Tagged: rehab
The Best Coaches Teach Fundamentals
As a trainer and coach I tend to read a lot of stuff written by other successful trainers and coaches in order to try to make me better at my job. Throughout the years there has been one main theme I have seen that I thought I’d point out to the rest of you, trainers and potential clients alike.
Newer trainers and coaches tend to think they need to reinvent the wheel in order to make themselves more marketable or stand out among the crowd. They try whatever the latest fad trend is with the hopes that it will cause the client to be impressed. Eventually (with any luck) they realize that a coach is only as good as their results. Doing something showy and flashy in order to create a temporary response is usually a sales tactic – anyone can push someone really hard, as I wrote about previously HERE.
This means whatever the client goal is they need to be working towards it and making constant improvement. For my strength clients, this is being able to generate more force or move more weight. For my running clients it is being able to run greater distances, faster or both. If you coach a sports team, then they should be increasing their skill levels at whatever position they are performing in and also hopefully using that to win games.
So what is the key? Throughout history of successful coaching, it really comes down to one word: fundamentals.
Successful coaches can make people better at things that they should already be doing well. For a strength coach, this can mean the basic lifts like squatting, deadlifting, pulling and pressing. For an athletic coach this can mean things like power, agility and coordination. For my runners, it means being more efficient with every foot strike, which in some cases means starting over again at the beginning.
Throughout the sports world, high level athletes will tell you that they spend hours upon hours practicing fundamentals. Basketball players practice foul shots. Cyclists ride their bikes for hours a day. Swimmers swim lots of laps. Baseball players take batting practice daily for hours. Often this has no major goal beyond building the fundamental mechanics or strength they need in order to improve.
Just two months ago I started working with a post surgery client who had recovered but had shin splints daily. When her basic walking gait was corrected and she started to use the proper muscles again the shin splints disappeared. The same thing tends to happen for back issues when the person learns how to deadlift and squat properly. Some trainers would call this “correcting an imbalance”. I’d rather call re-educating the client (and their tissue) on something they already know how to do.
Your body is a very smart thing. It learns based on the input it is given. As I always say, crappy information IN means that you will generally get crappy information OUT. If you overwhelm your nervous system from the get go it doesn’t have a chance to adapt and make improvement. This means spending weeks (for some people) practicing simple things until they have them down.
So what are the fundamentals? Well, it really depends on the person. For some people, walking properly is hard enough. Throw in a few activities of daily living like sitting down, picking things up and climbing stairs and they might be done. I’ve had to reteach these things to hundreds of people over the years, and more often than not when they are practiced and put into place little painful issues tend to resolve very quickly. Same with high level performers. Often with my athletes they simply need to be coached on how to perform a movement they have forgotten how to do properly. This can be as simple as a squat (for a powerlifter) or as complex as an ankle mobility movement for a soccer or football player.
Most movements can be broken down into basic primal movement patterns, which is echoed by both movement gurus and athletic trainers alike. Deadlifting. Pushing and pulling. Spinal flexion, extension and rotation. This is generally what 95% of my clients start with, even if it is completely de-progressed like a basic box squat within a range of motion their hips, knees and ankles can perform at without deviation.
In fact if you’re a reader of fitness magazines, you can see this plain as day. Any program that tells you how to get a BIG LEGS has a squat in it. BIG CHEST means lots of bench pressing. Not a one armed dumbbell press on a Swiss Ball. Stick to fundamentals and you are guaranteed to see progress. Another of my mantras is that you EARN THE RIGHT TO DO MORE. This means if you can’t do something basic you have no business doing a progressed version of it. Most high level coaches adhere to this.
If you have run into a coach or trainer who tells you that you need to perform some sort of elaborate system in order to improve a simple movement, maybe you should think twice. There’s a time and a place for breaking down movements to isolate weak points, but it should not be the primary focus of any workout. There always needs to be a goal, and in my opinion that goal should be centered around the fundamentals.
So the next time you read about some amazing NEW system that is going to explode your gainz please put down whatever article you’re reading (unless it’s mine) and go deadlift. Or do some pullups. It’s probably what any decent coach would tell you to go and do anyway.
Peace With Inches
In June of 2012 I ran a 5k after training with my learn to run group from the gym I worked at. I performed okay considering everything, took 3rd in my age group and placed 39th out of 215 people overall. I ran a 4:30/km pace for the race, which was not a PB but decent.
Four weeks later I couldn’t run for three minutes. No one has ever been able to explain what happened but my suspicion is that during a swimming race with my wife I had a mild heart attack because it knocked me for a loop for a couple of days. Then the next week I got on a treadmill and couldn’t run. Nauseous, pressure in my chest, pounding, etc.
