Category: Training

Teaching the Hip Hinge

1/8/2017

Everyone who has been serious about moving around heavy weights, knows what the hip hinge is. This movement is key in developing strong, powerful hamstrings and glutes which carry over to improved athletic movement. The hip hinge is not a squatting movement and being able to separate these two patterns is very important.

Now anbody who has tried to coach a hip hinge movement, especially to young athletes, knows just how difficult it can be for people to pick up. Many athletes do not know how to separate a squat vs hinge or spinal movement vs hip movement. If you want to be humbled as a coach - take a group of 10 youngsters (5-7th grade) and try to teach the group an RDL.

You'd think a RDL was the hardest thing in the world for a human to perform, and boy can it be frustrating to see a total lack of body awareness/control. For all of us with a ton of experience using hinging exercises, we often take for granted how "easy" it is to hinge.

I've coached thousands of athletes to hip hinge, and it is HANDS-DOWN the most difficult movement to teach. That being said, through many trails, tribulations, mistakes - I've found some strategies to be very effective in teaching athletes, especially young athletes, to learn the hip hinge.

Starting Point

I always like to start my athletes off with an actual RDL - just to see HOW they perform the perform the movement. So I give them an empty bar - demonstrate and cue the movement - then ask them to perform.

This works on 2 fronts. 1 - If they actually perform the movement well, viola, I don't have to waste my time doing different progressions to get here. Unfortunately, this is NOT the norm. 2 - I can see where the movement breaks down. Are the squatting? Are they flexing their spine? Are they lacking posterior chain tension?

This gives me a specific area of focus or correction for the athlete - again rather than just throwing random things at the wall and seeing what sticks.

Squat Pattern Mistake

If I see the athlete maintain good spinal integrity, but rather than hinging at the hips, the athlete presents a more squatty pattern - here are some progressions.

Dowel RDL

This is my go to for teaching the RDL - why? Because it presents an external cue, that allows the athlete to self-correct and FEEL their mistakes and corrections. It's not just me giving them cue after cue after cue - they actually get to play around with the movement, and get kinesthetic feedback.

There is no better coaching cue than giving the athlete ownership of the process and they need to self-corrrect, self-learn.

Kneeling Band Hip Thrust

Now I call this a hip thrust, but it's basically a kneeling hip hinge. The beauty of this is 2-fold - 1. The band naturally pulls the athletes into a hip hinge position. So it essentially guides the athlete on the correct path - some slight "nudging" to the correct technique. 2. It removes a couple of moving parts - simplifying the movement.

Good Morning w/ Wall Touch

The next progression involves a good morning with a wall touch. The good morning, again externally rotates the shoulders and promotes a big chest and flat back.

The wall now provides an external point they must contact, and if they squat - they won't reach the wall. So again the wall provides feedback, that we as a coach could never provide. They know if they touch it or not - concrete, external feedback!

Put your athletes in situations where THEY are the owners of the learning process.

Spinal Control/Awareness Mistake

The other major mistake I see with hip hinging is a total lack of spinal awareness. Essentially the athlete can't feel the difference between a neutral spine and a flexed spine. So the goal with this is again to educate or give the athlete experience of spinal movement, so they can contextualize movements.

My favorite starting point is the Cat-Camel - the athlete gets exposed to spinal flexion and extension and can now FEEL the difference between the two. One thing you'll find is that many athletes can't even do a Cat-Camel - they literally have no coordination or control of their spine - they're a motor moron. How the hell can I think they'll perform a hinge pattern, if they have absolutely no idea how to move their spine, let alone actually have an understanding of what their spine is doing during movement.

Next time you see an athlete flex their spine during a movement, ask them - "Do you feel your spine doing that?"
You'll be surprised when you hear many young athletes say - NO! They don't have the knowledge/awareness of what their own body is doing. So it's our job to give them that experience and expose them to these movements in a controlled/highlighted manner.

When you do this, you'll see the lightbulb go - Feel when you do the Camel - that's what you're doing during this exercise. Feel the Cat, we want you more towards this when you perform this exercise. NOW, I'm not saying I want my athletes in spinal extension during a hinge - but in this example, I'll gladly rather have an athlete get out of flexion and trend towards extension - because typically they'll find the middle ground - neutral.

KB RDL to Box/Bench

This is a nice progression, as it gives a specific landmark on the hip hinge and the bench restricts forward motion of the knees (aka a squatty hinge). Again, the beauty is the constraints on the task that allow the athletes hinge movement to emerge. No coaching cue can duplicate the effectiveness of constraining the task/environment in this case - instead the art of coaching the hinge, or any movement for that manner, is putting the athlete in an environment that ensures the "correct" movement pattern to emerge, otherwise they won't be able to complete the task.

Cues

Now, everybody LOVES cues - cue this, cue that, external cue vs internal cue, etc.

What do many do when someone can't hinge? We cue the hell out of them!

Well, I don't know about you, but this hasn't worked extremely well for me. I've found that cues work well, when the athlete has a basic understanding of the movement pattern. Cues don't work when the athlete lacks general motor control, and can't contextualize the meaning of many cues.

That being said, here are some of my favorites - cues that have fine-tuned some minor technique errors or reminded athletes of the correct mindset

"Peak Out Of A Window"
"Imagine A Wall Is 1ft Behind Your Butt, Reach Your Butt Back To That Wall"
"There's A Rope Around Your Hips and It's Pulling You Back"
"There's A Rope Around Your Shoulders and It's Pulling You Forward"
"Feel A Stretch In Your Hamstrings"

Now that we've gotten our athletes hinging well in a controlled manner, it's time to progress to dynamic hip hinging!

This could be Olympic variations, dynamic deadlifts, but my favorite to start with is the KB Swing.

The swing is a dynamic hinge movement that allows for greater speeds to overload the eccentric portion and really stress the SSC for great dynamic hip power.

The problem I see when starting to move to more dynamic movements - in any pattern - is a breakdown of mechanics/technique. This may mean the athlete is not ready for this progression - which means we have to step-back and continue with our previous regressions. It may also mean, the athlete just needs some more fine-tuning.

