank March: 4 x 20s
C1) 1-Leg Squat:3s Negative: 3 x 5 each
C2) Glute Ham Raise: 3 x 10

Feb 3, 2009: 165 lbs weigh-in
A1) Standing Shoulder Press: 45 x 4; 95 x 4; 135 x 4; 135 x 4; 125 x 4; 125 x 4
A2) Scap Wall Slides (Back to Wall): 3 x 8
B1) Weighted Chin-Up: BW x 5; BW+35 x 3 sets of 6; BW+35 x 5.5
B2) DB Triceps Extension Ecc-to-Close Grip Con: 2 x 45 DB 4 x 8
C1) 1/2 Kneeling Chop: 1 set to Left; 3 sets to Right 50 lbs x 8 reps
C2) Face Pull w/ External Rotation: 100 lbs x 3 x 10

Feb 4, 2009: 163 lbs weigh-in
A1) Front Squat: 135 x 5; 185 x 3; 225 x 3; 245 x 3; 265 x 3
A2) Side Plank w/ Abduction Hold: 3 x 15s each
B1) DB Back Leg Raised Split Squat: 2 x 65 DB x 1 x 6each 2 x 70 DB x 2 x 6each
B2) 1-Arm DB 1-Leg SLDL: 1 x 40 DB x 3 x 6 each
B3) Bar Rollout: 3 x 10
B4) Stability Ball Hamstring Curl: 3 x 12
CON 1 x 25min Med-High Intensity Bike Ride 7.75 miles, 215 calories, HR about 170

Feb 5, 2009: 163 lbs weigh-in…173 lbs weigh-out Best Refeed Day Ever!
CON Interval Bike Ride: 8 x :20/:40

Feb 6, 2009: 170.5 lbs weigh-in
A1) Bench Press: Medium Grip 135 x 5; 225 x 3; 245 x 1; 215 x 8; 215 x 7.5+Help; 205 x 6+2Help
A2) I, Y, T Holds: 1 x 30s each
B1) 1-Arm DB Row: 1 x 90 DB x 3 x 6 each
B2) Standing Cable Chop: To Right Only 50 lbs x 3 x 8
B3) 1-Arm DB Push Press: 1 x 50 DB x 2 x 6 each; 1 x 55 DB x 1 x 6 each
B4) DB Hang Clean-to-Curl Eccentric: 2 x 40 DB x 3 x 6
B5) Bird Dog: 3 x 8 each
CON 10 x 10 Medicine Ball Overhead Floor Slams 30s rest between sets

Feb 7, 2009: 169.5 lbs weigh-in
CON KB Swings: 16kg x 20; 20kg x 20; 20kg x 4 x 15 16kg x 4 x 15 30s rest between sets

-Kevin Neeld

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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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