"What are you doing and Why are you doing it?" The Future of Exercise Program Design

The Future of Exercise Program Design: A Standard Operating Procedure

If you have been following my post(s) over the last couple of years you have noticed that I talk alot about my biggest passion in Sports Medicine: Injury Prediction and the art and science of Pre-participation Physicals and improving Return to Sport Testing. Another area in Sports Medicine, Health and Fitness, also deserves our attention. Health and Fitness is the general term(s) we use to describe the attempt by individuals in the general population to stay active. As personal trainers and strength and conditioning coaches the majority of our clientele are drawn from this group. If you have not questioned your standard program in a while it might be time. If you have not attended a continuing education workshop or symposium in a few years you are over due. And if you are running your gym the way you "always" have I added a few links to guide you in the right direction.

Ok, ok I hear ya "Paul, I am up to date on my education, techniques and business model", "I need to know how to implement the testing and training model you suggest into "my client population".

Well here you go. In one jam packed DVD set. The Future of Exercise Program Design: A Standard Operating Procedure

Disk 1
-Awkward
-Disconnected
-Intimidated
The 3 things that many (be honest-most) of personal training clients feel when beginning and performing some the the programs we concoct for them. These 3 things greatly limit our ability to help our clients achieve their goals. That said a central component of becoming a master training/instructor is to first become a student/client. Get uncomfortable and explore methods and instructors that push you out of your "normal" program. I think you'll be surprised what you learn.
In this first disk Gray Cook PT does a fantastic job of providing you the information necessary to understand why we as fitness professionals need a standard operating procedure for starting our clients in programs. We have to begin with a baseline set of measures. A baseline measure which helps us identify potential for dysfunction. A Red Flag. Cook explains that once red flags have been removed "taken off the table" we can apply our methods of choice (yoga, kettlebells, Pilates) and the S.A.I.D. Principle by manipulating frequency, intensity and duration.

But before we begin to apply all the cool exercises and methods we know it is our responsibility to determine if the individual in front of us has the requisite joint mobility and postural stability to perform body weight resistance movements in a competent manner. Gray gives us the tools and insight to begin to see the needs of our clients first and a system to help us measure our intake processes before designing programs.

Disk 2 & 3 "The How"
Lee Burton and Alwyn Cosgrove help us by asking hard questions such as "What are you doing and Why are you doing it?" Learning for us as fitness and healthcare professionals can also be Awkward, Intimidating and Disconnected, but we have to be willing to be life long learners. Lee and Alwyn teach us how to successfully implement a standard operating procedure into our system and obtain laser focused results for our clients by giving them what they need in order to achieve their desired results.
These 2 disks cover case studies that cover the spectrum of clientele that we all can relate to.
These case studies walk you though the steps of formulating an effective client specific program to give the results your clinets want.

Bonus material on the disk set includes slides from the talks, further background articles, handouts and resources to facilitate you in the utilizing this information.

After completing this DVD educational set you'll be better equipped to answer the questions What are you doing, and Why are you doing it?

TankGym Kettlebell Rehab Handouts- Clean & Press

Kettlebell Clean & Press is another great exercise for shoulder and scapulothoracic stabilization in a dynamic movement. The key is to keep it close to your body and drive with the hips. One way I prefer to teach the Clean is by first teaching the negative phase of the exercise. I have found that it is easier for me to teach this new pattern using this method. "Unlearning" a poor motor pattern (technique) is much harder than acquiring the correct technique the first time. Enjoy

Jack LaLanne was a major innovator in our health and fitness culture

Jack LaLanne's Lasting Fitness Contributions. http://google.com/producer/s/CBIwr6Ga4Q0

TankGym Kettlebell Rehab Handouts- 1/2 Kneeling Windmill progressions

The 1/2 Kneeling Windmill variations are an excellent exercise to drive home dynamic shoulder stabilization. Most will be familiar with the windmill as a transitional stage in the Turkish Get Up. When slowed down this movement becomes an ultra challenging example of proximal stability for distal mobility. Begin with the variation most commonly used in the Get Up: Once the athlete "owns the movement" add in head rotations or shoulder rotations for an added degree of difficulty. Once this position is mastered progress to the "Front position" (below). Once the athlete "owns the movement" add in head rotations or shoulder rotations for an added degree of difficulty. As the precision of the movement improves consider progression to bottoms up postures and then to the Standing Windmill which we will cover in another post.
Enjoy and remember basic Kettlebell safety and know your surroundings and use a spotter. A poorly executed exercise that results in an injury is not worth the thrill of a new cool exercise.

