Brian Schiff’s Blog

The FMS is a great tool to uncover asymmetry and movement dysfunction in fitness clients as well as patients in the clinic who are ready to transition back to sport.  I have been using this tool consistently for 2.5 years in my practice.  One of the questions I have asked myself about the screening tool is how reliable is it?

Click here for an earlier post I wrote on this topic regarding what it tells us as practitioners.  One of the challenges with any screen or test is not only validity but reliability.  In the April edition of the Journal of Strength and Conditioning Research, we gain some new insight regarding intra and interrater reliability via 2 new articles.

The first article discusses a controlled laboratory study where repeated measures were used to investigate how experience using the FMS and clinical experience as an athletic trainer (AT) affects the intrarater reliability of FMS testing.  The raters (17 men and 21 women who were recruited from the university’s athletic training clinical staff and academic programs), with different levels of FMS and clinical experience (AT students, AT or AT with at least 6 months experience using the FMS) viewed each of the 3 videotaped models.

None of the AT students or AT members had seen or used the FMS previously compared to the AT group with at least 6 months of experience. Each group rated the models on each of the FMS exercises according to the script presented by the lead investigator.  A week later the raters watched the same videos again in a different randomized order and rated each model on each exercise.

The intersession scores were examined to establish intrarater reliability of all participants.  In addition, the intrarater reliability of different groups of participants (students and clinicians) was compared to infer differences about the influence of clinical experience as an AT along with previous experience using the FMS.

Results:

1. Average FMS score was 13.68 +/- 0.98
2. There was moderate intrarater reliability was observed when all participants were analyzed
3. The AT group with experience had the strongest intrarater reliability followed by the AT group (no experience)
4. The AT students demonstrated poor reliability with a large 95% confidence interval

Key takeaways:

• Previous research by Minick et al. had established excellent agreement on all components of the FMS among expert and novice raters indicating strong interrater reliability, but authors point out that is first study to look at intrarater reliability
• This helps establish reliability of assessment giving more credibility to using it as an effective assessment tool
• All raters were either AT’s or AT senior undergraduate students – need to include other professionals in future studies to confidently apply the external validity of the results in this particular study
• Primary limitation of this study is the fact that video was used as opposed to live assessment
• Possessing clinical experience and experience with the FMS strengthens intrarater reliability so learning to use the tool with other experienced clinicians may be wise to improve validity

Click here to read the abstract on this article.

Continue reading…

Many people struggle with faulty posture (forward head and rounded shoulders).  Tightness in the pec major or pec minor can negatively affect the body.  Often, the throwers I see suffer from tightness in this region.  Any overhead athlete can be affected as well as the person who sits and types all day long in the office.

The video below reveals how to use a trigger point ball and block to work on soft tissue tightness.  I like the TP ball and baller block from Trigger Point for this exercise sequence.

For more information on this technique and its application, click here to read my online column for PFP magazine. Note: the final “W” motion in the video is not described in the column article, but it is another option that can be included.

For those familiar with my blog, you know I like to post research updates and exercises that prevent injury and maximize performance.  In my setting, I get to work with a very active population ranging in ages from 10-50 in most cases, including elite and professional athletes.  I am pointing this out simply because I have an opportunity to test and measure unique and challenging exercises every day with fit, athletic clients.

As part of my world, I am often faced with restoring shoulder, core and hip stability.  As clients progress through rehab and conditioning, I am always seeking advanced training options that are feasible and functional.  One training tool I like to employ, especially in upper body, core and hip training is the BOSU Balance Trainer.

Emphasizing co-contraction and scapulothoracic and glenohumeral stability is essential for optimal shoulder function.  But more importantly, addressing kinetic chain function in the shoulder, torso and hips is a must if we are to soundly address energy leaks and reduce injury risk.  To that end, I like to incorporate unstable closed kinetic chain training when my athletes are ready.  The video below demonstrates two upper body step-up progressions (forward and side-to-side) on the BOSU Balance Trainer that I utilize for higher level clientele.

Upper Body Step-ups

Regression – in place stepping (this can be used to prepare clients for the step-ups)

This regression can also be a very effective training tool especially if the client lacks sufficient strength, endurance and form to execute the full step-up patterns.  Pain and form should always guide exercise selection and progression.

Below are two links to my Functionally Fit columns describing the execution and application of these exercises:

Unstable Upper Body Step-ups (forward)

Unstable Upper Body Step-ups (lateral)

I am big fan of lat pull downs and pull-ups.  I think when done properly, this is a fantastic way to improve postural strength and safeguard the shoulder against injury.  In April 2012, I wrote a column on lat pull downs addressing shoulder pain (click here to read that post).

I decided to add to that previous post and discuss a recent article published in the February NSCA Strength and Conditioning Journal.  In the article, the authors present some research regarding how altering hand orientation and grip width affects muscle activity during the exercise.

