The Three “R’s” Rest, Recovery and Regeneration: Part 1

Exertion can come in many forms; physical, cognitive and emotional to name a few. Exertion is a critical aspect of life. We can have differnet levels of exersion. Think of the original Borg Scale of 13-20 when categorizing perceived exersion duirng cardiovascular exercise. We can apply a value or rating to any form of effort, exersion or experience. Think of a hike, bike rider, social situation or experience that you have had recently and rate it.
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You could use the score of one for a low intesity experience and a 10 for the highest intensity experience. For example sitting quietly on the couch day dreaming might be a one for you and skydiving might be a ten. Of course we can track every component of our workouts in this manner if we choose.
On a given day we might subject yourself to different intensities of resistance training, cardio, core (and so on) workouts. The stress or exersion is where we often experience the richest parts of our lives. I can think of when my children were born, those were some of the most intense feelings that I have ever experienced in my life. The highest of most wonderful highs for sure. I can also remember the physical fatigue and emotional exhaustion that came over me as I started to come down from these experiences. It pushed me to the edge of my known emotional capacity. Just like making it through a challenging spin class, CrossFit W.O.D. or completing your first marathon, there is more there than we probably know.
We go up to and sometimes past our known limits. These are the times when we experience the necessary overload or stimulus to create new adaptations and experience richer and more intense experiences from there. The thrill of competition, the joy of victory, the exhaustion of physical exercsion, all good stuff! But when we put that much out, we need to take some time to build our reserves back up.
This is what some might call recovery or rest. I will use the distinction that rest is passive and recovery has an active component. When recovering you eat something, drink something, go to get a massage, ride an exercise bike at  low intensity, apply some self myofascial release, perform some flexibility techniques on a vibration platform, use some hydrotherapy-you get the picture. I have heard others cataegorize some of these actives as regeneration techniques. You could classify recovery techniques as strategies that are employed immediately following a bout of exersion or exercsie. The window of opportunity to maximize recovery from exersion is opew widest for approximately 60 minutes. You might also hear the term regeneration, not like the Lizard Man from Spiderman , but how we go from able to return to our daily activities to starting to develop adaptations to the stimulus that you just introduced your body to. You might utilize some of the same techniques during both recovery and regeneration, the differentiation is when they are applied. For the purposes of this post I’ll stick with recovery occurring 0-60 minutes post workout and regeneration occurring between 60 minutes and three days. Of course, you can rest anytime during either of these processes.
The original topic for this post was hydrotherapy for post workout recovery. Specifically the useage of steam rooms and saunas. Hydrotherapy involves the use of water for pain relief and treatment. The term encompasses a broad range of approaches and therapeutic methods that take advantage of the physical properties of water, such as temperature and pressure, for therapeutic purposes, to stimulate blood circulation and treat the symptoms of certain disease according to Wikipedia. Now the use of ice and heat is often referrred to as modalities in the physical therapy world. We’ll leave those to techniques out of this conversation.
As I started to do some research and type this I found it difficult to focus in on just those two subjects without first adressing the larger topics of rest, recovery and regeneration. To cover that I think I would need to write a few chapters in a book on performance training or at least a short stand alone book. So I have bene putting this off for probably a few years.
Why put this together now? The biggest motivating factor was the trip that I am on the way back from. I had the opportunity to workout this past week at an amazing, and I mean amazing, club in Rotterdam in the Netherlands called Wellnesslande
The club was on the outskirts of the city, on the edge of suburbia. It was built up in a small and very nice technology center which abutted a residential area. It was designed and built from the ground up. It was in a four story building complete with a rock climbing wall, cafe, five tiered spin studio, mind-body studio, sport performance room, group exercsie room, golf room, wellness /personal training studio, complete line of Life Fitness cardio equipment, complete lines of Life Fintess Circuit series and Signature series equipment, select Life Fitness Cable Motion pieces, Selected Life Fitness plate loaded equipment, a near complete line of Hammer Strength MTS equipment, the Life Fitness Synergy/360 XL, free weight, core, vibration training area, and “wet area” that included a pool, two hot tubs, one steam room, poolside showers and more!!!! This was a showcase for Life Fitness sicne their European headquarters are right around the corner. The attention to detail, quality, craftmanship, service, music and the entire experience was one of the best I have ever had. Truely op notch. Their “wet area” was unreal. It was well throught out and well planned. Here is a small detail, the showers had no tempaerature adjustment, simply a  push button and the water comes out warm at the perfect termperature for about 60 seconds. You know what it’s like when you get out of the pool and you’re a little chilly and the first few drops of water are cold? This water came out just right….the temperature of the pool, the room, everything was designed with painstaking effort and focus on the customer’s experience. This is a picture that I took of the pool. The windows on the top are actually a glass floor by the lobby.

