This seems to be the theme in the introductions of my writing this year, but the last few months have been a whirlwind.

As we were wrapping up another busy Summer, I left for two weeks to work at the pre-season camp for USA Hockey’s Women’s National Team, came home Sunday night, then we had pre-season testing/training Monday-Thursday of the next week for the Philadelphia Flyers Junior Team, and Friday mid-morning I left for my bachelor party weekend in the Poconos.

It was a fun stretch, until I came home to broken water heater and ~20 gallons of water spread throughout our laundry floor and my man cave!

ManCave

Cleaned up and open for business.

Around the middle of last week I finally got my head above water (pun intended), which brings me to the topic of today’s post.

PRI, CrossFit and Stability

Last Thursday a guy came into Endeavor to get assessed.

He was a former D1 lacrosse player that had transitioned his competitive spirit into CrossFit. He started to transition away from the lifts and into more body weight work after being diagnosed with degenerative disc disease, but was currently experiencing pain/discomfort in his left SI area, lateral hip, left hamstring, and patellar tendon on both sides, but it started and was worse on the left. This was in addition to his low back pain.

When I get emails from people that have pain, especially significant enough that they’ve pursued medical help, the overwhelming majority of the time I refer them out immediately to someone in my network. In this case, the pain was more “sub-clinical” and he specifically requested to go through a “functional assessment” to make sure he wasn’t doing anything that would cause him to get hurt in the future.

The new yearly check-up?

I really admire this attitude. That idea, of periodically getting your movement patterns checked, is something Shirley Sahrmann proposed over a decade ago as an opportunity for physical therapists to pre-emptively help a lot of people by performing yearly movement screens. If you think about it, we do this with our cars (certain things are checked with oils changes every 3,000 miles or so), and it’s common to go see a dentist every 6 months (or so I’m told…I’ve been to a dentist once in the last decade. The Neeld family tree doesn’t possess a lot of super powers, but our teeth are strong), but the importance of optimal movement is completely overlooked by post.

Unilateral pain patterns can have a lot of explanations, but the pattern he’s describing is one I see fairly commonly and can be appropriately addressed using an approach I learned from the Postural Restoration Institute. If you’re unfamiliar with PRI, you can read more about their philosophy, methodology, and education opportunities here: Postural Restoration Institute

The birds-eye view is that the overwhelming majority of human beings have common structural, and more importantly neurological asymmetries that interact with daily movement predispositions to cause predictable movement limitations and potentially pain patterns.

PRI Integration for Fitness and Movement

If you’re interested in learning more about PRI, we’re hosting their first ever PRI Integration for Fitness and Movement at Endeavor in Pitman, NJ October 17-18. As of this writing, there are 11 seats still open. I’m particularly excited about the event because there’s an incredible list of attendees already registered, so the discussions will be outstanding.

To be overly simplistic, his lower half was shifted and twisted right; his upper half was twisted left.

PRI Left AIC-Right BC-Front

This is a different client, but similar presentation. Note how his pelvis is looking to his right (your left), and how his thorax has counter-rotated back to the left. You can see this by looking at how his sternum lines up relative to his belly button and by seeing how much more stretched his left pec looks compared to his right.

Assessment Findings and Injury Patterns

A few notable findings from his assessment:

  1. Limited L Adduction
  2. Limited R Abduction
  3. Left Hip: External Rotation: 43-degrees; Internal Rotation: 27-degrees (70 total)
  4. Right Hip: External Rotation: 32-degrees; Internal Rotation: 34-degrees (66 total)
  5. Seated Thoracic Rotation: Left: ~50-degrees; Right: ~35-degrees
  6. Active Straight Leg Raise: Left: 1; Right: 3

I also had him perform several movements that he performs commonly in training. I took pictures on his phone (which I unfortunately don’t have access to), but a few things that jumped out right away:

  1. When squatting down, his hips appeared to be “looking” toward his right knee, not straight
  2. When pressing a bar overhead, his head was considerably closer to his right arm than his left (e.g. torso was shifted right, but rotated back to the left)
  3. When he did box jumps, he didn’t load his hips backwards, but dipped straight down (more like a jump shot pattern). He did this during the jump load, the landing on the box, and the landing on the ground when he jumped down.

