The Injury Prevention Roundtable
Featuring Mike Boyle, Eric Cressey,
Bill Hartman, and Mike Robertson
by Nate Green
While injury prevention doesn't have the same sexy ring to it as, say,
"Blast Your Biceps" or "Quick Ways to Increase Your Bench," it's
arguably
the most important aspect of your training. I
mean, how the hell much can you bench press with a screwed up shoulder?
How can you play pick-up basketball with the guys if you're suffering
from anterior knee pain? Whether it's horrible technique,
complete disregard of quality programming, or just plain ol' poor
exercise selection, it's a safe bet that a lot of trainees are making
unsafe decisions in the weight room. Mike Boyle, Eric Cressey,
Bill Hartman, and Mike Robertson sat down with T-Nation to discuss the
finer points of injury prevention and playing it
smart.
Testosterone Nation:
It seems like a lot of trainees are becoming more aware of actually
balancing movement patterns (horizontal pushes vs. horizontal pulls,
vertical pushes vs. vertical pulls, etc.) in their programming. If one
is aware of the importance of this balance and adheres to it in their
training, how important or necessary are isolation movements such as
external rotations and the like?
Mike Boyle: I
think stabilizer work is always necessary. Current research trends seem
to show a difference between training stabilizers and movers. Most of
the conventional multi-joint stuff we do works on the larger movers
(what are referred to in the literature as "global muscles").The local
muscles are small stabilizers and need work of their own. I think the
key is that single-joint movements are helpful for rotary muscles, but
not for hinges.
It goes back to the
joint-by-joint idea. Simple hinge joints (elbow and knee) probably
don't need isolation and will be well served by multi-joint exercises.
Multi-directional joints like the hip and shoulder may benefit from
additional work for the rotators and stabilizers.
Mike Robertson:
In this case, your posture needs to dictate your training. For
instance, if you're already in a kyphotic or slouched upper body
posture, "balanced" training (matching a horizontal push with a
horizontal pull) isn't going to fix the problem!
However,
if you have optimal posture and alignment, the right muscles are
naturally going to be more efficient because you have proper
length-tension relationships. If we take that slouched upper body
posture into movement, your external rotators simply can't produce the
force they're capable of. So until you fix the bad alignment, direct
rotator cuff work isn't going to do too much for you.
Long
story short, if you're in good alignment, go ahead and add in direct
work for the rotator cuff, lower traps, serratus, etc. If you're not,
focus on fixing the bigger issues first and foremost. Eric Cressey: I
agree with Mike Boyle that you have to take it joint-by-joint. You
won't get true full ROM (range of motion) external rotation on many
movements. So it becomes necessary to include some of these movements
in your assistance work to not only build strength in crucial
stabilizing muscles, but also build and maintain active range of
motion.
To be honest, though, it just
seems silly to even debate this stuff. It's an extra set or two in your
warm-up or at the end of a session once a week. If you have the time
and willingness to debate this stuff, I think you'd be better off
devoting some time to charity work. T-Nation: True, but let's debate it anyway. What do you think, Bill?
Bill Hartman:
I think there's support for movement pattern balance when you look at
ideal strength relationships around the scapula, which are pretty much
a one-to-one relationship. The problem that I can see is that this is
misinterpreted or misunderstood by saying things like a bench press
will balance a row.
If
you look at the scapular function in such an exercise selection,
they're not all that different, so it's really not "balanced." Then
take into account that most horizontal pressing exercises provide
proximal (trunk) stabilization (the bench), which means when the
stabilizing muscles like the rotator cuff and scapular stabilizers
would typically shut down the exercise, the prime movers can keep
working.
This creates a case where the
stabilizing musculature can't keep up and larger muscles overcome the
stabilizers, making them relatively weak. The bottom line then is that
if there's an isolated weakness, it needs to be addressed.
This
doesn't even take into account the other potential influences like
spinal mobility and even hip mobility that can affect shoulder
function, though. T-Nation: We
always say that deadlifts are a great exercise when performed
correctly. However, most people have absolutely atrocious form. Do you
think most trainees can deadlift heavy
and well? Cressey: Over
time, yes. Not everyone can pull from the floor right away, though. In
fact, I start most beginners with rack pulls and progress them to the
floor as their dynamic flexibility improves.
It
actually makes it easier to teach as well, as most people struggle the
most with the lockout portion of the lift (using the glutes to complete
hip extension rather than the lumbar erectors to initiate
hyperextension).
To be honest, though, I think that the better question is: "Do most trainers know how to coach the deadlift well?" T-Nation: True. What do you think, Mike?
Boyle:
As a former powerlifter it pains me to say it, but very few people are
able to deadlift both heavy and well. I know many who read this site
have an affinity for the three powerlifts, but I think in the
performance world most coaches have all but abandoned the conventional
deadlift. It still comes back to the risk/benefit idea, though. Robertson: The
average trainee? Is there such a thing? The "average" client I work
with can deadlift heavy and well because I'm working with them in a
one-on-one setting. I'm constantly reinforcing good mobility, proper
posture, and flawless technique.
However,
this "average" client of mine is vastly different from the casual gym
goer who reads about deadlifts in a muscle rag. I'd argue that most of
these people have no business doing deadlifts for multiple reasons:
1. They don't have adequate mobility to assume a good starting position.
2. Most have no concept of "neutral spine."
3. They use absolutely horrendous technique from start to finish.
4. The majority also use excessive loading too soon.
I love deadlifts, but there are a lot of people out there doing more harm than good by performing them.