Building upon the bricks laid earlier - let's put an athlete in an environment that allows the correct movement to emerge. For the swing, this might involve placing an object betwen the athletes legs. This prevents a squatty swing, and overall fixes a while mess of technique errors that commonly occur in the swing.

Depending on the height of the athlete, we want the object to come up to the tibial tuberosity (object in video is too low). So this could be a cone, yoga block, medicine ball, whatever works for you. In the video I use a dumbell, but I would recommend using something like a cone or yoga block, so if the athlete hits it, their won't be any chance of injury or damage to equipment.

After finishing all of these progressions the athlete will be very proficient in the hip hinge. They can now safely move on to higher loads and greater speeds of movements.

This is a great basis for learning olympic lifts, deadlifts, good mornings, and RDL's. If you work with youth athletes or even higher level athletes that can't hip hinge, this progression is key. The hip hinge technique will allow these athletes to progress to later exercises that will build the foundation of their lower body strength, especially the glutes and hamstrings.

Hip hinge teaching progression, finishing with RDLs

A video posted by Building Better Athletes (@bbaperformance) on Jul 28, 2016 at 10:26am PDT

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Squat Science - Why We All Squat Differently

11/3/2016

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The squat, a movement that most believe is a fundamental pattern to humans; a movement that we should strive to train and maintain for performance and just general wellness.

It is also a topic of much debate when it comes to HOW to perform a squat...

What stance?
What width?
What toe angle?
What bar position?
What variation?
How deep?

I've worked with close to a thousand athletes and guess what… they all squat differently. Different stance widths, different foot positions, different depths, different variation preferences, different bar positions, etc.

I'm tired of hearing athletes being told they MUST squat a certain way or there is only ONE way to squat… that is rubbish and certainly isn't rooted in science.

Let's think about this - do you really think someone 6'6 should squat the same as someone 5'2? Should someone with long femurs and a short torso squat the same as someone with short femurs and a long torso? Should someone with retroverted hips squat the same as someone with anteverted hips?

If I have a group of 20 athletes and had them all squat with a stance of their preference, to a depth they felt comfortable, with a toe angle that allows the most freedom - you know what I'd find? 20 different squats with different widths, foot angles, depths, trunk angles, etc.

So why do coaches & PT's still try to jam a square peg into a round hole by thinking there is only one way for people to squat? You NEED to squat with toes forward, in a shoulder-width stance, to a parallel depth!

Now I'm a man of science, not just anecdotal evidence, so let's see what some of the literature on anatomy and skeletal structure of the hips says and how this may effect the squat

The femoral neck/head isn't the same in every person. Zalawadia et al (2010) demonstrated that as much as 24-degrees difference in anteversion and retroversion is common. Zalawadia also noted that these differences of anteversion and retroversion can differ from side to side - not all hips are symmetrical!

With sooo much potential variation is peoples hips, not to mention potential side to side difference in the same person - you still think everybody's squat should look EXACTLY the same? Femoral and acetabulum structure will play the main role in ones ability to squat in certain positions to certain depths - NOT a universal preference made up by some person.

Laborie et al (2012) noted that anteversion and retroversion isn't strictly contained to the femoral head, it can also be present in the acetabulum. They looked at over 2000 samples of centre-edge angles of the acetabulum and found angles differed from 20.8-45 degrees

Again, how can we expect someone with a 20.8-degree anteversion to squat the same as someone with a 45-degree retroversion?

Knutson (2005) looked at leg length, and found that about 90% people have a discrepancy with the average difference of about half a centimeter.
Flanagan & Salem (2007) examined different kinetic variables in the squat of 18 experienced lifters. They looked at many things including average joint moments at the hip/knee/ankle, ground reaction forces in each foot, center of pressure for each foot, and maximum flexion angle at the knee/hip/ankle. They found many things (some statistically significant, others not) including side to side differences in center of pressure, ground reaction forces, and joint moments at the ankle, knee, and hip (especially the hip). The researchers concluded that NOBODY was balanced and every subject demonstrated differences in at least on of the joints (ankle, knee, hip)

It is COMMON that people squat with asymmetries and differences from side to side. It's normal to have someone feel and perform better with one toe angled out/in, staggered forward/backward, externally/internally rotated compared to the other.

If pain isn't present - THERE IS NOTHING WRONG WITH THIS - and it's likely aiding in performance, comfort, and health. We aren't symmetrical beings and sometimes forcing symmetry may actually be taking someone out of their "neutral".

Want to see what these differences actually look like? Check out the below photos and see how these skeletal structures can differ and visualize how they'll dictate an athletes optimal squat.

If we tried to take these people and squat them in a toes forward, shoulder width stance, to parallel, what do you think would happen?

Some would ace the test, while others would fail miserably… why?

Much of it would have to do with this structure - NOT some mobility, stability, strength, motor control dysfunction, but rather something they CANNOT change - their bone structure.

We seem to be in a stage where we see someone who can't squat deep, or prefers a wide stance, or turns their feet turn out, or has butt wink and we jump all over them with how their "insert joint/muscle" is tight/weak and needs soft-tissue, mobility, or activation work, BUT in many situations, no matter what correctives, or soft-tissue, or crazy mobility you throw at the athlete - they just won't be able to squat in certain positions.

Let's wet our whistle with a little more literature

Elson and Aspinal (2008) showed what is tremendously obvious for coaches that actually work with people - there are vast differences in range of motion in hip flexion and extension - meaning some people are just better suited for deep hip flexion (deep squat), while this position would cause massive problems for others.
D'Lima et al (200) demonstrated that differences in femoral neck/head thickness (as little as 2mm) could impact hip flexor ROM by 1.5-8.5 degrees.
Lamontagne et al (2009) looked at people with femoroacetabular impingement syndrome (FAI) and squat ability and concluded due to anatomical variations at the hip such as cam or pincer, there are plenty of lifters who will never be able to deep squat with proper form.

So should everybody squat to parallel or ass to grass? Should everybody have the same stance width and toe angle?

NO!!!

Some have a tendency for hip flexion (squat deep), while others have tendency for hip extension. If we force them to parallel or ass to grass we may be forcing bone on bone or a hip impingement - not good things. The only people that NEED to squat to parallel are powerlfiters, it's a requirement of their sport. As for athletes, there is no rule book that says you have to squat to parallel or beyond - it's not a requirement nor is it going to make or break performance.

