Squat Science

The squat, a movement that most believe is a fundamental pattern to humans; a movement that we should strive to train and maintain for performance and just general wellness.

It is also a topic of much debate when it comes to HOW to perform a squat...

• What stance?
• What width?
• What toe angle?
• What bar position?
• What variation?
• How deep?

I've worked with close to a thousand athletes and guess what… they all squat differently.  Different stance widths,  different foot positions, different depths, different variation preferences, different bar positions, etc.  

I'm tired of hearing athletes being told they MUST squat a certain way or there is only ONE way to squat… that is rubbish and certainly isn't rooted in science. 

Let's think about this - do you really think someone 6'6 should squat the same as someone 5'2?  Should someone with long femurs and a short torso squat the same as someone with short femurs and a long torso?  Should someone with retroverted hips squat the same as someone with anteverted hips?

If I have a group of 20 athletes and had them all squat with a stance of their preference, to a depth they felt comfortable, with a toe angle that allows the most freedom - you know what I'd find?  20 different squats with different widths, foot angles, depths, trunk angles, etc.  

So why do coaches, PT's still try to jam a square peg into a round hole by thinking there is only one way for people to squat?  You NEED to squat with toes forward, in a shoulder-width stance, to a parallel depth!

Now I'm a man of science, not just anecdotal evidence, so let's see what some of the literature on anatomy and skeletal structure of the hips says and how this may effect the squat

• The femoral neck/head isn't the same in every person.  Zalawadia et al (2010) demonstrated that as much as 24-degrees difference in anteversion and retroversion is common.  Zalawadia also noted that these differences of anteversion and retroversion can differ from side to side - not all hips are symmetrical!  

With sooo much potential variation is peoples hips, not to mention potential side to side difference in the same person - you still think everybody's squat should look EXACTLY the same?  Femoral and acetabulum structure will play the main role in ones ability to squat in certain positions to certain depths - NOT a universal preference made up by some person. 

• Laborie et al (2012) noted that anteversion and retroversion isn't strictly contained to the femoral head, it can also be present in the acetabulum.  They looked at  over 2000 samples of centre-edge angles of the acetabulum  and found angles differed from 20.8-45 degrees

Again, how can we expect someone with a 20.8-degree anteversion to squat the same as someone with a 45-degree retroversion?

• Knutson (2005) looked at leg length, and found that about 90% people have a discrepancy with the average difference of about half a centimeter.
• Flanagan  & Salem (2007) examined different kinetic variables in the squat of 18 experienced lifters. They looked at many things including average joint moments at the hip/knee/ankle, ground reaction forces in each foot, center of pressure for each foot, and maximum flexion angle at the knee/hip/ankle. They found many things (some statistically significant, others not) including side to side differences in center of pressure, ground reaction forces, and joint moments at the ankle, knee, and hip (especially the hip). The researchers concluded that NOBODY was balanced and every subject demonstrated differences in at least on of the joints (ankle, knee, hip)

It is COMMON that people squat with asymmetries and differences from side to side.  It's normal to have someone feel and perform better with one toe angled out/in, staggered forward/backward,   externally/internally rotated compared to the other.

If pain isn't present - THERE IS NOTHING WRONG WITH THIS - and it's likely aiding in performance, comfort, and health.  We aren't symmetrical beings and sometimes forcing symmetry may actually be taking someone out of their "neutral".  

Want to see what these differences actually look like?  Check out the below photos and see how these skeletal structures can differ and visualize how they'll dictate an athletes optimal squat.

If we tried to take these people and squat them in a toes forward, shoulder width stance, to parallel, what do you think would happen?

Some would ace the test, while others would fail miserably… why?

Much of it would have to do with this structure - NOT some mobility, stability, strength, motor control dysfunction, but rather something they CANNOT change - their bone structure.

We seem to be in a stage where we see someone whose can't squat deep, or prefers a wide stance, or turns their feet turn out, or has butt wink and we jump all over them with how their "insert joint/muscle" is tight/weak and needs soft-tissue, mobility, or activation work, BUT in many situations, no matter what correctives, or soft-tissue, or crazy mobility you throw at the athlete - they just won't be able to squat in certain positions.

