Movement Assessment Article Archives

Check out all my articles on assessing movement.  Explore the archives below or click the button to subscribe and never miss another post.


How to Assess the Scapula

The latest Inner Circle webinar recording on How to Assess the Scapula is now available.

How to Assess the Scapula

How to assess scapular dyskinesisThis month’s Inner Circle webinar is a live demonstration of How to Assess the Scapula.  In this recording of a live student inservice from Champion, I overview everything you should (and shouldn’t) be looking for when assessing the scapula.  When someone has a big nerve injury with significant winging or scapular dyskinesis, the assessment of the scapula is pretty easy.  But how do you detect the subtle alterations in posture, position, and dynamic movement?  By being able to identify a few subtle findings, you can really enhance how you write a rehab or training program.

In this webinar, I’ll cover:

  • What to look for in regard to static posture and scapular position
  • How to check to see if static postural asymmetries really have an impact on dynamic scapular movement
  • What really is normal scapulothoracic rhythm (if there really is a such thing as normal!)?
  • How to reliably assess for scapular dyskinesis
  • How winging during the concentric and eccentric phases of movement changes my thought process
  • How to see if scapular position or movement is increasing shoulder pain
  • How to see if scapular position or movement is decreasing shoulder strength

To access this webinar:

 

 

 

A Simple Test for Scapular Dyskinesis You Must Use

A common part of my examinations includes assessing for abnormal scapular position and movement, which can simply be defined as scapular dyskinesis.  Scapular dyskinesis has long been theorized to predispose people to shoulder injuries, although the evidence has been conflicting.

Whenever data is conflicting in research articles, you need to closely scrutinize the methodology.  One particular flaw that I have noticed in some studies looking at the role of scapular dyskinesis in shoulder dysfunction has involved how the assess and define scapular dyskinesis.

Like anything else, when someone has a significant issue with scapular dyskinesis it is very apparent and obvious on examination.  But being able to detect subtle alterations in the movement of the scapula may be more clinically relevant.  There’s a big difference between someone that has a large amount of winging while concentrically elevating their arm versus someone that has a mild issues with control of the scapula while eccentrically lowering their arm.

Most people will not have a large winging of their scapula while elevating their arm.  This represents a more significant issue, such as a nerve injury.  However, a mild amount of scapular muscle weakness can change the way the scapula moves and make it difficult to control while lowering.

 

A Simple Test for Scapular Dyskinesis

One of the simplest assessments you can perform for scapular dyskinesis is watching the scapula move during shoulder flexion.  Performing visual assessment of the scapula during shoulder flexion has been shown to be a reliable and valid way to assess for abnormal scapular movement.

That’s it.  Crazy, right?  That simple!  Yet, I’m still amazed at how many times people tell me no one has ever looked at how well their scapula moves with their shirt off.

However, there is one little tweak you MUST do when performing this assessment…

You have to use a weight in their hand!

Here is a great example of someone’s scapular dyskinesis when performing shoulder flexion with and without an external load.  The photo on the left uses no weight, while the photo on the right uses a 4 pound dumbbell:

scapular dyskinesis

As you can see, the image on the right shows a striking increase in scapular dyskinesis.  I was skeptical after watching him lift his arm without weight in the photo on the left, however, everything became very clear when adding a light weight to the shoulder flexion movement.  With just a light load, the ability to prevent the scapula from winging while eccentrically lowering the arm becomes much more challenging.

I should also note that there was really no significant difference in scapular control or movement during the concentric portion of the motion raising his arms overhead:

scapular winging concentric

This person doesn’t have a significant issue or nerve damage, he simply just needs some strengthening of his scapular muscles.  But if you didn’t observe his scapula with his shirt off or with a dumbbell in his hand, you may have missed it!

 

How to Assess for Scapular Dyskinesis

In this month’s Inner Circle webinar, I am going to show you a live demonstration of how I assess scapular position and movement.  I’ve had past talks on how to assess scapular position and how to treat scapular dyskinesis, however I want to put it all together with a demonstration of exactly how I perform a full scapular movement assessment and go over things I am looking for during the examination.

I’ll be filming the video and posting later this month.  Inner Circle members will get an email when it is posted.

 

 

 

How “Movement Age” Impacts Program Design

Any half way decent strength and conditioning program must be individualized to the unique needs and goals of the trainee.  Developing programs that specifically address our clients’ “goals” is fairly straightforward, however, mastering how to design programs that also consider their “needs” can really take you to the next level as a personal trainer or strength coach.

