Panel Discussion: Does elite performance of a task or activity create a reliable model for optimal
Example, should everyone be cued to squat the way the strongest Olympic lifters squat, regardless of the individual’s goal?
Moderated by Brent Brookbush DPT, PT, MS, PES, CES, CSCS, ACSM H/FS
This Panel Discussion was originally posted on my facebook page - https://www.facebook.com/brent.brookbush - on August 16th, 2014
Brent Brookbush Looking forward to this one after a conversation with Rick Richey earlier this week - we were discussing the overhead squat assessment, optimal versus compensatory, rationales for compensation, evidence, and corrective exercise. The question above has many implications, and many spin off questions. This should be an awesome discussion.
August 16 at 11:53am
Ryan Crandall I believe in movement variability. I teach many ways to squat and lunge. Depends on the person in front of me.
August 16 at 11:53am
Leon Chaitow Watching elite tennis players serve offers a strong sense of the variations possible when achieving similarly optimal outcomes. Where weight-lifters are concerned I would have thought that any model based on 'best-practice' should logically be tailored to the unique characteristics of the individuals structural makeup, involving minor adjustments as needed (length of legs, length and flexibility of spine pelvic orientation etc)
August 16 at 11:57am
Brent Brookbush Ryan Crandall, although you may teach variety, the way you teach is still based on a model of ideal movement. What defines that ideal is the question. Otherwise, you would not cue form at all… right?
Another way to look at this would be… why so much variability… do you think people really vary by that much? 15 degrees is a huge deviation from the norm in the human body, so why do we see everything from feet parallel to feet at 45+ degrees in squats?
August 16 at 11:58am
Brent Brookbush Hey Leon Chaitow,
In my humble opinion this is an often over-used excuse for extreme deviations from a set of ideal possible forms in the weight training world. Although we all have some structural differences they are most often small (for example only a centimeter leg length discrepancy is actually very significant), and fairly uncommon when each joint is looked at individually. I would have to imagine that even in tennis, with a multi-joint motion like the serve, the deviations from one another are fairly small. If we overlapped a picture every tennis player at the peak of there serve with tracing paper, would they not all fall within a fairly narrow range?
When we compare this to squats in the gym, we see 45 degrees of foot turn out to 2nd toe parallel with feet under hips. That seems to me, to be a huge range, that no normal deviation structural variance can create a rational for.
We could apply this same line of logic to optimal shoulder external rotation in tennis players? Should they have more than the ideal because many of the top players are hyper-mobile in this range… what impact does that have on our interventions for these athletes?
August 16 at 12:11pm
Ryan Crandall On the way down…ankles DF, STJ eversion, tibial internal rotation (relative), knee flexion, hip flexion…on the way up, the opposite. Start with the basics and work from there. No OH squat assessment needed (don't use it and get great results in the clinic and in the home setting), unless that is your thing. I think more of the PT world should get exposed to Gary Gray of the Gray Institute for a more broader look at human movement. Cheers!
August 16 at 12:12pm
Ryan Crandall 1cm LLD is no big deal. We shouldn't scare people into thinking there pain is CAUSED by a LLD.
August 16 at 12:15pm
Mike Peters Was just discussing this with a football coach. Not every player/athlete can squat "ass-to-grass", they just don't all move the same. I have them lift to fit their to each individuals movement ability…. If that makes sense.
August 16 at 12:16pm
Brent Brookbush Hey Ryan Crandall,
No offense… but I think we can do better. The amount of eversion allowed during the eccentric phase of a squat for example, or the amount of tibial external rotation, and what about the amount of medial and lateral knee displacement. We know medial knee displacement has been linked to ACL injuries, should we just let that go?
And will have to save the discussion on leg length for a different post, but by significant, I mean significant enough to address with an orthotic.
August 16 at 12:18pm
Brent Brookbush What about the addition of release and stretching techniques followed by a some corrective exercise in your warm-ups Mike Peters? Do you think that would have an impact on what you see in the weight room, and potentially performance?
August 16 at 12:19pm
Leon Chaitow Brent Brookbush - thankfully my participation in dealing with athletes is minimal…I speak as an observer of function in general, NOT as someone involved in any form of athletic activity. I have been watching over the summer a fascinating contest (cricket) between England and India. The action of bowlers (equivalent of baseball pitchers) is so enormously variable (as I maintain is the case in tennis serving) that there is no ideal - 'perfect'- way of delivering a ball….and just as well as it would be tedious to watch cloned actions…..good luck with this discussion
August 16 at 12:21pm
Brent Brookbush Thank you for chiming in Leon Chaitow… I will have to start watching some cricket. Always flattered by your participation, and a huge fan of your work -
Sincerely,
B2
P.S.