One of the biggest challenges people have regarding PRI’s contention that all human beings are biased towards certain patterns and consequent limitations is that if everyone has the same limitations and not everyone has pain, then it’s a stretch to suggest that the limitation is causing the pain. There is A LOT that goes into whether the brain interprets something as painful, but from a pure mechanical perspective, it’s important to recognize that whether or not a limitation will result in an injury has a lot to do with the individual’s movement patterns and physical activity.

As an illustration, if your car has an alignment issue such that it pulls to the left, it may not cause any significant issues elsewhere throughout the car (e.g. wearing down one tire, or side of the axel) if you only use it once per week to drive down the road to get groceries. Simply, the demand placed on a subtle asymmetry isn’t enough to cause it to be symptomatic.

Similarly, if you only needed to drive the car in circles to the left, hypothetically, the alignment issue wouldn’t cause as many problems as it would if you only needed to drive circles toward the right. In fact, the alignment issue may make the car more economical in driving exclusively in left circles.

In contrast, if the alignment is off in your 24’ moving truck that you’re using to move across the country, the load of a packed cabin and the volume of movement required to transport from coast to coast will obviously lead to faster breakdowns.

This longwinded analogy is relevant here, because my client started experiencing symptoms while participating in CrossFit, an activity stereotyped by doing trying to do as much work as possible within a finite amount of time. If he played pick-up basketball with his friends once a month, his jumping pattern may have never caused anterior knee pain. But when he needs to, say, perform 100 box jumps as quickly as he can, he’s performing 300 reps (jump load, box landing, jumping off the box landing) in a poor pattern with altered alignment. You can’t always predict what will break down with improper movement, but you can feel pretty confident that SOMETHING will wear down. In this case, all of his discomfort was fairly predictable based on the positions he presented in and how they affected the movement patterns he performed most often.

Quick Fix?

In his case, I decided not to do any manual work. He was already doing some good soft-tissue work on his own with various implements (lacrosse balls, foam rollers, etc.) so I showed him one more that most people haven’t seen before:

[quicktime]http://www.kevinneeld.com/wp-content/uploads/2015/07/Lax-Ball-Posterior-Adductor-on-Box.mp4[/quicktime]

Read more about this here: 3 Rolling Exercises You Should Be Doing

And showed him how to do three exercises that took about 15 minutes to teach and perform: A 90-90 Hip Lift w/ Shift & 2-Arm Reach, a Left Side Lying R Glute Max, and a Paraspinal Release w/ Left Hamstring. The exercises were intended to “untwist” him, and teach his body a few stabilization strategies to hold the new “more neutral” position. When we retested him, he presented with:

  1. Full symmetrical adduction bilaterally
  2. Full symmetrical abduction bilaterally
  3. Left Hip: External Rotation: 40-degrees; Internal Rotation: 32-degrees (72 total)
  4. Right Hip: External Rotation: 42-degrees; Internal Rotation: 30-degrees (72 total)
  5. Active Straight Leg Raise: Left: 2; Right: 3

Not only did his hip motion improve, but it became more symmetrical. Of note, his Active Straight Leg Raise was limited, but the 2 was just under the 3 threshold, and the 3 was just over. In other words, they were inconsequentially different, and we improved his left motion by strengthening his left hamstring in a shortened position.

Most importantly, he said he felt better walking out the door AND during his workout later that day.

Naturally, time will tell if these remedial exercises are enough to teach his nervous system how to control his positions and movement more optimally, but the early results are encouraging.

Take Home

High training volumes are sometimes necessary to drive specific adaptations, but if you’re going to perform movements at a high volume you have to OWN them. Layering high volume on top of poor positions or movement patterns will increase the likelihood of a breakdown.

