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The Future of Exercise Program Design

I’m a big stickler when it comes to laying out a program.

Let’s discuss the overall concept of programming and planning. In the back of the book Athletic Body in Balance, which is taking its 10-year anniversary lap, I talked about my dad’s most-used quote: Make your plan. Work your plan. I went into an explanation of that statement, because it doesn’t mean make a plan and then make your plan work.

The battle plan most generals come up with isn’t the one they finish with, but they have to start with a plan. A plan needs to be based on some metrics you can reproduce, and if somebody put you on the witness stand, the metrics would be strong enough to make you look credible. You don’t just follow a plan because it’s the plan you used yesterday. You make a plan based on science and based on the art and technology of the impact you’re trying to make.

Make your plan; work your plan means massaging that plan, making modifications, looking at your GPS and realizing if you’re a little off course. The way you work your plan is to not be obsessive-compulsive about every minor detail, and micro-manage the process.

It’s simply saying, ‘My goal is to be here by a certain time.’

If you’re not even close at the halfway point, you probably wouldn’t stay on the same program. That’s what my dad meant. Make your plan. Go forward. Pay attention. Watch what’s happening.

Are you ahead of schedule? Are you behind schedule? Are you heading in the wrong direction? Are you delivering what you said you could deliver through this plan?

abbNow let me tell you another story. I referenced a lot of John Wooden’s thoughts in Athletic Body in Balance, and also some of Bruce Lee’s material.

From a philosophical standpoint, I love the approach Bruce Lee brought back to martial arts. He re-energized the beauty, precision, technology and art of martial arts. He did it from a philosophical base by reminding us that many of the things we do are not as efficient or as practical as they could be, and if we continually work the plan, we can continue to make things better. We want to honor the history and to honor the classic teaching style, but when we can improve with new technology, new approaches and new paradigms, we should.

John Wooden was the basketball coach at UCLA, and many refer to him as one of the winning-est coaches of all time. But John Wooden didn’t consider himself just a coach. He was also a teacher. Even when he was coaching, he was continuously teaching. He had a method for doing everything, even something as simple as the way his players put on their socks. His ‘why’ statement—his rationale—was, ‘If you get a blister, you can’t practice tomorrow. Let’s pay attention to all the things other teams aren’t paying attention to.’

At the time, what struck me as a young coach, teacher, lecturer and therapist is that with all the prestige John Wooden had, he was essentially his own strength coach. He was the head coach of the basketball team, but he didn’t sub out the conditioning.

Here’s what he did. He created skill drills on the basketball court that put a spotlight on each of the very important movement parameters involved in a complete basketball game—a defending drill, a rebounding drill, a shooting drill, a stalling-the-clock time drill and others.

Small pods of athletes who had similar problems or similar responsibilities were grouped together. The competition drill was a microscopic aspect of a sport skill. They would go to a station, execute the sport skill and move to another station. The execution of the drill created some degree of fatigue. Moving to a new station offered very little rest breaks. What these drills taught was not only a higher skill rate within the drill, but the athletes had to recover from that energy expenditure on the fly. They had a very small rest break from which to regain composure, center their breathing, stabilize their focus and take action.

What do we do with the rest breaks when we work out? Do we really try to recover quicker? Do we focus on that?

ingridmarcumropesOne of the reasons I love battling ropes, jump rope and kettlebell swings and snatches is because there’s a huge metabolic demand. We’re going to get smoked—some people earlier and some people later—but we’re all going to get smoked.

But smoking you with one of these devices is not my goal. I want to find out how quick you can be ready to step up again. The point is to zero in on what you do in that rest break—regaining your composure, maybe working on a corrective area that tenses up really quickly with exertion, refocusing your breathing, doing something with your eyes or your posture to reset yourself.

How many of us can accelerate recovery? That’s a very important concept; it’s a great sidebar to consider.

John Wooden used basketball skill drills to create a metabolic demand to execute speed, agility, quickness, shot precision and more. Then, just like in a game with limited time to recover and rest, he moved the athletes to the next stations.

The beauty of this is that those 40 minutes didn’t just all happen by accident.

As accomplished as he was, John Wooden often spent two hours designing a 40-minute practice. That’s very, very important. He made a plan.

He knew exactly what was going to happen every second of the practice. By doing that, he kept people at or near the edge of ability, constantly digging, learning and refining patterns of movement.

Long Beach 1As technology and science continue to offer us more information about the people we train and rehabilitate, we have to realize that every time we introduce a new metric, we don’t have to completely gut the system. We just ask, What does this metric affect? Does it find a bottleneck we weren’t finding? Does it find an area of inefficiency?

