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That Grinds My Gears: Trainers Playing Pretend

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  • #31
    Originally posted by Ken Jakalski View Post
    Talk about grinding one's gears...

    How's this for insanity?
    Yeah, I've got a whole book filled with pictures and instructions about how to do stupid stuff like this. It's all about the "extreme training", right?
    Novice Woo Shoo Kung Foo practitioner. Experienced critic of Truthiness.
    "It used to be, everyone was entitled to their own opinion, but not their own facts. But that's not the case anymore. Facts matter not at all...Truthiness is 'What I say is right, and [nothing] anyone else says could possibly be true.' " - Stephen Colbert

    Comment


    • #32
      Great discussion!

      For nearly 6 years, I've been the trainer who was recommended to gym members with medical issues of all kinds. PTs, DCs, MDs, etc. referred their patients to me, and other trainers sent me the people they didn't know how to work with, or would have me do paid consultations with their own clients.

      One of my most frequent bread-and-butter phrases has been, "I don't know." I refer a LOT of people for medical evaluation and treatment, and I train a lot of people to exercise safely and effectively despite limitations imposed by a medical condition.

      Now and then I teach workshops for trainers and/or massage therapists. I always discuss scope of practice and safety concerns. My explanations are increasingly neuro-based, particularly when it comes to pain-related subjects. I am getting better at explaining concepts to those unfamiliar to neuroscience concepts and terminology.

      Now that the gym I've worked at has been bought out and my income slashed by over 50%, I am considering updating my credentials with the NASM-CES because it would be handy for marketing and to increase my chances of landing the kind of training job I'd like to have. I've been involved with "corrective exercise" (or as I call it: "training") since 2004, so I don't expect any trouble passing the test... but I am a bit skeptical of the OPT model. I suspect that it may be one of those things I study just enough for a passing grade. I could skip the CES thing altogether, but I think the marketing value is worth the investment *IF* I choose to pimp it sufficiently.

      I could go for ATC, but the closest reputable program is several hours away, and that's just not an option right now.
      Novice Woo Shoo Kung Foo practitioner. Experienced critic of Truthiness.
      "It used to be, everyone was entitled to their own opinion, but not their own facts. But that's not the case anymore. Facts matter not at all...Truthiness is 'What I say is right, and [nothing] anyone else says could possibly be true.' " - Stephen Colbert

      Comment


      • #33
        JasonE,

        Last I heard the NASM-CES and PES are both open book tests. You get the test online and take it from your home. I could be wrong about this but this is what I've understood from those I know with the credential.
        "The views expressed here are my own and do not reflect the views of my employer."

        Comment


        • #34
          Hip Pain in Athletes: What's the Scoop?

          Bringing our focus back to FAI, it’s widely debated whether those with FAI are born with it, or whether it becomes part of “normal” development in some kids. World-renowned hip specialist Marc Phillipon put that debate to rest with a 2013 study that examined how the incidence of FAI changed across various stages of youth hockey. At the PeeWee (10-12 years old) level, 37% had FAI and 48% had labral tears. These numbers went to 63% and 63% at the Bantam level (ages 13-15), and 93% and 93% at the Midget (ages 16-19) levels, respectively. The longer one played hockey, the messier the hip – and the greater the likelihood that the FAI would “chew up” the labrum.

          I’d estimate that over 90% of the femoroacetabular impingement cases I’ve seen have come in hockey, soccer, and baseball players. What do these sports have in common? They all live in anterior pelvic tilt – with hockey being the absolute worst. Is it any surprise that the incidence of FAI and associated hip issues has increased dramatically since the AAU generation rolled in and kids played the same sport all 12 months of the year?
          Conversely, I’ve never seen a case of FAI in a cyclist. Why? It’s likely because they live in lumbar flexion and a greater degree of posterior pelvic tilt. And, taking it a step further, I’ve never seen an athlete with FAI whose symptoms didn’t improve by getting into a bit more posterior pelvic tilt.

          Finally, a 2009 study by Allen et al. demonstrated that in 78% of cases of cam impingement symptoms in one hip, the cam-type femoroacetabular impingement was bilateral (they also found pincer-type FAI on the opposite side in 42% of cases). If this was just some “chance” occurrence, I find it hard to believe that it would occur bilaterally in such a high percentage of cases. Excessive anterior pelvic tilt (sagittal plane) would be, in my eyes, what seems to bring it about the most quickly, and problems in the frontal and transverse planes are likely to blame for why one side presents with symptoms before the other.