Again, ones ability to squat to different depths in different stances can be explained by their skeletal structure - NOT necessarily mobility or soft tissue or strength issues. It also means trying to say everybody should squat the SAME WAY is a terrible thought process and could actually be causing more harm than good.

Here's a quote from the great Stu McGill, considered the World's foremost expert on spinal health - "The most important matter on all of this is the depth of the hip socket. If people are looking up on the internet, depth of the hip socket and squat ability, they won’t find it. They have to go to the hip dysplasia literature. What they’ll find is that there are groups in the world with very shallow hip sockets (allow greater hip flexion) and some with deep hip sockets (make it difficult for deep hip flexion)."

Even the World's expert says it's structure that dictates deep squat ability, it's NOT some universal standard.

Insert pictures of strong peeps, lifting heavy things and what do you see?

No identical stance, depth, toe angle, etc.

Why again do we try to force people to squat a certain way, to a certain depth? Coach athletes as individuals.

Let's look at some more myths that pertain to squatting

Knee's Can't Go Beyond The Toes

Here is another myth is purported in all areas and there’s little evidence to support this claim. The knees passing beyond the toes is not some universal point where all of a sudden the stresses on the knee become dangerous and every point before that is safe.

You know what's even more? Artificially restricting or trying to prevent forward movement of the knees may be detrimental to the hips and back. Fry et al (2003) looked at the effect of restricted squats where a wooden board was placed in front of the lifter that didn't allow the knees to track past the toes.

What did they find?

Restricted Squat

As expected, the board restricted setting reduced torque on the knees, but increased torque at the hip and low back. So you take stress on one joint, only to increase it at another - so pick your poison.
The researchers concluded, "Exercise technique guidelines should not be based primarily on force characteristics for only one involved joint (e.g., knees) while ignoring other anatomical areas (e.g., hips and low back).”

While shear forces have been shown to increase in the deep squat position with forward knees, the body can handle them appropriately without risk for injury (Schoenfeld (2010)). The most thorough review of squat depth on knee pain showed the demands on these tissues in a deep squat are well below the maximum that those tissues can withstand (Hartmann et al (2013)). What's important is not whether the knees go beyond the toes, but when they track beyond toes.

Plus, every Olympic lifter of all-time, theoretically should have messed up knees and some PT would tell them they're lifting wrong...

Squat Stance and Squat Variation

Guess what - the type of squat you use isn't vastly different from each other. EMG between a front squat and back squat aren't that different, with some studies even showing NO STATISTICAL DIFFERENCE in muscle activities between front and back squats. (Contreras et al (2016); Gullet et al (2009)). In general, the front squat will lead to slightly more quad activation and thoracic extension strength; while back squat slightly more glute/hamstring activation, but again, the EMG difference between the two isn't as big as people think.

How about wide stance vs narrow stance?

Wide stance squats tends to activate greater adductor and glute compared to narrow squat, with no difference between quad activation (Escamilla et al. (2001); Paoli et al (2009); Steven & Donald (1999)). Swinton et al (2012) recently demonstrated exactly this as the researchers showed EMG results for glute activation were significantly higher in a wide stance compared to a narrow stance. These EMG results also showed that quadricep activation between the stances were identical - concluding, muscle activation wise, a narrow stance isn't superior to a wide stance.

How about toe angle or hip angle?

Ninos et al. (1997) found no difference in vastus medialis activation between barbell back squats with two different hip rotation angles (feet pointing outwards vs. feet pointing forwards). While, Pereira et al (2010) found externally rotating the hip to 30 and 50-degrees resulted in greater hip adductor activation with no change in rectus femoris activation, leading the researchers to conclude that squatting to 60-90 degrees of knee flexion with 30 degrees of external rotation maximized muscle activation.

Again, there is NO LITERATURE supporting the NEED to squat with toes forward! Rather than squatting with your toes forward or pointed out to a predetermined degree and forcing your knees and hips to follow along, you’re better off seeing what hip and knee position feels the strongest and most comfortable, and letting that determine how far out you point your feet (Nuckols (2016))

In a great review of all the variables that effect muscle activation of a loaded back squat, Clark et al (2012) concluded, research of common variations such as stance width, hip rotation, and squat variation (front vs back) do not significantly affect muscle activation. Turning the toes out, however, only changes the activation of the adductor muscle group. The glutes and quads (the main movers in the squat) are not significantly activated to a greater extent by any of the variables (Clark at el (2012)).

So we've seen, specific squat variations - wide, narrow, toes forward, toes out, depth - aren't make or break factors when it comes to muscle activation, joint stress, or performance.

So again, why would be ever think there is only one way to squat and what would make this way superior? The fact is, there isn't a single strategy to squat and instead should be dictated upon by the individuals unique skeletal structure, limb lengths, past injury history, mobility/stability factors, and biomechanics.

Here's just a small list of things that influence squat mechanics

Foot Wear (elevated heel vs flat heel)
Long Tibia vs Short Femur
Short Tibia vs Long Femur
Short Femur vs Long Torso
Long Femur vs Short Torso
Body Mass
Stance Width
Toe Angle
Foot Size (Length)
Cueing
Anterior vs Posterior Chain Strength
Specific Joint Mobility and Stability Strengths and Weaknesses
Bar Position

Linked below is a really cool website that demonstrates how different body part lengths, stance width, bar positioning, etc effect the outcome of what a squat will look like - again it's basic biomechanics - http://mysquatmechanics.com

Here are some pictures of how simply changing levers, stance width, ankle mobility, and bar position effect the end look of a squat

Poor Ankle Dorsiflexion

Good Ankle Dorsiflexion

Short Femur - Long Torso

Long Femur - Short Torso

Short Tibia - Long Femur

Long Tibia - Short Femur

Low Bar Positioning

Wide Stance

All-In-All

The goal of this article is to demonstrate there is no universal way to squat and we need to work to allow and find our athletes optimal way to squat based on their individual anatomy, levers, mobility/stability needs, past injury history, etc - and NOT try to pigeon-hole everybody into a certain way of squatting.