If you’re interested in joining us for PRI’s Integration for Fitness and Movement, you can register here: PRI Integration for Fitness and Movement

To your success,

Kevin Neeld
HockeyTransformation.com
OptimizingMovement.com
UltimateHockeyTraining.com

P.S. If you want to know how to apply this process in a small group or team setting, this is for you: Optimizing Movement

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One of my favorite things about the “Throwback Thursday” process is that I have an opportunity to re-read some of my older work. Aside from picking up some information that I may have forgotten about, it also allows me to reflect on where I was at in my education at the time of writing it, and what, if anything, has changed since.

Today’s post comes from 2011, when I was very early in my journey of digging into the Postural Restoration Institute’s information.

Nearly 4 years later, my assessment process has evolved significantly. Nonetheless, the pervasive predictable asymmetries discussed in this post continue to present themselves, and are one of the primary things I look at in designing training programs. I even reported some of the results of my “corrective” approach, particularly as it pertains to improving hip mobility in hockey players, in Ultimate Hockey Transformation.

Check out the post below and let me know if you have any questions in the comments section below!

The Myth of Symmetry

Over the last couple weeks, I’ve been doing a lot of hip assessments at Endeavor Sports Performance on our incoming hockey players before they start their off-season training programs. The results of these assessments have shed light on the significant variations in hip structure and range of motion within (side-to-side differences) and among (differences from one player to the other) hockey players. Last week, I also started to dive into the Postural Restoration Institute‘s Postural Respiration home study course.

Over/Under on number of weekends I can spend going through 16-hour PRI home study courses before I wake up and find my Facebook relationship status has changed to “single”: 2

An underlying assumption of many hockey training programs is that players are entering the program in a state of symmetry. In recognition of the idea that side-to-side imbalances are one of the greatest injury risk factors, most training programs have the same number of sets and reps for each exercise on each side of the body or in each direction (depending on the exercise).  Somewhat in contrast, in the past I would have said with great confidence that an underlying goal of a training program is to restore symmetry across joints and between sides of the body using asymmetrical programming. An illustration of this thought process lies in the idea that players rotate thousands of times more in one direction to shoot the puck than they do the opposite direction. As a result, doing horizontal rotation or “anti-rotation” exercises emphasizing the opposite direction will help restore symmetry across the involved joints and muscle groups. Still, this presumes that, in the absence of hockey, the players would be symmetrical.

Thousands of high velocity unilateral rotations result in structural and neurological asymmetries

In reality, there are a number of structural and pattern-driven asymmetries that affect hockey players that warrant improved awareness. This includes, but is not limited to:

  1. The left thoracic cavity houses the heart and pericardium; the right is wide open
  2. The right diaphragm leaflet is 2/3 larger than the left
  3. The right lung has 3 lobes; the left lunge has 2
  4. There is a liver on the right that is not on the left
  5. The vagus nerve extends longer on the right than the left

Note the side to side differences between the left and right hemi-diaphragms

From a movement pattern standpoint, we’re a very right-side dominant society. We have a greater tendency to shift weight onto our right leg, reach with our right hand, etc. (You’re probably in a state of left external thoracic rotation using your right hand to control your computer mouse, tracking pad, ipad or cell phone right now!). This leads people to a state whereby they:

  1. Are in a position of right weight shift, which can result in an increase in right foot supination and left foot pronation
  2. Are in a position of relative left hip flexion, external rotation, and abduction, and right hip extension, internal rotation and adduction
  3. Are in a position of right pelvic orientation and left thoracic rotation
  4. Present with a lower right shoulder compared to the left
  5. Have a left rib flare and decreased left zone of apposition with a concomitant chronic state of insufficient exhalation

The combined effect of these structural and patterned asymmetries has profound performance implications. To be clear, the structural asymmetries are built into our system and are necessary for proper function. The goal is never to “eliminate” them (which would be impossible), but rather to ensure that they remain in as close to a state of NEUTRALITY as possible. In other words, we aren’t symmetrical, but we can be neutral. The major paradigm shift here is that neutral is in a relative state of asymmetry and that the goal of systematic asymmetrical programming is to restore neutrality to the player, not symmetry.