Thanks for the good luck wishes… this is sure to be a very live debate
August 16 at 12:24pm
Scotty Butcher Phd I agree that the movement standards are where to start, but that each individual will have their own variable needs. Brent - although I agree that this individualization is very important, PTs often suffer from paralysis by analysis. I've found many 'dysfunctions' seem to correct themselves with good movement coaching.
August 16 at 12:25pm
Mark Jamantoc I agree with Ryan Crandall. I really base my evaluation on the person in front of me. Of course, I use principles that I know but there is no one clear cut model I follow. I've taken so many pelvic and biomechanics courses that the technique to me doesn't matter at all. It's what that individual has in store for me, what they do for a living or the sport they play, and how I can help them use their own muscles to correct itself - with my guidance, and then evaluate how it responds to their specific function. I hope that makes sense.
August 16 at 12:33pm
Ryan Crandall There will be some medial knee displacement…it should be controlled. The knee is not a perfect hinge and a degree of valgus is ok…so is varus. Heck, when I got trail hiking and running my knees go through all kinds of varus and valgus forces, but they are controlled and mitigated through good muscular timing to prevent the knee from going into the "Oh shit zone."
August 16 at 12:37pm
Brent Brookbush Hey Scotty Butcher Phd and Mark Jamantoc,
So I think it's safe to say that I may be the most nit-picky of the 3 of us.
But, nit-picky with good reason. If our interventions are linked to our observations and assessment, than how do we improve our interventions without also becoming more "detail oriented" in our observations?
August 16 at 12:38pm
Brent Brookbush Hey Ryan Crandall,
What does "controlled" mean?
My knees do not deviate medially, and when they have in the past is when I feel "instability"?
I am not saying that these movements do not occur, but using vague terms without specific definitions is how we get some of the ridiculous things we see in the gym.
August 16 at 12:40pm
Mark Jamantoc I like to be detail oriented but I always keep an open mind and I expect to be surprised every day just my opinion and outlook I guess, Brent Brookbush. I used to be so detailed that I get lost in the forest when the tree I was looking for was right in front of me all along….
August 16 at 12:41pm
Scotty Butcher Phd Brent - good question and good discussion. I think the attention to detail you're discussing is relevant, but the problem tends to lie, for many PTs or CESs, in becoming so focused on the little things that may not be 'perfect', that they lose sight of the bigger picture. Getting someone to move their whole body well and develop strength through those movement patterns does more for someone than staying so focused on the little dysfunctions that they don't ever progress to getting someone actually stronger.
August 16 at 12:42pm
Brent Brookbush That is a great point Mark Jamantoc… and I think I know what you are getting at. It takes a little experience to know which deviations will pay dividends and which deviations will have you chasing your tail. The simplest example is the individual who goes biomechanics crazy and wants to treat the ankle for shoulder impingement. Although they may be related… at some point you need to treat the shoulder… because that is were the patient's problem is.
Back to an example we were discussing before. You may get great results from improving dorsiflexion for the individual with medial knee displacement, where targeting the VMO and medial rotators may not get you much.
August 16 at 12:46pm
Ryan Crandall Brent, walk on uneven terrain (like the stuff outside of NYC, get out in the country and find some rocks!) and I'm sure you will find that trochlogingymus joint of yours deviating in all kinds of directions outside of the sagittal plane. It's kind of fun especially if you can control it and prevent it from going to far.
August 16 at 12:46pm
Brent Brookbush Great point Scotty Butcher Phd,
I think this is actually an education issue.
Many people know me as the "corrective exercise guy" or the "posture" guy" and I have to remind people that when it comes to performance and training… the corrective stuff is how I design the "warm-up" or the first half of an hour if we include core, integration, stability and SAQ in the mix. The second half of the hour is resistance training (generally in a circuit) focused on large movement patterns.
August 16 at 12:46pm
Brent Brookbush I get what your saying Ryan Crandall,
But I can assure you that as a New Yorker for 13 years, it has not prepared me for a jump stop, coming off a fast break at the rim on a basketball court. We have to be careful to note how much deviation is present given the amount of force. If I deviate a little during a body-weight prisoner squat, imagine how much I am going to deviate when I run at full speed, jump into a stop to load for a ballistic explosion to the rim.
August 16 at 12:51pm
Rani Mulhem Elite Preformance is relative. An individual should preform movements without compromising the spine or form. When Olympic lifting is concerned, it seems to me that form and functionality can be compromised. There for compromising optimal mechanics. What are your thoughts Dr. Brent?
August 16 at 1:02pm
Kathy Benson Zetterberg My observation of "most olympic lifters" movement patterns are 1. Feet externally rotated 2. Feet beyond hips width… Although this position may allow the athlete to move "easier" it is only because it circumvents the dysfunction of the lower leg and the inability to go into dorsiflexion…this position of dysfunction not only limits the force the athlete can generate but the repetitive movements create the cumulative injury cycle causing more dysfunction along their kinetic chain.
