Panel Discussion: Why do we stick to outdated methodologies?
Iman Shumpert and Derrick Rose go down with ACL tears - both suffering several injuries over the course of the season - these were both preventable injuries - Why, oh why do we stick to outdated methodologies - Why are we obsessed with intense and painful, when progressive and preventative are available?
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 April 29th, 2012
Rich Fahmy Just watched the replay of the Rose injury. A move he does thousands of times. I think intense and painful require less "homework" on the part of the athlete. They are instant gratification workouts. Get in, train like a beast, then forget about it. That's all great and definitely necessary but flexibility techniques or tissue maintenance techniques are like flossing, huge value but not done often enough. Everyone knows daily flossing (flexibility) can prevent dentures (ACL surgery) but it doesn't hit home till you're at the dentist's office (orthopedic OR). We need to do a better job of reinforcing the importance of tissue maintenance as an industry. Says the guy with thoracic restriction himself.
April 29 at 12:34pm
Brent Brookbush Great analogy Rich Fahmy - To build on what you said and play a little devi'ls advocate - Everyone has some level of postural dysfunction (your thoracic spine and shoulder girdle for example), and these dysfunctions alter reciprocal inhibition, inter- and intra-muscular coordination, length/tension relationships, proprioception, and inevitably neuromuscular efficiency and of course endurance, strength, and power output. I could argue that there is instant gratification when corrective measures are implemented well. If you can improve mechanics you will optimize neuromuscular efficiency and notice the results immediately. I'm talking 10% more on your bench, 4" inches on your vertical, less residual fatigue between repeated attempts… instantly.
April 29 at 12:47pm
Marty Miller Only to be fair since I was in a similar situation I can not pass judgement as I am unaware of Derrick Rose's training regimen. However my instincts tell me that there would be predictable movement compensations.
April 29 at 12:50pm
Rich Fahmy I totally agree B2, i think maybe it needs to get sold that way too.
April 29 at 12:56
Brent Brookbush To your point Marty Miller - I noticed D - Rose was sporting a pretty nasty anterior pelvic tilt about 2 months ago in the only Bulls game I caught this season. I really didn't mean to insinuate that it was anyone individual's fault or one strength and conditioning teams fault - more like an immense amount of pressure from the players and those who are guarding the past. -
A quote that was recited to me by an academic monster, whom I am fortunate enough to have as a client. Seems very appropriate in this conversation -
"On every road that leads to the future, there are a thousand men appointed to guard the past. The best that the least of us can do is not add to the immense dead weight that nature drags along." Lincoln Steffens from "Shame of the Cities".
April 29 at 1:00pm
Brent Brookbush Yes Rich Fahmy - "Sales" - what a great way to place this issue in the appropriate perspective. We sell it as "injury prevention," but nobody cares until they get hurt. We should start selling it more as instant upgrade to your performance
April 29 at 1:02pm
Kyle Stull The most alarming fact to me, as you mention Brent Brookbush, why isnt it changing? These injuries are just as prevelant now as they were years ago, if not more so. Are people just resistant to any change? Is the athelete's that are not open to ideas or is it their Athletic Trainers and Dr's that are not?
April 29 at 1:05pm
Brent Brookbush Great question Kyle Stull, who is guarding the past? I don't know anymore… I think it may be a little of everyone.
April 29 at 1:25pm · Like
David Weinstock Brent, you're asking for a paradigm shift. Be patient.
April 29 at 1:32pm
Brent Brookbush So true David Weinstock, I can't imagine the changes you have seen. I am sure we have come along way since the publication of your book… Hopefully, we keep changing.
April 29 at 1:34pm
Rodney Corn What a great topic… but it sounds like a very traditional mainstream conversation here discussing muscle imbalance, movement compensations and flexibility issues. Rich touched on very important point, people don't think about it until they get hurt. Well, either do we as practitioners. Sure we may address "Flexibility" or "Core Stability" or what we think is "Tissue Health", but we're still missing the boat. Forgive me as I do not intend to sound brash, but we are still far away from corrective exercise here. Most people cannot even define 'corrective exercise'. I recently gave a presentation at Fit Pro in the UK titled The New Wave in Corrective Exercise: Rhythm… I will also be giving the same presentation at IDEA World in San Diego. ACL tears, hamstring pulls, LBP, etc. goes way beyond muscle imbalance, anterior pelvic tilts and movement compensations. Working on these is great, but it is still like treating the knee for knee pain - we're still missing the big picture. There is a plethora of research out there that goes way beyond the biomechanical / biological approaches and produces fantastic results… I am not talking about smoke and mirrors either people - real applicable practices that we overlook and ignorantly play off as meaningless or irrelevant because we forget that the whole human body is one functional unit, not separate systems working in isolation that somehow fit together… AND the greatest part is that when we use these techniques it doesn't even require special 'exercises' that most clients don't like to do or don't do when you tell them too anyway. But please don't take my word for it.