I’m very excited about the newest DVD we just released called The Future of Exercise Program Design. I laid the groundwork in this DVD for how to think through what you already know, and then add the new information offered by movement screening. Movement screening wasn’t even an issue 15 years ago. It wasn’t something we considered. If we had an appreciation of movement patterns, it was because of our intuition or experience, not because of a formal metric or system. We now have that, but it sometimes creates just as much confusion for some people as it does success for others.

Long Beach 12Lee and I worked on this DVD to show people they don’t have to throw away their programs. They just have to listen to what the movement metric and the movement information is saying about the success or lack of success in training movement patterns, as well as metabolism, sport skill, body symmetry, muscle development, endurance, stamina, speed and quickness.

Long Beach 5But star of this show is Alwyn Cosgrove. He comes up like a true coach with his dry-erase board and starts talking program design. I appreciate listening to Alwyn lecture because as part of the audience, we realize he’s not just a professional lecturer. He’s deeply involved in program design in his facility. He’s thought about it. He’s the kind of guy who spends two hours figuring out a 40-minute workout.

Once you do that a few times, your brain gains a precision in finding wasted time in a workout. By doing these program designs, by listening to the things on this DVD and by studying coaches like John Wooden, you become an economist. You manage a scarce resource… and that scarce resource is training time for you and your clients. You want the maximum benefit from that scare resource.

Most of us want to be fit, not simply so we can say we’re fit, but also so we can participate in every opportunity of adventure, activity, movement, exercise or competition. I want you to look at this programming DVD as a way to get a competitive advantage. People sometimes feel the movement screen is constrictive to their programs. It’s not; instead, it shows you where your program is constrictive.

It’s giving you a competitive advantage.

Click here to order the Future of Exercise Programming DVD.

The Three Rs

We use the three Rs concept in rehabilitation and exercise to create a checklist. Here’s what I mean by that: Imagine that each R has a box next to it—you’ll check off that box before moving to the next R.

threeRs Now I’ll tell you what the Rs are: Reset, Reinforce and Reload.

The first time I addressed this concept was to a group of physical therapists in Amsterdam. They were trying to get their heads around the reason we need to look at movement before a lot of other medically condoned breakdown tests.

We’re trying to capture movement dysfunction at the level of the pattern—not just having an assumption the glutes are weak, or measuring a lack of dorsiflexion. My first role is to demonstrate how perhaps glute weakness affects a movement pattern, or how the dorsiflexion limitation may provide a poor foundation and create faulty balance.

We can go through the body with checklist of the many imperfections we all carry, or we could try to discover each individual’s major dysfunctions. We could then work back from those dysfunctions to find what we think are some of the driving forces behind them.

Once we do that, our intervention requires that we do something. What’s the first something we do? Reset.

If you’d prefer to listen instead of read,
here’s a longer audio version of this article,
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In clinical rehabilitation, we have to make an intervention. We don’t just tell people to do more of an exercise. Usually these people are in pain. If they could do more, they would, but they’re limited by pain or disability… and they can’t.

Many times, we have to use manual therapy to help them climb out of the well. The first order of business is to see if inflammation is driving the system, because if it is, we consider that a chemical problem, not a mechanical problem. As long as you have inflammation on board, you’re going to have inappropriate signals, inappropriate muscle tone and poor movement patterns.

Imagine you hurt an ankle. It’s red, hot, swollen and twice the size of the other ankle. Today is not a good day for squats. As a matter of fact, today’s not even a good day for walking. Today’s a good day to get rid of that inflammation.

We’ve clinically demonstrated that when your joints are swollen or effused, you immediately have reciprocal muscle inhibition. The muscles around that joint are inhibited by the swelling. Pushing your way through joint pain or a swollen or inflamed joint doesn’t make sense on any level, much less on a neurological level.

Let’s say inflammation has been appropriately managed by modalities, medications and behavioral modifications of rest and recovery. We might still see poor motor control or poor movement mechanics. It could be because of the time spent not doing anything, or it could be because of the behaviors associated with limping, bending, twisting and compensation after the injury.

In this example, for all practical purposes there’s no longer a chemical problem because we’ve managed the activity level. We don’t have a lot of inflammation. There are the after-effects of the trauma, but the inflammation is gone.

We still have poor motor control. We could have a certain degree of muscle atrophy. We could have uncoordinated muscle behavior. We could have increased tone. We could have residual trigger points. What we have to do is identify, What are those motor control and movement limitations? What are the problems with mobility and stability?

clinic In rehabilitation, we make a manual intervention. We might hold a joint with our hands and mobilize or manipulate that joint. We do soft tissue work either with our hands or tools, and work deep into the tissue or on the fascia. We might use needles to do a musculoskeletal technique called trigger point dry needling.