A more comprehensive understanding of these asymmetries provides incredible explanatory power for why hockey players have such a significant prevalence of injuries such as CAM impingement, adductor strains, sports hernias, and SI joint instabilities. It also explains why we see more CAM impingements and sports hernias on the right side, and hip adductor/flexor strains on the left side. Most importantly, it provides a framework from which assessments can be designed to identify these non-neutralities and exercise progressions can be implemented to bring the player to a more optimal alignment.

If you’re interested in learning more about the Postural Restoration Institute or how structural asymmetries influence performance, I highly recommend you check out the interview with PRI founder Ron Hruska that Joe Heiler did as part of the 2011 Sports Rehab to Sports Performance Teleseminar. Joe is selling all of the audios as a package for $29.99, but you could always just grab a membership to his site for $1 (14-day trial then $9.95/month after) and listen to them that way (it’ll save you a couple bucks). Either way, it’ll be well worth the investment. I’ve listened to the Hruska interview at least 5 times and there are a few others that have received similar playing time. Click the image below to check out SportsRehabExpert!

Check back in a couple days for an easy way to assess for a structural hip abnormality that a lot of hockey players have, but don’t know about!

To your success,

Kevin Neeld
HockeyTransformation.com
OptimizingMovement.com
UltimateHockeyTraining.com

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“Kevin Neeld is one of the top 5-6 strength and conditioning coaches in the ice hockey world.”
– Mike Boyle, Head S&C Coach, US Women’s Olympic Team

“…if you want to be the best, Kevin is the one you have to train with”
– Brijesh Patel, Head S&C Coach, Quinnipiac University

When I was growing up playing hockey, at least once every season I’d have some sort of left groin or hip flexor issue.

None were ever significant enough to keep me off the ice, but they were always enough that I was constantly “aware of it”, which is not where you want your focus going while you’re playing.

I always wondered if there was something I was doing, or not doing, that was causing these injuries.

Now that I’ve made the transition from player to S&C coach, I’m thankful for my long list of injuries as they’ve motivated me to learn more about functional anatomy, biomechanics, and a number of other injury risk factors.

Naturally, one of the major goals of every program I write is to reduce my athletes’ risk of injury. As a result, it’s important to understand what factors may predispose an athlete to injuries in the first place, and then make decisions about what I have the ability to influence.

With the increasing popularity of PRI and FMS courses over the last several years, a lot of attention is being paid to the potential for faulty movement patterns to contribute to breakdown. This is obviously an area I subscribe to, as I’ve taken FMS Level 1&2, the SFMA course, and spent over 100 hours in PRI courses, in addition to becoming PRT-credentialed a couple years ago.

Postural Restoration Institute

With that said, purely postural/biomechanical approaches to injury risk have been appropriately questioned in the research, as these are really just one piece of the puzzle. In an effort to perfect movement, coaches may be inadvertently increasing their athletes’ risk of injury.

Identifying Injury Risk Factors

The most effective approach to injury risk reduction is to attack it from all angles. While this topic can get pretty complex, I generally think of risk factors as falling into these major buckets:

  1. Postural/Biomechanical: Determines length/tension relationships, how mechanical stress is distributed during movement, and movement efficiency in general
  2. Neuromuscular Abilities: Force production, rate of force development, and timing of force production
  3. Conditioning/Fitness: The ability to repeat the sport-specific movement demands at a consistently high level and recover appropriately, both in a short-term perspective following a work bout, and at the conclusion of a training session/practice/game
  4. Stress Tolerance: The resiliency of the body to the accumulation of stressors from within and outside the training/sports paradigm. This also determines the individual’s adaptation capacity at any given period of time
  5. Accumulated Fatigue: Related to stress tolerance; influences all of the above factors

Each of these areas is an important contributor to injury risk and needs to be considered in a training program.

When Corrective Exercise Goes Wrong

A couple years ago, I remember hearing people talk about how some personal trainers and strength coaches were taking some of these movement-based courses and basically not letting their clients/athletes do anything except corrective work until they met some standard. At the time, as I would now, I remember thinking “people actually do that?”

As time has gone by, I realize this is more common than I would have ever thought.