Once I got my echocardiogram and stress test it finally got figured out. I had not only a faulty heart valve (which I had my whole life and didn’t know it) but something called a dilated aortic root. Not completely severe requiring open heart surgery, but enough to affect things. In case you’re wondering what that is, it’s a swelling at the base of my aorta, the largest artery coming from the heart. If the swelling ruptures, then I’m dead. In minutes. Gone.
So what did that mean? No working out. No increased blood pressure. No exertion. Too risky, they said.
What?
Imagine all the things you love suddenly getting ripped away from you. All the things you do that make you feel strong and accomplished. What you do for a living.
For months I tried to grasp it and had a really hard time. Workouts fell away. No idea what I could do to help myself. I felt weak and like a loser for not being able to practice what I preached. I’d try to lift weights and have to stop after ten minutes, even mild stuff. I could walk, but jogging for more than 5 minutes made me feel awful.
And I was scared. I had a little girl on the way and now I have another. I didn’t want to leave my family alone because I was too prideful to let go of the fact I wasn’t an athlete any more. I was scared of dying. So I stopped living.
Then I found out I could walk. That was a start. Got into race walking and did a ½ marathon walking in 2:45. 18 months ago. I remember I was very emotional at the start line. I was actually wearing a holter monitor at the time just in case anything happened. I never thought I’d be able to do that again but I was okay. And maybe, just maybe that meant I could do more.
So maybe if I can do that, I can start to jog. So I did. Started with 3 minutes jog, one walk. Like a beginner. Built up, one minute at a time. 6 minutes jog, two walk. 7 minutes jog, two walk. Every step I was paranoid about what might happen. I had to tell my wife exactly where I was going in case I didn’t come back. I had to work out at my studio only if someone else was there so if I collapsed they might be able to do something. But at least I was still working.
About a year ago I finally went to a respirologist who finally decided to red line my heart and see what happened in the hospital where I was safe. My VO2 max was still above 40 and I could push 195 watts on an ergometer (for about 20 seconds). After two years of not exerting myself. And I was good – tired, but good. That gave me hope. I got on the bike at my gym religiously, building up from 20 minutes bit by bit to 45 and then starting to push power numbers. Still afraid to run, plus it was winter anyway so I wasn’t about to start. Got to 245 watts for 20 minutes, or 3.0W/kg – not bad for someone my age who hadnt worked out hard for two years.
Why am I telling you all this?
Today I ran 6k. Continuous. For the first time in three years. The final 2k was uphill. And it felt fucking amazing. When I stopped at the top of my street and walked home there were tears in my eyes and I was pumping my fist. You know why? I never thought I’d be able to do that again. And this is from a guy who has run two marathons and over a dozen half marathons.
Three. Years. Imagine someone telling you it would take that long to be able to feel strong again. To feel like you were an athlete again.
I’m going to declare right here on my blog that I have entered a 5k race in September, and you know what? I’m going to beat that time I set three years ago. I’m not just going to beat it, I’m going to crush it.
How did this happen? Careful progression. Not taking my body for granted. Listening to it and backing off when I have to. But never, ever, ever stopping. Can’t do that? Find something else you can do. Not progressing? Change things up. Try. Try. Try. And try again. Just don’t stop.
Like one of my favourite motivational speeches says, life is this game of inches.
And I know, if I’m going to have any life anymore, it is because I’m still willing to fight, and die for that inch. Because that’s what living is. And I know when I add up all those inches, that’s going to make the difference between winning and losing. Between living and dying.
Fuck you heart disease. Fuck you faulty valve. Fuck you doctors who told me I can’t.
Nothing can beat you unless you let it.
So what are you going to do?
I’ll see you in September.
How To Set Your Year Up Right
On my recent podcast with Dan T and Canadian Minds on Health I spoke about resolutions, and how 88% of people fail at them. There are some simple strategies you can use in order to be more successful in your fitness and nutrition life this year, however. This article is all about the big things that you can change and some strategies that you can use in order to get your year off to a good start and keep it that way – until NEXT Christmas.
#1: Think Long Term
When we set goals the problem is that we don’t think about things in a long term sense most of the time. We want immediate gratification like everything else in society today. The problem with that is not only are you not really setting a well defined goal, it isn’t long enough to have lasting impact if it is only in place for a few weeks.
All of my athletes have their yearly goals typically planned by February, and successful fitness people do this all of the time as well. It allows you to then break up the year into smaller chunks and makes it more manageable. You can then set short term goals to move towards, and then even shorter ones. In athletic vernacular this is called periodization, but for the average person it just means that you always know what you’re going to be working on from start to finish in 2015.