We’re going to do something physical to see if we can change motor control or mobility. If you couldn’t bend forward and we saw some stiff vertebral segments, we may want to mobilize those.

Moving those segments completely changes the neuromuscular support around that joint. It may free up some muscle tone and allow you to move through your spine a little bit better. This is still without suggesting an exercise or making you actively do anything.

We did something passively, meaning your role was passive. At the end of that, we should see an appreciable change in something we measured. Did your level of control go up or did mobility improve? If it did, clinically that could be considered a reset.

It’s a window of opportunity.

gray cook long beach The first thing we want to do is protect the reset. Having you jump off the table to go play 36 holes of golf is not a real good plan. What I’m going to do is reinforce the change I just made.

There are two ways to do that—Both protective and corrective measures can do that.

Protective measures keep you from getting worse, but may not make you better. Corrective measures actually work toward helping you foster or start the reset process yourself.

If I thought sleeping on your stomach might be complicating your neck problems, I might give you some advice on lifestyle. I might give you a brace or an orthotic, but I might also use some leukotape or kinesiotape to hopefully facilitate better activity or enhance the feedback when you move. This reinforcement doesn’t push you farther along; it keeps you from backsliding between therapy sessions.

The reloading is where we actually teach exercise and look for a pattern or a part of a pattern to reinstate motor control. It would be futile to try to reload something if we didn’t have good reinforcement. We’d continually be taking two steps forward and three steps backward.

It would also be inappropriate to expect you to fix it yourself when part of this vicious loop of moving poorly and not sensing enough information to self-correct will perpetuate itself.

The reset is a largely passive activity on the patient’s part.

The reinforcement is where we do lifestyle management and offer conservative advice.

The reloading is therapeutic exercise.

glute-medius You have no idea how many people come to our workshops, dispense with some of the advice we give, attempt a corrective maneuver on somebody who probably needs some manual intervention and some lifestyle critique, and hope that half-kneeling for four minutes a day will correct all the ailments discovered on a movement assessment.

I just gave you a medical scenario. However, I can completely turn these three Rs into corrective strategy used both in fitness and performance enhancement when people have movement dysfunction  not complicated by pain.

The corrective strategy we impose may be foam rolling. It may be stretching. It may be static stability. It may be dynamic stability. But if we’re doing it right, the reset can demonstrate how the movement has changed.

How do we know the movement has changed? We’ve done a movement screen.

What are some of the things we can do to reinforce the corrective strategy? We may have to temporarily delete some activities. If we think your attention to detail in your kettlebell swings is sloppy, we may have to pull you back from that to get you moving. This will give you a better platform to have more attention to detail in your swings the next time out.

I didn’t say you couldn’t deadlift. I didn’t say you couldn’t work on your presses. I just said, ‘Your swings are not too good right now.’

Part of what I’m going to do to reinforce you not backsliding in your program is to temporarily delete an exercise.

I often have to do this for runners. Compounding a stride or gait pattern with more mileage probably isn’t going to get them any faster or make them a better runners.  A lot of runners have gotten better by cutting back their running. A lot of lifters have gotten better by deleting a lift they weren’t doing correctly until they’re doing it better.

program design dvd Reloading is also about programming. Programming could mean using a corrective strategy blended with some conditioning work, such as using supersets to establish better hip hinging and then doing deadlifts, and then maybe add some swings. We cover that in our forthcoming DVD, The Future of Exercise Program Design, due out in October.

This whole reset, reinforce and reload can be applied to both rehabilitation and exercise. In rehabilitation, we’re dealing with both pain and dysfunction. In exercise professions if people are acting as they should, we’re only really dealing with dysfunction.

If you identify pain, it’s not a fitness problem anymore. It’s a health problem. Let somebody who is licensed in healthcare deal with it or you’ll be banging your head against the wall looking for a new exercise for something that’s not a fitness problem.

Reset, reinforce and reload is a pretty simple concept, but don’t just do it and assume success. The way for you to know you did a reset is to see that you changed something, and you changed it without a lot of programming. You changed it in a very short session—often in a single session.

Then think what you can do to reinforce that, both by deleting things—being protective—and maybe by adding behaviors, which is being corrective.

For example, you might say, “I want you to superset this movement with a flexibility move every time you do it. I never want you working on your squat without doing squat mobility work first.”

One reinforces the other.

Then the reloading is the programming that maintains and supports the gains you’ve made.

But remember this: The three Rs don’t work if you don’t have a baseline.

