What I Learned in 2008

In what has become a yearly tradition, it's now time for this year's installment of What I Learned. As always, I learned a ton, but here are a few that stuck out in my mind as I sat down to write this article.

1. Non-exercise activity is as important as exercise.

I've always had to really work my butt off to stay lean. As a powerlifter, though, just throwing in a bunch of metabolic conditioning has never really been an option for staying in my weight class, as I don't want to sap my strength.

Interestingly, though, in 2008, I stayed lean relatively effortlessly — and I realized why in late October.

You see, in May, we moved to a bigger facility — twice the size, in fact — so there was a lot more walking involved in coaching. At one of our client's suggestion, I put on a pedometer one day — and found that I walked just under four miles between 11 a.m. and 7 p.m.

When that day was over, I trained like I always do. In between, I was demonstrating exercise, helping to load and unload plates... just moving constantly — but without any real effort.

Then, right around Thanksgiving, a lot of our guys started their throwing programs, which meant that I played a lot of catch. One Monday, I made over 500 throws. While this isn't the norm, 150 or so throws a day between 45 and 60 feet is routine.

There was no extra "cardio" or more planned exercise sessions, but I was getting hungrier and "accidentally" dropping weight (a big deal for a guy who has been able to maintain his weight in a four-pound range subconsciously for over two years). Now, I eat a lot — more than I've ever eaten, in fact.

I think that we get so caught up in trying to find the latest and greatest fat loss exercise plan that we lose sight of the fact that most of us really don't move enough outside of our daily exercise. Non-exercise physical activity is more important than you think, so stop taking the elevator and parking so close to the building and you might find (as I did) that it isn't as hard as you think to stay pretty lean.

2. I love the goniometer.

If you had asked me a year or two ago, I've had told you that I was only interested in dynamic tests, and that static flexibility measures didn't hold all that much water.

That was until I got to spend some time at the Morgan-Kalman clinic in Wilmington, Delaware. During my visit, I was fortunate to observe Dr. Craig Morgan and one of his colleagues, Dr. Elliot Leitman, perform a total of seven shoulder surgeries and see patients in the clinics alongside Randy Dillon, an athletic trainer who works with the doctors.

The Goniometer

To give you a little background on Dr. Morgan, he's operated on loads of multi-million dollar athletes — and been a pioneer in the development of a host of arthroscopic surgery tools.

What a lot of people don't realize about Dr. Morgan, though, is that he's at the forefront of injury prevention research, especially in overhead throwing athletes, and sends far more athletes to rehabilitation than he does to surgery.

In the Morgan-Kalman Clinic, the goniometer (which measures an axis and range of motion) gets a ton of use, particularly in assessing shoulder internal and external rotation, shoulder total motion, hip internal and external rotation, and knee flexion. While an individual may have an unfavorable MRI result, in most cases, it's a better strategy to recommend a conservative course of action to address these flexibility deficits (and associated weaknesses) than it is to operate immediately.

I used the goniometer here and there prior to my Delaware experience, but since that trip, every overhead throwing athlete that walks through my door has a host of goniometer measurements taken at the shoulders, hips, and knees.

In the past, I'd seen these issues on the fly as people moved and as I manually tested range-of-motion, but only this year did I start to quantify them. Now, we can give athletes quantifiable feedback on whether or not they are appropriately carrying out the flexibility portions of their programs.

3. The first thing I look at is total range of motion at the shoulder joint.

This relates closely to my first point of this article, as I use the goniometer to quantify it.

Over the past few years, as is always the case with the fitness industry, we overreact to a new concept and take it too far in one direction. Examples inclue unstable surface training, kettlebells, aerobic exercise, Crossfit, static stretching — you name it.

The concept of viewing the entire kinetic chain with an injury has definitely advanced the industry, but the problem is that it's become so "vogue" that some people have taken it too far. Believe it or not, when some "forward-thinkers" see a shoulder problem, they start off their assessments by looking at the opposite big toe, or glute activation, when someone with shoulder pain walks in the door.

Everything I do starts at ROM of the glenohumeral joint, particularly in internal and external rotation, as assessed by a goniometer. According to the Total Motion Concept, in a healthy shoulder, total combined rotation (internal rotation plus external rotation) should be virtually identical on the right and left sides.