Please share this with anybody you think would benefit and let's stop the squat stupidity from spreading.

PS - Below are some squat assessment videos on what we might use to assess our athletes to find their best squatting stance.

References:

Clark, D. R., Lambert, M. I., & Hunter, A. M. (2012). Muscle activation in the loaded free barbell squat: a brief review. The Journal of Strength & Conditioning Research, 26(4), 1169-1178.

Contreras, B., Vigotsky, A. D., Schoenfeld, B. J., Beardsley, C., & Cronin, J. (2016). A comparison of gluteus maximus, biceps femoris, and vastus lateralis electromyography amplitude in the parallel, full, and front squat variations in resistance-trained females. Journal of applied biomechanics, 32(1), 16-22.

Escamilla, R. F., Fleisig, G. S., Lowry, T. M., Barrentine, S. W., & Andrews, J. R. (2001). A three-dimensional biomechanical analysis of the squat during varying stance widths. Medicine and science in sports and exercise, 33(6), 984-998.

Flanagan, S. P., & Salem, G. J. (2007). BILATERAL DIFFERENCES IN THE NET JOINT TORQUES DURING THE SQUAT EXERCIS. The Journal of Strength & Conditioning Research, 21(4), 1220-1226.

Gullett, J. C., Tillman, M. D., Gutierrez, G. M., & Chow, J. W. (2009). A biomechanical comparison of back and front squats in healthy trained individuals. The Journal of Strength & Conditioning Research, 23(1), 284-292.

Hartmann, H., Wirth, K., & Klusemann, M. (2013). Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports medicine, 43(10), 993-1008.

Knutson, G. A. (2005). Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & osteopathy, 13(1), 1.

Lamontagne, M., Kennedy, M. J., & Beaulé, P. E. (2009). The effect of cam FAI on hip and pelvic motion during maximum squat. Clinical orthopaedics and related research, 467(3), 645-650.

Ninos, J. C., Irrgang, J. J., Burdett, R., & Weiss, J. R. (1997). Electromyographic analysis of the squat performed in self-selected lower extremity neutral rotation and 30 of lower extremity turn-out from the self-selected neutral position. Journal of Orthopaedic & Sports Physical Therapy, 25(5), 307-315.

Nuckols, Greg. http://strengtheory.com/how-to-squat/. 2016

Paoli, A., Marcolin, G., & Petrone, N. (2009). The effect of stance width on the electromyographical activity of eight superficial thigh muscles during back squat with different bar loads. The Journal of Strength & Conditioning Research, 23(1), 246-250.

Pereira, G. R., Leporace, G., das Virgens Chagas, D., Furtado, L. F., Praxedes, J., & Batista, L. A. (2010). Influence of hip external rotation on hip adductor and rectus femoris myoelectric activity during a dynamic parallel squat. The Journal of Strength & Conditioning Research, 24(10), 2749-2754.

Schoenfeld, B. J. (2010). Squatting kinematics and kinetics and their application to exercise performance. The Journal of Strength & Conditioning Research, 24(12), 3497-3506.

Steven, T. M., & Donald, R. M. (1999). Stance width and bar load effects on leg muscle activity during the parallel squat. Med Sci Sports Exerc, 31, 428-436.

Swinton PA, et al (2012) A Biomechanical Comparison of the Traditional Squat, Powerlifting Squat, and Box Squat. The Journal of Strength & Conditioning Research 26(7):1805–16

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The Myth of the FMS

10/7/2016

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The Functional Movement Screen (FMS) is a popular screen used by coaches and sports medicine professionals as a screen for movement competency. It is composed of 7 movements and scored on a 0-3 scale, where 0 = pain, 1 = couldn't perform the task, 2 = performed task with compensation, 3 = performed task correctly.

The scores from the 7 movements are combined into a final score out of 21. The score is supposed to predict injury and performance and it is even suggested that scores under 14 predict a greater risk of injury.

The FMS claims to identify compensatory movement patterns that are indicative of increased injury risk and inefficient movement that causes reduced performance.

That's a pretty big claim and one the FMS has NOT lived up to.

First and foremost, the FMS is supposed to be a SCREEN and unfortunately practitioners far out-reach the boundaries of a screen when applying the FMS. The FMS places labels on people and their movement and with anything that places labels, we certainly hope there is some strong evidence that supports these labels.

This is tremendously important because when someone scores poorly on a test, they get told their chance of getting injured is high and their performance is decreased. This only implants fear and guarding in the client, rather than confidence and overall is a great way to build fear of movement and sport. Coaches and those in sports medicine NEED to get beyond telling clients that because they score poorly on a test, they'll get injured - this isn't beneficial to anyone.

Again, the FMS is supposed to be used as a screen, NOT a diagnostic tool… it doesn't and should NOT be used to diagnose things. Yet, I hear people all over, use the FMS to diagnose supposed dysfunction.

It is a baseline screen, and honestly only scratches the surface of what else needs to be assessed. I have heard of athletes who performed the FMS, and then get told rash diagnoses and the things they get told put fear in the athlete basically saying that it's a miracle they can even make it through a day of school with all the dysfunction's they have.

"You shouldn't squat based on your OH Squat assessment;
your core is sooo weak; you have tight hamstrings - you shouldn't sprint;
you have an asymmetrical rotary stability score - you will get injured if you don't improve it"

Given all radical leaps in faith the FMS asserts, let's take a closer look at various aspects of the FMS and their claims

The FMS claims to identify compensatory movement patterns that are indicative of increased injury risk and inefficient movement that causes reduced performance.

This is the big one I'll address because it claims an awful lot, and as you'll see, without much scientific support.

In order for the FMS, or any screen for that matter, to be a valid indicator of injury or inefficient movement in sport, it is logical that the compensatory movement patterns that are tested during the screen must be the same or similar to those that are performed in sport - which the FMS does not (Beardsley)

Dossa et al. (2014) studied junior level hockey players to see if the FMS could predict injuries throughout a season. The researchers concluded the FMS could NOT be recommended as a screening tool for injury prevention.