If you have a baseline for movement, you can tell yourself whether you have permission to go from one box to the next because you’ll know you changed something. A couple of weeks down the road you’ll know if you have maintained something and reinforced it, and you’ll know if your programming is efficient.

It’s a mouthful, but I’ll tell you what: If you check those reset, reinforce and reload boxes, it might real hard. But it’ll make you better.

MEG-graycook-Rs
I talked about the 3Rs in this new lecture for movementlectures.com.

FMS Screening and Physical Limitations

We often get screening questions from people who have clients who can’t do a test because of a physical limitation. For example, there was a man on my Facebook page who asked about this; he couldn’t do the rotary stability test because his stomach got in the way.

What if someone is missing an arm? What if somebody has a deformity? What if somebody has a large, protruding belly and is unable to do one of the tests?

Let me make it really simple: You’re the professional. Modify the program, not the screen.

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&
Episode 22 of Gray Cook Radio

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This means don’t obsess on adjusting a score. If somebody can’t do the quadruped diagonal pattern because the belly is in the way or because the upper body is too tight, it doesn’t matter. The score is the score. The screen is blind.

The screen only says a person cannot move in a pattern. The reason doesn’t matter on the screen, but it should matter in your programming. Modify your programming with the things you know that none of the rest of us can know about your client.

with alwynWe go into this in great detail in the forthcoming Future of Exercise Programming DVD Lee and I shot with Alwyn Cosgrove. The DVD is due out in October.

You are the professional on the ground, and you need to work with the information available to you. You can choose to attack one of the patterns the screen exposes to be deficient, or choose not to. Don’t keep trying to modify the screen or make the screen see things it wasn’t designed to see.

The reason we screen is we’re going to be giving exercise suggestions. If your quadruped diagonal pattern is limited by your belly and mine is limited by my flexibility, let’s agree that if the pattern looks like any of the exercises we’re planning, there’s probably going to be a lot of compensation.

The reason you compensate or have difficulty doesn’t matter at the screening stage.

Don’t try to modify the screen or throw people scores they don’t deserve. The reason they may not be able to change that score could be a structural problem, or something else. Let the screen expose the movement profile. Let it be what it is, and modify your programming to match.

I see patients with certain movement patterns that, because I have knowledge outside of the screen, I may choose to ignore one of the patterns. I continually check to see if it changes, but there may be a total joint replacement, a previous surgery or another reason for limited potential of improvement in one pattern.

whatifI take it off the grid in the programming, but I still let the screen say what it says. That’s really the advice I give. We waste a lot of valuable time asking ‘What if? What if? What if?’

We have personal trainers working with clients who have had strokes. These people are often considered disabled in some way, especially if they have an assistive device or walk with a serious gait deviation. You’re welcome to screen on them. What are the first two tests we do? Active straight leg raise and shoulder mobility. You may not want to do anything more than that.

When we have an evaluation that has been done for a medical limitation or a structural abnormality, it trumps whatever the movement screen says. If the movement screen in some way disagrees with a medical diagnosis or evaluation, there’s a good chance you used the screen inappropriately.

Most people who are severely limited yet wish to exercise or participate in an activity are  going to have difficulty just getting a score of ‘2’ on the active straight leg raise or shoulder mobility. You have plenty of programming right there. You don’t need to take a stroke client through a deep squat. It’s not even close to the weakest link.

Don’t expect a test to modify itself to every situation. You choose and modify the programming to accommodate the other information you should collect in addition to the movement screen.

glutemed Now let’s consider the next question we usually get: How important are body proportions as a factor?

Let’s use the example of the overhead squat. Maybe the way one person is built, he needs more ankle flexion and has more of a forward lean in the deep squat than another person. Because he leans forward more at the hip, he wants to know if he needs more thoracic extension or more shoulder flexibility to keep the bar over his feet.

This is where the person asks if we can  cut a little slack if the stick isn’t over his feet or if his upper arms are over his ears. Is the screen self-adjusting or does he just have to work a little harder?

Look, I cut no slack, but just to make things fair, I don’t cut myself any slack either.

I’m always going to struggle with a perfect overhead squat. I’m 6’4” and weigh 250 pounds. I’ve broken both ankles twice. I’m pretty long-legged compared to torso length. If I invented the screen and I’m not going to cut myself any slack, I’m sure not going to dole it out to anybody else.

Here’s what I will tell you… again: It’s simply a screen.

This is probably most important point you’ll ever get from me when it comes to the Functional Movement Screen. There’s perfection; there’s imperfection; there’s dysfunction.

fms scoring
A score of ‘3’ on the movement screen demonstrates close to perfection. I would want to use you for a textbook demonstration of what this pattern looks like at its best.