          People have tried to blame the increased incidence of hip injuries on resistance training. My personal opinion is that you can’t blame resistance training for the incidence, but rather the rate at which these issues reach threshold. Quality resistance training could certainly provide the variety necessary to prevent these reactive changes from occurring at a young age, or by creating a more ideal pelvic alignment to avoid a FAI hip from reaching threshold.

          Conversely, a “clean-squat-bench” program is a recipe for living in anterior tilt – and squatting someone with a FAI is like overhead pressing someone with a full-thickness cuff tear; things get ugly quickly.

          Honestly, this probably isn’t revolutionary for folks out there – particularly in the medical field – who have watched the prevalence of femoroacetabular impingement rise exponentially in recent years. However, what may seem revolutionary is the realization that an entire generation of young athletes have been so mismanaged that we’ve actually created a new classification of developmental problems and pathologies: femoroacetabular impingement, labral tears, and sports hernias.

          How do we fix the problem?

          First, we give young athletes more variety at a young age to ensure that they don’t live in these problematic positions year-round.

          Second, we counsel them on what good posture really is – and it doesn’t look like this.

          Third, we make sure that their strength and conditioning programming is appropriate by training them out of this heavily extended pattern. This includes a big focus on the anterior core, glutes, serratus anterior, and lower traps through a combination of corrective exercises, positional breathing drills, and resistance training in the right positions.
          Kyle Ridgeway, PT, DPT
          PT Think Tank |@Dr_Ridge_DPT | Google+
          "It takes a deep commitment to change and an even deeper commitment to grow." - Ralph Ellison

          Comment


          • #35
            http://www.ericcressey.com/strength-...uld-read-22712

            The Prevalence of Radiographic Hip Abnormalities in Elite Soccer Players – This recently published study in the AJSM shows us just how common hip issues are in soccer players – even if they’re asymptomatic. You can apply this to hockey players as well – and possibly on an even more pronounced level. This goes hand-in-hand with some of my writings in the past about knees, shoulders, and lower backs. Just because someone is asymptomatic does not mean that they are “healthy” – and this is why assessment and an understanding of population-specific norms are so important!
            My response...

            I think you are grossly misinterpreting the results of some of these asymptomatic imaging result studies. The conclusion is NOT that they HAVE pathology and it is just waiting to hit threshold or laying dormant. The take home from them is that our imaging is too sensitive and their are many folks who have what SEEMS LIKE PATHOLOGY on imaging, but NO other signs or symptoms of dysfunction (and may actually never have dysfunction). So, it is only pathological if the image matches the clinical picture (we are talking musculoskeletal pain picture here, not other occult medical illnesses like cancer). In addition, there has been no follow up studies that suggest that these folks with abnormal imaging, but no pain or clinical signs or symptoms go on to then become symptomatic. PLEASE, PLEASE do not spread the word that the these positive imaging findings on asymptomatic individuals are problematic. They just aren't.

            The imaging studies on bulging discs in the spine have been very helpful in this regard. The finding of a bulging disc does not always correlate to any or the clinical pain picture. The progression or resolution of the bulge also does not correlate with/predict symptom recovery. Some people get better but their bulge gets WORSE, and vice versa.

            If someone is asymptomatic but has some "abnormalities" on imaging, I call this person healthy. Why? Because they are. As you have pointed other in other posts, abnormalities on imaging are actually NORMAL. So, what gives? Please do not try to sell the fact that these folks with abnormal images need some type of further assessment or intervention or are at risk for future pain or dysfunction. We have no data to support that claim. And with the hoards of studies showing many, many folks with bad images feeling good, we don't have any solid reasoning to think imaging findings are concerning in asymptomatic individuals.

            I really love that you are highlighting some of these imaging findings, and agree with 90% of what you say regarding them. I just needed to highlight that point.

            The authors even state in their conclusion: "The establishment of the prevalence of these findings represents the first step in identifying the relationship between radiographic abnormalities and injuries of the hip and groin in athletes."