In addition to “playing” in every room except the spin room I visited the hydrotherapy room the each day that I could. On two of the days I started in the hot tub, then moved to the dry sauna and finished under the old bucket of cold water. The suaunas pretty much looked like this.

And the steam room had some L.E.D. mood lighting.
On the other day I went from the hot tub, to some sort of open heat lamp section then on to the steam room and finished with the sauna and cold bucket treatment.
The two hot tubs were different depths, one 70 cm and the other 80 cm. The two dry saunas were held at differnte tempratures, 70 degrees Celsius and 90 degrees Celsius. I spent about 25-30 minutes in this area of the club at the end of each workout or just visit to the club. I was fortautne to have the time to do some rolling and stretching before hand as well and stayed well hydrated. I felt like a million bucks after these treatments!
I also of course did some strething in the hot tub as well. I was feeling pretty banged up from the flight over, a fall I had at my son’s hockey practice and some of the workouts I did while I was there. One thing they did not have was a cold plunge which I always love using!
There is limted literature on the benefits that steam rooms and saunas provide for the purposes of health, athletic performance and recovery. Most of the claims are impirical and based on old world thinking. which is fine with me. I like evidenced based information as much as the next guy but sometimes the “if it feels good, do it” philosophy works well.
Remmebr the old Simpsones episopde with the personal develomet guru that came in and got the town on board with his teachings? The Red hot Chili Peppers made a guest appearance on this particular show.  I used to be a huge Simpsons fan, but I digress…
Let’s call it a night there.
Back with Part II later this week.
“You stay classy San Diego!”
Eric Beard’
A-Team
Corrective ExerciseSpecialist
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The Five Deadly Sins of Corrective Exercise

Okay. They’re not deadly sins. I don’t think anyone has ever died at the hands of a foam roller, and I don’t think yon need to go to confession if you commit one of these errors, but I liked the tittle. 

 

Without further adieu, here they are:

 

1) Selection. 

 

2) Execution. 

 

3) Sequencing.

 

4) Omission. 

 

5) Excess. 

 

It’s never that simple. Is it? I’m watching the Celtics pretty handily beat the Pacers.  The Celtics have a 20 point lead in the 4th quarter. I was talking with a friend about the C’s woes of late. They have not been playing the defense that they need to win, or rebounding, but the rebounding is a longer standing problem. Whether the newer players are not grasping Doc Rivers’ system or that Ray Allen was a bigger part of the team than some thought or perhaps they really missed Avery Bradley’s quickness and on the ball defense, they have just not had the success that most around these parts have expected. Until tonight.

 

I won’t continue about the Celtics sporadic defensive intensity but I will relate it to corrective exercise programming. Many of us know what we should be doing but we may miss out on the how or consistency. Selection, execution, sequencing and consistency are important in many aspects of life and corrective exercise.

 

1) Selection.  An old adage that holds true, your program is only as good as your assessment. I have a friend who is also a massage therapist and on his business card he lists “source work” as one of his services. Now he is not talking about going back in time like Jake Gyllenhall in the “Source Code”, a good flick, but he is talking about identifying and treating the cause vs. the symptom. Get good at this and you will develop quite a following. 

 

2) Execution. Just like the computer programmers will tell you , junk in equals junk out. One reason we will never be replaced by computers is the ability to assess and correct form. Most people are working off of faulty motor patterns and they will continue to perpetuate those even when they are trying to rewire them. Do the right thing, right. I’d rather have most clients doing the wrong exercise well than the right exercise poorly. 

 

3) Sequencing. You may be familiar with NASM’s approach to corrective exercise. They have a four step system; inhibit, lengthen, activate and integrate. This makes perfect sense to me, however there can be even greater detail paid to the sequencing of the muscles or patterns addressed when performing these techniques. For instance, releasing the plantar surface of the foot can have cascading effects up the posterior chain due to the fascial connections. If someone has a restriction in the hamstring complex or the calve complex, try starting with the foot first. Obviously you need snow before you build a snowman and the base of the snowman needs to go down before the mid section. But would you ever put the hat on the snowman befor the eyes, buttons or arms? I think not. You’ve seen how Frosty does it right? The order of the muscle or movement addressed may not be as important as the sequence of techniques, but it will make a difference. Play around with this on your own and see what works best for you. 