April 29 at 2:24pm · Like
Brent Brookbush Can you give an example Rodney Corn, I did see your video on "pre-tensing" the fascial system… interesting stuff. I think some of the questions you bring up, fall back on some grey area around on how our nervous system controls human movement, but this of course is why there is more than one methodology. I think even you will have to agree that regardless of potential additions to corrective exercise, the correction of postural dysfunction still moves way beyond what is commonly practiced now. Thoughts?
April 29 at 2:29pm
Rodney Corn Brent Brookbush - I am not referring to pre-tension or fascia (though it will play a role in this no doubt) and I would respectfully and practically disagree that addressing postural dysfunction 'moves way beyond what is commonly practiced today'… in 2000, when we started addressing PD, I would have agreed with you, but we are 12 years removed and still doing most of the same stuff… AND most people out there are doing some form of it - whether you realize it or not. I have been to Hong Kong, New Zealand, Singapore, UK, Europe and all over North America - I have seen thousands of trainers in hundreds of clubs all doing some form of what you are all talking about. You all are touching on many valuable points in your posts - "things haven't changed much", "injuries are not significantly decreasing", "why isn't anything changing"… maybe it has (actually it has dramatically in the last 13 years) but maybe it is not working as well as everyone thinks or thought it would. Not because its wrong, but because it is incomplete. You did rightly mention the nervous system as major player, but most people don't think about the Autonomic Nervous System when they think of corrective exercise… why not? Should we? If so, how can we observe it? How can we influence it to make dramatic changes… yes changes in movement…?
April 29 at 2:43pm
Rick Richey Vague, but intriguing.
April 29 at 3:03pm via mobile
Brent Brookbush I kind-of figured you would respectfully disagree Rodney Corn, that's why I enjoy your interjections… It's not much of a discussion if everyone agrees. Thanks for another perspective. April 29 at 3:12pm
Brent Brookbush As I have mentioned before, I have tried to work in various formats - (facebook, wordpress, linkedin and the Small Machines Forum that acts as an archive for our conversations - http://b2cfitness.com/trainer_forum/ ) I wish we could set up regular round table discussions on a forum that everyone had access to, and marquee trainers from all sides of the debate would interact on - The point is not whether or not this panel agrees on everything, but rather, what we do agree on and how the discussion has evolved. The learning that comes from discussion and debate is imperative to learning, our own personal development, and our development as a profession, and I think it sets an incredible example for the next generation of trainer. So back to the debate at hand, who is guarding the gates to future advancement and how do we change them?
April 29 at 3:22pm
Rodney Corn Rick Richey - let the intriguing overcome the vague. I had the fortune of working with Mike Clark in the early years. He provided me with an invaluable lesson… he always gave me 'vagues' and asked me questions. This left me with a choice - I either did my homework and found out the answer or I got frustrated and learned nothing. Thanks Mike Clark ;-)
April 29 at 3:25pm
Kyle Stull Rodney Corn, when considering the Autonomic Nervous System and the ability to induce "change" as therapist and trainers we continuously address the biomechanical influences, both structural and functional. And, to get back to injury prevention, this is what is more commonly understood by athletes. How do we express the importance of psychosocial and biochemical influences on form and function? Or, is this taking it too far? Sure we could postulate that childhood stress is correlated to kyphotic posture that inhibits the diaphragm which decreases pelvic stability and increases the chances of a knee injury or whatever. But, is this necessary?
April 29 at 4:50pm
David Weinstock Rodney, I work with a system that is based on motor control via manual muscle testing and kinetic chain analysis. I consider it a "whole system". Please explain what you mean by working with the ANS.
April 29 at 6:30pm
Scott Helmer · Friends with Rodney Corn
You guys are definitely more educated than I am, but would it be logical to address the shortened season with regards to the types of training regiments these athletes indulged in? The season was cut some 20 games, yet the league had them playing back to back to back games for the first time ever. Shorter rests between games and more intensity on the court….sounds like they were not properly "trained" for the long haul, or increased court time they would have to endure. I guess I am just seeking to understand if this had any bearing on the late ACL injuries, not to mention a few Achilles tears. Any thoughts?