You also need to factor in changes to things like weather, vacations, any major family events and think ahead to manage these things. If you set it up long term then you’re much more likely to succeed.
#2: Make Small Changes, Not Big Ones
Big changes like trying to work out five times a week and completely overhaul your diet also just sets you up for failure – because it isn’t realistic. Lots of people think they need to throw out everything in their pantry and suddenly find an extra 5 hours a week to spend at the gym, which isn’t totally necessary.
If you’re going to cut something out of your diet – make it one thing. And that thing should be fairly easy to do. An example would be processed sugar – easy to cut out and easy to maintain once you get over the withdrawl and taste of your coffee. Another good one might be a processed carb like pasta. Tell yourself no pasta for 30 days, then after 30 days pick something else and remove that too – by the end of 6 months you can remove pretty much everything major that might cause a problem.
When it comes to exercise, start simple. 20 minutes is my general recommendation. Whether it be walking, cycling, weightlifting (which would be my number one choice), yoga at home in front of YouTube, set your timer for 20 minutes – you can even get away with doing one exercise if it is the right one (see my article on deadlifts for this). Will this turn you into an Adonis overnight? No. But it will start a good pattern. Find that 20 minutes isn’t a problem? Bump it to 30 – then 40 if you can or add another day if your time allows.
#3: Find Something You Really Want To Do
We are all motivated by different things, but for many people at this time of year it comes down to vanity and looking better. In my opinion as I always say, health first – looks second.
So what’s a good example? I want to run a 10k in the spring. I want to fit into my dress for that upcoming wedding. I want to climb a mountain in the fall. I want to rock that bathing suit at the resort I go to next year.
Or how about I want to get off my medication? I want to stop thinking that I’m awful looking every time I look in the mirror? I want to be a positive example for my kids? I’m single and I really want to have sex with someone? These are more emotionally motivated but you get my point.
Bottom line is if you don’t really want to do it you’re not likely to – so find out what that thing is, make it stick for a long period of time and set the goal for the long term.
#4: Put Together a Team
This can be your family, friends, or experts in the field like myself or Dan – or even starting to blog online and getting support through that. Ongoing support is vital towards success in any stage of the game.
Women are 20% more likely to achieve a goal if they tell their friends about it – so do that. Guys prefer to do things solo generally but they like to learn, so hire a good trainer and sit down with a dietician and go over everything, with a way set up for support and constant feedback. Some of my clients are completely virtual (I’ve never met them in person), but we correspond through email and I track them online. Dan meets with people via Skype and with modern technology there is no excuse for not reaching out and finding someone you can trust with your goals.
Are you a group person? Join a meetup workout group or a running group or a sports team locally if you can manage the time. Not into groups? There are tons of tracking apps and anonymous ways to support yourself with whatever physical thing you are doing.
Family is typically really important for these things – my wife and I trade off care of our daughter and you can too. We also plan ahead for meals and make sure that even if things go off a bit they come back quickly. But even telling your family about what you want to do can be enough for them to support you at meals and with your activity outside of the home.
So before you set a resolution, take the time to plan ahead and set things up properly. If you need help with anything feel free to contact or email me. Good luck and before you know it, 2016 will be here, and a whole new you as well!
Case Study: Chris D
Often I have cases come into my practice where they stand out as a good example of what appropriate progression can accomplish. Also, frequently I get people asking me: what do you do with people? What is your secret to helping people get pain free and strong? I thought this case might be a good example of both and allow me to share some of the principles that have brought me success with people like Chris D. While this is an extreme example of a case, it might help give you insight as to what proper progression and intention can accomplish.
Chris started working with me ten weeks ago. He came to me through a referral described as a “back problem”, which I quickly found out was a bit of a loose description. I can’t obviously share what his scans MRI revealed but needless to say they were detailed and he had a lot of spinal issues stemming from a long career as a contractor. The biggest problem with our initial assessment was a pretty glaring one:
Chris couldn’t sit down. He couldn’t sleep for more than about an hour without waking. He couldn’t work without constant pain in his neck and shoulders and legs. Even driving his car was an exercise in pain management. Due to the pain in his neck, upper back, shoulders, lower back and legs after just sitting in my office for five minutes he was uncomfortable enough to have to stand up. No matter what I tried to do in order to check movements through his upper and lower body he was in pain, and it would flare up at the slightest bit of movement or force. Even isometrics, which is usually the most minimally irritating to most people was really irritating to Chris. I’ll share later what we have found out during the course of his treatment but needless to say it was a very daunting task.
For only the second time in my training career (and you can read about the first HERE) I was faced with a situation where I wasn’t 100% sure if I could help. Chris expressed that his previous physio experience left him feeling better, but of course things came back once he stopped because he didn’t have strategies to keep helping himself after he was done. This is all too common – physio can help to an extent, but then it takes getting stronger to really complete the rehabilitation process.