When designing training programs, we often begin individualizing based on age.  That’s a great place to start, but there are many limitations with just using age.  I want to review how we design programs using “age” by starting with a review of chronological, biological, and training age.

More importantly, I wanted to introduce a new “age” we use at Champion called “movement age.”  This may be the most important, yet most neglected as well.

 

Chronological and Biological Age

Movement Age Program DesignAt the very beginning of the spectrum when discussing the “age” of your client is their actual chronological age, which is their precise age.  While this probably isn’t as big of an issue when discussing the training program of two people aged 34 and 38, it is much more relevant when comparing two people aged 14 and 18.

Chronological age is a good place to start, obviously, but their biological age is far more important. The anatomical maturity of a 14 year old is quite different from an 18 year old and does become a variable that must be adjusted for within your program design.

Line up 6 kids that are aged 14 and you’ll see the difference.  One looks like he is 10 years old, another looks 18, and the rest all fall somewhere in between.  According to the data accumulated at Wikipedia, girls will go through puberty between the ages of 10 and 16, while boys tend to go through puberty between the ages of 11 and 17.  That’s a 6 year range!

Our focus with those with a low chronological age is different that the older high school athletes.  While strength and power tend to become more of the focus in the older trainee, we focus on what we call the ABC’s of movement with our younger trainees, focusing on Agility, Balance, and Coordination.  Strength training is included but the results are obviously going to be limited by the hormonal and skeletal maturation differences.

But, I urge you to not downplay this stage of athletic development.  Developing the basics of movement skills is important and unfortunately this generation of children are not getting the same development as past generations.  In fact, our younger athletes at Champion see some of the biggest changes in athleticism.  These programs are impactful.

Here are my 2 and 6 year olds working on their athleticism!

So it’s apparent that chronological age has limited usefulness and biological age is a much better place to start.  However, chronological age does not take into consideration the experience of the trainee.

 

Training Age

As chronological age becomes less relevant with older trainees, the next variable to consider is their experience in training.  Image the difference in two individuals:

  • Trainee 1 – 28 year old – Wants to lose 10 pounds – Did not participate in athletics growing up, has never participated in a strength and conditioning program, currently has desk job.
  • Trainee 2 – 28 year old – Wants to lose 10 pounds – Was athletic growing up playing multiple sports in high school, and club sports for fun in college, trained at a sports performance center through high school, hasn’t trained consistently in 10 years.
  • Trainee 3 – 28 year old – Wants to lose 10 pounds – Was athletic growing up playing multiple sports in high school, and club sports for fun in college, trained at a sports performance center through high school, consistently trained through college and has continued since college.

We have people that are 28 years old and want to lose 10 pounds.  Same age, same goal.  Do they all start with the same program?  Of course not.

Training age takes into consideration the experience of the trainee.  Have they strength trained before?  Do they know how to perform the lifts with proper form?  Do they know how to exert force with intent (more on this in a future post…)?

Remember the success of your programs are based around how the body adapts to the stress applied.  You can pretty much do anything to Trainee 1 to stimulation enough stress to make a change, which is good because they have a lot to learn!  On the other end of the spectrum, Trainee 3 has a great understanding of how to train and has been exposing his body to different stresses for years.  To make progress in this trainee, you’ll likely need a more complicated periodization scheme to create a different stimulus for their body.

I have discussed these concepts in the past in my article Does Periodization of a Program Help Improve Strength and in more detail in an Inner Circle Webinar on Periodization for Strength Training and Rehabilitation.

There is one HUGE flaw with training age.  Just because you have been training for several years does not mean you understand how to train, or even that you know proper technique!

Don’t assume that since someone has been training consistently for years that they have been training correctly!

This is a common finding in people that have dabbled in strength training in the past and are starting a formal program or starting to work with a personal trainer or strength coach for the first time.

 

Movement Age

Poor Movement SkillsThe last age we consider when designing strength and conditioning programs is one of the most important, but often neglected.  We can have an advanced trainee in regard to chronological age, biological age, and training age, however, can they move well?  At Champion, we’ve started to use the terminology “Movement Age” to discuss someone’s ability to move.

We don’t even have to make this too complicated – can they hinge, squat, lunge, step, rotate, push, and pull?