McCall et al. (2015) reviewed the scientific level of evidence of three of the most commonly-reported risk factors, screens, and injury prevention exercises in a previously published survey of 44 premier league soccer teams. The FMS was one of the identified screens. They assigned the FMS a grade D, where D = insufficient evidence to assign a specific recommendation.

Parchmann et al. (2011) studied the FMS to evaluate whether it was related to sport performance and found there were NO significant correlations between the higher FMS scores and on-field sports performance.

Even the founders of the FMS did a literature review on the FMS and stated “the use of a total FMS score for predicting injury risk should be avoided, as the individual components of the test are not correlated with one another and are therefore not measuring the same underlying variable" (Cook et al. (2014)).

Several researchers have assessed FMS scores on athletes of different ability levels to see if higher performing athletes scored higher on the FMS compared to lower level athletes. They found there to be no difference between FMS scores and the level of the athlete. This shows that the FMS does not and cannot predict performance. (Fox et al. 2013; Grygorowicz et al. 2013; & Loudon et al. 2014).

Lockie et al. (2015) found very little correlation between FMS scores and multidirectional speed and jumping tests in healthy male subjects.

In addition, many investigations have been performed to assess the correlations between sprinting, jumping, throwing and agility performances and FMS scores and most have found no relationship between any measure of athletic performance and FMS score (Okada et al. 2011; Parchman et al. 2011; Lockie et al. 2015).

When it comes to predicting injury, Dallinga et al. (2012) reviewed the literature in respect of the tests that could predict a greater risk of injury. They reported that general joint laxity, the Star Excursion Balance test, age, a lower hamstring-to-quadriceps strength ratio, and a reduced hip abduction range of motion could all predict a higher risk of lower body injuries. To test an aspect of this injury prediction model, Paszkewicz et al. (2013) investigated the association between total FMS score and Beighton and Horan joint mobility index (BHJMI) in adolescent athletes. They found no correlation between total FMS score and BHJMI index. We also know the FMS can't target any of the other aspects shown by Dallinga et al. (2012) as being predictive of injury.

A major flaw with the FMS is it's ability or lack of ability to distinguish between athletes. Shouldn't we assess individual variances between athletes in different sports? A baseball player should definitely be assessed differently than a cross country runner or an offensive lineman in football. Each one of these athletes will exhibit markedly different mechanical adaptations based on the demands of their sport and position. Whose to say these adaptations are wrong or bad? "Faulty" movement patterns do not always lead to pain or injury and in many cases these adaptations are what make athletes better performers in their sport. Guess what, tissues positively adapt and get stronger based on the stresses placed on them… this is why a pitcher's arm will be very different from others - and this IS NOT a bad thing. Poor posture does not mean its pathological nor does it mean that person will suffer from more musculoskeletal problems. So can we please STOP TELLING ATHLETES THIS

The FMS Can Predict Injury

Short answer - NO IT DOESN'T

Schneiders et al. (2011) looked to find normative values in the FMS with young athletes. They evaluated the FMS based on the assumption that identifiable biomechanical deficits in fundamental movement patterns have the potential to limit performance and render the athlete susceptible to injury. In this study, the researchers found that healthy individuals and previously injured individuals had the same scores. So the FMS could not even detect differences in injured individuals compared to healthy ones. This is of concern as past injury is a main risk factor of future injury. If FMS cannot detect any sign of recent injuries, it seems unlikely that it can detect future risk, let alone be used as a basis for a specific therapy.

Frost et al. (2013) questioned the ability of the FMS to assess dysfunction. They looked at 21 firefighters who initially performed a standard screen followed by a repeat screen 5 minutes later, but on the 2nd trial participants were given a verbal description of the grading criteria before performing each test. All firefighters improved their scores within minutes of being told what movement patterns were required - The average score improved from 14.1 ± 1.8 to 16.7 ± 1.9 points; remember in just 5-MINUTES. Therefore, changes in FMS score may not be due to actual improvements in mechanical efficiency such as mobility, stability or coordination of an athlete but rather simply a knowledge of what the task requires. This isn't the first time this outcome has been shown, as there are indications that subjects may deliberately alter their movement patterns during the FMS test in order to score higher (Teyhen (2012); Schultz (2013)). This is supposed to be a reliable screen?

To piggyback the last bullet point - The FMS sum score appears to be very reliable between raters (inter-rater) and within raters for a video of the same test (intra-rater). However as we just discussed, test-retest is less reliable, indicating that the same subjects may score differently on different occasions, despite there being no biomechanical changes made (Beardsley).

Okada et al. (2011) studied the relationship between FMS scores and "core" strength on actual sport performance. To keep beating a dead horse, it was found "core" strength and FMS scores are NOT strong predictors of sports performance… yet PT's continues to tell clients/athletes core strength and quality FMS scores are important for performance and pain.

As I said earlier, it has been suggested that scores under 14 predict a greater risk of injury. BUT, O'Connor et al. (2011) demonstrated that scores of 18 or more were more at risk for injury than those who scored less than 18 in 874 marine officers. Scores above 14 are supposed to have decreased risk of injury, not the opposite, especially with a score so close to being perfect.

These 7 Tests Predict Global Movement?

At the end of the day, it is a far stretch to think these 7 tests somehow can predict an athletes global movement, especially when the athlete is under load, speed, chaos, and fatigue.

Yet, some believe that these slow, safe, pre-planned, mostly static tests will predict dynamic movement. It's one thing to do tests in a very controlled, passive type of environment compared to dynamic. I've seen a lot of good things in table assessments or FMS type screens, only to go to HELL under speed or load… Let this be clear, while these screens can have some benefit, they tend to have absolutely NO transfer to dynamic, reactive, and chaotic environments such as sport.

For example, what do we gain from the Overhead Squat (OHS)?

Let's be real here, using the OHS as an assessment of general movement ability, is like using a tennis serve to test coordination (Quote from Dr. Cobb of Z-Health). The OHS is arguably the most complex version of a squat. So instead of starting with a baseline test and a more basic squat version, we skip A-Y and go straight to Z. In addition, squatting while reaching overhead is not something that humans are designed to do. It is a skill, and anybody, the first time you ask them to perform something that is completely new to them will struggle. Chances are, the faults you find in the OHS are due to a lack of performing this specific task as opposed to a lack of good general movement patterns.