4) Omission. Sometimes what someone isn’t doing is the problem. Either personal preference, poor planning or poor programming can lead to a sin of omission. Some people just don’t like to roll. If you have soft tissue dysfunction, tough, do it or pay a therapist to do it for you. If clients are in a rush they tend to bag the things they either don’t like or don’t think are important. Educate them about the importance of setting the appropriate amount of time aside to train and then the importance of competing their program in it’s entirety. And practitioners have been known to miss out on the occasional muscle, movement or technique so be dilligent while programming. 

 

5) ExcessThe fewer movement issues that someone has the more precise the programming needs to be. Beginners will often benefit from a general “shotgun” type of approach but those in the upper echelon of athletics and movement quality will require much greater precision. Save the 30 minutes of foam rolling for the retired banker without much to do during their days or the busted up ex-athlete who is just a train wreck. More work does not mean better results. Be as efficient as possible for maximum effectivenessq and compliance. 

 

Thanks for reading and Happy Moving!

 

Eric Beard

A-Team’er

Corrective Exercise Specialist

Integrated Manual Therapist

EricBeard.com

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Frontal Plane and Knee Pain: Tennis Player

             Your plane or mine?

Dysfunction is quite common in the frontal plane. Beyond uncontrolled or excessive valgus is a cornucopia of goodies to dig into. This image is perhaps a bit dated and myopic but serves it purpose. The key musculature responsible for providing frontal plane stability while on a single leg has been drawn in. 

I like how this second image expands the view further up and down the kinetic chain. One area that I think is often overlooked is inversion and eversion of the calcaneus. Another is the impact that the shoulder complex (or thoracic spine) can have down through the chain. You can take an even more complex look through the Thomas Myers Anatomy Trains lens as well. The lateral line, spiral line and arm lines can easily be added into the equation.
I have been working with a tennis player who has reported left knee pain, right shoulder pain/tightness, and left medial heel pain. Their left knee pain when they are playing singles and have to move quickly to the net, especially on hard courts, is their primary source of discomfort. They are right hand dominant and display many of the imbalances that you would expect from a tennis player. I have used; static postural analysis (standing-anterior, posterior and lateral views, seated-A,P,L views, supine and prone positions), the Functional Movement Screen, and NASM’s Overhead (regular and two modified versions) and Single Leg Squat assessments.  I performed goiniometric assessments on the major load bearing joints and manual muscle testing on some of the key players based on the results of her previous assessments. I also checked their sacroiliac joints and subtalor joints. Their thoracic rotation was limited when they rotated to the right (tried to look over their right shoulder for example). Unlinke the #3 picture above, this client did not have the thoracic mobility to reach over head in the frontal plane without causing disjointed pronation on the left and some excessive supination on the right.
In NASM nomenclature their right knee aBducted at the bottom of the Overhead Squat and left knee aDducted. There was more right knee aBduction than left knee aDduction. Their right shoulder did not maintain flexion as well as the left. There was an asymmetrical weight shift to the right at the bottom of the squat as well. When on a single leg this client demonstrated poor stability and their stance leg knee moved in excessively (aDducted) when standing on either leg. When standing on their left leg their trunk also moved inwards during the descent of the squat.
I released their; adductor complex (spent longer on the right adductor magnus than the left “flexor” adductors due to limited right hip internal rotation), TFL (right more than left due to limited hip extension on the right), right piriformis, right biceps femoris (both heads), right quadratus lumborum, right lat, right pec minor and both calves. I mobilized their right SIJ (which was restricted mildly in the sagital and frontal plane and moderately in transverse plane) and right illum (which was elevated and rotated anteriorly). Then assisted them in performing some thoracic mobilizations.  We then performed some activation techniques for their deep core stabilizers and  left glute maximus and minimums.
We then progressed to some additional correctives including; a 1/2 kneeling tubing chop (I used a Grey Cook purple tube), left VMO, left medial gastroc activation, left medial hamstring activation and split stance front foot elevated tubing (same tube) lift.  I have them repeating the SMR and corrective work 5-6 times per week in addition to their general warm up before workouts and tennis. Their workout consists mainly of corrective exercise and includes core stability training and total body/integration types of exercises designed to help them relearn common movement patterns. I only have the client perform exercises that they can control without repeating their movement faults observed during the assessment process. They also complete an SAQ and conditioning workout several times per week. No plyos at this time.
We also discussed their footwear. They wear pronation control running shoes (even though they don’t run for conditioning) when not on court and tennis shoes when on court. I recommended that they move away from the running shoe because of the elevated heel. They have higher arches so the support feels good for them when in the pronation control show so we went to a hiking/walking shoe that has a much lower heel but still had some support for the medial arch.  We also have discussed the importance of preparation and recovery from a movement and nutritional stand point. Specifically focusing on the odd stint of time away from the tennis court. It appears that travel plus 3 or more days out of their regular routine exacerbates old (or new) aches and pains. My recommendation was to enjoy the time away from the game, but to go through their corrective work, dynamic flexibility and light cardio (just enough to break a sweat) every day that they are away. This program would take 20-30 minutes and help them to recover “actively” while off away from the tennis court and ease their return a few days later. If they are feeling burnt out and can’t bear the sight of a roller, some tubing or a gym, then just get some body work while on the road at the very least.
Does any of this sound familiar?
Do you have clients with similar issues?
Anything else that you have grown in that has worked well?
Thanks for reading! And oh yeah….Happy New Year,
Eric Beard
A-Team’er
Corrective Exercise Specialist
Integrated Manual Therapist
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My Thoughts on the Level 1 Functional Movement Screen Workshop

