About once or twice a year, I like to ask a a bunch of experts in a broad range of fitness, sports medicine, rehabilitation, and performance specialties to answer one question for my readers. In the past I accumulated the best career advice for sports medicine and performance as well as formulated a comprehensive essential reading list for sports medicine and performance (which I need to update this summer…).
These are by far some of my favorite types of posts as I receive so much feedback from my readers on how much these posts have helped them. It is hard to get advice from experts in our field, so being able to provide this to my readers is awesome!
This year’s question was simple:
What have you done differently this year?
I received a ton of nice responses, and I will share my answer to this question at the end as well. There are some amazing and inspiring answers below. There are also some trends that seem to appear:
- We need to start thinking out side the box and probably more importantly outside the text book
- We need to appreciate a wider approach to rehabilitation and performance and think about the integration of total body, movement awareness, and multiple systems (musculoskeletal, fascia, neuroscience, etc)
- We need to use advanced techniques but master the basics first
- We need to never to stop learning, adapting, learning, adapting…
I have come to appreciate that kinesiology, biomechanics, and EMG don’t lie, but they rarely tell the whole story. Just because things are in the “literature,” doesn’t completely validate their message. Often things are in the literature because they are easy to measure and can be studied in univariant environments. It is important to look past the literature into the neuromuscular model which is inherently much more difficult to develop research around.
This year, I was not afraid to use every skill I’ve learned and apply it to every athlete I see, regardless of what others may think. My goal is to keep players on the field, by whatever means necessary within my scope of knowledge and skill set.
E Benedict Valencia
My motto in 2012 has been “Less is More”. I have found that with all of the techniques, methods and styles that our Sports Medicine Team has we tend to strive to learn more versus refining what we already know. With more focus on using the things that get results and cutting out the things that don’t we can improve our results with the knowledge that we already have. Secondly communication and evaluation of strengths and weaknesses from our piers has really improved each member individually which in turn improves us collectively.
Hope this helps as it really seems simple but many times simplifying is improving.
I’m always trying different things and experimenting. I’ll read some new research, or watch a new technique on someone’s blog, and then try it out in my routines and those of my clients. Many things fade away, but certain things stick. My beliefs today are completely subject to change based on what I learn tomorrow. Here are some of my current beliefs today:
When training everyday folks, know that full range resistance exercises with good form will do more for their “functionalism” than just about anything. It will increase their mobility, stability, motor control, breathing function, posture, hypertrophy, strength, power, and endurance.
I used to feel overwhelmed thinking that I had to include every method in existence to the point where my programs were too crammed. Now I just view all folks as being on a certain continuum with each movement pattern and my job is to get them better at squatting, lunging, hip hinging, hip thrusting, vertical and horizontal pressing, and vertical and horizontal pulling.
I used to think the secret to curing knee pain was all about the hips, now I know that it’s often more complicated and that strong quads are important too.
I used to be afraid of strengthening certain muscles – for example the psoas and the upper traps. Now I believe that every muscle and every muscle part should be strong through a full ROM to maximize body function.
For core stability training, I used to only consider the lumbar spine; now I also consider the pelvis and believe that proper pelvic strength and stability is one of the most underrated aspects of ridding and preventing low back pain.
When training sprinters, I believe coaches should focus the vast majority of their strength training efforts on strengthening hip extension and knee flexion and get the glutes and hammies strong and powerful. I feel that many coaches overvalue the importance of certain movements patterns or muscles when training for speed and shouldn’t worry so much about the upper body, the core, or the quads for this group of athletes.
When training women who simply want to look better, I used to prescribe too much work for the upper body and quads. These days their training sessions focus mostly on the gluteus maximus. It’s not always an easy muscle to re-shape, but if you succeed they’ll never want to give up training! Not to mention the fact that hip extension exercises effectively raise the metabolism especially as strength improves so you’re essentially performing HIIT training to help lean them out.
These are just some of the things I’ve changed up in the past year.
When I look over the past year and think about my clinical approach to movement, dysfunction, and injury have a renewed passion for learning and practicing what I do. It has been a fun year, as I have stepped away a bit from the clinical picture and really focused on movement. How it looks, how it feels, how it is affected by breathing, emotion, and exercise or sport.
The movement practices of Pilates, gyrotonic, feldenkrais, and Tai Chi have really been able to teach me what it means to really move from the center and how important spinal movement or mobility is to truly find stability and the movement from your center. These movement practices have allowed me to take a closer look at the myofascial system as a whole, pulling from the likes of Tom Myers and his “Anatomy Trains” and tensegrity to James Oschmann and “Energy Medicine”. As well as a closer look at the bony and visceral anatomy and how everything slides, glides, and spins together to create efficient movement pulling from Eric Franklin and his “Dynamic Alignment Through Imagery” and use of small props to create a movement experience for the athletes to feel efficiency, stability, and moving from their center without spending a lot of time in the unconsciously incompetent stage of motor acquisition.
All in all I have been inspired by the passion for learning, doing, and sharing by the many movement practitioners I have encountered along the way, regardless of the letters behind their name or yours there is something to be learned; something to be shared, to improve, grow and truly be able to support someone with their health and happiness.
My biggest difference was a change in thought process away from conventional “rehab in the gym” training to looking to get someone stronger while taking into consideration their specific concerns. For instance, someone with rotator cuff tendinitis or partial impingement may not benefit very much from doing external and internal rotations on a systemic level, but would see a lot of benefit from doing something like a loaded carry or lunges while holding a weight in a goblet position, and even from trying to do chinups with additional weights. These are all positions that could be said to help save any potential damage to the area while also getting the person a really awesome workout. The transfer between these is that they tend to recover faster than simply performing isolated segmental exercises, which means it’s more than a simple conditioning or total body strength program.