            Long story short, even the authors are unsure of the significance (if any, likely little) of such findings....
            Kyle Ridgeway, PT, DPT
            PT Think Tank |@Dr_Ridge_DPT | Google+
            "It takes a deep commitment to change and an even deeper commitment to grow." - Ralph Ellison

            Comment


            • #36
              Hip Pain in Athletes: What's the Scoop?

              And beyond injuries that are actually observed and reported, you can find something “wrong” with just about every athlete’s hips if you just do some diagnostic imaging.
              Silvis et al. (2011) found that 77% of asymptomatic collegiate and professional hockey players had “findings of hip or groin pathologic abnormalities” on MRI.
              Larson et al. (2013) reported that 87% of high-level college football hips imaged had findings consistent with FAI, but only 31% of those hips presented with actual symptoms. Not surprisingly, the more bony overgrowth present, the higher the likelihood of symptoms.

              Some folks say that diagnostic imaging and functional tests are improving and that’s why the prevalence has increased in recent years. In other words, some people are asserting that we’ve always had significant hip “abnormalities,” but we just learned to clearly define them.

              Let’s stop and think about that, though, folks: if we had hip pain and dysfunction on this level for decades, don’t you think anecdotal evidence would have at least tipped us off? I find it hard to believe that generations of athletes would have just rubbed some dirt on a painful hip and bear with it for decades.
              Kyle Ridgeway, PT, DPT
              PT Think Tank |@Dr_Ridge_DPT | Google+
              "It takes a deep commitment to change and an even deeper commitment to grow." - Ralph Ellison

              Comment


              • #37
                Mike Boyle published something particularly spurious the other day regarding a link between shoulder stiffness and low back pain.

                Suddenly poor shoulder mobility became a major causative factor in back pain. How could I have missed this for so long? If I try to overhead press and lack shoulder mobility, what do I do? I extend my lumbar spine. If I try to position the bar to back squat and lack shoulder mobility, I arch my back. If I try to get my elbows up in the clean or front squat and lack shoulder mobility, what do I do? Just like in the wall slide I extend my lumbar spine.
                Just as we have realized that the hip and spine are linked, so are the lumbar spine and the shoulder. Next time you have an athlete with low back pain don't just look at hip mobility, look at shoulder mobility and at exercise selection. I think this might be why we have less low back pain when we dumbbell or kettlebell split squat or when we deadlift instead of squat. The elimination of forced external rotation in those who lack it may cause a significant decrease in back symptoms. It's amazing what you learn when you listen and think.
                Rod Henderson, PT, ScD, OCS
                It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                Comment


                • #38
                  It seems to me that the diagnosis of FAI has pretty much paralleled the advancement in videoarthroscopy equipment to invade the hip joint. Am I wrong?

                  "If you have a hammer, then everything looks like a nail."

                  Cressey seems to have become one of those p.t.'s who fancies himself a medical differential diagnostician while lacking the education or credentials that would warrant such a capacity.

                  He needs to rein it in quite a bit.

                  I think you were very charitable in your responses to him. That stuff about "living in anterior tilt" is mind-numbingly simplistic and anatomically incorrect. Just because an athlete spends a lot of time in hip flexion doesn't mean their pelvis is anteriorly rotated relative to the femur- it just means their hips are flexed a lot of the time! Hockey in particular, is very demanding on the hips. I've played the sport extensively, and when I lay off for a while and come back, I really feel it all around my hips. Of course a sport that places high demands on the hip is going to see a higher incidence of hip joint issues. On dry land, you tend to see more ankle and knee joint injuries- go figure!

                  We've got enough problems with people with medical knowledge making well people unwell, we certainly don't need it from non-medical people.
                  John Ware, PT
                  Fellow of the American Academy of Orthopedic Manual Physical Therapists
                  "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                  “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                  be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                  Comment


                  • #39
                    Well stated John.

                    We continue to lack understanding to normal physiologic and anatomical changes to sporting demands upon discovery of "new" morphologies.

                    No one would ever claim that a pitcher with more shoulder ER on his throwing arm was "pathologic" yet a hockey goalie with radiologic evidence of FAI is? Go figure...

                    There is much to learn about normal, normal variation, and "normal" deviations in anatomy and physiology to repeated demands and performance.