If you come back to the list above, focusing on movement capacity to the exclusion of other qualities will only improve that one injury risk factor. An argument can be made (that I’d agree with) that improving movement quality can improve stress tolerance by reducing unnecessary tension/tone resulting from a compensatory attempt to produce the desired movement, but not to the same degree that also addressing fitness/conditioning and accumulated fatigue would.

Probably the biggest oversight in an overly “corrective” approach is that the athletes actually detrain. Having slow, weak, and poorly conditioned athletes that move well doesn’t only neglect many key areas of injury prevention, it makes them worse at their sport.

A Better System

Even in the presence of movement limitations, athletes need to train to improve, or at least maintain, their performance capacities. The key here is to pick exercises and methods that are best suited for the athletes based on their current movement abilities. This is one of the major topics I discussed in in my DVD Optimizing Movement, as having a system for what to do in the presence of specific movement limitations makes it easy to individualize training, even in a group or team setting.

Optimizing Movement Cover-Small

Assessing factors that influence movement, and demonstrating how to use them to drive your training approach

It’s important to recognize that slow, weak, poorly conditioned, stressed out, and/or tired athletes are all at a greater risk for injury. With this in mind, training programs should be designed to develop physical capacities using individual-specific exercises/methods while also improving notable movement limitations, with coaches monitoring stress and accumulated fatigue to make any necessary adjustments to training loads or recovery strategies on an ongoing basis.

Wrap Up

Looking back on my own injuries, I can remember that some happened when I just didn’t feel right (possibly an alignment issue), some were the result of overuse, and others were simply because I was too weak.

As strength and conditioning coaches, our job is to deliver highly trained, injury resistant athletes to our coaches. As more emphasis is placed on assessments and corrective work, it’s important to not lose site of the importance of continuing to develop the speed, power, strength, and conditioning of our athletes, while also monitoring fatigue. Ultimately, a more comprehensive approach will not only improve their durability, but also their performance.

To your success,

Kevin Neeld
OptimizingMovement.com
UltimateHockeyTraining.com

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“A must for anyone interested in coaching and performance!”

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As I’ve dug further down the rabbit hole of the coursework offered by the Postural Restoration Institute, I’ve gained a better appreciation for the totality of their message.

I think of “corrective exercise” through their lens less about correcting posture and more about:

  1. Providing a sensory-rich environment for the individual to feel positions that he/she may not have much experience in achieving or controlling
  2. Down-regulating excessive muscle tone, largely driven by primitive reflexes
  3. Providing a “clearer pathway” for optimal respiration

It’s not the “stand up tall and breathe with your diaphragm” approach that I think most people associate with the word posture. In fact, I don’t think posture serves as anything more than a metaphor for how the individual is responding to the cumulative stressors and sensory inputs in their lives at any given moment.

While I don’t think I’m saying anything inconsistent with what PRI teaches, I don’t think these concepts necessarily come across readily in the introductory courses and believe that people that form opinions on what PRI is or isn’t after taking an intro course or two haven’t even begun to see past the tip of the iceberg.

Iceberg

I see you down there

With this in mind, I recently came across an article on PRI’s site from Bill Hartman that I really enjoyed. The article discusses some of the deeper implications of PRI’s information and what we’re really looking at by using their tests. Great read for anyone interested in their courses. Check out the article at the link below.

Click here to read the article >>PRI Conversations by Bill Hartman

As an aside, I’ll be heading to Lincoln for Advanced Integration this December. If you’re thinking about going, shoot me a note to let me know. It was one of the best courses I’ve ever taken when I took it a few years ago, so I have high expectations for this year!

To your success,

Kevin Neeld
OptimizingMovement.com
UltimateHockeyTraining.com

P.S. Interested in how I apply PRI concepts in our performance training programs? Check this out: Optimizing Movement

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“…one of the best DVDs I’ve ever watched”
“A must for anyone interested in coaching and performance!”

Optimizing Movement DVD Package

Click here for more information >> Optimizing Movement

A few weeks ago, we were very fortunate to have an opportunity to host Ron Hruska teaching the Cervical-Cranio-Mandibular Restoration course at our training facility Endeavor Sports Performance in Pitman, NJ.