Exploring Functional Movement DVD set

Exploring Functional Movement

I am fortunate to have the opportunity to preview the new DVD offering from the

Functional Movement Systems video education series which has brought together Gray Cook and Erwan Le Corre of MovNat. 

 This 3 disk set is loaded with information and techniques for better understanding and coaching self-limiting exercise.  Self-Limiting exercise as defined by Gray Cook: “Self-limiting exercise demands mindfulness and an awareness of movement, alignment, balance and control. In self-limiting exercise, a person cannot just pop on the headphones and walk or run on the treadmill, fingering the playlist or watching the news on a well-placed monitor. Self-limiting exercise demands engagement.” Examples of self-limiting exercises. Gray further defines that when “Used correctly, self-limiting exercises improve poor movements and maintain functional movement quality. These exercises are challenging and produce a high neural load, which is to say they require engagement and increased levels of motor control at the conscious and reflexive level.”

Disk 1 establishes the working definition of self-limiting exercise, the philosophy behind Functional Movement Systems and the appropriate integration of practical and adaptive movements as taught in Erwan’s  MovNat physical curriculum. Following the hierarchy of movement skills, the initial coaching session builds the steps of locomotion and takes you through each posture in the progression. 

I highly recommend that you work through these steps as you watch the video. I was challenged and excited to feel the difficulty of the movements as they were being described and demonstrated, some I struggled with more than others.

Disk 2 is a goldmine of information. If you are an exercise professional, coach or rehabilitation clinician disk 2 gives you the opportunity to see how two individuals attempt to perform specific movements in a live session. Erwan demonstrates how to recognize different faults in basic patterns and gives us his insight on how to appropriately coach and cue the individual athlete in front of us as opposed to the blanket approach of attempting to teach a skill. 

Watching the two athletes initiate and perform the movements so different helped me to appreciate that an individualized approach to coaching and cuing is essential.

The second section of the disk gives us a practical application of how to progress someone up to the “edge of their ability”. Scalable and progressive exercise in a safe yet sensory rich environment.

Disk 3 

provides a video vault of the movements and drills performed in the first 2 disks. These videos are great for quick review and demonstration for clients.  Additionally article resources are include in the data side of the Disk from Gray expanding on all the concepts touched on in the discussions during the training sessions. Erwan also include his Introduction to MovNat manual which allows you to better understand the context and the 10 MovNat Principles prior to implementation. And being a clinician myself I find the Exploring Functional Movmenet Exercise Manual a huge resource. It includes clearly defined exercise handouts for each of the movements including the practical application, efficieny tips and coaching pointers and directs you to the relevant FMS tests.

I highly encourage you to challenge and expand your working definition of movement and exercise, be redefining your recovery day routines. This DVD set will get you started. Thanks Gray & Erwan for the opportunity to get an advanced look at the set.  Implementing it will be fun.

ppg

TankGym Kettlebell Rehab Handouts- Kettlebell Swing

The Kettlebell Swing is one of my favorite exercises for teaching athletes how to develop explosiveness. Typically I will begin by instructing the athlete in the correct technique for the double leg dead lift, moving to the single leg dead lift, hikes and then towel drills for rooting (the concept of stability during dynamic movements) and explosive loading at the hip hinge. The key to the Swing is the efficient transfer of energy from the hips. An explosive dead lift maneuver that emphasizes posterior chain activation of Glutes and Hamstrings. It is important to tell your clients that the kettlebell swing should never be "felt" in the back. If performing this exercise results in pain or soreness in the back cuing and corrections are necessary for correct technique.

TankGym Kettlebell Rehab Handouts- Snatch (negative phase)

The kettlebell overhead snatch exercise is great for developing and learning how to direct explosive power.
When my athletes and clients have progressed and are proficient at the kettlebell basics (front squat, dead lift, clean & press & swing) I will progress them to the Turkish Get Up (see previous post). As they improve with the TGU I will begin to introduce the kettlebell Snatch exercise. One of the ways I instruct this new pattern is by teaching the negative phase. I have the athlete perform 1 rep sets x 3-5 sets each side and progress them as they improve.