                    It's just not as simple as presented.
                    Kyle Ridgeway, PT, DPT
                    PT Think Tank |@Dr_Ridge_DPT | Google+
                    "It takes a deep commitment to change and an even deeper commitment to grow." - Ralph Ellison

                    Comment


                    • #40
                      I’d estimate that over 90% of the femoroacetabular impingement cases I’ve seen have come in hockey, soccer, and baseball players. What do these sports have in common? They all live in anterior pelvic tilt
                      I guess nobody told Buster Posey:

                      Ryan Appell DPT
                      @Rappell_PT

                      Comment


                      • #41
                        WTF does "live in anterior tilt" mean? They stand? Run? So I suppose athletes who "live in posterior tilt" have what?

                        These guys just say sh*& and then expect their reputation to buoy its credibility. You know what? It seems to work. Certainty sells. No one wants to keep hearing "possibly", "maybe", or worse yet "not likely". That means they have to continue using their brains (such as they are) to address complex problems.

                        That seems too much to ask. Coming from both sides of this debate I cringe every time I see the exercise gurus try to physical therapist (and vice versa btw). It's just painful to watch.
                        Last edited by HeadStrongPT; 30-04-2015, 04:31 PM.
                        Rod Henderson, PT, ScD, OCS
                        It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift

                        Comment


                        • #42
                          He also references the Larson et. al. study that demonstrated increased likelihood of being symptomatic and amount of overgrowth present.

                          Here is how the authors from that study defined symptomatic:

                          Hips with prior or current activity-related groin pain, groin strains, sports hernia symptoms, and surgery and prior hip joint surgery(arthroscopic or open) were included in the symptomatic group.
                          Prior or current? If you are using prior pain as a indicator of "symptomatic" then wouldn't that inflate the predictive value of bony overgrowth?
                          Ryan Appell DPT
                          @Rappell_PT

                          Comment


                          • #43
                            I would like to see one of you post an article on T-nation questioning these biomechanical "pathologies".

                            Atleast, we can post the link of the article as a response when anyone writes another treatment article based on imaging abnormalities and perpetuates the myth.
                            Anoop Balachandran
                            EXERCISE BIOLOGY - The Science of Exercise & Nutrition

                            Comment


                            • #44
                              It seems to me that the diagnosis of FAI has pretty much paralleled the advancement in videoarthroscopy equipment to invade the hip joint. Am I wrong?

                              "If you have a hammer, then everything looks like a nail."

                              Cressey seems to have become one of those p.t.'s who fancies himself a medical differential diagnostician while lacking the education or credentials that would warrant such a capacity.

                              He needs to rein it in quite a bit.

                              I think you were very charitable in your responses to him. That stuff about "living in anterior tilt" is mind-numbingly simplistic and anatomically incorrect. Just because an athlete spends a lot of time in hip flexion doesn't mean their pelvis is anteriorly rotated relative to the femur- it just means their hips are flexed a lot of the time! Hockey in particular, is very demanding on the hips. I've played the sport extensively, and when I lay off for a while and come back, I really feel it all around my hips. Of course a sport that places high demands on the hip is going to see a higher incidence of hip joint issues. On dry land, you tend to see more ankle and knee joint injuries- go figure!

                              We've got enough problems with people with medical knowledge making well people unwell, we certainly don't need it from non-medical people.
                              Hey John,

                              He is one the very popular names in strength and conditioning field. In fact, makes a good living just with his injury prevention and treatment strategies for athletes. I have seen him present at NSCA on injury topics. So he is pretty much considered to be a "medical expert" in pain and injury treatment by some of the leading strength organizations!

                              And here is a latest article posted on Creesey site about FAI: http://deansomerset.com/troubleshoot...rior-hip-pain/

                              One of you seriously should publish an opinion article in one of your journals about the widespread practice of strength professionals giving advice about injury and pain.
                              Anoop Balachandran
                              EXERCISE BIOLOGY - The Science of Exercise & Nutrition

                              Comment


                              • #45
                                I'm gonna let Rod do it.
                                John Ware, PT
                                Fellow of the American Academy of Orthopedic Manual Physical Therapists
                                "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                                “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                                be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                                Comment

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