We simply define the ability to “move” as using proper form through the movement’s full range of motion.  This then becomes a scale:

  • Can they move with assistance?
  • Can they move without assistance?
  • Can they move without assistance with load?
  • Can they move without assistance with load and speed?

When it comes to program design, “movement age” trumps training age every time. [Click here to tweet this]

It’s amazing how our movement skills have deteriorated.  How many of your high school athletes can touch their toes?  Isn’t it amazing?!?

In order to advance from beginner, to intermediate, to advanced trainee in our Champion program design system, you need to demonstrate maturation of your chronological, biological, training, and movement age.

On the Performance Therapy side of Champion, we work with a lot of athletes that want to optimize themselves and get the most out of their bodies.  It’s amazing how many of the “advanced” athletes we see have poor movement skills.  They don’t hinge well, or squat well past neutral, or can’t even balance themselves in a half kneeling position!

This can lead to imbalances, asymmetries, and compensation patterns that can suck performance, lead to tissue overuse, and eventually breakdown.  This is especially true if you try to just blast through your poor movement skills and add load and speed to your lifts.

Sometimes we don’t need an advanced and complicated strength training periodization scheme, sometimes we just need to clean up movement patterns.  Consider this taking one step back to take 5 huge steps forward.  Movement age may be the most important variable to consider when designing strength and conditioning programs.

 

 

 

Should We Stop Blaming the Glutes for Everything?

Today’s guest post comes from John Snyder, PT, DPT, CSCS.  John, who is a physical therapist in Pittsburgh, has a blog that has been honored as the “Best Student Blog” by Therapydia the past two years.  He’s a good writer and has many great thoughts on his website.  John discusses some of our common beliefs in regard to the role of the proximal hip on knee pain.  I’ll add some comments at the end as well, so be sure to read the whole article and my notes at the end.  Thanks John!

 

Should We Stop Blaming the Glutes for Everything?

should we stop blaming the glutes

Anterior cruciate ligament (ACL) rupture1,2 and patellofemoral pain syndrome (PFPS)3,4,5 are two of the most common lower extremity complaints that physicians or physical therapists will encounter. In addition to the high incidence of these pathologies, with regards to ACL injury, very high ipsilateral re-injury and contralateral injury have also been reported6,7,8.

With the importance of treating and/or preventing these injuries, several researchers have taken it upon themselves to determine what movement patterns predispose athletes to developing these conditions. This research indicates that greater knee abduction moments9,10, peak hip internal rotation11, and hip adduction motion12 are risk factors for PFPS development. Whereas, for ACL injury, Hewett and colleagues13 conducted a prospective cohort study identifying increased knee abduction angle at landing as predictive of injury status with 73% specificity and 78% sensitivity. Furthermore, as the risk factors for developing both disorders are eerily similar, Myer et al performed a similar prospective cohort study finding that athletes demonstrating >25 Nm of knee abduction load during landing are at increased risk for both PFPS and ACL injury14.

 

Does Weak Hip Strength Correlate to Knee Pain?

With a fairly robust amount of research supporting a hip etiology in the development of these injuries, it would make sense that weakness of the hip musculature would also be a risk factor, right?

A recent systematic review found very conflicting findings on the topic. With regards to cross-sectional research, the findings were very favorable with moderate level evidence indicating lower isometric hip abduction strength with a small and lower hip extension strength with a small effect size (ES)15. Additionally, there was a trend toward lower isometric hip external rotation and moderate evidence indicates lower eccentric hip external rotation strength with a medium ES in individuals with PFPS15. Unfortunately, the often more influential prospective evidence told a different story. Moderate-to-strong evidence from three high quality studies found no association between lower isometric strength of the hip abductors, extensors, external rotators, or internal rotators and the risk of developing PFPS15. The findings of this systematic review indicated hip weakness might be a potential consequence of PFPS, rather than the cause. This may be due to disuse or fear avoidance behaviors secondary to the presence of anterior knee pain.

 

Does Hip Strengthening Improve Hip Biomechanics?

Regardless of its place as a cause or consequence, hip strengthening has proved beneficial in patients with both PFPS16,17,18 and following ACL Reconstruction19, but does it actually help to change the faulty movement patterns?