So, the first thing I do when someone comes in with shoulder pain is (with the scapula fixed) assess internal and external rotation on the non-injured side, and then add them up to get a total motion figure. This is my baseline — and I'll repeat the measures on the injured side to see where things stand.

Here is a great example: a 17-year old baseball player who had recently been cleared to return to throwing by his doctor following an overuse elbow condition that resulted in medial elbow pain. No physical therapy was prescribed; he was just told to rest it.

Here's what you're looking at:

Right Shoulder: 19°IR +103°ER = 122° Total Motion
Left Shoulder: 53°IR + 90°ER = 143° Total Motion

So, you've got a 21° total motion deficit, and a 34° glenohumeral internal rotation deficit (GIRD). This goes to show that just because you're asymptomatic, it does NOT mean that you're healthy; this is another problem waiting to happen.

All the research on ulnar collateral ligament (elbow) tears and SLAP lesions (shoulder) in overhead throwing athletes has demonstrated that a large percentage of the patients present with a GIRD of over 20°.

The course of action for a guy like this is stretching for the posterior rotator cuff (and potentially capsule) until he regains that 21° of total motion he's missing.

The Sleeper Stretch: Good for Guys with an Internal Rotation Deficit

This would put him at this:

Right Shoulder: 40°IR + 103°ER = 143° Total Motion
Left Shoulder: 53°IR + 90°ER = 143° Total Motion

Effectively, you could call this guy a "Perfect GIRD" example. A 13° internal rotation deficit is actually relatively normal in baseball players who have thrown a lot during their developing years and developed what's known as retroversion. Basically, this means that in their developing years, their shoulders warped to accommodate the demands of throwing by allowing for more external rotation so that they can "lay back." Just ask Billy Wagner.

This goes in the opposite direction, too. It's not uncommon to see guys with terrible external rotation ROM. I had a right-handed pro pitcher come in for his initial evaluation, and his non-throwing shoulder had markedly less range-of-motion than his throwing shoulder. This is strange, as an injured throwing shoulder will show more external rotation, less internal rotation, and less total motion. So, seeing that his health history didn't tell me anything, I probed.

Me: "You've never had any issues in this shoulder?"

Him: "Nope, I don't think so."

Me: "Never worn a sling on it?"

Him: "Oh, wait! I fractured my scapula in a car accident when I was 17."

Me: "That would have been a good thing to put on the health history, huh?"

Apparently, total motion tells you things that the athletes themselves can't even remember to tell you!

4. All certifications and licensures are the tip of the iceberg.

I can remember when I took my first certification exam pretty clearly. Even though my knowledge and experience didn't hold a candle to where it is today, I still knew that a ton of my "correct" answers on the test were simply me telling the certifying body what it wanted to hear — even though I knew that the answer was not how I'd handle things in the real world.

They wanted to hear that the food guide pyramid was the optimal way to fuel athletes, enhance performance, and improve health status. They wanted you to tell them that linear periodization was "where it's at." And, they wanted to hear that you couldn't build power without Olympic lifting. And, since many college programs are geared toward helping students pass these tests, that's what's also preached in the classrooms.

For whatever reason, I guess I subconsciously believed that this phenomenon was confined to the fitness world. However, in reality, it's something that I've come to regard as "normal" in every industry.

Back in December, I heard one very bright chiropractor joke that all he learned in school was that all chronic back pain without definitive diagnosis was simply a matter of sacroiliac joint dysfunction or glute inhibition. Apparently, soft tissue issues didn't exist. There's no way adhesions on the psoas could possibly be part of the problem. Riiight.

And, think back to your favorite teacher of all time? Did he/she go by the books on how to optimally educate students? Hell no! Chances are that he/she was the one who thought outside the box the most and was non-traditional in order to get your attention.

So, whether you're an aspiring fitness professional yourself or just an informed consumer looking to cut through the BS, recognize that it's not always as simple as what you read in the textbooks, and initials after someone's name don't tell you much at all. The smartest guys I know are the ones who just got in the trenches, tried different stuff, and kept evolving.

5. You've got to be creative if you're going to train the upper back of athletes with elbow issues.

As many of you probably know, medial elbow pain is very common in lifters. What you may not know is that it's even more common in athletes who do a lot of throwing. It's not uncommon for guys to get somewhat tender here during spring training and early in their seasons when pitch counts are going up and they're spending more time throwing off the mound, which increases arm stress over flat-ground work. My experience has been that the problem is most prevalent in guys who throw predominantly across their body.