Let's wet our whistle with a little bit more literature

• Elson and Aspinal (2008) showed what is tremendously obvious for coaches that actually work with people - there are vast differences in range of motion in hip flexion and extension - meaning some people are just better suited for deep hip flexion (deep squat), while this position would cause massive problems for others. 
• D'Lima et al (200) demonstrated that differences in femoral neck/head thickness (as little as 2mm) could impact hip flexor ROM by 1.5-8.5 degrees.  
• Lamontagne et al (2009) looked at people with femoroacetabular impingement syndrome (FAI) and squat ability and concluded due to anatomical variations at the hip such as cam or pincer, there are plenty of lifters who will never be able to deep squat with proper form.

So should everybody squat to parallel or ass to grass?  Should everybody have the same stance width and toe angle?

NO!!!

Some have a tendency to squat deep, while others have tendency for hip extension.  If we force them to parallel or ass to grass we may be forcing bone on bone or a hip impingement - not good things.   The only people that NEED to squat to parallel are powerlfiters, it's a requirement of their sport.  As for athletes, there is no rule book that says you have to squat to parallel or beyond - it's not a requirement nor is it going to make or break performance.

Again, ones ability to squat to different depths in different stances can be explained by their skeletal structure - NOT necessarily mobility or soft tissue or strength issues.  It also means trying to say everybody should squat the SAME WAY is a terrible thought process and could actually be causing more harm than good.

Here's a quote from the great Stu McGill, considered the World's foremost expert on spinal health - "The most important matter on all of this is the depth of the hip socket. If people are looking up on the internet, depth of the hip socket and squat ability, they won’t find it. They have to go to the hip dysplasia literature. What they’ll find is that there are groups in the world with very shallow hip sockets (allow greater hip flexion) and some with deep hip sockets (make it difficult for deep hip flexion)."

Even the World's expert says it's structure that dictates deep squat ability, it's NOT some universal standard.

​Insert pictures of strong peeps, lifting heavy things and what do you see?

No identical stance, depth, toe angle, etc. 

​Why again do we try to force people to squat a certain way, to a certain depth?  Coach athletes as individuals. 

Let's look at some more myths that pertain to squatting

Knee's Can't Go Beyond The Toes

Here is another myth is purported in all areas and there’s little evidence to support this claim. The knees passing beyond the toes is not some universal point where all of a sudden the stresses on the knee become dangerous and every point before that is safe. 

You know what's even more?  Artificially restricting or trying to prevent forward movement of the knees may be detrimental to the hips and back. Fry et al (2003) looked at the effect of restricted squats where a wooden board was placed in front of the lifter that didn't allow the knees to track past the toes.  

​What did they find?  

Restricted Squat

As expected, the board restricted setting reduced torque on the knees, but increased torque at the hip and low back.  So you take stress on one joint, only to increase it at another - so pick your poison.  
The researchers concluded, "Exercise technique guidelines should not be based primarily on force characteristics for only one involved joint (e.g., knees) while ignoring other anatomical areas (e.g., hips and low back).”  

Artificially or cueing an athlete to change their natural mechanics may effect the joint being cued, but those forces and torque need to go somewhere.   

While shear forces have been shown to increase in the deep squat position with forward knees, the body can handle them appropriately without risk for injury (Schoenfeld (2010)).   The most thorough review of squat depth on knee pain showed the demands on these tissues in a deep squat are well below the maximum that those tissues can withstand (Hartmann et al (2013)).  THEY AREN'T DANGEROUS!
​
Plus, every Olympic lifter of all-time, theoretically should have messed up knees and some PT would tell them they're lifting wrong…

Squat Stance and Squat Variation

Guess what - the type of squat you use isn't vastly different from each other.  EMG between a front squat and back squat aren't that different and some studies even showing NO STATISTICAL DIFFERENCE in muscle activities between front and back squats.  (Contreras et al (2016); Gullet et al (2009)).  In general, the front squat will lead to slightly more quad activation and thoracic extension strength; while back squat slightly more glute/hamstring activation, but again, the EMG difference between the two isn't likely a good reason for choosing one over the other.