Gluteal strengthening can cause several favorable outcomes, from improved quality of life to decreased pain, unfortunately however marked changes in biomechanics is not one of the benefits. Ferber and colleagues20 performed a cohort study analyzing the impact of proximal muscle strengthening on lower extremity biomechanics and found no significant effect on two dimensional peak knee abduction angle. In slight contrast however, Earl and Hoch21 found a reduction in peak internal knee abduction moment following a rehabilitation program including proximal strengthening, but no significant change in knee abduction range of motion was found. It should be noted that this study included strengthening of all proximal musculature and balance training, so it is hard to conclude that the results were due to the strengthening program and not the other components.

 

Does Glute Endurance Influence Hip Biomechanics?

All this being said, it is possible that gluteal endurance may be more influential than strength itself, so it would make sense that following isolated fatigue of this musculature, lower extremity movement patterns would deteriorate.

Once again, this belief is in contrast to the available evidence. While fatigue itself most definitely has an impact on lower extremity quality of movement, isolated fatigue of the gluteal musculature tells a different story. Following a hip abductor fatigue protocol, patients only demonstrated less than a one degree increase in hip-abduction angle at initial contact and knee-abduction angle at 60 milliseconds after contact during single-leg landings22. In agreement with these findings, Geiser and colleagues performed a similar hip abductor fatigue protocol and found very small alterations in frontal plane knee mechanics, which would likely have very little impact on injury risk23.

 

Can We Really Blame the Glutes?

The biomechanical explanation for why weakness or motor control deficits in the gluteal musculature SHOULD cause diminished movement quality makes complete sense, but unfortunately, the evidence at this time does not agree.

While the evidence itself does not allow the gluteal musculature to shoulder all of the blame, this does not mean we should abandon addressing these deficits in our patients. As previously stated, posterolateral hip strengthening has multiple benefits, but it is not the end-all-be-all for rehabilitation or injury prevention of lower extremity conditions. Proximal strength deficits should be assessed through validated functional testing in order to see its actual impact on lower extremity biomechanics on a patient-by-patient basis. Following this assessment, interventions should be focused on improving proximal stability, movement re-education, proprioception, fear avoidance beliefs, graded exposure, and the patient’s own values, beliefs, and expectations.

 

John SnyderJohn Snyder, PT, DPT, CSCS received his Doctor of Physical Therapy degree from the University of Pittsburgh in 2014. He created and frequently contributes to SnyderPhysicalTherapy.com (Formerly OrthopedicManualPT.com), which is a blog devoted to evidence-based management of orthopedic conditions.  

 

Mike’s Thoughts

John provides an excellent review of many common beliefs in regard to the influence of the hip on knee pain.  While it is easy to draw immediate conclusions from the result of one study or meta-analysis, one must be careful with how they interpret date.

I think “anterior knee pain,” or even PFPS, is just too broad of a term to design accurate research studies.  It’s going to be hard to find prospective correlations with such vague terminology.  Think of it as watering down the results.  Including a large sample of people, including men, women, and adolescents and attempting to correlate findings to “anterior knee pain” is a daunting task.

Imagine if we followed a group of adolescents from one school system for several years.  Variations in gender, sport participation, recreational activity, sedentary level, and many more factors would all have to be considered.  Imagine comparing the development of knee pain in a 13 year old sedentary female that decided she wanted to run cross country for the first time with an 18 year old male basketball player that is playing in 3 leagues simultaneously.  Two different types of subjects with different activities and injury mechanisms.  But, these two would be grouped together with “anterior knee pain.”

What do we currently know?  We know hip weakness is present in people with PFPS and strengthening the hips reduces symptoms.  As rehabilitation specialists, that is great, we have a plan.  I’m not sure we can definitely say that hip weakness will cause knee pain, but I’m also not sure we can say it won’t.  Designing a prospective study to determine may never happen, there are just too many variables to control.

John does a great job presenting studies that require us to keep an open mind.  I’m not sure we can make definitive statements from these results, but realize that there are likely many more variables involved with the development of knee pain.  Hip strength and biomechanics may just be some of them.  Thanks for sharing John and helping us to remember that it’s not always the glutes to blame!

 

 

Anterior Pelvic Tilt Influences Hip Range of Motion and Impingement

One of the most common postural adaptations that I see on a day to day basis is anterior pelvic tilt.  In fact, it’s getting more rare to find someone that isn’t in a large amount of anterior pelvic tilt.

I blame it on our seated culture.  The human body is excellent at adapting, and the seated posture produces an anterior pelvic tilt.