So, knowing we deal extensively with two populations (throwers and lifters) who inflame these issues a lot, we had to find ways to work around it. Ask anyone who has had these issues and they'll tell you that pulling movements — rows and chin-ups — give them the most trouble. The problem is that these athletes need upper back strength and scapular stability the most, so what do you do?

We started implementing the crossover reverse fly extensively this year with great results.

It's also a great exercise for those coming back from elbow issues who might not be ready for heavier rowing exercises. We also use this quite a bit with our pitchers when they train the day after they pitch and have considerable delayed onset muscle soreness.

Combine this exercise with deadlifting variations (with straps, in those who have pain with gripping) to keep upper back strength up, and then add in some aggressive soft tissue and flexibility work at the shoulder and elbow, and things tend to pass relatively quickly.

6. Heavy keychains can ruin your ignition.

My girlfriend's keychain had too many keys on it — to the point that it warped her ignition. She knows the trick to starting it, but I can't pull it off — even if I click my heels, clap three times, and do a rain dance around the car before trying to get it going.

The janitor keychain works well with a plumber's crack

Apparently, this is just one more thing I don't know about women. At least I now know to keep my keychain small, though.

7. Spike is an entrepreneur's best friend.

Yes, that's really all I have to say.

8. Alcohol kills soft tissue quality.

Back in the spring, I had lunch with a buddy of mine who is a manual therapist for a major league team. He told me that just by working on one of his athletes' tissues, he could tell that they had been out drinking the night before, describing the tissue as "boggy." So, right when I got home, I hopped on Pubmed to investigate further and came across this:

"The development of alcoholic muscle disease, which affects both cardiac and skeletal muscle, leads to increased morbidity and mortality in patients who abuse alcohol. The disease pathology includes myocyte degeneration, loss of striations, and myofilament dissolution, which is consistent with alterations in structural and myofibrillar proteins" (1).

Now, it's been a while since my muscle physiology courses back in graduate school, but I can still say with almost certainty that these effects can be acute and not just chronic. All in all, alcohol isn't great for tissues, but I'd call it especially problematic for those who are trying to bounce back from injuries.

This becomes especially problematic when you're also suppressing the Testosterone levels on which you're counting to help maintain muscle mass while on the shelf. Add in that alcohol consumption interferes with sleep quality, and you'll quickly realize that growth hormone output won't be optimal (sleep is an extremely important time for growth hormone, which is very important in strengthening connective tissues).

9. Your training and nutrition lifestyle is completely impacted by the company you keep.

As perhaps the best example that comes to mind, consider my girlfriend. Back in July, she decided to plug her daily intake into an online program to figure out her total caloric consumption and macronutrient breakdown. It came out pretty low-carb — virtually identical, in fact, to what I've eaten myself for about six years now to stay lean (particularly while trying to remain in a weight class for powerlifting).

Honestly, this breakdown really isn't right for her, and we're changing things up. But, the interesting aside to this is that I am completely hands-off with respect to her nutrition. She eats whatever she wants and we probably only have two of our six meals per day together during the week, but apparently, I influenced her without even knowing.

With that in mind, regardless of your goal, who you surround yourself with is probably just as important as your plan of attack itself and overall motivation.

10. Loads of pitchers write with the non-throwing hand.

Believe it or not, I'd actually say that the majority of accomplished pitchers write with their non-throwing hand. Yes, a lot of southpaws write with their right hands and vice-versa. I probably see it 5-6 times a day at Cressey Performance and it never ceases to confuse the hell of out me!

11. Fat people are more likely to be misdiagnosed.

Earlier in the year, I interviewed Dr. Jason Hodges, a radiologist, for my newsletter. I asked the question, "Aside from lifting, what other lifestyle habits have you found lead to less-than-stellar diagnostic imaging? Alcohol? Certain occupations?" Here was his response:

"By far, the biggest limitation is obesity. All of the imaging modalities are limited by it, mostly for technical reasons. An ultrasound beam can only penetrate so far into the soft tissues. X-rays and CT scans are degraded by scattered radiation, which leads to a higher radiation dose and grainy images. Also, the time it takes to do the study increases, which gives a higher incidence of motion blur."

