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Maybe Thoughts | Boddicker Performance

Filed under: Anatomy and Physiology, coaching, corrective exercise

Maybe Thoughts

by on Apr 23rd, 2010

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People in the fitness world often talk about “Ah-ha” moments, I know I have, but more frequently I get “maybe” moments that occasionally turn into “ah-ha” moments or are forever lost.  Today I’ll list a number of my “maybe” thoughts with some of my evidence in hopes that you will either destroy or confirm my hypotheses.

1.  Maybe I have been reading research a bit less then ideally over the course of my education.  In my early days, I’d read the introduction, skim the methods, and then read results and discussion sections.  This, in retrospect, was a great error as I should have paid more attention to methods to understand methodological quality.  My friend Mark Young has recently posted a great piece about how to read the literature.  Check it out.  It’s more than abstracts and conclusions!

2.  I wrote a few pieces talking about sports hernia in runners a while back and I have since been involved in some good discussion concerning the idea.  In runners I wonder if this “runner’s hernia” (and the other grab bag of associated issues) is maybe a ground up injury.  You see, many of the runners with whom I have worked after stints of long standing groin issues and some post-surgical sports hernia folks have had atrocious foot and ankle function and pronated a lot and very quickly.  If we look at the subtalar joint as the “torque” converter that it is resulting in relative IR of tibia and femur with pronation, the active restraints that control transverse plane motion at the hip have to work over-time and do so eccentrically.  What we know from repetitive eccentric contractions is that they damage the muscle, and those involved in high velocity eccentric contractions lose range of motion (this is evident often in baseball pitchers following a game).  When this range of motion is lost, the muscles lose the ability to fire well to control femoral head position, close the SI joint well, and stress is transmitted elsewhere.  With thousands of steps per day and tens or hundreds of thousands per week, ultimately the tissues will reach their threshold.  Maybe it is a ground up issue.

3.  Maybe we should think about a redesign of the entire fitness world.  I’m all for having tools and using them, but can anyone tell me why a pullover is more effective on a stability ball than on a bench?

Or can you tell me why this guy is doing barbell curls and not working more on single leg stance and rotary stability?

Of course this is tongue in cheek because we already know that exercise can make you smarter.

4. Recently, thanks to Mike Boyle, I began to think that maybe we can blame shoulder mobility (or lack thereof) on why back squatting can be deleterious for the health of the lumbar spine. If you think about it, to properly address a straight-bar back squat an athlete needs a sizable degree of GH external rotation bilaterally. Not only can this be stressful to the anterior capsule of the shoulder, but those who lack this range of motion compensate by hyperextension at the lumbar spine pushing it to the end ranges of extension, and we know end ranges are generally not the best position for the disks.

There you have it. What are your maybe thoughts?

Best regards,
Carson Boddicker

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Leave a Comment »13 Comments
  • Mark Young April 23, 2010

    Carson,

    Thanks for the link to my post.

    My “maybe thought” is that is despite the talk of many industry professionals talking about evidence based practice, maybe we’re not paying enough attention to the evidence. Despite the widespread use of the FMS as a screening tool, it seems the science just isn’t there to validate it as a tool (yet). Until it is, maybe we’re getting ahead of ourselves by making this the primary tool for assessment of athletes.

    I also think that MAYBE this comment will piss some people off. 🙂

  • Carson Boddicker April 23, 2010

    Mark,

    Good comments, and I agree (somewhat). The FMS is a tool with limitations, I’ve seen people with awful table assessments, but can put together the hallowed 14 on the FMS, and I’ve seen people show great results on table and walk away with an 8.

    Yes, there is not a ton of evidence to support its efficacy, though there is some, and there is a lot of support for it’s effectiveness. My question in return would be to define “evidence based practice.”

    I personally do not subscribe to the belief that just because it is not in the literature means that it is not worthwhile. I’m not aware of any pieces of literature that show that a front squat paired with a chin up and a chop is effective, but you do get results in strength or power. In my mind the tests make sense from a practical standpoint based on an understanding of mechanics and motor control, which would be evidence based by my definition as motor control can be a marker for injury potential.