TankGym Kettlebell Rehab Handouts- Turkish Get Up & Bottoms Up Get Up

The Turkish Get Up is one of my favorite exercises. For patients the TGU offers a functional way to breakdown floor transfers and for personal training clients the TGU is at the foundation of their training. The Turkish Get Up offers a unique way to demonstrate fundamental joint and soft tissue mobility while maintaining stability during postural changes. Once the individual is able to perform the movement competently and safely the Turkish Get Up can also be used as a movement prep activity prior to sport and as a reset after. Demonstrating coordinated motor patterns through a full range before and after activity allows the individual to monitor the effects of their activity on fundamental movement patterns thus giving instant feedback to how sports specificity has the potential to alter fundamental movement patterns.
Once the TGU is mastered the Bottoms Up Get Up will up the ante and challenge the neuromuscular system in new ways. Enjoy.

You call that a Squat?

Towards Standardization of the Nomenclature of Resistance Training Exercises

Was recently published in the Journal of Strength & Conditioning Research:

May 2013 - Volume 27 - Issue 5 - p 1441-1449

This article highlights one of the challenges in communicating effectively with athletes and clients.  Physical Therapists, Certified Athletic Trainers, Chiropractors, Certified Strength and Conditioning Specialists, Sport Coaches, Personal Trainers all have different opinions about what an exercise is called, how the exercise is performed and who the exercise is appropriate for and when.

Pistol Squat

Bottoms Up Windmill 

In clinical practice I spend a good deal of time educating my patients and clients about terminology and how I am applying terminology. Squat, Dead Lift, Clean, Press, Snatch, Turkish Get Up just name every exercise you have ever performed and I bet I can show you another technique of that same exercise and we could disagree all day about it. No wonder the general public does not know who to listen to and trust. 

Kettlebell Swing

 I think the most important thing I educate my clients on is the concept of "Know WHAT you are doing and WHY you are doing it". This applies to individual exercises as well as types of exercise. For example I am often asked :What's the best (exercise, sport, fitness fad......) for (Fill In The Blank)? I answer with a question. What is your end goal? Followed by another. What do you enjoy doing?
Just because I like kettlebell exercises and trail riding on mountain bikes doesn't mean it is the best thing for everyone standing in front of me seeking my guidance.

Hike for One Arm Swing? Snatch, Clean, Press? Not Sure?

In short, Give your patients and clients better answers when they ask you questions about health and fitness, and admit to them when you do not know why the coach at school calls it one thing and you call it something else. Then go find out the answer.

TankGym Kettlebell Rehab Handouts- Squat Progression

Teaching the fundamental squat can be a challenging task when considering the fact that everyone has their own perception of what the correct performance of a squat is. Wikipedia  identifies a few of the variations of the squat but the most misunderstood (important to clearly define) concept is that the Back Squat specifically is one of the three lifts in the strength sport of power-lifting. More later on the evolution of health and fitness in our North American culture over the last 100 years later.

From a rehabilitation and movement perspective I am referring to the squat from a fundamental movement (neuro-developmental) perspective. As we grow and develop, specifically from birth to 12 months of age, we earn our movement patterns by learning and often failing in a rich sensory environment (great 3 DVD set from Gray Cook of Functional Movment Systems and Erwan Le Corre of MovNat on Exploring Functional Movement available that really expands on this). We learn how to squat at an early age and we learn from the ground up. That is we literally start on the ground and stand up from a deep (but on the ground) squat. In training and rehab many time we need to reverse engineer the squat pattern with a stepwise progression. One technique is to teach the dead-lift with the help of handrails, or a physioball in this example, and progressively lower into a squat posture and return to a standing position. 

The take home message: Provide exercises that challenge your clients to successfully move on the edge of their ability and allow them to earn, or in the words of Gray Cook "own the movement"

TankGym Kettlebell Rehab Handouts- Front Squat

The front squat is a great exercises to help teach athletes how to perform a good fundamental squat. It is my exercises of choice when consulting with athletes on how to improve their Power Lifting Back Squat.

TankGym Kettlebell Rehab Handouts- Knee Rolls

Knee Rolls are a great way to begin working on local stability. Many of you may be familiar with knee rolls from Functional Movement Systems and their approach to corrective exercises. If you have not been exposed to their approach I highly recommend it. If you are FMS certified and wanting to take the advanced courses or if you are looking to become certified this is the course for you. Once yearly the experts gather in one location to help you keep current with the latest techniques and research the annual 2013 Functional Movement Summit is a must. See you there.

TankGym Kettlebell Rehab Handouts- Toe Touch Progression & Breathing

Yesterday we posted handouts for the Dead Lift. For clients having a difficult time  reaching their toes with proper technique we may have to start at a lower fundamental level. The Toe Touch Progression is one technique that can help facilitate learning that movement pattern.