Also, why are no other squat assessments used, such as adding a counter-weight (clarify mobility vs stability needs), taking a wide stance, letting toes track outward, using an asymmetrical stance, etc.

Nope, instead the FMS forces everybody to take a shoulder width stance with toes forward and discounts the fact that everybody's hip anatomy is different and to say that you need to be able to OHS with a shoulder-width stance, with toes forward is absurd… how are we still on this? Take a look at the pictures below and tell me if these people should be judged on the same squatting scale given their vastly different anatomical structures.

It's like trying to fit a square peg into a round whole when we say you should be able to squat in this stance at this depth and apply it to the whole population.

In Closing

This isn't to say that the FMS is useless, but let's be honest, anybody with a grasp of anatomy and biomechanics can clearly see the gaps in reasoning in using solely the FMS as an assessment tool.

Now, the FMS and those who use it, do a wonderful job of marketing and "scaring" athletes/clients into thinking that because they scored poorly, they need additional training. I mean, it's a beautiful system in a business sense, although as I've shown, it lacks support from research to do what it claims to do.

So a word of caution to athletes/clients/parents - usually those promoting the FMS have something to sell. They'll show you where you're "lacking" and probably have some program that will "fix" these problems.

A word to coaches and professionals - come up with your own assessment that is based in science and evaluates the athlete not only statically, but dynamically and in a manner that is the same or similar to those that are performed in sport. Also, please use tremendous caution when telling athletes/clients they are "broken" or dysfunctional or on their way to injury. This is bad business and psychologically damaging to the athlete/client and only creates fear of movement.

Check out our Elite Performance Podcast for a little breakdown of what goes into our assessment process (Starting at 4:00-14:00min)

References:

Beardsley - https://www.strengthandconditioningresearch.com/functional-movement-screen-fms/#CONT

Cook, G., Burton, L., Hoogenboom, B. J., & Voight, M. (2014). Functional movement screening: the use of fundamental movements as an assessment of function-part 2. International journal of sports physical therapy, 9(4), 549-563

Dallinga, J. M., Benjaminse, A., & Lemmink, K. A. (2012). Which Screening Tools Can Predict Injury to the Lower Extremities in Team Sports?. Sports medicine, 42(9), 791-815

Dossa, K., Cashman, G., Howitt, S., West, B., & Murray, N. (2014). Can injury in major junior hockey players be predicted by a pre-season functional movement screen–a prospective cohort study. The Journal of the Canadian Chiropractic Association, 58(4), 421.

Fox, D., O’Malley, E., & Blake, C. (2014). Normative Data for the Functional Movement Screen™ in Male Gaelic Field Sports. Physical Therapy in Sport.

Frost, D. M., Beach, T. A., Callaghan, J. P., & McGill, S. M. (2013b). FMS™ scores change with performers’ knowledge of the grading criteria-Are general whole-body movement screens capturing” dysfunction”? The Journal of Strength & Conditioning Research.

Grygorowicz, M., Piontek, T., & Dudzinski, W. (2013). Evaluation of Functional Limitations in Female Soccer Players and Their Relationship with Sports Level–A Cross Sectional Study. PloS one, 8(6), e66871

Lederman E. The Myth of Core Stability. Journal of Bodyworks Movement Therapy. 2010 Jan;14(1):84–98.

Lockie, R. G., Schultz, A. B., Jordan, C. A., Callaghan, S. J., Jeffriess, M. D., & Luczo, T. M. (2015). Can selected functional movement screen assessments be used to identify movement deficiencies that could affect multidirectional speed and jump performance?. The Journal of Strength & Conditioning Research, 29(1), 195-205

Loudon, J. K., Parkerson-Mitchell, A. J., Hildebrand, L. D., & Teague, C. (2014). Functional movement screen scores in a group of running athletes. The Journal of Strength & Conditioning Research, 28(4), 909-913

McCall, A., Carling, C., Davison, M., Nedelec, M., Le Gall, F., Berthoin, S., & Dupont, G. (2015). Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues. British journal of sports medicine.

Okada, T., Huxel, K. C., & Nesser, T. W. (2011). Relationship between core stability, functional movement, and performance. The Journal of Strength & Conditioning Research, 25(1), 252-261

O’Connor, F. G., Deuster, P. A., Davis, J., Pappas, C. G., & Knapik, J. J. (2011). Functional movement screening: predicting injuries in officer candidates. Med Sci Sports Exerc, 43(12), 2224-30.

Parchmann, C. J., & McBride, J. M. (2011). Relationship between functional movement screen and athletic performance. The Journal of Strength & Conditioning Research, 25(12), 3378-3384.

Paszkewicz, J. R., & Cailee Welch McCarty, D. (2013). Comparison of Functional and Static Evaluation Tools Among Adolescent Athletes. The Journal of Strength & Conditioning Research.

Schneiders, A. G., Davidsson, Å., Hörman, E. & Sullivan, S. J. (2011). Functional movement screenTM normative values in a young, active population. International Journal of Sports Physical Therapy, 6(2),75.
Shultz, R., Anderson, S. C., Matheson, G. O., Marcello, B., & Besier, T. (2013). Test-Retest and Interrater Reliability of the Functional Movement Screen. Journal of athletic training, 48(3), 331-336

Teyhen, D. S., Shaffer, S. W., Lorenson, C. L., Halfpap, J. P., Donofry, D. F., Walker, M. J., & Childs, J. D. (2012). The Functional Movement Screen: a reliability study. The Journal of Orthopaedic and Sports Physical Therapy, 42(6), 530-40

Unsgaard-Tøndel M, Fladmark AM, Salvesen O, Vasseljen O. Motor Control Exercises, Sling Exercises, and General Exercises for Patients With Chronic Low Back Pain: A Randomized Controlled Trial With 1-Year Follow-up. Phys Ther. 2010 Jul.

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The Myth of Triple Extension?

9/28/2016

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There is a fascination in the Strength and Conditioning world with triple extension. For those not familiar - triple extension is extension of 3 joints - ankle, knee, and hip.

In fact, achieving triple extension has become, in many cases, the main priority in exercise selection.