I looked a bit further and came across a CBS News Online article that actually had some figures related to this problem:

"Obesity interfered with seven out of every 1,000 abdominal ultrasounds in 1989. That rate more than doubled — to 19 in 1,000 — by 2003. Similarly, obesity interfered with eight out of every 10,000 chest X-rays in 1989. By 2003, the rate had more than doubled, to 19 in 10,000" (2)

So, if you're carrying too much body fat, you're not only at risk of loads of chronic diseases; you're also at risk of medical professionals missing crucial diagnoses of everything from fractures, to ligament ruptures, to tumors.

The rest of the interview with Dr. Hodges is pretty interesting, too; you can check it out HERE, if you're interested.

12. Dads are interesting.

If you train young athletes, you'll see an amazing phenomenon. The fathers of the legitimate stud athletes are usually very humble and easygoing; you can talk to them all day and really enjoy their company. For every one of these guys you'll meet, though, you'll encounter ten fathers who talk your ear off about how great their sons are, how their kids are the next NFL or MLB superstars, and how they've carried their teams. Interestingly, in 50% of these cases, their kids aren't even playing because "the coach has something against him." Riiiiight.

13. The new-fad supplement salesman who cold calls you is quite possibly the most peculiar — yet predictable — creature on Earth.

I'd see these guys here and there at seminars where they occupy vendor tables, but I never really appreciated how hysterical they really are until I opened my own facility. Not a week goes by when I don't get an email or drop-in visit from a guy trying to sell me the latest, greatest supplement that can fix your eyesight, get you jacked, make your wang bigger, and increase IQ by 17.8%. These guys all have the same pitches:

a. This supplement is "revolutionary."
b. "It's now being used by <Insert Pro Sports Team Here>, and <Insert Pro Athlete> swears by it."
c. "This supplement has magically healed my <Insert Long-Term Ailment> here after years of thinking that I had no hope."

What's going through my brain as they say this? Well, besides "I heard this same speech last Tuesday," I'm thinking:

a. I can think of a few other words beginning with the letter R that accurately describe this product and sales pitch...

b. This statement is usually accompanied by an awkwardly flamboyant hand gesture that usually leaves me fighting back laughter. Then, upon further consideration, in about 50% of cases, I realize that I know a strength coach, athletic trainer, nutritionist, or manual therapist working for these organizations and could easily put in a quick phone call to one of them to make this guy really uncomfortable right away. I don't really want to waste any more of my time, though.

c. Not a single one of these individuals has ever looked like they exercised, let alone weight-trained. So, I'm not surprised they had these ailments — and I'm immediately suspicious of them having some mid-life crisis of health where they decided to exercise, eat right, and take many supplements, including the crappy one they're trying so hard to sell me. I don't believe in a sample size of 1, particularly when so many other variables are involved.

Or, these schmucks could just be making this all up.

My favorite story of all time took place at the vendors' section of a conference. My buddy Randy and I were checking things out, and a guy going about 6-0, 130 pounds with atrocious posture and a bitchin' pseudo-mullet jumps out and asks if we want to instantly improve our flexibility, balance, strength, and speed. We play along — and he takes us over to his table, where he's selling a souped-up new water.

Now, Randy goes about 6-1, 250 and he's been a bouncer in the past. This guy tells him to stand up, and explains that he's going to push down on his arm and knock Randy off balance, but after the consumption of the water, Randy will instantly be able to resist the guy. Of course, I'm thinking that the guy is simply going to push harder on the first attempt than on the second to try to fulfill his "revolutionary" prophecy.

As it turns out, he struggles for about 15 seconds against Randy, who's clearly exerting almost no effort. The dude literally couldn't budge him, no matter how much of his body weight he launched against Randy. Frustrated, he gives up — and through his heavier breathing — says, "Well you're too strong for me, so I can't demonstrate how great this is, but try this and you'll definitely be even stronger and more balanced." Randy takes his super-oxygenated H20 and we walk off.

I guess the salesman was too busy drinking the Kool-Aid to have time to put his own "revolutionary" product to his own lips.

References

1. Vary TC, Lang CH. Assessing effects of alcohol consumption on protein synthesis in striated muscles.Methods Mol Biol. 2008;447:343-55.

2. Bridgman, AR. Too obese for a good x-ray? 25 Jul 2006.