    That said, I am steeped in the Kool-Aid. What do you think?

    Best regards,
    Carson Boddicker

  • Bret Contreras April 23, 2010

    Good job as usual Carson. I thought of the same thing when Mike said that at the seminar!

    Mark, there you go again!

    As far as evidence-based practice goes…most of what we do isn’t evidence-based (as Carson alluded to). If we always waited for adequate journal support we wouldn’t be doing half the stuff we currently do. So it’s always nice to have evidence to support what we’re doing, but we’ll always be trying to stay ahead of the evidence by trying out new ideas. The evidence lets us know if we were right or wrong about our hunches.

    Agree?

  • Patrick Ward April 23, 2010

    Good piece, Carson.

    Mark, I hear what you are saying about the FMS and the evidence not being their (yet). However, like Carson, I also believe that just because something hasn’t been obsessed over in a lab, doesn’t mean that it garbage.

    If we waited for research to tell us it was okay to do something to people, we would end up doing nothing at all. There are always issues with research, the way it was conducted, who it was conducted on, etc…We could wait our entire lives for the certain piece of literature that is perfect in every way, and applies 100% to our population and situation. I think this is where the ART and the SCIENCE meet. Science helps us explain what we are doing, and ART is about looking at the person in front of us and determing how to best approach them and what their needs are.

    Great stuff guys.

    Patrick

  • Pete Brown April 23, 2010

    I wont add anything revolutionary to this,

    IMHO…..Worst case scenario the FMS is a “gateway drug” that gets people interested in taking a look deeper than just putting a client through the latest flex magazine workouts, and even then it can be an objective look at whether or not a persons programming is doing much of anything or making matters worse. However I feel in the right hands and with the right knowledge it can provide a pretty cool road map. I think it can be used well with other methods and agree that it is not the be all end all but then again I dont think it was ever designed to be. It is a start.

    When it comes to evidenced based I think I will go with something I heard Charlie say in an interview, I clearly have notes on….
    1. What is in the literature..look at it with a fine tooth comb but dont really care if you can pick appart every little statistic.
    2. Is it within your skill set…as in techniques with good support but you dont know how to do them.
    3. does it make common sense. (we dont always need 2 feet or research paper as in the joint by joint approach)

    “when something is relative and something is qualitative it is very difficult to apply to statistics and literature” you combine it with common sense.

    For example:
    Ill go out on a limb here and i could be wrong. McGill may have proven this (Mark your sort of the McGill guy in my small world) already but I am not sure, I would need to re-read Low Back Disorders, but as far as I know he did not prove that crunches will ruin a human back, but the read of his book was pretty solid evidence that we could start to lead in that direction. I dont think I will wait for science to confirm on a human spine as I feel McGill did a fine job with pigs and also proving why he used pigs.

  • Rob Murphy April 24, 2010

    In my mind, research serves to show us where we may have missed the boat or been a bit misguided and as a map on how to potentially tweak what we’re doing in that quest to refine and optimize, or at least alert us to areas we may need to reconsider to one degree or another. (and it’s also there to let us know when those hunches were correct, as pointed out by Bret).

    We should never blindly rush out onto any limbs, but as we gain experience, we certainly know when we can take some calculated chances in terms of the methods we employ and when it may be best to go with the sure thing, at least so far as current knowledge and literature tells us.

    As with all things, I think it’s that sweet spot.happy medium we’re looking for, since we don’t want to be handcuffed by requiring a mountain of journal articles, nor do we want coaches and therapists who have avowed to do a lifelong ostrich impersonation and leave their heads firmly entrenched in the sand.

    I think so long as the client is your primary concern and that you’re dedicated to the why behind whatever it is that you’re doing in practice, then you’re bound to be on the right track. Heck, just tracking progress with everyone and having an open dialogue with all patients and clients is bound to have us on the right track. And communicating with the best and networking with them is living research in a way. With so many sharp minds in collaboration it’s hard to ge lead too far astray.

