A Philosophy of Strength and Health

ACL injuries do not happen in a void. People sustain injuries when their infrastructure is unable to manage a specific set of physical circumstances. To describe the mechanism of the injury without the context of the person and their level/type of sport, is to miss valuable insight. In sport, we prepare the person, to the best of our understanding, to meet the physical demands of that sport. We do not just work to prevent one particular injury; we prepare athletes to navigate the total sport physical environment. By "we" I mean the coaching and support staff -- specifically the athletic development staff.  Athletic development (AD) coaches prepare athletes through the development of physical literacy and movement competencies via movement progressions. It is more than strength, power, agility; it is the acquisition of knowledge, skills, abilities and behaviors to manage themselves within the entire sporting environment. At the higher levels of sport, AD coaches coordinate wit

Young coaches and clinicians are overwhelmed with information and ideas. There is so much stuff to wade through these days.  (Here is a thought: instead of constantly crying out for "more" research, how about firmly eliminating and deleting the piles of myth and bad information out there that clutter the landscape? How about refining our processes of implementing the good knowledge that is already out there? Listen to the The Knoweldge Project podcast episode 42 with Atul Gawande -- love his thoughts on medical ignorance vs ineptitude, along with the problems of autonomy/assumptions of mastery afforded medical professionals after completing formal training and acquiring titles/letters.) Part of maturing as a professional is building a solid bullshit filter and the confidence to say "No" to methods or tools that do not serve you well. This comes from making your own mistakes and learning from the mistakes and experiences of others. Shout out to all the mentors.  Eli

Knee rehab is rife with shallow work. Historically, we have been distracted by the idea of "neuromuscular control" -- people standing on unstable surfaces with a 30 deg knee flexion angle, being perturbed, in search of the holy grail of hamstring co-contraction. And we forgot to ask people to bend and straighten their knee. To develop knee extensor strength -- THE KEY TO KNEE HEALTH. We now (again) have to use isokinetic devices to tell us what the knee extensor strength is because we have lost the skill and ability to program and observe movement that develops and is indicative of that strength & capacity. Note: I am not saying it isn't important to inform RTS with objective measurement. I am saying that many clinicians now rely on those occasional measures solely because they do not have the ability to design in session challenges / progressions that ask the patient to demonstrate and express the necessary capacities and movement competencies.  Now, there is a new d

The term "strength" comes with many images and stereotypes. The most common stereotype usually includes intimidating men who look like action figures, in spaces that look like iron jungles. Strength is associated with mass gain, limb girth increases, muscle hypertrophy and maximal force production against an external load. With regard to lower body strength, we speak in terms of multiples of bodyweight (BW), with the ratio of 2x BW historically viewed as necessary and desirable. We have historically trained in terms of 1 RM. There has been a trend recently to adopt a VBT (velocity based training) approach, as we know 1 RM changes on a daily basis and technology now allows us to more finely tune things with velocity as the target within each set. These things can be helpful as we initially learn to measure and document progress. But I think it is important to step back from this narrow outlook, because this view of strength does not serve all of us well, in either the rehab or

2015. Chloe Kim warms up for a commercial video shoot at 11 pm. It is 20 deg F. I talk explicitly with my athletes about warm up and the importance of taking it seriously. This is specific work that gives us information and it forms the foundation for that particular session. It is not just about raising body temperature or sweating. Nor is it a time for mindless busywork. There will be general things that work for an entire team; but there will also be things that are specific to the individual athlete. It is important to allow each athlete to have input into their warm up. Personal accountability here helps develop good overall habits and lays the foundations for a lifetime of using movement for self-care. Intentional effort is important. This is the time where one learns to become "in tune" with the body and its potential physicality. The only way to do this is to work through a variety of movements, repeatedly, over time. These experiences allow you to choose those moveme

I am reviewing things for a new project and this blog post from April 2020 has some things I want to keep in mind. Thought I would share it again. Might prompt some good reflection for the physio crowd. ----- Last week Donie Fox had a great article for HMMRMedia --  "Using Foundational Legs Exercises as the Cornerstone of Rehabilitation."  Check it out if you haven't already. Donie's article is important in my mind because it addresses a critical issue in the rehab world. There is a serious lack of appreciation for and mastery of the use of basic movements (squats, lunges, step ups) to build foundational lower extremity strength. Donie and I have decided to go into more depth on this topic in our next few podcasts. We will also hopefully touch on return to running programming criteria. Here are some barriers, in my opinion, to rehab professionals adopting a "foundational legs" approach. I'm not trying to be overly critical or a curmudgeon here. I am simp