April 29 at 6:48pm
Brent Brookbush Hey Scott, I think everyone would agree the the shortened season was bound to end up in more injuries regardless of training strategy. The game is too intense, competitive, and demanding on the human movement system… just the thought of back to back to back games frightens me, but the question really is in regard to non-contact injuries and the extent to which they can be avoided by addressing certain maladaptations in the kinetic chain the occurs in all individuals over time. Strength and endurance training will only serve to reinforce these maladaptations. Even the most in shape players are falling apart - (ex. Colby Bryant, Derrick Rose, Dwight Howard, etc…) player's known for their work ethic, but they all had issues as well. For example both derrick rose and dwight howard were sporting anterior pelvic tilts throughout the season. If they had been adressed would they be injured now?
April 29 at 7:15pm
Scott Helmer · Friends with Rodney Corn
I totally agree. As was mentioned earlier, these athletes go balls to the wall during their "training" for bursts at a time and do not fully understand, nor do their trainers, the importance of balance and working on the weaknesses that these guys all have, as varied as they may be.
April 29 at 8:23pm
Rodney Corn Kyle Stull & David Weinstock - great posts and great work by both of you! thank you for what you do! I would, however, suggest that if we do not take biochemical & behavioral aspects into consideration when addressing 'corrective strategies' we are incomplete. Biological, biomechanical, behavioral & biochemical all play a key role in corrective strategies and tissue health. It is easy to argue that biochemical, biological & behavioral influence has as much to do with an ACL tear as biomechanical (i.e. postural distortions), perhaps even more so. If an athlete does not eat, sleep, hydrate and 'cope' well (and most do not), they place their body in a state of heightened stress. Stress leads to an inflammatory response and inflammation is the #1 factor in most disease states and injuries. So managing a athlete or client's stress is perhaps a much more complete way to perform corrective exercise. Examples… 1) Heart rate variability is perhaps one of the easiest and most powerful ways to monitor the ANS. When athletes or clients are monitored for "Training Load" - the measure of stress placed upon their bodies that impacts HRV and thus ANS, it is very easy/predictable to tell when they will get injured IF they do not recover adequately. I have personally worked with clients who are runners/triathletes and when they do not pay attention to their training load - a monitor of the ANS stress - they all of a sudden pull hamstrings, get hamstrings strain and/or knee pain (runner's knee). However, as long as they stay within their proper levels - no injuries. Why? I didn't have to use any "corrective exercise"… I just monitor HRV (ANS) through training load. This has also recently been shown to exist in research, so I know that I am not totally crazy… http://www.8weeksout.com/online-courses/online-courses/wordpress/wp-content/uploads/2011/12/HRV-and-Immunity.pdf - 2) An athlete/client's circadian rhythm also plays into their tissue health and response. How their sleep / wake patterns can dramatically influence hormones (leptin being a massive player as it is effected by circadian rhythm, correlated to inflammation and controls the mitochondria - kind of important for tissue health).. so when your client or athlete goes to sleep too late and/or falls asleep with the TV on, this alters the light/dark pattern as viewed (literally) by the SCN (suprachiasmatic nucleus). The interesting part about this is the SCN is intimately tied to ANS functions and also involved in dictating rhythms for locotomotor activity. Who would have thought that your sleep patterns and too much light while sleeping would effect your tissue health & rhythmical motions…? 3) I think that most of us who have looked at the research in the last few years would also agree that most injuries are to 'connective tissue'. Connective tissue is largely made up of collagen. So anything that decreases collagen's capacity to endure stress could very likely lead to an injury. By way of Glycation, too much 'sugar' as well as vegetable oils have been shown to damage collagen. Is it possible that regardless of how much we stretch, foam roll, etc we may still be decreasing our tissue health biochemically…? I am sure I have bored most of you enough, but these are just 3 simple scenarios where movement, injury, etc. is effected by factors non-biomechanically.