Initially Chris decided to give me a two week period to see if what I was doing would help a bit. Here’s a layout of how our first movement session worked (I keep notes on everything I do with every client so this is directly out of my notes):
- Priorities: Mobilize upper neck C5/6/7, upper trap, R side shoulder blade, strengthen L side upper quadrant. Standing mobility in L side hip com/glute com/lower back, strength in R side glute/hip coms and ankle on R side. (this was all based on what I could assess)
Release therapy was done on his upper trap areas on both sides to bring blood flow into the area and expose him to self myofascial release that we could do on his own with a ball. There are varying sizes of these and we used the largest one in order to have the largest surface area and the least access to deep tissue. Chris could not stretch conventionally because any movement would cause his pain to flare.
We started with a manual two legged hip hinging movement with about 20-30 degrees of hip and knee flexion (with a base for support that was 30 inches high as a guide) for control and teaching how to use his pelvis. My initial goal was to work on getting him sitting down (to help with work and being at home), then lying down (to help with sleep). We did some R side isometric engagement (while standing) for his glute and hamstring. We did some standing brace work to teach his inner unit how to engage properly and worked on his walking gait. One major discovery we did right away was that if he flexed his L shoulder 20 degrees forward while walking his pain diminished significantly through his neck and upper back.
After 35 minutes we had to stop because Chris was getting major irritation in his shoulders and neck.
Using proper microprogression and trial and error Chris was able to sit down in his car so that he could drive to his father’s place 1 hour away for Father’s Day in June, about five weeks after we started. His sleep was still an issue and his shoulders and neck would still get irritated quite easily, but through constant self therapy and working on movement patterns we had established on his own, things started to improve. Chris started to experience periods of time without neck/shoulder pain. Through more trial and error we found that if Chris rotated his shoulder blades a certain way he experienced relief. Being mindful of all of these things kept him encouraged and improving.
His lower back and legs started to improve significantly and we introduced compound movements. After the eight week point we discovered that his thoracic spine was likely twisted and began to work on that aspect, which helped quite a bit. Chris discovered that when driving (which he could do at all previously and now could do for extended periods) if he consciously kept his shoulder blades even he could eliminate pain in his neck. By now Chris could squat (with load), split squat, flex his shoulders almost to 90 degrees and even hold his spine against rotational torque.
After ten weeks Chris could deadlift 60 pounds with perfect form. I have a video of it but Chris asked that he remain relatively anonymous.
He has been getting proper nights’ sleep and been able to do more driving for work. He has been able to do work around his home that would have caused serious problems three months ago. Here’s a layout of our most recent workout:
- Alpha Ball warmup – mobility in rotator cuffs (both sides), one legged balance and thoracic spine mobility. Blood flow increase to VL/IT Band fascial line on R side (since doing more with his legs he started to experience some weakness through this area on his R side).
- Dead Lifts starting at 50 lbs and increasing to 60 (he holds the bar in external rotation because his shoulder is able to maintain in that position) for up to 9 repetitions.
- Lying position shoulder flexion with 3 lbs load on both sides maintaining position above 20 degrees from floor (through various positions we found that he is able to use front delt/pec/serratus in this position)
- Single Legged Leg press at 90 lbs of load (does not affect his lower back or hip complex any more)
- Eccentric loaded row in an incline position (I would have to take a picture of this for you to understand but think about lowering through a chest press focusing on the negative portion only)
Chris had made phenomenal progress over his time so far seeing me for only two hours per week. He also does a lot of work on his own, which is what I expect from my clients. He is aware of what he needs to do (and not do) and every time he comes in we have some new insight into a movement pattern that he experienced and we are able to build on that. One thing I constantly express to him is how I love the fact that he wants to understand what is going on and focuses constantly on moving properly. Chris has invested in his recovery, which is vital to any progress you want to make physically. It doesn’t happen slowly, it happens with careful application and time.
So here’s a good example of how a properly progressed strength program can help someone that has been in chronic pain for a long period of time. Many people walk around in situations that can easily be diminished or resolved through a properly progressed program with lots of intention and appropriateness. I’m hoping that Chris will continue to improve. One of our major goals was achieved last week when he actually slept properly, something he couldn’t remember doing for a very long time. These little things can make a huge difference to someone’s quality of life.
If you have any comments or questions about what I have been doing/have done with Chris please simply ask and I will share it (with his permission of course). Also, if you have any people who you think could benefit from the type of treatment Chris has gone through feel free to let me know.
Until next time – keep moving!
Therapy and Exercise Refined 