Why has triple extension become a prized possession when training athletes?

Well it has been proposed as a key in athlete performance, mainly imho, because when you look at still pictures of jumping or accelerating or sprinting coaches perceive the key performance indicator behind these movements is triple extension.

Go into Google and type in Triple Extension and here are some of the top images...

As you can see, Olympic lifting is very closely associated with triple extension and hence why it is thought to be a valuable training tool.

BUT, BUT what if I told you triple extension is far overrated? What if triple extension occurs FAR FAR LESS than what you've been told? What if I told you triple extension has only a small amount to do with athletic success?

For many it would be blasphmaomy, but let's take a deeper look at triple extension.

First, let's take a look at these picture and tell me if triple extension is occurring…

See Triple Extension?

How About During Acceleration?

When it comes to sprinting, triple extension does NOT occur. During top-end sprinting neither full hip, knee, or ankle extension occurs.

In fact, the more extension one gets, the slower they will run. In order to maximize speed, less active ankle, knee, and hip extension occurs, and the sooner flexion in these joints occur during and immediately after Ground Contact, the better.

Understand this, during top-end speed, the athlete is only on the ground for .07-.13seconds, this is no where near enough time for someone to fully extend each joint, and the more they try to, the slower they would run. The best sprinters have less hip and knee extension at toe-off

If an athlete tried to triple extend, they would create excessive backside mechanics which leads to long, inefficient GCT, and further lead to poor flight positioning of the swing leg which would finally result of the swing leg contacting the ground out in front of the body, rather than closer to the COM.

It's a deadly cycle.

During acceleration, athletes MAY triple extend during their first 1-2 steps, but after that - triple extension DOES NOT occur. Same as top-end speed, their simply isn't enough time on the ground, and extension power should be put forth during ground preparation and during the 1st half of GCT - the goal during ground contact is to get off the ground as quickly as possible.

Let's take a look at some great charts by James Wild (@wildy_jj)

The below chart shows that full hip extension doesn't occur during the 1st 3-steps, and this is amplified in team sport athletes - who are less technically proficient as sprinters.

This chart shows knee extension during the 1st 3-steps, again full knee extension is no where to be found.

This chart shows ankle extension, again the less ankle extension, the better the performance.

When it comes to the vertical jump, Chang et al. (2015) demonstrated that vertical jump performance was not dictated by triple extension. Instead, successful performance in the vertical jump could be described by knee and ankle extension, not hip extension.

In fact, I think triple flexion is on the same level of triple extension. Flexion angles of the hip, knee, and ankle are vitally important for sprinting speed. Ankle dorsiflexion is a must during sprinting, COD, and braking actions. Hip flexion is a must to allow the body to produce maximal forces during sprinting, acceleration, and jumping. Triple flexion allows the body to create a ton of stored elastic energy to be reproduced during extension phases. Triple flexion is the loading, coiling, and absorbing - extension is uncoiling and expression.

This chart shows the LESS ankle dorsiflexion range equals faster speeds… in normal english, this means the less the ankle deforms at GCT the better - so coming into GCT with MORE FLEXION can help allow less deformation, better utilization of stored elastic energy, and shorter GCTs.

At the end of the day, triple extension plays a role in athletic performance, but let's be clear - it's a lot less important than most claim.

Being able to produce extension forces IS very important, but they are not necessarily end range of motion extension forces.

So the moral of the story is this - if you're choosing your exercises/programming based on achieving triple extension, take another look because that is a poor reason to include or exclude certain exercises.

Got Get 'Em!

References

Chang, E., Norcross, M. F., Johnson, S. T., Kitagawa, T., & Hoffman, M. (2015). Relationships between explosive and maximal triple extensor muscle performance and vertical jump height. The Journal of Strength & Conditioning Research, 29(2), 545-551.

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Why We Don't Olympic Lift

5/24/2015

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Every Thursday we have a staff meeting where we discuss various topics or bring in presenters to help our continued education. This past Thursday we had a debate on Olympic lifting and whether they should be used by athletes.

We had a great group with people from many backgrounds and experiences, which of course gave us an insightful debate on the Oly's.

For those of you that know us here at BBA know we don't use Olympic lifts, something that surprises many athletes and coaches when we tell them.

We explain why we feel they aren't necessary, why we avoid them and the severe short-comings of strictly performing Oly's. Below we outline why we don't perform them and our reasoning.

1. Why Are You Doing Them?

The first question I always ask is why are you performing Oly lifts? Is it because you've seen other people do them, or they look cool, or is it for a specific purpose. I could go and ask High School programs why they are programming Olympic lifts and I wouldn't get a very good answer other than it's what everybody does - unfortunately that's not a very good answer.

If you are going to perform them, then have a concrete reason. If it's because of the power production you can get from them, great. There are many ways to skin a cat and we'll dive into what we think are better ways to develop power in a more time efficient and safe manner. But if you honestly can't answer that question or aren't qualified to answer that question, then you shouldn't be performing Olympic lifts.

2. Assessing Your Athletes

Going hand-in-hand with the question, "why are you performing them", comes this question - Are your athletes qualified for them? Contrary to belief not everyone is suited or ready for the various Olympic lifts.

I ask you, does your athlete have adequate upward rotation of the scapula? Are they clear of valgus sign at the elbow and knee? Can they achieve full shoulder flexion without extending their lumbar spine or "breaking" at the ribs? Is your athlete free of history of shoulder injury? Is your athlete primarily an OH athlete?

If you answered no to any of these questions, then sorry to break it to you, it's wise to avoid Olympic lifts until these are resolved.

In my practice and experience it is very uncommon to be find an athlete who is clear of all these issues. If you continue to use Oly's with these athletes you risk potential shoulder impingement, rotator cuff strains/tears, elbow dislocations, UCL strains, excessive lumbar stress, on and on. The clean, jerk and snatch require great deals of mobility, stability, and joint integrity to be performed safely and many athletes do not possess these qualities.

3. Wear and Tear

Being an athlete is a tough life and the body takes a beating. All sports, but especially contact and collision sports, put tremendous amounts of stress and beating on the bodies joints. If you look at sports like football, baseball, rugby, volleyball, basketball, wrestling - these sports beat the crap out of an athletes wrists, elbows, shoulders, and spine.