April 30 at 2:27pm
Pete McCall Stress is the key determinant -- too much of it - either emotionally or physically and the body will not have the capacity/ability to respond to any additional training input. in the context of this original question my guess would be the additional stress and reduced recovery time of a shortened season along with the shortened pre-season did not allow the athletes to properly prepare for the emotional stresses of the competitive season. likewise there was a limited time for teams to 'gel' and develop a rhythm of friendship/teammates (rapport, if you will) that is crucial to success. the best part about working in a team environment is when everyone syncs and flows together - this brings about a feeling of togetherness/synergy that is difficult to quantify with traditional pt methods. think about clients who seem to be frequently injured-what is their emotional stress? are they happy people? now think about clients who seem to perform above their ability and i'll bet they are generally happier people (or have a solid spiritual foundation in their lives). The fact that all cells resonate on certain frequencies which can be influenced by a state of mind can have significant impact on how individuals adapt to the applied stresses of exercise. I'll look forward to your sessions Rodney Corn
April 30 at 2:53pm
David Weinstock Rodney, agreed, all those factors are critical. Was responding to Brent's query about the biomechanical causes.
April 30 at 2:57pm
Joshua J. Stone Funny… I just saw this thread. I just wrote a blog about this very topic. http://on.fb.me/IAFhw9 :
"Every sports talk radio station is analyzing the rise of significant injuries in the NBA. ESPN had debates on the issue. Now the topic is trending on twitter. People are asking: Did the shortened pre-season lead to this rise in injury? Did the condensed schedule lead to the injury? The answer to both is yes. However, in both circumstances (shortened pre-season and condensed schedule) these injuries could have been prevented. Non-contact injuries are very preventable if you apply proper programming.
Many original research studies and systematic literature reviews have shown a significant reduction in ACL injuries following implementation of neuromuscular training. In fact, a systematic literature review was recently published in the Journal of Bone and Joint Surgery (March 2012). This showed that ACL injury prevention programming provides a significant reduction in ACL injury. Many others literature reviews and research papers have also shown the effectiveness of neuromuscular training programs. A shortened pre-season may have led to the increased injury rate, because players were not exposed to the pre-season neuromuscular training. Unfortunately, not all teams apply injury prevention programming as part of the workout routine.
As for the condensed season schedule; a condensed season schedule with limited recovery dates will yield higher incidence of injury. A study published in the American Journal of Sports Medicine (2011) shows that injury rates in a short recovery group demonstrated a significantly greater overall injury rate, practice injury rate, and game injury rate compared to those in the extended recovery group. The injury rates were 6.2 times greater for overall injury, 4.7 times greater for game injury, and 3.3 ties greater for practice injury in the short recovery group. That said, these injuries could have been prevented, even if neuromuscular training was not implemented in the pre-season. As the season progress gradual decline of neuromuscular efficiency occurs. This leads to breakdown of mechanics and subsequent injury. ACL injuries can be prevented. Identifying faulty mechanics as the season progresses and then applying corrective techniques to fix those mechanics will go a long way in preventing non-contact ACL injuries. "
April 30 at 3:01pm
danielbryanfitness Hello everyone, i will speak from my experiences as a trainer and sports massage therapist. I agree that our industry has failed to see this as a major issue in the light of corrective exercise or they simply choose to give it a back seat. In my opinion this should be at the forefront of what we should be looking to improve. Correct human movement should be paramount in any exercise programme from a trainers perspective I feel. If we cannot move properly and not teaching his to move properly we ask asking for trouble down the line, then we become injured and cannot move, then we can't exercise. I haven't been in the fitness space very long and I'm still learning, and always will so I wish I had all the answers, I can only say what I see in front of me. That simply is that the majority of trainers that I know and hear simply don't care or are not interested. Going back to what was being said about poor D Rose, overworking from traditional 'beastings' from the trainer may give us that instant gratification of being pushed to the limit and feel that 'it works' and is effective, but in truth was it really that effective across the board or just because we now feel shattered from an intense workout. I see a lot of trainers coaching people by literally pushing them to the edge of their limits, yet their technique and movement are suffering heavily and will have to eventually pay the price. I feel that our industry is rapidly becoming a quick fix in and out job for people looking to get healthy and were using and endorsing all sorts of crazy ideas now just so that we are seen as being tough and demanding of our clients to work work and work harder just so that we seem like were good at our jobs! without the coaching of all the other important areas, like corrective ex, posture control, injury awareness. We need to look deeper into improving the human body completely and educate and make aware of what is holding us back, such as ergonomics e.g. sitting at a desk all day causing postural disfunction, walking in straight lines, sitting in cars for hours etc etc. I believe that our job as trainers should be there for one thing only and that is to help improve the human race. We are in a position to do that, but I feel that it takes a back step and is not what people are focusing on. RANT!! HAHA SORRY EVERYONE LOL.
July 31, 2013, 02:02:41 PM