PRI Cervical-Cranio-Mandibular Restoration

Prior to this most recent course I had taken Myokinematic Restoration (twice), Postural Respiration (twice), Pelvis Restoration, Impingements & Instabilities (I&I), Advanced Integration, Postural-Visual Integration, and sat for the PRT, since first diving into PRI in 2010.  I tend to take courses for one or more of three major reasons:

  1. Attain information or develop a skill set that I can implement immediately
  2. Satisfy an immediate intellectual curiosity
  3. Recognizing that the information may not make any sense to me now, but it’s another important piece of the puzzle and taking it now may facilitate a light bulb moment years in the future

The CCMR course really satisfied all three criteria, and frankly, I left feeling like I should have taken the course a year or two earlier. Working in a training setting that deals with a lot of hockey players, I took my first course as a means of finding better information to prevent common hip injuries. I continued taking courses because I left each course with a sense of there being more to the picture. Simply, I could tell there was much more to the picture than the musculoskeletal system, and while I heard things like “it’s all neuro” in I&I, I didn’t feel like I appreciated the full concept of how integrated the patterns taught in the introductory courses are with every other bodily system until the CCMR course.

A few take homes from the course:

1)   There are cranium and jaw correlates to the pelvis. In CCMR, you’ll hear Ron say things like “you have iliac bones in your head, and you have temporal bones in your pelvis.” Often times these analogies are meant to make you think (can you follow him down the rabbit hole?), but they’re also great teaching tools. If you feel comfortable with the myokin material, you’ll be able to track the CCMR course material, even if you don’t feel as comfortable with the anatomy of the neck and head.

2)   The patterns taught in the introductory courses are body wide. If you think of everything in terms of gait patterns, it’s easier to appreciate how a change in foot position may change shoulder range of motion, as each phase of the gait cycle is associated with changes in musculoskeletal positions throughout the entire body. This explains why a cue like “find your left heel or right arch” may improve right HG (shoulder) IR. Relevant to the CCMR course, it’s important to recognize that these patterns don’t just stop at the thorax; they continue up through the neck, cranium, and jaw. As with the above example, this helps explain why changing a bite may influence loading through the foot. Ron discussed several examples of how a sub-optimal bite can influence body wide patterns and how simply interrupting the sensory input from this bite can shift the entire system. There are clear correlates here to foot orthotics. The goal is to find the primary driver for any given individual’s pattern and address that. The CCMR course provides a few new assessments, manual techniques and exercises to help find and address top-down drivers, but it also provides a new perspective on how to view the entire system.

3)   PRI, as a whole, is heavily based around controlling autonomics and sensory input. There are several reasons why someone may get “stuck” in a pattern. In my mind, the more obvious ones are pattern overuse (e.g. sitting at a desk shifted into your right hip for 8 hours a day for a decade), and injury (e.g. a left ankle sprain may cause someone to shift their weight to the right). Maybe less obvious is the idea that any trigger that shifts someone into a chronic pattern of excessive sympathetic tone could also result in them being stuck in a pattern. This could be a sub-optimally functioning visual or auditory system, insufficient sleep time or poor sleep quality, excessive work/relationship stress, etc. While I haven’t heard Ron say this directly, I think you could justify taking steps to improve someone’s sleep as a “PRI program”. Maybe more holistically, failing to address prominent lifestyle triggers may be hampering the individual’s progress within a rehabilitative or preventative program.

Of all the PRI courses, this one gave me the best perspective of PRI’s evolution and the totality of integration in which they’re viewing the human system. If you’re on the fence about taking the course, I would strongly encourage you to register. CCMR is more than a head/neck/jaw course; it’s an integration course, and in my opinion, one of the best ones they offer!

To your success,

Kevin Neeld
OptimizingMovement.com
UltimateHockeyTraining.com

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Get Optimizing Movement Now!

“…one of the best DVDs I’ve ever watched”
“A must for anyone interested in coaching and performance!”

Optimizing Movement DVD Package

Click here for more information >> Optimizing Movement