What I Learned in 2010

This is year 5 of my "What I Learned in" series here at T Nation, and it's actually being written in February of 2011 because I needed an extra month to process everything and put it down on paper.

Apparently, I also learned in 2010 that I was disorganized and senile. So, before I digress too much, let's get to it.

1. People Have Really Taken This Barefoot Thing Too Far

Before I get to the point I'm trying to make here, let me set something straight. As I wrote in my What I Learned in 2009, the introduction of high-tops and bulky shoes with big heel lifts has not only de-evolved the entire human race, but also changed the nature of the injuries we encounter in everyday life and regular athletic participation.

Accordingly, the push for minimalist footwear and barefoot training was a huge breath of fresh air.

We're taking it too far, though.

As Christopher McDougall wrote in Born to Run, members of the Tarahumara tribe in Mexico can run hundreds of miles each week with what amounts to a piece of cloth wrapped around their feet.

You know what the Tarahumara don't do, though?

Run on pavement
Do weighted lunges
Squat with external loading and markedly impaired ankle mobility
Sit at desks all day
Crush fast food
Sit indoors all day
Get fat (in spite of the fact that they drink more beer than the most obese frat boy you can find)

In other words, comparing Americans to the typical Tarahumara tribe is like comparing Lindsay Lohan to Mother Teresa. While we can learn some things from this tribe, adopting their footwear habits for everything we do will only lead to problems. Some of the most conditioned folks can certainly get away with it – especially if they're selective in what activities they do barefooted (or in minimalist footwear) – but the lay person just isn't ready.

So, how do we get the benefits of barefoot training without increasing our likelihood of injury?

Go barefoot for posterior-chain emphasis exercises like deadlifts, good mornings, box squats, barbell hip thrusts/supine bridges, and 1-leg RDLs.
Go barefoot for single-leg exercises other than lunges. In other words, step-ups and Bulgarian split squats (but not regular split squats) allow us to train the lower leg and foot in a "minimalist" context without destroying the big toe.
Go barefoot for walking around, but be careful about sprinting full-tilt or doing extended periods of jogging. We go barefoot for all our dynamic flexibility warm-ups.
Remember that going barefoot doesn't instantly improve your ankle mobility; it's a gradual process. So chances are that if you have locked-up ankles and try to squat barefoot, it could look pretty ugly (you'll make up for a lack of dorsiflexion with lumbar flexion – or lower back rounding – instead).
Remember that there are also lightweight sneakers that don't exactly simulate being barefoot, and these options are better for most weight training activities (and you can do the rest in just socks).

All in all, barefoot training is something that can be tremendously useful, but like mankind does with practically everything, we overdid it and wound up with too much of a good thing.

2. The Strasburg Sock Can Work Wonders for Some People

Strasburg Sock

Speaking of ankle mobility, this year, I reincarnated an old trick I'd learned years ago, but forgotten about. The Strasburg sock is a sock with a Velcro strap that holds the ankle in a more dorsiflexed position.

Dorsiflexion, of course, is what most ankles lose when they get stiff, and it's really important for normal human movement. We can do ankle mobility drills and static stretching of the Achilles until we're blue in the face, but the truth is that just about everyone fails to realize that we usually sleep in a plantarflexed position.

Imagine doing an isometric hold at the top of a biceps curl for 8-10 hours, and then trying to extend your elbow. As such, it shouldn't be any surprise that you sometimes feel so stiff walking downstairs first thing in the morning.

I recommended the Strasburg sock to quite a few people in 2010 and most utilized it with great success. My wife was actually one of them; she has very flat feet and hasn't had heel pain in ages thanks to wearing it at night.

3. Complete Symmetry is a Myth –

And You Might Very Well Hurt Someone if You Try to Get It

We've always been taught that symmetry is important, whether it's with respect to bodybuilding success or simply staying healthy.

Two eyes, two ears, two arms, two legs, etc. You get the picture.

Why, then, do we have one heart (left), one vena cavae (left), and one liver (right)? Why does the right lung have three lobes while the left has two? Why is the right diaphragm larger (both the leaflet and crural attachments to the spine) than the left (which also can't leverage the presence of the liver)? Why do we have better lymphatic drainage on the left side?

These are all questions that Ron Hruska of the Postural Restoration Institute asked when he developed his philosophy, which just so happened to shape the way I train my clients (particularly right-handed ones) more than anything else I learned in 2010.

The Cliff's notes version (if there really is one) is that most people are far more efficient at using their right diaphragm. The right diaphragm has direct attachments (more prominently than the left) to the lumbar spine, which pulls the lumbar spine and sacrum into right orientation. The thoracic spine must, as a compensation, rotate left to allow us to face straight ahead. Simultaneously, since the right diaphragm inflates the left lung, one can get a left rib "flair" (and posterior rib hump on the right side).

LL Cool J

If you put a neutral right scapula on a thoracic spine and rib cage that's rotated to the left (internally rotated right ribs), you get a low right shoulder, which equals a short pec minor and a loss of shoulder internal rotation (there's no need for the humerus to internally rotate on the glenoid). Just have a look at LL Cool J in any picture or TV segment:

He's not just doing that because it looks cool; it's the easiest way for him to breath.