This past year something filled in me. From a tiny local business, I have built to giving classes on every continent save Antarctica. My desire had been to see all these different places and work with a variety of professional groups. When this desire was filled – and teaching in Japan just weeks after the tsunami really started the end of this process – I began to be indifferent or even dislike what I had actively sought out before – not the teaching nor the people, but the travel and the lonely life. Recognizing these changes in the inner weather and altering to meet them is really important to me as a ‘change agent’ – so I am initiating a new internet stage to teach from, and now I am happy and excited again.
I think the one big change I made is to tailor FMS correctives to the lower body strength exercise being done. I think in the past we were a little random in what we did between sets. We are now trying to program lunge correctives ( hip flexor stretches) with split position single leg exercises and Active Straight Leg Raise correctives with single leg hip dominant exercises. Gray Cook talks about “correct the pattern/ strengthen the pattern” and we have probably not done that as well as we could have in the past.
We have also begun to implement more half kneeling exercises in an in-line split position. I think this creates a different type of core challenge to diagonal pattern work like chops and lifts.
We’ve regressed our most “advanced” athletes more than ever before, particularly with respect to core training (this was a prominent theme in our Functional Stability Training of the Core resource).
At the end of a long baseball season, everyone assumes that you’re just going to be managing tired arms, but the truth is that you likely see as many cranky hips and lower back after a year of aggressive extension and rotation. Many people will try to progress professional athletes too quickly because they assume a base level of fitness, but the truth is that you need some time to not only build back up “weight room work capacity,” but reapply the basics.
So, last fall, we did more prone and side bridges, birddogs, reverse crunches, and get-ups than before – and we did them for a longer period of time. Over the course of the off-season, they went from building initial stability to being low-level motor control exercises we could use as “reminders” of where neutral spine was.
We combined these exercises with a ton of soft tissue work (both foam rolling and manual therapy, particularly on adductors), and it led to what I’d call the healthiest hips and lower backs I could have foreseen in our 70+ professional baseball players.
Not sure if it’s “new” but I always feel like I’m getting better about cuing neutral spine. Most importantly, I’m getting better at cuing people to keep the chest up/t-spine extended while also keeping the ribs down. I actually wrote an entire blog post discussing this concept.
I think the main thing that I have done differently this year (and not only this year but sort of progressively over the past two years) is to move towards working lighter when doing soft tissue work. Everyone seems to want to work really deep, push really hard, and try and “work things out”. I think my main shift has been towards working only has deep as I need to work (i.e., only as deep as the client’s body allows me to work) and then progressing from there based on their brain’s ability to adapt to my stimulus.
As a clinician in a predominantly “hands-on” profession, my early years found me utilizing a passive approach in 99% of my clinical cases. While this approach is often warranted, I have found myself using a “hands-off” approach more and more, especially with the improvement in my functional diagnostic skills as well as my increasing knowledge in motor control principles. Some of the techniques I have found beneficial to this approach lie in the principles of Dynamic Neuromuscular Stabilization and Reactive Neuromuscular Training for example, but again only with better precision in functional diagnostics. And because of this, I have found that my outcomes are achieved much more rapidly than previous approaches used by passive care alone.
What have I done differently this year? EVERYTHING! My entire job is new :-) I equate it to an orthopedic doctor, after 15 years of practice and 10 years of specializing on the shoulder elbow, all of the sudden decides to become a hand specialist. It’s still the upper extremity, right? It still orthopedics, right? But the hand is so specialized and different!! That is what I am doing with my new role with the Dodgers. It is still rehab, prehab and sport performance but it is so specialized compared to what I have been doing. I am uncomfortable…in a good way! To do something new like this, at this stage of my career and time in my life is scary! But being comfortable with the uncomfortable is awesome at any stage in life! There are new challenges, new things to learn every day, and it’s hard. But it’s great. My advice…Be uncomfortable. It will make you stronger and better on many levels when it is all over.
Los Angeles Dodgers
To answer my own question, I have really probably changed three different thought processes over the last year or so.
- With the large trend towards “function” and “movement,” as well as the explosion of information sharing on the internet, I feel that we sometimes get excited with our progressions and get to fancy too quickly. I know I have been guilty of this in the past. My new (or should I say “renewed”) focus has been on quality over quantity. While this is important in rehabilitation, this is even more important in performance training. Compensatory movement patterns will always catch up with you over time. This was a huge reason why Cressey and I wanted to create our Functional Stability Training of the Core program.
- The huge trend towards “movement” seems to mean mobility to a lot of people. I often find that movement quality issues tend to be even more related to poor “stability.” Don’t get me wrong, you need both, but being stable in your limited mobility is much better than being mobile without stability over the long run. In fact, too much mobility my be even worse.
- Manual therapy and corrective exercise needs to be three dimensional in many ways – planes, motions, depths, etc. The glute max is just as important of a hip external rotator and abductor as it is an extensor. In addition to planes of motion, soft tissue needs to be pliable at every depth. One soft tissue approach is, well, one dimensional. I now try to focus my manual work on several layers of depth of the tissue, and this requires different techniques to achieve optimal results.
Hope this summary provides some great advice and more importunely motivation to continue improving yourself. Think about it, if all these great experts keep doing things differently, shouldn’t we all?
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Did you notice that there were only 14 people on the list above? The 15th “expert” is you. Let’s not stop here, comment on this post below and share what you have done differently this year too! THANKS!