For those clients that are still having a difficult time we may need to pay closer attention to how the movement is initiated and what compensatory strategies they are relying on. Often normal breathing patterns are altered when the neuro-muscular system is under stress. Diaphragmatic Breathing can be an important exercise to help individuals understand and feel what changes occur as they transition from one posture to another.  

  

TankGym- Kettlebell Rehab Handouts- Double Leg & Single Leg Dead Lift

For quite some time I have been putting together a few quick exercise instruction sheets for my clients and patients to refer back to after learning a new exercise. Feel free to use these with your clients/ patients as well and check back as I will continue to make more of them available about once a week.

Pre-Season Testing Team Reports

Answer: 
Standardized testing and Descriptive Summary reports.

Q: How do you communicate the musculoskeletal health of your team to medical and coaching personnel?

Q: How do you show that your training programs (Strength & Conditioning) or rehabilitation approach (Evaluation & Treatments)  are positively contributing to team performance metrics?

Q: How do quickly and accurately identify negative trends?



Team Summary Reports are a must for determining the readiness of your team for training and competition. They should offer a quick yet detailed snapshot of the teams overall performance, & guide clear recommendations for directing the right interventions to the right person at the right time.

With a Team Summary report (or an individual comparison report which we will discuss in a future post) we can quickly identify which individuals are ready for
A) Generalized & Sport Specific Training Programs
B) Generalized & Sport Specific Training Programs with Individualized Corrective Exercises
C) Individualized Training Programs & Individualized Corrective Exercises
D) Individualized Evaluation & Assessment by appropriate medical personnel

With detailed reporting we can make clear recommendations for teams and individuals based on objective measures. Detailed summaries also allow us to monitor the impact of those recommendations with repeated testing & comparison to baseline/ normative performance values.

You should be using a standardized system to administer Pre-Participation Physicals, Return to Sport Testing, & Assess the Success of your training programs. The system you choose should have a meaningful report associated with it to clearly articulate the results.

What do you use? 

Thanks to Move2Perform for allowing me to share their testing reports

Pre-Participation & Return to Sport Testing Reports

Pre-Participation & Return to Sport Testing Reports.

During my early years of clinical practice I felt uneasy at best when attempting to determine if and when an athlete was ready to return to competitive activity. I felt pressure from all sides. The athlete, parent, coach and physicians all wanted definitive answers as to when to return the individual to sport. While I would like to believe I presented the best available information at that time, it was almost impossible to give a recommendation with any certainty. 

Over the last seven years research in injury prediction and sports epidemiology has exploded. There are now several proven test that allow us to objectively determine when athletes are ready for release and more importantly identify when and why they are not. Here is a link to some of the research: Move2Perform

How do you communicate with the physician, parent and athlete? How do you articulate the Why of your recommendation?  Clear comprehensive reports are an invaluable tool and you should be using a standardized testing procedure, with clear criteria and easily understandable reports.

 Comprehensive reports generated from objective tests allow us to add value to Pre-Participation Physicals & Return to Sport Testing. Rating and ranking movement performance and test measures allows us to classify individuals and better return to activity recommendations.












An individualized approach to Corrective Exercises targets the limitations of the individual specifically and facilitates optimal performance improvements from training programs.










 Exercises are based on combined movement patterns and place the athlete at the edge of their fundamental movement ability.

 The Corrective Exercises should be utilized pre-activity as a movement prep and then again after activity or sport to help re-establish fundamental movement patterns.     

 

Clear graphs visually express where the athlete is on the Return To Sport/Activity continuum and accurately convey a summary of the objective testing results.

Detailed comprehensive reports also identify the specific area of limitation and allow the clinician to target  interventions efficiently. Baseline testing (Think Pre-Participation Physicals) allow for direct comparison post injury/surgery. When baselines are not available a normative database allows for comparison to the same Age, Gender, Sport & Competition Level; Yes performance varies based on age, gender, sport & competition levels.


A comprehensive approach includes multiple objective measures and includes, but is not limited to, Upper Quarter Y Balance Test, Lower Quarter Y Balance Test, Functional Movement Screen, Closed Kinetic Chain Dorsi-Flexion, Hop Testing, Isokinetic Testing, Height, Weight, Previous Injury History, Current Injury &/or Pain, & Cognitive Testing.

A great place to start: Move2Perform