LL Cool J 1

Likewise, that right orientation of the lumbar spine and sacrum pushes the right hip into posterior rotation and adduction/internal rotation, leaving the left side anteriorly rotated, abducted, and externally rotated. In other words, the right hip "falls" out, and you'll see an externally rotated left lower leg.

The truth is that you can see these patterns all the time, whether you're sitting around in an airport or watching people in the gym. I just happened to think of LL Cool J because I just saw him on the Grammy Awards.

The longer-term manifestation of these issues isn't just injuries, but specifically-patterned injuries like more labral tears and sports hernias in the right hip, more sacro-iliac dysfunction on the right side, more SLAP lesions in the right shoulder, and more pec tears on the left side.

The corrective strategies for these issues come down to a collection of more complex positional breathing drills (learning to inflate the right lung better) and strengthening exercises to "hold us in place," but for the lay population, there are still some important takeaway messages:

Stop standing like LL in the pictures above.
Remember that some asymmetry is normal, but when it goes too far, problems arise.
Our body cares a lot more about getting air than it does about getting jacked. We'd rather move poorly and breathe well than move well and breathe poorly.
Your left pec isn't smaller; you probably just have a lot of left thoracic rotation, so it's just shorter (no need for horizontal abduction, so you lose it).
A low right shoulder doesn't automatically mean that you have scoliosis. How many low left shoulders have you seen? Not many.
Try to be more left handed in your daily activities.

For more information, check out www.PosturalRestoration.com. It's been the best money I've ever spent on continuing education.

4. Appreciate Zones of Convergence

Dr. Nate Tiplady is a manual therapist who works on a lot of our clients at Cressey Performance, and he turned me on to the work of myofascial researcher Luigi Stecco. One concept that really jumped out at me as incredibly significant to what we do is the idea of "zones of convergence" being the most common sites for soft tissue restrictions.

A zone of convergence is an area where the forces generated by a myofascial unit come together. This is generally the muscle-tendon-bone "connection." Think about it; you don't typically see prominent soft tissue restrictions in the mid-belly of a muscle. And, overuse tendon conditions are much more stubborn to fix than strains in the belly of a muscle, not just because tendons have a poor blood supply, but because they are located in zones of convergence.

You can take this a step further and appreciate that the most problematic zones of convergence are going to be the ones where several soft tissue structures all converge on a small area. The medial elbow (golfer's elbow) is a great example; you have the flexor carpi radialis, flexor carpi ulnaris, palmaris longus, and flexor digitorum superficialis all attaching via the common flexor tendon on the medial epicondyle, and then the pronator teres and ulnar collateral ligament attach just a bit higher up.

A similar thing happens laterally (tennis elbow) with the lateral epicondyle, which consists of the common extensor tendon and supinator muscle. As a whole, you have more muscles crossing the elbow joint than you do the much larger knee joint. Taken all together, is it any wonder that pain is felt at the elbow instead of further down the arm when lifters do a lot of gripping?

This trend can be found in a ton of other areas. Here are just a few:

Deep in the shoulder where the rotator cuff tendons come together.
On the ischial tuberosity, where the hamstrings tendons attach.
On the pubis, where all five of the hip adductors attach.
On the plantar fascia, where several small muscles of the feet attach.
Just a few inches up and out from the nipple on the coracoids process, where the pec minor, coracobrachialis, and short head of the biceps come together.

Each restriction should certainly be considered individually, but an understanding of zones of convergence makes us appreciate exactly where we should look first in terms of preventing or eliminating soft tissue restrictions. Here are some modalities we use, with medial elbow restrictions serving as an example:

5. Diagnostic Imaging Isn't All That Important

Back when I wrote Lower Back Savers, I discussed how just about every asymptomatic spine you encounter will have a host of issues – from disc bulges and herniations to stress fractures. The truth, though, is that you'll find these types of issues at just about every joint. Consider the following stats:

79% of asymptomatic professional pitchers have "abnormal labrum" features in the throwing shoulder.(1)
40% of dominant shoulders in asymptomatic tennis/baseball players had evidence of partial or full-thickness cuff tears on MRI.(2)
In the general population, you'll see rotator cuff tears in 34% of cases, and 54% of those older than 60.(3)
Flanigan et al. looked at studies that collectively examined the knees of 931 athletes (40% of whom were professional athletes) using MRI and arthroscopy. They found that 36% of these knees had full-thickness chondral defects, but 14% of these subjects had no symptoms when diagnosed.(4

The preceding just looks at shoulders, knees, and lower backs, but I can show you research on elbows, ankles, and wrists, too. And, there's research demonstrating that a lot of these issues are as prevalent in kids as they are in older folks.

What's the take home message? Diagnostic imaging – MRIs, x-rays, and the like – are no doubt an important piece of the "get healthy" puzzle, but at times, they can muddle a true diagnosis.

Even the best radiologists around will tell you that results on these tests should be paired alongside provocative tests and movement evaluations on physical exam to create the best plan of attack.

