Brian Schiff’s Blog

The longer I work with clients, the more hip issues I see.  Generally speaking, I find the major issues to be related to decreased mobility, poor stability and muscle imbalances.  These may occur in isolation or combination.

It is a no-brainer that most people have tight hip flexors and external rotators given all the sitting that takes place in our computer age.  This inherently creates weakness and tightness.  I feel that a natural propensity to be positioned in hip external rotation may actually reduce the firing of these muscles which in turn allows for more valgus moments at the knee and reduces lower limb stability.

Typically, female athletes fail to adequately fire the gluteus maximus (hip extension and external rotation) and prefer to dominate movement with the quads.  So, how do we begin to change this?

Well, first we must focus on better hip mobility.  I believe we must work to gain better hip extension by stretching the hip flexor group.  I also believe we need to do this dynamically and not just passively.  A dynamic approach also allows us to improve knee stability on the opposite side as we work on hip mobility.  It will also allow us to resist internal rotation of the femur and the valgus moment at the forward knee.

Look at the images below:

I am demonstrating a BOSU split squat diagonal chop.  This is the first of a series of BOSU exercises I am doing for PFP Magazine.  The upward chop forces hip extension on the right side and the downward motion reinforces firing of the left glutes to reduce internal rotation and valgus.  What a perfect combo right?

To read more about this exercise, click here.

Now, you should start on the floor with just the arms and progress from there.  This is a great prehab exercise or warm-up activity, but it cna also be used for strengthening too.  I hope you find it as beneficial in your routine as I do.

A quick note for those who follow my blogs.  I have been wanting to launch two new information based platforms this year: a monthly printed newsletter and online membership site.  What I have realized is that I am so busy I will likely not get both done in 2010 as I am also working on my Fit Knees DVD series as well as running my training business.

So, I have prioritized the printed newsletter titled Brian Schiff’s Training & Sports Medicine Update.  My love and passion lies in sports medicine, injury prevention and sports performance training.  So, the newsletter will have the following components:

• Exercise of the month – I will share pics and how to info with you
• Sports performance – topics relevant for athletes and weekend warriors
• Injury prevention – tips on how to stay injury free
• Rehab – advice on how to rid yourself of aches, pains and injuries
• Research corner – review of current pertinent research and trends
• Q & A – ask me your own questions about training and injuries

My goal for this publication is to deliver solid up to date information for coaches, ATC’s, physical therapists, parents, weekend warriors and athletes seeking information on how to be their physical best and remain injury free.  You can see the art for the inaugural issue soon to be released below. 

For more information and to stay updated on the official launch, be sure to sign up for my newsletters at www.brianschiff.com.  I will be offering a special launch price to the first 100 subscribers.  I look forward to helping you stay healthy and performing optimally for many years to come.

At this phase of my career, I have been around long enough and successful (or rather blessed) enough to be considered an expert in my field.  This affords me the opportunity to see and work to fix complicated client issues as well as teach others how to do the same.

One mistake I see time and time again in rehab and sports training is a lack of sound sequential and functional progression.  I blame part of this on the demise of insurance programs as we once knew them as therapy sessions are now limited both in scope of coverage and number of visits.  But, the rest of the blame often falls squarely on the shoulders of therapists, doctors, sports performance specialists and coaches.  Okay, parents may deserve a spot in my blame circle too. 

Why do I say blame?  Well, to be honest we often mislead or let down athletes recovering from injury by not listening enough, pushing them too hard, not pushing them hard enough, using outdated or irrelevant protocols, or incorrectly assuming they will heal like the last person with injury X.  Sound at all familiar?  Ever wonder why some people with the same injury recover differently and/or suffer a re-injury so soon after going back to sport?

Now, read on as this blog post is not a rant.  The point I want to be crystal clear on is that we as caretakers and health providers of young athletes must be on our game at all times.  This means we must be willing to continually learn and drop our assumptions, standard protocols, experiences and such at the door each time we see a new case.  We must apply and adjust our plan based on each individual we see.

Ont thing I am certain of is that no two humans are exactly alike.  Therefore, we must consistently assess and re-assess.  I believe the real magic if you will that at times occurs for me with my athletes is less a result of my own doing and more a result of my intuition and ability to communicate and extract information at critical times from my clients.

You may think that this happens in every therapy clinic and sports training realm, but trust me when I say that line of thinking is naive.  I have personally heard and witnessed too many failed rehab stories and examples of lackluster care/training to validate it.  As trainers and rehab specialists, we must be willing to do the following to maximize the success of our clients:

1. Listen to the spoken and unspoken words
2. Observe everything (movement, emotion, and facial expressions)
3. Encourage the athlete or client to communicate freely, frequently and most importantly honestly
4. Craft a daily plan based 100% on how the client is doing at that very moment in time – this is tough as you may have to scrap your entire preplanned workout
5. Challenge our own beliefs, assumptions and strategies all the time – it becomes easy to get stuck in a rut or fall back on doing the same thing for similar problems.  We must guard against complacency in our programming.  We must always seek new and better ways to do things. 
6. Involve the athlete/client in the decision making process – in other words explain the “why” behind things and relate it to their activity, rehab or sport.  Most of the time they will work harder and cooperate more when you do this simple thing.
7. Provide routine progress updates verbally (I call them affirmations) to the client and their family.  We all like to know how we are doing and being vague and having no clear direction or goals is simply unacceptable.  Encourage your clients and let them know how they are progressing in straightforward terms.