Grip Width Summary

Lehman J Strength Cond Res 2005

• No significant difference between narrow supinated grip and wide pronated grip with biceps and latissimus dorsi
• Highest level of latissimus dorsi activity occurs with seated row with retracted shoulders

Lusk et al. J Strength Cond Res 2010

• No difference in biceps, latissimus or middle trapezius activity (note – wide grip only slightly larger than narrow grip)

Sperandei et al. J Strength Cond Res 2009

• In front of the head pull downs with standardized width and hand orientation revealed higher activation for posterior deltoid and latissimus compared to behind the neck
• This study did NOT compare different grip widths

Hand Orientation Summary

Youdas et al.J Strength Cond Res 2010

• Pronated grip during pull-ups (56 +/- 21% MVIC) was most effective for activating the lower trapezius compared with the supinated grip
• Pronated grip also resulted in greater infraspinatus activation (45 +/- 22% MVIC) compared with the perfect pull-up
• Perfect pull-up showed higher latissimus activity (130 +/- 53% MVIC) than the supinated grip of a chin up
• Supinated grip of the chin-up revealed an increase in pec major (57 +/- 36% MVIC) and biceps brachii (96 +/- 34% MVIC) versus 44 +/- 27% (pec major) and 78 +/- 32% (biceps brachii) for the pronated version
• Posterior deltoid showed no difference in all hand orientations

Lusk et al. J Strength Cond Res 2005

• Pronated grip during lat pull-downs elicited a 9% greater muscle activation of latissimus dorsi compared to supinated grip
• No difference between middle trapezius and biceps brachii in pronated or supinated grip

My Takeaways

1. If your goal is maximizing latissimus activity and improving scapular stabilizer and rotator cuff function opt for the pronated grip
2. Supinated grip elicits greater activation in the pectoralis major and biceps – no surprise here based on physics and kinesiology -> easier for clients to do and also not going to stress the shoulder as much in the presence of any inflammation or pathology
3. Range of motion, scapular dyskinesia, pain, soft tissue restrictions and imbalances play a vital role for each client so they may need some preparatory work to make the most of this exercise
4. Small tweaks (in my opinion) can make a big difference in comfort level and performance of the exercise (refer to number 3 for why) so do not be afraid to experiment between wide and narrow in a pronated grip
5. The authors mention that if individuals elect to do the behind the neck version they should have adequate range of motion to do it safely.  Let me be clear – there is NO reward big enough to justify the risk involved in doing behind the neck pull-downs.  Save your neck and shoulders by eliminating this option altogether as I would bet most of us do not have perfect bony anatomy, mobility and optimal muscle firing throughout the motion to ensure that potential repetitive micro trauma will not occur over time.

For my CrossFit friends – optimal shoulder mobility, scapular stability and adequate thoracic spine extension and rotation is a must to minimize risk with kipping and less than perfect pulling form.  I much prefer unweighting or assisting the body through pull downs, bands or partner assists to build pre-requesite strength initially until the client is better able to manage the movement under full body weight.

Quality movement ABSOLUTELY matters over hundreds and thousands of reps.

As far as research goes, I think we still need further studies on grip width and specifically how it may directly impact not only muscle activation but force on the glenohumeral joint itself.  For me, I opt for pronated pull-ups and or pull-downs once per week with a moderate grip width in my own routine.  I hope this information serves you well.  Happy lat training!!

I returned from a Disney vacation with my family last week.  While there, I saw all the runners who had just finished the marathon.  Several of them had compression socks and I was inspired to write today’s blog.

In 2009, I wrote a blog post on soleus strains, the Anatomy of a Soleus Injury. It is a widely read post about a commonly misdiagnosed issue and brings many inquiries as to how to solve this condition that plagues runners.  One question I often get is will compression socks help?  Over the past few years, I have seen a proliferation in the use of compression socks in the recreational running community.

But what exactly do these garments do?  Some of the proposed benefits are:

• Improved oxygen delivery to muscles
• Faster lactic acid resolution
• Prevention of muscle cramping
• Better stabilization of the lower leg leading to improved muscle efficiency
• Enhanced venous return to the heart through a more efficient calf muscle pump, leading to increased endurance capacity
• Diminished muscle fatigue resulting from more compact muscles, leading to improved balance and proprioception

What does science have to say about compression garments. I performed a literature search for relevant articles pertaining primarily to runners and endurance activity.  Below are some links to recent research abstracts:

– Physiological effects of wearing graduated compression stockings during running

– Compression stockings in male runners

– Impact on high intensity exercise in hot conditions

– Effect on 400 m sprint performance

– Impact on endurance running performance

– Effect of graduated compression stockings on running performance

– Calf compression sleeves and impact on oxygen saturation/running performance

In summary, much of the research we have no seems to tell us the following things:

1. Compression garments do not yield any measurable performance advantages
2. Runners prefer low compression socks over mod/high levels for comfort
3. Recovery does appear to be aided with compression in terms of improved venous flow and O2 saturation
4. No specific studies on gastroc/soleus muscle strains/rehab strategies using the socks

There is no conclusive evidence that these garments will prevent muscle strains, but research does indicate that perceived exertion is lower and the psychological impact of wearing the garment may aid runners.  I have not tried these myself, but some of my clients swear by them.  The idea of supporting/compressing soft tissue is certainly not new and many find some comfort in it.  We need more studies specific to injured populations to accurately evaluate the impact on those recovering from gastroc/soleus strains.

With that said, I am in favor of any modality that may allow athletes to train and compete with more confidence and less perceived exertion even if there is no direct measurable performance gain.  While I will stop short of endorsing these compression socks, I do see some potential benefits for those coming back from an injury in terms of recovery that warrant some consideration until they resume their prior levels of activity pain free.  For runners suffering from muscle injuries, utilizing soft tissue mobilization, stretching, strengthening, and proper running progression is still a an absolute must.