Olympic lifts do the same, they bang up these joints and as a coach I'd rather not put more stress and beating on them. The catch of a clean, jerk, and/or snatch is extremely tough on the body and it's not uncommon to see these joints get gunky, bruised, and beat-up when performing these lifts. My job as a Performance Coach is to keep my athletes healthy and reduce their joint issues, not compound them.

4. Transfer

The goal of Olympic lifting is for power production, and they do a good job at that, specifically in high level performers. Unfortunately the nature of Oly's is strictly a sagittal plane movement and specifically axial based. This is fine and dandy for this specific movement, but athletics require a athletes to produce force and movement in many different planes. For success on the field, plane specific movements are needed.

The point being, strictly sagittal based power training vs. multi-directional power training is that sagittal plane movements may not produce the most efficient carryover to sport.

In a recent article we showed how throwing and hitting velocity is associated with power in the frontal and transverse plane, NOT the sagittal plane. The point being, how many times in a game does an athlete perform a strictly sagittal planer movement? Vary rarely, and I could argue, depending on the sport, this type of movement occurs the least compared to lateral, rotational, multi-directional, and horizontal movements.

Instead, we choose to perform our power work in many different forms and fashions to get the greatest transfer to the athletes given sport. We feel this approach is much more sound and specific to the needs of our athletes rather than just the strict path Oly's provide.

To get the most transfer to your sport, movements need to be plane specific.

5. Time

The classic argument against Oly's is the amount of time it takes to teach and learn. The fact is Olympic lifts are an actual sport, with all the details and intricacies that come with a sport. Athletes that compete in the Olympic lifts take years and years to learn and master the movements, and here we are trying to teach athletes of another sport to master these same movements?

Depending on the setting, age of the athlete, and how good of a coach you are, it can take 2 weeks (being generous here) to 1 full year before an athlete is proficient enough to actually load and perform an adequate Olympic lift. In a 1-on-1 setting, sure an athlete can learn faster but in a team setting with 30-40 athletes to 1-3 coaches - the logistics just don't make sense. In my opinion, to coach the Oly's well and have them executed well, every single rep should be monitored and critiqued - that's how much attention to detail there needs to be, if not, movement inefficiencies will happen galore and even worse - injury.

Now on the other hand, I can teach a med ball throw and have the athlete loading and performing this movement in 30-seconds. So while the other athlete is taking weeks or months to learn a movement before getting any real benefit from it, I can have this other athlete getting hundreds, if not thousands of repetitions in practically the same movement. Plus all the time saved means I can focus on other plane specific movements or any other skill/quality I want.

Another point that can made is the goal of Oly's is power production. Well, research has shown that power is maximized at around 80% of 1RM; 80% is a pretty intense weight and a weight that most can probably perform only 2-4 times at most. The stronger athletes get in Oly's, typically, they can only perform singles, maybe doubles, with weight 80% and above. So it's not like a squat or deadlift where 80% can be performed 5-8 times in a single set.

Where I'm going with this is a typical Oly session will consist of 6-8sets x 1-2reps. This means only 6-16 total reps in the span of 20-25 minutes, if you're taking adequate rest to maximize training power production. Instead, I could get 25-40 med ball throws/kettlebell swings/bounds/jumps in 5-10 minutes. The peak power output of these movements may be slightly lower than Oly's, but I also performed 9-31 additional reps and saved 10-15minutes. Long story short, our thought process is - not only is time taken to learn and teach longer, but total time during sessions is also longer to potentially perform less work and volume. Again I can take this time on work on other skills/movements that would otherwise be neglected.

6. Coaching and Execution

Maybe my biggest qualm with Olympic lifts is my lack of 100% comfort in teaching them. I can admit that I don't feel comfortable teaching the ins and outs of Olympic lifts, and that's a major reason I don't have my athletes perform them.

I can admit to this, yet the same can be said for most High School coaches and even college coaches. I actually have plenty of experience not only performing Oly's but teaching them to many different populations and I still don't feel competent in teaching them. This leads me to question why so many programs include them yet the coach teaching them has no business teaching them. When you go to the doctor, you definitely want a Dr. that has gone through med school and passes his/her boards; well shouldn't it be the same for learning the Olympic lifts? If a coach doesn't hold a USAW certification, they probably shouldn't be coaching them. Compound this with what we mentioned earlier, most settings involve a ton of athletes to very few coaches. The overall logistics don't make sense to us and we aren't one to over step the scope of our abilities.

7. Risk Isn't Worth the Reward

The health and safety of our athletes is our number 1 concern and with this in mind, Oly's don't fit into this philosophy. The number of times we've seen athletes doing cleans, snatches, or jerks despite not having full shoulder flexion ROM is difficult to comprehend. Add in seeing athletes who present valgus signs at the elbow performing OH Oly's is another concerning subject. Then add in athletes who can't even perform a quality squat or hip hinge and are trying to perform Oly's is common place.

Look at HS or College teams performing Oly's on Youtube or in person and you'll likely see some very poor execution of the lifts. I've seen athlete break their wrist, bruise AC joints/collarbones, strain rotator cuffs, have weights fall on them, sprain wrists, dislocate elbows, tear their biceps, strain UCL's, and even seen video of people break their necks from Oly's.

I just don't find the risk worth the reward. I question where the benefit of Oly's is over jumping, bounding, KB swings, jump squats, etc in terms of both power production and safety.

Go Your Own Way

The biggest takeaway we had from our debate is that there isn't necessarily a right or wrong way. As a coach you have to weigh the pros and cons of your situation and figure out what's best for your athletes. At BBA we critically think about everything we do, and when we critically think about performing Oly's it just doesn't fit our philosophy. The important thing is to do what you believe in and what fits your philosophy; not just what you see others doing.

Hope this information helps your created your own path and philosophy and where the Olympic lifts fit into that scheme.

Go Get 'Em!

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Teaching the Hip Hinge

Squat Science - Why We All Squat Differently

The Myth of the FMS

The Myth of Triple Extension?

Why We Don't Olympic Lift

Michael Zweifel CSCS-

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