These are just the seven biggies that come to my mind right now.  The takeaway here is that training and rehab is and always should be exacting, yet flexible at the same time.  Fluid, seamless tweaking and adjusting are hallmarks of all the greats.  Clients should accept nothing less than this precise, analytical and results driven process, nor should we be willing to offer any less.

Following this blueprint will accelerate recovery, maximize performance gains and minimize injuries.  Isn’t that what it is all about?  Here’s to harnessing our passion and giving the absolute BEST to those we are fortunate enough to serve.

I have been rehabbing rotator cuff injuries for the better part of 13 plus years now.  I also have the privilege of teaching fitness boot camps, educating other fitness pros on training/rehab and training athletes.  One of the most common issues I encounter in my work is rotator cuff pathology (tendinitis, tears, etc.).

I have sold well over 10,000 copies of my Ultimate Rotator Cuff Training Guide (e-book and print versions) since its release in 2004.  While most of the training methodology is still sound today, I wanted to add some new content and tweak a few progressions.  Like anything, with time you gain more experience and wisdom.

In addition, many people were asking me for the DVD version to better understand how to perform the exercises.  So at last, I have released the DVD version.  Some of the new additions include:

• Soft tissue mobility exercises
• Self assessment screening tools
• Integrating a towel roll with rotation exercises

In addition to the DVD itself, you get a companion CD-ROM with my Self Stretching Guide, personal interview on rotator cuff injuries, my 60 minute rotator cuff explained power point and audio seminar, the entire updated rotator cuff e-book, and 5 second video clips of each the particular exercises in the rehab plan.

I am selling this product for $49.95, but until next Wednesday (June 16) you can get it for only $29.95.

Click here to see a sample clip from the DVD

If you decide to grab a  copy, simply use the code BFITCUFF (all caps) at checkout and be sure to hit apply to get credit for the coupon.  You can order at www.brianschiff.com.

This DVD is ideal for people with acute or chronic nagging shoulder pain related to bursitis, scapular imbalances, rotator cuff tendinitis and rotator cuff tears.  As always, I offer a 60 day money back guarantee on all my products.  If you have any questions, simply post them on the blog.

Here’s to happier and healthier shoulders!

Core training is common terminology thrown around in fitness circles today.  However, not much research has specifically addressed more advanced stability ball exercises and muscle activation until now.

A recent article released in the May 2010 Journal of Orthopedic & Sports Physical Therapy looked at 8 stability ball exercises and maximal voluntary isometric contraction (MVIC) versus traditional bent knee curl ups and crunches.

The 8 stability ball exercises studied with EMG were:

1. Roll out
2. Pike
3. Knee up
4. Skier
5. Prone hip extension left
6. Prone hip extension right
7. Decline push-up
8. Seated march right

Pike (end position)

All exercises were performed with a cadence of 1/1/1.  A metronome was used to ensure uniform repetitions and holds.  Researchers concluded that the pike and roll-out were the most effective exercises based on EMG activation.  However, keep in mind that these also require the greatest effort and pose a high degree of difficulty.

Why is this stuff important?  Research done by Cholecki and VanVliet concluded that no single core muscle can be identified as the most important for spinal stability.  Additionally, they believe that the relative importance of the muscle varies based on the direction and magnitude of the load imposed on the spine.

We have known for years the spine is least stable and most vulnerable in trunk flexion (as in the knee bent curl up), and that no one muscle contributes more than 30% to overall spine stability.  Choosing more demanding core exercises also typically increases spinal compressive forces as well.  This may be contraindicated in some populations.

Therefore knowing your client and condition is essential.  For example, flexion is often contraindicated with active disk pathology, whereas it may be indicated in those with facet arthropathy or spondylolisthesis.  Over the past decade or so, much attention has been placed on the transversus abdominus muscle. 

The prevalent thinking has been that it is a major contributor to spinal stability, although this is somewhat controversial and has not been unequivocally validated with science.  Another flaw here is that isolated contractions of it have not been demonstrated in higher level activities (e.g. sports). 

So, where is the functional tie in here?  The transeversus abdominus has shown similar activation patterns (within 15%) to the internal obliques with exercises similar to those in this study.  The highest activity from internal obliques was during the pike, roll-out, knee up, skier and hip extension left exercise.  This may indicate that transveresus abdominus activation is also high, but further research will need to be done.

The last critical piece of data involves looking at hip flexor activation as the psoas generates remarkable spinal compression and anterior shear forces at L5-S1.  This can be especially troubling for individuals struggling with lumbar disk pathology.  The exercise in this stud that demonstrated moderate hip flexor activation were:

• Bent knee sit-up
• Pike
• Seated march
• Hip extension exercises

So, if you or your client has a weak rectus abdominus and/or obliques or lumbar instability, these exercises may be contraindicated.  In the end, know that the stability ball provides much greater muscle activation compared to traditional bent knee sit-ups and crunches on the floor.  The caveat is identifying which ones are appropriate and most efficient in your case.

As a general rule, I suggest that you avoid long lever arm action with the legs in the presence of active disk pathology and instability.  You may opt for stability based exercises in a neutral spine position like planks as there is minimal shear and compressive loading here until clients develop more stability and strength.  With healthy and mroe advanced clientele, many of the stability ball exercises studied would be good alternatives to traditional crunch work to build muscle strength for the core.