A score of ‘2’ means an imperfection. You passed the test, but there’s room for improvement. You may have an anatomical proportional reason or a training or other problem that keeps you from the ‘3.’

Continue working on it because if I were able to improve the deep squat at all, you have to admit there’s room for improvement. Letting you blame 100% of your lack of overhead squatting ability on your proportions in anatomy absolves you from exploring corrective strategy and trying to improve it.

Will I be able to promote you as the best overhead squatter at Cirque du Soleil in Vegas? Probably not. Would you have about 25% improvement potential if you were to do some of the corrective strategies? Maybe!

But don’t obsess over that squat if you don’t have ‘2s’ on everything and no asymmetries anywhere in the screen. The squat problem is demonstrated further down the developmental chain, maybe in your active straight leg raise or thoracic spine mobility. Many people want to peg a ‘3’ on the squat without preparing the body for the squat.

The squat is the last thing that we fix.

Finally, we come to dysfunction. That means you have a ‘1’ somewhere on the screen.

If you get imperfection across the board on the Functional Movement Screen, I don’t consider you dysfunctional.  Don’t consider ‘2s’ as failure. A ‘2’ is average. Because of your proportions, training and previous injuries, a ‘2’ may be the pinnacle you’ll reach.

However, if you have a ‘1,’ that’s dysfunction. Whether you have a lot of excuses or none, it’s a potential risk factor even if you do exercises perfectly.

Let’s recap. You don’t have to be perfect on everything. You can be imperfect and still not be at an elevated risk of injury.

Then there’s dysfunction. There are too many people splitting hairs about perfection versus imperfection while dysfunction walks by and gets on the pec-dec at the gym.

Where I see a lot of the other assessments and functional tests nitpicking the differences in perfection and imperfection, my life’s work has been, ‘Please, before you throw exercises and load at people, identify those who have true dysfunction.’

FMSscoresheet The people who need your help the most, the people who train and are still obese, and the people who work hard and still get injured are probably walking around with a couple of ‘1s’ on their movement screens. They haven’t met the person who cares enough to intervene.

You have some imperfections in your overhead squat. My first thought is I bet it’s not your only imperfection. Look at the rest of your screen, honestly look. See where you have asymmetries and dysfunctions and clean those up to ‘2s on everything with no asymmetries before you squat.

Then start working on your squat. If you improve it 25%, you can’t blame anatomy and proportions for a poor score. You had some room for improvement, which is my whole point. Will you ever achieve perfection? No, it’s not even possible—what is perfection in movement? But there’s probably room for improvement.

There is enough of a buffer zone built into these tests that allow for body proportions such as a longer-than-average femur length. There are enough other segments that can do a little more or a little less elsewhere in the body.

Remember, the American Medical Association has produced goniometric measurements referring to the degrees each of the joints should move. Not one test on the Functional Movement Screen asks more than that.

Most of the debates people get into about the Functional Movement Screen are about perfection and imperfection, while dysfunction gooses through everywhere. Check for a dysfunction first and you’ll be a better trainer.

I could split hairs in the gym all day long and not make a difference. Once I started following the FMS model, I could change lives. It’s the most rewarding thing in the world.

 

Lee and I go into this in great detail in our two-day Perform Better FMS Workshops, coming up in Rhode Island, Los Angeles, Chicago and Charlotte, NC.
You can also learn on your own by reading Movement. In fact, I encourage you to read Movement before attending an FMS workshop. You’ll get more out of it.

I also talk about this topic in the new audio lecture, The Three Rs, available on movementlectures.com.

Walk the Line

Since the Exploring Functional Movement: (DVD), (Digital) project I did with Erwan Le Corre of MovNat, balance has been a major topic at my Perform Better Summit appearances, where I have about an hour to help people learn to balance better. In the hands-on workshop, people walk a balance beam, then get to a hurdle-like obstacle and have to step over it. We see a lot of faltering early in the session.

EFMdvdBalance and stability are an integral part of almost every sport or activity. A concept I use to describe stability is ‘motor control,’ which might better define the subtle adjustments we make with the stabilizer muscle groups while the larger muscle groups propel us forward, turn us, or slow us down. That stability can easily be analyzed or even trained in a balance situation.

One of the mistakes we make in training is to go right into training single-leg stance. Single-leg stance is a great test for balance; you see it in the Functional Movement Screen with a hurdle step, and you see it in the SFMA with a single-leg stance test.

If you’d prefer to listen instead of read,
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Episode 39 of Gray Cook Radio,

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We have many variations, and we always compare the left and the right sides. We look at single-leg stance with eyes open and eyes closed. There are different ways to break down single-leg stance, but when it comes time to train, it’s sometimes better to give the brain a little more meaning.