I got a nice treat a few weekends ago. I got to sit in the seats of a continuing education course instead of leading one. I thoroughly enjoyed Gray Cook and Lee Burton’s 2 day presentation of the Functional Movement Screen Level 1 workshop sponsored by perform better. It was right down the road in Providence, RI at the RI Convention Center. I made sure to say “hello” and introduce myself to Gray and Lee at the end of day 1 even thought I felt that I already new them to some extent since we have presented at the same events several times in the past.

I’d like to write about my experiences and what I took away from the workshop. If you are unfamiliar with the Functional Movement Screen (FMS) it is a system designed by Gray and Lee that entails the assessment (or screening) of seven different movement patterns. There is a 0-3 scoring system for each of the patterns and ensuing corrective exercise recommendations based on the results of the assessments (screens). I should stick with their vernacular and use screen. Gray and Lee differentiate between screens and assessments.  What I would call a movement assessment, they would call a movement screen. They reserve the term assessments for their Selective Functional Movement Assessments (SFMA). Specifically they call them “Top Tier Movement Assessments.” The FMS screens are designed to provide a “systematic way to observe movement patterns(1).” Practitioners are looking to identify “significant limitations or asymmetries (1)” and challenge mobility and stability.

The seven movement screens are:

  1. Deep Squat
  2. Hurdle Step
  3. In-Line Lunge
  4. Shoulder Mobility
  5. Active Straight Leg Raise
  6. Trunk Stability Push-Up
  7. Rotary Stability

If a client/patient/athlete (CPA) reports experiencing pain during one of these movements the practitioner scores this movement a “0” and it is recommended that they refer the CPA out to a licensed healthcare practitioner to either complete the SFMA or or other necessary evaluation techniques to identify the source of the pain.

If the CPA cannot complete the movement, they are assessed a “1.” If the CPA completes the movements with compensations they are assigned a “2”. If a CPA earns a “2” on screens 1, 6 and 7, they are provided modified movements to attempt. If the movement is perfect, the earn a “3.” For screens 2-5 and 7 a score is assigned to both the left and the right of the body.

This is a basic overview of the FMS and there is more depth to the system as well as it’s rationale, but it’s a start.  The Deep Squat is the movement that I am most familiar with and it is the first movement in the FMS screen. I find more similarities with Gray and Lees work and NASM’s Overhead Squat Assessment (OHSA) than I find differences.

Some similarities in the set up and movement: the feet are positioned about shoulder with apart (acromion for the FMS and the gleno-humeral joint for NASM), feet are to be pointed straight ahead, and the shoulder/arm position is similar, however the FMS utilizes a dowel and is more precise in the positioning.

Some differences in the set up and movement: the FMS, like the title of the screen states, is looking at a deep squat and requires the CPA to sink as low as they can go, NASM’s OHSA asks the CPA to squat to parallel or a 90 degree angle at the knee.

The scoring is quite different. NASM is checking off compensations at the five major load bearing joints of the kinetic chain. The FMS hangs a number on the overall movement. Both assessment/screening tools consider the feet turning out (inability to keep the feet pointed straight ahead), knees moving in (inability to maintain alignment of the tibial plateau and the 2nd and 3rd toes), excessive forward lean (inability to keep the tibia and torso parallel).