6. Watch Out for Isotretinoin (Accutane)

We had two young athletes have significant and prolonged negative reactions to the Accutane they were using to treat their acne. Both kids were excellent athletes who dragged ass for months and felt awful every time they moved, and it led me to look further into the side effects of this prescription medication.

I was blown away at the far-reaching potential side effects (from depression, to muscle weakness, to joint pain, to vision problems, to skin dryness, and a whole lot more). The FDA even says "Accutane may stop long bone growth in teenagers who are still growing."

I'm not here to say that taking it is right or wrong as I'm no dermatologist. I'm just going to say that most kids would be much wiser to start with getting rid of all the crap in their diets before resorting to medication. But then again, that wouldn't be the American way, would it?

7. Power (and Strength) is Very Plane (and Skill) Specific

We've known for a long time that proprioception and balance are both very skill-specific. Back in 1966, Drowatzky and Zuccato found little carryover from static to dynamic balance.(5) Tsigilis et al. confirmed this finding 35 years later.(6) What I never bothered to consider is that if we look at the "big neural picture," how we stabilize ourselves is no different than how we develop power (and strength).

You need proprioception to inform the body of what's going on, and you need balancing proficiency (which is highly dependent on strength) to establish stability. It's the same exact thing you need to establish power (or strength). And, if static balance training doesn't carry over to dynamic balance, it stands to reason that a lot of our conventional strength training methods don't carry over as well as we thought to the world of athletics.

Now, don't worry, I'm not going to get all "functional" on you. I am, however, going to make some observations in my frame of reference, which is baseball players. Babe Ruth hit a ton of homeruns in spite of being a seemingly out-of-shape fat guy. I've seen more than dozen pitchers throw well above 90 mph without even being able to vertical jump 23 inches.

What gives? Well, these athletes are just incredibly efficient – and powerful – in the transverse and frontal planes. Would being an elite sprinter make one a successful hitter or pitcher? Of course not, yet most strength and conditioning coaches train their rotational sport athletes as if they were trying to elevate them to elite status in a sagittal-plane dominant sport. They assume that general exercises like squats, deadlifts, and Olympic lifts will simply carry over once an athlete starts throwing or hitting.

And, to some degree, they do carry over because of the involved structures and systemic training effect, but I think that there's a way to tighten up the learning loop.

People think I'm crazy when I say that we don't Olympic lift our baseball players. We also don't do much vertical jumping. At the end of the day, jumping high doesn't really matter that much. Rotating fast and moving laterally quickly does, though, so we focus our power-oriented work on rotational medicine ball drills and lots of laterally-directed jumping/landing, and supplement it with lifting and sprinting.

8. People Really Don't Understand Work Capacity

I often see people implementing measures in their programs geared toward enhancing work capacity.

Most of the time, this training simply consists of a bunch of cardio or lower-intensity resistance training exercises done with little to no rest. My question is, what happens if you're a powerlifter, sprinter, or jumper?

In other words, does teaching yourself to not get out of breath really mean that you'll be able to perform more quality work at a high percentage of your 1-rep max? Or does it mean that you'll be able to increase the number of faster sprints or higher jumps in the same amount of training time and with less imposed fatigue?

I'd argue that for the more strength/speed oriented athletes, teaching yourself to not get out of breath may enhance the density of your program, but you aren't necessarily enhancing the quality of work.

If I deadlift 660 pounds, doing a bunch of lighter-weight circuits might mean that I won't get out of breath as much with regular training, but that doesn't necessarily mean that I'll be able to get in more reps over 595 (about 90% of 660) during a deadlifting session. In fact, I'd argue that it would actually lead me to get in fewer reps due to the deleterious effects on maximal strength.

Lots of folks in professional baseball try to convince pitchers that just going out and "running poles" will help to build up pitching endurance. They improve aerobic capacity, no doubt, and then go out there and throw with less velocity than they'd had before.

However, when they just go out and throw – gradually building up their pitch count along the way – they maintain their velocity (or even improve it, based on the additional opportunities to become more neutrally "comfortable" with their mechanics without the presence of fatigue).

What's the point? Even when it comes to work capacity, specificity wins. You didn't learn how to read faster by playing checkers. You simply kept reading.

Want to stop getting so gassed while playing soccer? Play soccer.

Want to be able to squat a lot of heavy weights in a training session? Start squatting a lot of heavy weights in a training session.

The more non-specific you get, the more likely you are to be enhancing work capacity for a different task than you'd intended.

Until next year, keep learning.

References

Miniaci A. et al. Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers. Am J Sports Med. 2002 Jan-Feb;30(1):66-73.
Connor PM, et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7.
Sher JS, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5.
Flanigan DC, et al. Prevalence of chondral defects in athletes' knees: a systematic review. Med Sci Sports Exerc. 2010 Oct;42(10):1795-801.
Drowatzky, JN and Zuccato, FC. Interrelationships between selected measures of static and dynamic balance. Res. Q. 38:(3) 509-510. 1966.
Tsigilis, N, et al.. Evaluation of the specificity of selected dynamic balance tests. Percept Mot Skills. 92(3 Pt 1):827-33. 2001.