In the Exploring Functional Movement video, we found all kinds of opportunities to get on a beam or a pole or to balance on a line. That’s where the title Walk the Line comes from.

Instead of putting clients in a doorway to challenge single-leg stance, a beam provides purpose—single-leg stance, one side, the other side, and then walk the beam. When we do things to juice balance, people can walk up and down a beam, and can practice that.

In our physical therapy clinic, we work with different levels of balance. We have a piece of Trex board, which is synthetic decking we ripped down to a four-inch ‘beam,’ although some people feel more comfortable starting with a six-inch width.

photo98Beam walking is something we superset in fitness, say after a hard set that makes you tired. You’re going to need a rest break before the next set of walking lunges, front squats or kettlebell swings. Why not walk a beam while you’re recovering? It’s sensory motor engagement. It’s not high demand, but it does require a stabilizer reset, and doing that may actually make the next set of lunges, squats or swings tighten up a little.

Walking that beam barefoot or in minimalist footwear, whether the ‘beam’ is elevated off the ground or flat on the ground, is a self-limiting activity because it provides quick feedback. But I don’t like to see intense concentration. I don’t like to see you looking at your feet; I don’t want to see you flailing your hands.

At the recent CK-FMS, I coached people through a little gauntlet of balance beams. We use it in the rehab setting at the clinic, all the way to a fitness setting like CK-FMS, and it doesn’t have to be an exercise of itself. It can be a superset to complement another exercise. Here, have a look.

When trying to improve balance, the first pre-requisite is to check for mobility. If you can’t pass the hurdle step test, we may want to grab some mobility before we challenge balance. If you have restricted ankle dorsiflexion, your hips are extremely stiff, you can’t touch your toes, or you can’t even break parallel on a deep squat, you may be running up against a mobility problem that’s hurting the sensory feedback of the balancing activity. You’re going to balance better if we get you a little more mobile before the next balance challenge.

If your FMS score has a bunch of ‘2s,’ and you don’t have a lot of flexibility problems, you could probably get after some pretty good balance challenges to feed the system. You have enough sensory information coming in to probably get better motor control, and then you can refine it.

Listen carefully to what I said. If you have ‘1s’ on the movement screen, attack the mobility the screen asks you to attack. You will save time. You will get greater stability by opening up that mobility, because that will change the balancing experience.

Why?

More proprioception provides more and probably more correct information. When walking a beam with a locked-up ankle, you’re not receiving the benefit that ankle and foot are prepared to provide. Your body unconsciously and reflexively knows how to level the pelvis and use the glutes as an advantage, not a disadvantage.

If you see people struggling, looking at their feet, flailing their arms and using unnecessary trunk movement, is this a motor control problem or a mobility problem?

My way to answer that question is if there are ‘1s’ on the FMS, get the mobility fixed first, and then attack stability. If there are ‘2s’ on the FMS, do some of these balance drills.

One question I get along these lines is about my recommendation of bear crawling to regain reciprocal balancing with better stabilization. As a matter of fact, we do bear crawling on a beam. You can determine how wide of a beam, or you can just do bear crawling on the ground.

What if you can’t do bear crawls?

Let’s all be honest here. We have clients, or recovering patients, or perhaps older golfers who because of fitness levels can’t comfortably do enough bear crawling to get the balance benefit.

photo96Did you ever think about walking with sticks or dowels in hand? We get the reciprocal gait we get from bear crawling, without the unnecessary stress on the upper body. We get less of the unfavorable blood pressure changes people sometimes get when they get in a quadruped position.

Imagine watching a guy on a low balance beam who has sufficient mobility, yet has a very hard time balancing. You decide to regress, but don’t hand him one stick. Hand him two dowels and get him to do a right-left reciprocal action. Have the dowel handgrip adjusted at a nice walking height. When the left foot advances, he advances the right dowel.

Have him grab the ground with the dowel, not too far in front of the stepping foot. Make sure the dowel has a nice push so it’s complementing extension. Think about it—he’s engaging the right lat and the left glute at the same time. That’s not a bad concept, is it? That’s what we do in bear crawling, but we can do that upright without bear crawling, and the brain still benefits from the reciprocal activity.

Using sticks is a quick way to juice stability when mobility is adequate. First of all, make sure your clients use reciprocal gait with the sticks; make sure they get the rhythm down.