Hartman: If
you're self-taught in the deadlift, it may be a good idea to get some
instruction from a qualified coach. So I guess my answer would be that
no, most can't deadlift well from what I've seen.
In
fact, you can throw about any lift from the floor into this category.
Many just don't grasp the need for sufficient mobility, trunk strength,
and scapular strength to take a barbell safely from the floor.
The
deadlift also seems to be the one exercise where technique goes out the
window in an effort to pull more weight to satisfy the ego. That said,
deadlifts certainly have their place. T-Nation:
Okay, let's talk deloading. When it comes to training, just how
important is it? Any general rules of thumb in terms of volume,
frequency, and the like? Robertson: The
greater the training and chronological age of the athlete, the greater
the need for deloading. Each and every time they train they impose
greater demands on their bodies, therefore necessitating more recovery.
I've also found that I need to cut back more so than others when it comes to unload weeks. For instance, in my Modified 5x5 Squat Routine
article, I discussed how when I cut back my volume/intensity on my
unload weeks, I saw even greater gains on my loading weeks. After all,
we're not trying to set PR's on unload weeks, right?
The
"it depends" answer works well here, but I think this is a very
individual thing and something each trainee should learn to understand
for himself. Cressey: In a nutshell:
1.
Beginners really don't need to worry about deloading. Changing
exercises alone comprises enough of a deload because fiber recruitment
and overall volume drop when you impose a new challenge.
2. Intermediates do well with maintaining intensity, but dropping volume.
3. Advanced lifters generally need to drop intensity
and volume. Along
the injury prevention lines, a valuable approach with the deload is the
"prehab week." Basically, I just substitute a higher volume of
corrective training exercises to replace the ordinary assistance work
in the program. For instance, we might do an extra two to three sets of
seated rows and drop the close-grip bench presses altogether. Hartman: From
a performance standpoint, the greater the amount of fatigue that you
can induce, the more important deloading becomes. Fatigue has to be
able to dissipate or progress stagnates. Nothing new there, but a lot
of guys don't consider that the structural tissues need time to adapt
to progressive loading.
How many guys
set a gym PR and then try to go for more weight? Sure you may have the
muscular strength, but I'd hazard to guess that most don't consider
whether they have the connective tissue strength to handle such
loading.
For dynamic athletes, it's even more
important because in a single week they may be lifting explosively,
running, and performing jumping exercises. That's a tremendous stress
to your connective tissues, where most injuries are from cumulative
trauma.
T-Nation: Good point, Bill. What say you, Mike? Boyle: This
is an area where Jason Ferrugia has really opened my eyes in the last
month. I think Jason has really looked at things from the performance
side and come to some great conclusions. The reality is his thoughts on
CNS fatigue are going to cause me to rewrite a lot of workouts.
This
again illustrates the disconnect between powerlifting and performance.
Powerlifters don't have to worry about the volume of sprinting, Olympic
lifting, plyometrics, and conditioning work impacting their pursuit of
strength. Other athletes do.
I think when many of
us follow a conjugate template we're frying the nervous system. Jason
pointed this out to me a few weeks ago. As much as I wanted to argue,
he was right. In our periodization scheme, it's not unusual for us to
do five to six CNS intensive exercises in a week between squatting,
Olympic lifting, plyometrics, and speed work.
We
really need to look at the amount of CNS intensive work we're doing and
try to balance it. From a frequency standpoint, I'm going to move from
a situation where I work each strength pattern twice a week to once a
week.
Jason also had some great points about
upper body versus lower body. My previous feeling was that upper body
might benefit from less frequency more than lower body. The thing I
wasn't accounting for was the cumulative CNS fatigue of all the
non-strength lower body work we do. T-Nation:
It seems that for more and more strength trainers, elbow extension
exercises such as skull crushers are being replaced with heavier
compound movements such as board presses, floor presses, etc. But are
we saving the elbows at the expense of the shoulders?
Hartman: Considering the fact that I'll use limited range pressing to spare the shoulders, I'd have to provide a conditional no.
The limited range can reduce the demands on the rotator cuff to stabilize the shoulder, so it
canhave
a sparing effect. However, in the cases of extreme loading, if the
loads used exceed your ability to effectively stabilize the shoulder
joint, then you're talking about potential wear 'n tear. T-Nation: Eric, are we saving the elbows but jacking up our shoulders?
Cressey: I think so. As I mentioned in my 13 Tips for Mighty Elbows and Wrists
article, it's likely a matter of the muscles crossing a joint becoming
too strong for the joint itself. This is even more readily apparent in
guys with smaller joints. I'd much rather have the load distributed
among the scapulae, shoulders, elbows, and wrists than just place it
right on the elbows.
Boyle: I
don't think this is the case. Historically, most good lifters have
favored multi-joint assistance work over single-joint assistance. I
wouldn't say this was true in every case, though. I don't remember
reading about too many great bench pressers who were big single-joint
assistance guys. Most recommend exercises like close-grip bench press
or dips to improve the bench press.
I
think most shoulder problems relate more strongly to the volume and
intensity of pushing versus pulling than to an elbow-oriented
assistance strategy versus a shoulder-oriented assistance strategy.
Accueil 
Robertson: This
Cressey: Let me preface my response by saying that I love watching Olympic lifting; it's a great sport. In fact, it's such a great sport