  • Kyle Norman April 24, 2010

    Carson,

    Good job asking some questions. I think it’s the sign of a healthy mind to be unsure of a lot of things–including much of what we see in scientific literature. Probably a good idea to wonder if we’re doing it right or not.

    Of course maybe the biggest issue with using the classic double-blind placebo study is one of money. How much of what we’re practicing can we realistically put through a rigorous scientific test or tests? Who can afford this process?

    Patrick Ward’s comment on the art and science of training was well put. I think we must keep a scientific mindset but recognize that we must allow ourselves a lot of wiggle room. Otherwise we’ll be paralyzed with uncertainty and our clients will desert us.

  • Mark Young April 25, 2010

    I agree that not everything worth doing is necessarily validated by science, but I’m also cautious when I see a pendulum swinging in one direction and when a great number of people are on board. It seems to me that the FMS has been accepted with little discussion as to whether it is valid or not. The more people that jump on board, the less people are apt to question it (especially when those people are big names).

    So I’m not saying the FMS isn’t valid or useful. I’m basically just wondering how much skepticism has been applied to this before it was widely accepted.

  • Patrick Ward April 26, 2010

    Good post, Mark.

    I’ll buy that. That is why we have science – to validate claims.

    Hopefully more research will come out on the FMS regarding its validity as an assessment tool, as well as the sensitivity/specificity of the actual tests and how good they are at potentially predicting an injury. I know there have been a few studies conducted on the test (I have them), but there does need to be more.

    patrick

  • Aaron Schwenzfeier April 26, 2010

    Good discussion.

    I agree with what you’re saying Mark regarding the FMS. What has been good about the FMS is that it has gotten more discussion and attention towards movement (which great coaches have been doing for years) throughout the profession. But here’s a question:

    Using it as a prime method of assessment; does it broaden one’s scope or decrease it?

    Whether it holds great validity or not is largely to be determined. Proponents (monetary or users) will not argue it’s vailidity otherwise they would not be proponents.

    For some, depending on where they are at as a coach/trainer, the FMS might be great, but to continue to rely on it after one gains deeper knowledge and understanding of all that might be at work within an individual, is to really not be “present” with the client. A movement screen is just one small glimpse of how that person performs in those specific movements at that specific time. Nothing to be said for the “state” of the athlete at the time. …or the cultural background of the person… or the context of the testing… and how does it exactly match-up with whatever the activity the individual part-takes.

    Which is why assessments never stop and it’s key for us as practioners to educate people enough to assess themselves. It does not do anyone much good to make the coach/trainer indispensible.

    As far as science goes, all it does is lend “proof” to exactly what occured before the testing and the specific outcome after the testing. What we can gain from “science” is generalizations or possibly common principles that seem to hold true over time. But with assessments, science, and validity… it’s why the athlete/client must be just as aware as the coach/trainer, because most times it’s they who have the most ‘complete’ idea to what happened before, as cause and effect isn’t quite as clear-cut as we’d like it to be. From this we can make better observations to what works for each case.

    Anyway, just rambling thoughts…

  • Patrick Ward April 26, 2010

    I agree, Aaron. I think the FMS is only “part” of the picture. I don’t use it as my only assessment, as there are other things I often want to look at, and I try and draw from other ideas and concepts when assessing a client. I think it is a piece of the puzzle not the puzzle itself.

    Patrick

  • Sam April 26, 2010

    To take the discussion another route I would also say that end of the day I believe we, though Proffesionals, are sometimes too confident that what we are doing with our athletes and clients is actually transferring over to the competition and/or real life.

  • Mark Young April 28, 2010

    Wow…this certainly turned into a good discussion. Great points from everyone…especially me. 🙂 Just kidding.

    And Aaron, your point about teaching the person to assess themself was especially important in that we as trainers and coaches are sometimes so wrapped up in assessing and programming that we forget to educate.

    Sam, I think you’re also bang on. I personally wonder sometimes how much coaching has to do with the success of an athlete. Would the genetically gifted not have done equally as well with a lesser coach? Maybe it makes the difference between first and second, but I sometimes don’t know if it makes the difference between being on the podium and being in the stands.

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