Put them on the beam with the sticks. Then as soon as they get confident, have them drop one or both sticks and continue on the beam. What you’ll usually see is until they start thinking about things, they’re great. The instant they start turning, walking on a balance beam and thinking about the exercise, they’ll probably falter.photo97

It’s important to realize human balance is almost a reflexive activity. We should train it between exercises as a reset—as a stability reset. Introduce a balance beam instead of just single-leg stance exercises. It’s more functional, and it will have more carryover into other activities.

In sports where we have to shift weight with crisp precision, walking a balance beam can change the workout. Put it between sets. Use little things like mobility drills or the stick drill for certain people to juice stability. If you have a group of younger people, do a few bear crawls between each balancing activity. You’ll see crawling juice that stability as well.

Look at we did with Erwan Le Corre in Exploring Functional Movement. Watch the video, practice some drills and enjoy getting your balance!

To order Exploring Functional Movement: (DVD), (Digital)

Breathing

Breathing is probably the most simple and yet complex thing we do. It is a conscious thing if we choose it to be, but the instant we stop thinking about it, it continues on its own. One of the biggest questions we have is when it continues on its own, how do things work? When we do a breathing drill, did we reset it in any way?

single-leg-bridgeThink about the current popularity of muscle activation, say… activating the glutes. Almost everyone with a little knowledge of isolation and hip extension can say they activated the glutes, but when you stand up to leave the session, are your glutes doing something better than they were when you entered?

Simply because we run the circuit and create activity in a temporary, isolated situation, does that activity carry over into the other things we do? Heck, that’s my definition for function! If you do this one thing and it carries over into many other things, it’s functional.

If you’d prefer to listen instead of read,
here’s a longer version of this article,
Episode 38 of Gray Cook Radio,

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If you do this one thing and just get better at it, we call that specific training—specific activity training, specific sports training, the specificity of the task.

Just like any other exercise, this is also true with breathing. When we do an exercise, we must ask ourselves if the exercise only improves itself in the single act we’re participating in, or if it has carryover into other activities.

In the discussion of breathing, breathing efficiency and breath training, as a healthcare professional my first responsibility is to start with health, not necessarily performance or fitness.

The first consideration largely overlooked is whether there is a structural problem. Is there an airway obstruction? Is there a deviated septum? Is there a closure or an anatomically small airway?

Think about this for a minute. When a person has horrible posture with an anterior head, rounded shoulders and a sunken chest, what if that happens to be the posture where the anatomical airway is the largest? When you stand totally erect in a perfect military or actor’s posture and your airway is compromised by 30 or even 50%, what is the motivation to stay in that position?

The first thing—before we start giving postural cues—is to recognize if there’s an obstruction. That’s a health problem and the person probably needs to get that checked out.

First we take the anatomical airway problems off the table. If you’re working with a client and this just created a bunch of questions, or if you’re a rehabilitation professional in physical therapy and chiropractic and breathing is not your specialty, a quick history can guide you. Just ask!

Do you have seasonal allergies? Are you congested? Do you cough? Have you had episodes of bronchitis? Do you wheeze when you breathe? Do you find yourself on exertion going right into mouth breathing? Do you have a constantly dry mouth (another sign of mouth-breathing)?

These are things that might beg us to do further investigation before we assign an exercise to improve breathing.

gray-aslrSecondly, many of us try to activate muscles. I can make your glutes fire, but if you lack full hip extension, you will not use your glutes efficiently in gait or other activities.

Let me state that again: It’s no problem to make you bridge and your glutes will fire. Yet when you stand up and get into that end range of extension and your joint capsule becomes tight, you fire your hip flexors a little to stay out of the end range—to not sort of bang the joint against its end.

You will inhibit your glutes in many situations because you don’t have the available range of motion in the hip. It’s not because the glutes can’t be fired, but it would be inefficient to fire a glute near the end range because micro-trauma and damage of the joint could occur.

Lie on the ground and activate your glutes all you want, but did it carry over when you stood up?

The same is true for a breathing exercise. We can lie you on your back and rehearse crocodile breathing, see-saw breathing or a motor control activity to have you fire the circuits that allow your intercostals, diaphragm, abdominals and other breathing contributors to work. But what if there’s a mobility problem?

We should probably have a neck, shoulder girdle and ribcage that freely move, but the pelvic floor and diaphragm also work in sync, so having pelvic and hip mobility is also advantageous. If you’re going to try to train or coach breathing, you have to discover if there are significant mobility restrictions on board.

The first two things we look at in the Functional Movement Screen for their influence on breathing are shoulder mobility and the active straight-leg raise.

Shoulder mobility is more than looking at range of motion of the shoulder. It lets us know if you actively extend the upper spine. It lets us know if there are restrictions in the ribcage.