 

Anterior Pelvic Tilt Influences Hip Range of Motion and Impingement

Anterior Pelvic Tilt Hip Range of Motion ImpingementA recent research study published in the American Journal of Sports Medicine looked at the effect of changes in pelvic tilt on range of motion and impingement of the hip.

The authors looked at CT scans of the hips of  50 subjects with femoroacetabular impingement and simulated range of motion using 3D-generated models.

A 10 degree increase in anterior pelvic tilt, which I would say is something we see clinically, resulted in a significant loss of 6-9 degrees of hip internal rotation and increase in FAI.  This increase in anterior pelvic also resulted in a loss of 10 degrees of hip flexion.  Subsequently, an increase in posterior pelvic tilt resulted in greater hip internal rotation, less impingement, and more hip flexion.

 

Clinical Implications

The results of the study have several implications

  • Assessment of hip ROM should take pelvic position into consideration.
  • FAI symptoms may be reduced by decreasing anterior pelvic tilt.
  • People with limited hip internal rotation or hip flexion may have too much anterior pelvic tilt.  Focus on alignment before starting to torque the joint.  This is a fundamental principle I talk about in Functional Stability Training of the Lower Body.
  • People with poor squat mechanics, especially in the deeper positions, may have an underlying pelvic position issue.  People with excessibve anterior pelvic tilt that are squatting deep maybe impinging and beating up their hips.

 

I talk a lot about reverse posturing, my terminology for focusing on reversing the posture that you assume for the majority of your day.  But there is a big difference between reducing static anterior pelvic tilt posture and dynamic anterior pelvic tilt control.  You have to emphasize both with dynamic control being arguably more important.

Keep these findings in mind next time you see someone with a large amount of anterior pelvic tilt.

If you are interested in learning more about how I work with anterior pelvic tilt, I recently outlining my integrated system of manual therapy and corrective exercise in my Inner Circle webinar on Strategies to Reduce Anterior Pelvic Tilt.

 

 

Laxity Does Not Mean Instability

Several years ago, when Eric Cressey and I released Optimal Shoulder Performance, I discussed the Beighton Laxity Scale and how I use it to determine the amount of laxity that individuals may possess.  This is just one of the many factors that go into how I design my rehabilitation and performance programs, as an individual’s amount of laxity influences program design.

Since then, I have started to hear comments from people that their clients may have Ehlers-Danlos syndromeLoeys-Dietz syndrome or Marfan syndrome because of their Beighton score.

 

Laxity is Normal

Beighton Scale Laxity InstabilityIf you Google “Beighton Score,” you see that this is a scale often used to diagnose the above hypermobility syndromes, however each has their own specific features.  A Beighton score is not the only factor involved, and actually is probably not the most important finding in any of these syndromes.

Laxity is not a syndrome, in fact, laxity is normal.

We all have a certain degree of laxity, you’ve probably seen many people along this spectrum from the really tight to the really loose.  A high Beighton score does not indicate that they have a syndrome or problem, it just helps determine where they sit in the laxity spectrum.

 

Laxity Does Not Mean Instability

While joint laxity is normal, a high amount of laxity does not necessarily mean you have instability.  Stability is a combination of the function of your static and dynamic stabilizing systems.  Instability is when you have an issue with either (or both) of the static and dynamic stabilizers.  Functional stability is the ability to dynamically stabilize a joint during functional activities to allow proper control and movement.  This is the basis behind our entire Functional Stability Training programs.

Check out this video of my friend Sam’s Beighton score.

As you can see, Sam has a high Beighton score and a lot of joint laxity.  But Sam can deadlift over 2x her body weight.  That is laxity combined with functional stability.  She doesn’t have any problems because she can control her laxity.

Don’t automatically assume a lot of laxity is a bad thing, in fact many professional athletes possess a high amount of laxity.  Remember laxity is normal, does not mean instability, does not mean you have a clinical syndrome, and something you can control with the right program.

 

 

Assessing Scapular Position

The latest Inner Circle webinar recording on the Assessing Scapular Position is now available.

Assessing Scapular Position

Assessing_Scapular_PositionThis month’s Inner Circle webinar was on Assessing Scapular Position.  While I have openly stated in the past that assessing scapular position is not as significant as looking at dynamic mobility, I do feel it is worth starting your assessment with position.  You have to know where to start to know where to go.  This is a great follow up to my past talk on Scapular Dyskinesis.

Here is how I assess scapular position, but more importantly how I integrate it into my assessment.