NASM counts an excessive lumbar extension and anterior pelvic tilt as well as spinal flexion  and posterior pelvic tilt as a compensation. FMS just wants to see the depth while maintaining alignment at the aforementioned check points. NASM looks at the ability to maintain a neutral arch in the foot and documents over pronation at the lower extremity. Now, in passing, Lee came over to our break out group and he agreed that was a compensation, but the FMS is practitioner is taught to focus on easier to identify compensations.

Here is video on the FMS deep squat that is over 5 years old, but gives you a visual:

http://youtu.be/UdragwWQzbc

Here is a run down of NASM’s OHSA if you have not seen it:

http://www.nasm.org/1/global/videos/Overhead_Squat_Assessment_Video/

I feel like I could go joint by joint and work through why each organizations either emphasizes or deemphasizes certain movements. I look forward to applying the FMS for longer to get a better feel for things. The FMS does not focus on muscles, only movements, and this translates into the screen. This is attractive. Don’t get caught up in anatomy, is it this muscle or that muscle? Just score the movement as it is.

On the other hand, some of the movements might be termed synergistic dominance according to NASM’s school of thought. This is something I would like to explore further as well as the fascial lines superimposed across these 7 FMS movements and NASM’s OHAS, Single Leg Squat and accompanying movement assessments.

More of that on another day!

Thanks for stopping by.

Eric Beard
CEO A-Team
Corrective Exercise Specialist
AthleticShoulder.com
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Fascial Flexibility at the Perform Better Functional Training Summit

“Fascial Flexibility for Fitness Professionals”. I love using aliteration! This is the tittle of the presentation that I delivered at the Perform Better Summit  in Longbeach, CA this past weekend.

Over 800 of the regions best were there to learn, share and grow. I know I did all three. I went to see Dr. Craig Liebenson, Josh Heniken (small group/sandbag), Lee Burton (corrective exercise), Todd Durkin (Core and Cuff), Christopher Moore (nutrition), Vern Gambetta (periodization) and Gray Cook’s pre-conference session on top functional movements. Unfortunately I missed some great sessions either because they ran concurrently with mine or I left before they were offered. I flew home Sunday morning and could not take in Anthony Carey or Charlie Weingroff’s presentations. Both which I was looking forward to.

Just as I have seen in the past couple of years there are more unifying messages than divergent ones. I also see plenty of cross promoting within the group. Many of these presenters have great respect for each other’s material and reference them regularly.

During my presentation I communicated the importance of using a complete corrective exercise system, like NASM’s 4 step approach to corrective exercise. The fascial work is a big part of corrective exercise, but the activation and integration components should not be ignored.

I referenced Thomas Myer’s Anatomy Trains book and utilized some great artwork from my friends at Trigger Point, makers of The Grid 2.0 ().

I did not go into the depth that Myers does when he discusses fascia, which fascinates me, but I did talk enough about what it is, what is does and why it’s health is important. During the hands on session we practiced using different techniques and different tools to release adhesions  and restrictions. Much of this material was contained in my DVD on SMR however I did add some new wrinkles and twists.

Key take aways in regards to the selection of tools;

Select tools with different diameter and with different density depending on the technique that you are using and the region of the body that it is being applied.

You should assemble your tool box accordingly.

Key take aways in the technique section of the presentation;

This is not your parents foam rolling. Just kidding your parents didn’t foam roll…but there is much more to it than just rolling back and forth or holding a tender point (or trigger point, more on that here a great set of reference books click on here to see in Amazon) till it feels better. There are a plethora (yes el Guapo I know what a plethora is) of soft tissue release techniques that can be self applied with external objects. Ot foreign objects if you are into 1980’s wrestling.

Key take aways for where to apply these techniques;

In regards to the high value targets, I took visual representations of Myer’s Anatomy Trains, cross referenced those with common areas of restriction and created a list of areas that we typically need to release.

Well, I’m getting ready for some vacation time at the beach with my family. My next presentation is at the Cybex Institute in Medway, MA for more info or to register follow this link http://www.nehrsa.org/club/scripts/section/section.asp?GRP=11424&NS=CON

Eric Cressey and I are on thr docket for what promises to be a fantastic worksop. “Taking Your Clients from Good to Great! Understanding Upper & Lower Extremity Conditions”

For more info or to register follow this link http://www.nehrsa.org/club/scripts/section/section.asp?GRP=11424&NS=CON

Thanks for reading and have an awesome day!

Eric Beard
CEO A-Team
Corrective Exercise Specialist
AthleticShoulder.com
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