It’s the same with the active straight-leg raise. The symmetry and ability to lift a leg in an unweighted situation tells us quite a bit about the pelvis, the core and the way the hips work together.

Restrictions from the neck through the pelvis can interrupt and restrict the natural rhythm we authentically use in breathing. If there’s a restriction, you have to pick another path and use an asynchronous breathing or an inefficient breathing pattern.

gray-cook-mobilitybeforeAs I’ve always said, mobility then motor control, or mobility then stability. The first order of business: Mobility must come first.

If mobility is clear—and it doesn’t have to be perfect—we can move on. But huge restrictions in the neck, thoracic spine, pelvis, hip and shoulder mean if you’re doing a breathing exercise to sink the diaphragm or not to use the upper chest as much, you’re missing the whole point of why the breathing is bad in the first place.

Take the big mobility restrictions off the table first. I’ve helped many endurance athletes by improving active straight-leg raise and shoulder mobility, not because I improved oxygen transport at the cellular level, but because we made the mechanics of breathing more efficient.

You can fatigue the breathing muscles, especially if you’re using the wrong ones. The biggest limiting factor in your next run may not be the endurance in the quads or calves. It may be the endurance in the breathing muscles used inappropriately and inefficiently around poor upper body and trunk mobility patterns.

Now, let’s say mobility is not the problem. You’re going to take Brett Jones’ and my advice in the video Secrets of the Shoulder and do crocodile breathing, or you’re going to use see-saw breathing from Feldenkrais.

In medical observations, see-saw breathing is probably a problem when we see the diaphragm going up, the chest going down and then reversing. This probably means an infant maybe has an airway obstruction or another problem. What we like to see is everything moving together. Obviously, we want belly breathing, but we want a gentle contribution of the chest as well. If we see one significantly more than the other, it could denote a problem.

But in our sedentary society with the stress levels and emotional issues that accompany a fast-paced, sedentary society, we may have to reset breathing. Yes, you can be fast-paced, stressed-out and completely sedentary. Think about darting in and out of traffic…not really doing anything, but the emotional engagement is way up there.

We have to remind the brain of its options. If mobility problems are not the reason breathing is out of sync, maybe breathing is out of sync because breathing has not been used authentically in quite some time.

Practice is like meditation, like the use of the breath in yoga and martial arts. If you think about it, some of the oldest forms of exercise start with the breath and some of the newest fads in exercise don’t even consider it. Today’s coaches often just think if they get you winded, all good things will happen. I don’t know if that’s the best way to approach this.

Think about that. The wisdom of the ages tells us to start every exercise or movement with attention and efficiency in the breath, because that fuels everything we do in every other movement we make. Do we do this? Nope. We want to grow those pecs, shred those abs and activate those glutes.

Oh, and just breathe however you want.

As we look at opportunities to re-coordinate or reconnect breathing, what we’ll find is that see-saw breathing is a way to de-emphasize chest breathing and improve abdominal breathing.

Crocodile breathing is another way to do that, and gives a different sense of feedback where the belly expands both side-to-side and pushes into the floor, lifting the low back, or the sway we normally have in the low back when we lie on our bellies. We see the back going up and down, which looks much like a crocodile lying on its belly and breathing.

We have some amazing techniques to reset or reconnect authentic breathing to remind the brain of the options other than upper chest breathing. Think about the restricted areas first—the low back, the chest, the ribcage, the abdominals, a lot of tightness in the pelvic floor region and definitely in the neck.

FMS8_22_09_068Look how many people are swinging kettlebells who still think the neck is the core. They’re totally engaged across the anterior neck muscles, not breathing right and the other things go from there. If the breath is out, we have problems.

Take it one step further. If you’re dealing with somebody with a history of breathing problems, there could be an anatomical obstruction. There could be a compromised airway. There are many, many things that can be done for this, but I wouldn’t start with exercise.

We have to be responsible when we talk about breath. We have to make sure there’s no anatomical obstruction. We have to make sure there’s mobility in the breathing regions of the body. Remember how much of the chest the lungs cover. The lungs cover the area from almost under the traps all the way down to below the ribcage, so any restriction in that area can interrupt natural breathing.

If the restrictions are taken off the table and there are no obstructions, some of these breathing coordination exercises are absolutely awesome at resetting breathing. Once you reset, take the new breathing into your activities because these are, in fact, corrective exercises.

Corrective exercises should be a temporary measure so you can pull the new thing you gained into activities. You’ll breathe better the next time you run. You’ll breathe better the next time you hike. You’ll breathe better the next time you lift. You’ll breathe better the next time you cycle.

We follow the same rules with breathing as we do with every other body movement.