August 16 at 1:04pm · Unlike · 4
Brent Brookbush I think it is important to note Kathy Benson Zetterberg, that without correcting the dysfunction, that this position will actually improve performance. That is, if you are not going to correct compensation than you will achieve more by working around it.
This is why it is so hard to sell corrective exercise… it's the delayed gratification that is the obstacle. Convincing someone that they will be better in a few weeks is not easy when ego's and pounds lifted are on the line immediately.
Of course, the benefit is a new level of performance and decreased risk of injury overtime.
August 16 at 1:41pm
Brent Brookbush Hey Rani Mulhem,
It is definitely compensation for the sake of performance… which we see in all sports. Lately, the problem is the assertion that because more weight can be lifted in this position, everyone should do it that way.
August 16 at 1:42pm
Steve Middleton It is rare that someone has significant femoral anteversion or retroversion that needs to be trained around. The majority of individuals work around muscle tightness, muscle weakness or hip/shoulder impingements. Te more you compensate, the more you will have to continue to compensate until the system breaks down.
Because of this, I do teach ideal movement patterns. Any deviation is a compensation for mobility (typically) or stability (rarely).
It doesn't help that the majority personal trainers and CSCS in my are don't understand the proper mechanics of the lifts they are recommending. I have a patient who squats 450 for reps but can't do a proper rolling pattern because she can't activate her glutes.
August 16 at 1:47pm · Unlike · 1
Howard Fidler Has to be done to function. I talk about this all the time with how I work. I don't treat an NFL football player the same as a MMA fighter. It's all about the function of the person.
August 16 at 1:55pm
Ryan Crandall Can't "activate" their glutes but they can squat 450? Maybe they just forgot how to roll.
August 16 at 2:00pm
Steve Middleton MMT = 2/5
August 16 at 2:08pm
Scotty Butcher Phd Right on, Ryan.
August 16 at 2:10pm
Ryan Crandall maybe in non functional positions his body doesn't know how to recruit it.
August 16 at 2:10pm
Kathy Benson Zetterberg As a fitness professional the main goal for all my clients is complete Neuromuscular efficiency = The ability of the neuromuscular system to allow agonists, antagonists, synergists, and stablilzers to work synergistically to produce, reduce, and dynamically stabilize the kinetic chain in all three planes of motion. The importance of a comprehensive corrective exercise program is vital! Otherwise I am offering a disservice to the clients who come to me for training. If I allow movement compensations to continue, not only will their performance be hindered but will eventually lead to injury.
August 16 at 2:13pm
Rani Mulhem Without proper development of optimal neuromuscular communication, the risk of developing imbalances, compensations or even worse trauma is high. I completely agree. You should be an athlete or training as such to put the body under load in that manner. Adolph Jacob you would love this conversation.
August 16 at 2:23pm
Rick Richey Training for optimal movement is important for optimal performance, even though sports do not need the athletes to perform solely through neutral positions. Neutral squat patterns (feet and knees straight ahead) will help heavy squat athletes. Wide stance heavy squats won't necessarily transfer to better running or jumping performance. Neutral stance squats, based on mechanics, can and will.
Train to move better and your sports coach train you for the sport.
Oly lifts are pointless for most sports except for oly lifting, yet numerous S&C programs require them. Pointless.
Wide stance squats for heavy squat sports is sport specific and should not be looked at as "this is how the strongest squat guys out there do it, so it should help me at …. Tennis, racquet ball, golf, MMA, football, etc."
A fitness or performance based model, neutral first, then you can supplement and play outside of neutral for short duration, before transitioning back to neutral. Variety without cementing poor mechanics.
August 16 at 2:31pm
Brent Brookbush Hey Ryan Crandall,
What Steve Middleton is referring to is synergistic dominance. In essence, this individual can compensate by using the hamstrings and posterior fibers of the adductor magnus to generate force, but their is a definite cost for such compensation. When Steve tested their glutes (that is tested them in a position that would not allow the hamstrings and adductor magnus to contribute) they could not even generate enough force to overcome gravity. Unfortunately, this is way more common than people think it is.
August 16 at 3:22pm
Brent Brookbush Nice Kathy Benson Zetterberg,
Don't forget to site your sources… your definition of neuromuscular efficiency is from the NASM CPT text.
Otherwise, I totally agree
August 16 at 3:25pm · Like · 1
Ryan Crandall I know of it (S.D.)…It's a good day when my hamstrings and adductor magnus help me squat and lunge. I thank my posterior calf musculature too. Thanks to all of them. #teamapproachtomovement. #thebraindoesntknowmusclesitknowsfunction
August 16 at 5:14pm · Like · 1
Kathy Benson Zetterberg Brent Brookbush sources cited .. Thank you… Ps it's only a Facebook reply otherwise I always cite