To access the webinar, please be sure you are logged in and are a member 0f the Inner Circle program.

How Does Laxity Influence Program Design?

Today’s article is a guest post from Sam Sturgis regarding the influence of joint laxity on program design.  This is an important concept to understand when individualizing programs to achieve the best results.  People can fall on both ends of the laxity spectrum, from super loose to super tight.  Knowing this information will help you develop the best programs that are specific to the needs of each person.  Thanks for contributing Sam!

 

How Does Laxity Influence Program Design?

A heavily debated topic in the strength and conditioning world involves stretching.  It seems like there are never ending questions about stretching, such as “Who needs to stretch?,”  “When is the best time to stretch?,” “Does stretching even work?,” and many more.  Often times I will have clients mention to me that they “want to get more flexible” and that they “always feel tight”.  While this may be true in some instances, other times this feeling of “tightness” can be protective muscular tension since other structures aren’t quite working properly.

Being too tight obviously isn’t good, but neither is being too loose. It’s important to strike a balance of joint mobility and stability.

In our bodies we have two types of stabilizers: static and dynamic.  Static stabilizers are inert structures like bones, ligaments and joint capsules. These are non-contractile structures that do not create movements, they are simply there to create joint articulations and hold them together.  Dynamic stabilizers are the muscles. By contracting during a joint movement, they actively hold our joints in position so that they can move freely.  Laxity is a normal occurance.  Each joint has a certain amount of laxity.  However, in joints that have a lot of laxity, the static structures that hold the joints together may have a more difficult time keeping the joints in a neutral position.  Therefore, the muscles must work harder to create dynamic stability.

This laxity can either be congenital, meaning that you were born with it, or secondary to injury or repetitive activities.

During your assessment, one way to determine how lax a client may be is to use the Beighton Laxity Scale.  Mike Reinold and Eric Cressey mention this in their DVD Optimal Shoulder Performance and show how they use a Beighton Score when designing their programs.

 

The Beighton Score

The Beighton Scale is a 9 point scale that goes through a series of passive ranges of motion where a point is given for each indicator:

Beighton_scale

 

  • Hyperextension of the 5th finger MCP joint beyond 90 degrees
  • Apposition of the thumb to the flexor aspect of the arm
  • Hyperextension of the elbow beyond 10 degrees
  • Hyperextension of the knee beyond 10 degrees
  • Toe touch with the knees straight, touch the palms flat on the floor

A score of 0-4 would indicate an individual who is within normal levels of joint stiffness whereas a score of 5-9 would indicate joint laxity.  (photo from Physio-pedia.com)

Note From Mike: In Optimal Shoulder Performance, I teach how I actually use a 5-point scale.  In my mind if one of your elbows can hyperextend, for example, than you get a point.  If you perform a lot of unilateral activities, like throwing a baseball, you may have some chronic adaptations that may alter your score.  If you non-throwing arm has the laxity, then your throwing one probably had it too!

 

How to Use a Beighton Score

beighton-score-dynamic-stabilizationNow that you have determined how someone scores on the Beighton Scale, how should you change your program design?  Someone that scores 5 or higher on this scale should not be focused stretching! They need joint control and dynamic stability. For example, a baseball pitcher with a high Beighton score and 200 degrees of total ROM at the shoulder won’t get ANY shoulder mobilizations, they need to learn how to stabilize within those 200 degrees rather than try to gain more motion.

Conversely, someone who scores a 0 on the Beighton scale may be a candidate for more soft tissue and mobility work because they may need to create more range of motion to move freely and safely.

There is a continuum that clinicians should assess for and use to rationalize their decision making.  If a client presents with joint laxity outside of the normal limits, act appropriately and promote better proprioception and dynamic stability. Stretching or mobilizing someone who is already loose could make their issue worse. That protective tension is there for a reason, to keep the joint from getting injured! On the contrary, if someone presents as tight outside of normal limits, focusing on increasing their range of motion may be the most appropriate solution. If you can know which side of the fence each person falls on, this will help you individualize everyone’s program to maximize their training results.

 

About The Author

Sam SturgisSam Sturgis holds a Bachelor’s Degree in Athletic Training from Quinnipiac University and Master’s Degree in Strength and Conditioning from Springfield College.  A skilled Strength Coach and Athletic Trainer at Pure Performance Training in Needham, MA, Sam works primarily with baseball athletes and clients rehabilitating from injury.