How about wide stance vs narrow stance?

Wide stance squats tends to activate greater adductor and glute compared to narrow squat, with no difference between quad activation (Escamilla et al. (2001); Paoli et al (2009); Steven & Donald (1999)).  Swinton et al (2012) recently demonstrated exactly this as the researchers showed EMG results for glute activation were significantly higher in a wide stance compared to a narrow stance.  These EMG results also showed that quadricep activation between the stances were identical - concluding, muscle activation wise, a narrow stance isn't superior to a wide stance.

How about toe angle or hip angle?

Ninos et al. (1997) found no difference in vastus medialis activation between barbell back squats with two different hip rotation angles (feet pointing outwards vs. feet pointing forwards).  While, Pereira et al (2010) found externally rotating the hip to 30 and 50-degrees resulted in greater hip adductor activation with no change in rectus femoris activation, leading the researchers to conclude that squatting to 60-90 degrees of knee flexion with 30 degrees of external rotation maximized muscle activation.

Again, there is NO LITERATURE supporting the NEED to squat with toes forward! Rather than squatting with your toes forward or pointed out to a predetermined degree and forcing your knees and hips to follow along, you’re better off seeing what hip and knee position feels the strongest and most comfortable, and letting that determine how far out you point your feet (Nuckols (2016))

In a great review of all the variables that effect muscle activation of a loaded back squat, Clark et al (2012) concluded, research of common variations such as stance width, hip rotation, and front squat do not significantly affect muscle activation.  Turning the toes out, however, only changes the activation of the adductor muscle group. The glutes and quads (the main movers in the squat) are not significantly activated to a greater extent by any of the variables (Clark at el (2012)).

So we've seen, specific squat variations - wide, narrow, toes forward, toes out, depth - aren't make a break factors when it comes to muscle activation, joint stress, or performance.

So again, why would be ever think there is only one way to squat and what would make this way superior?  The fact is, there isn't a single strategy to squat and instead should be dictated upon by the individuals unique skeletal structure, limb lengths, past injury history, mobility/stability factors, and biomechanics.

Here's just a small list of things that influence squat mechanics 

• Foot Wear (elevated heel vs flat heel)
• Long Tibia vs Short Femur
• Short Tibia vs Long Femur
• Short Femur vs Long Torso
• Long Femur vs Short Torso
• Body Mass
• Stance Width
• Toe Angle
• Foot Size (Length)
• Cueing
• Anterior vs Posterior Chain Strength
• Specific Joint Mobility and Stability Strengths and Weaknesses
• Bar Position

Linked below is a really cool that demonstrates how different body part lengths, stance width, bar positioning, etc effect the outcome of a squat will look like - again it's basic biomechanics - http://mysquatmechanics.com

Here are some pictures of how simply changing levers, stance width, ankle mobility, and bar position effect the end look of a squat

All-In-All

The goal of this article is to demonstrate there is no universal way to squat and we need to work to allow and find our athletes optimal way to squat based on their individual anatomy, levers, mobility/stability needs, past injury history, etc - and NOT try to pigeon-hole everybody into a certain way of squatting.

Please share this with anybody you think would benefit and let's stop the squat stupidity from spreading. 

 PS - Below are some squat assessment videos on what we might use to assess our athletes to find their best squatting stance. 














References:

 Clark, D. R., Lambert, M. I., & Hunter, A. M. (2012). Muscle activation in the loaded free barbell squat: a brief review. The Journal of Strength & Conditioning Research, 26(4), 1169-1178.

Contreras, B., Vigotsky, A. D., Schoenfeld, B. J., Beardsley, C., & Cronin, J. (2016). A comparison of gluteus maximus, biceps femoris, and vastus lateralis electromyography amplitude in the parallel, full, and front squat variations in resistance-trained females. Journal of applied biomechanics, 32(1), 16-22.

Escamilla, R. F., Fleisig, G. S., Lowry, T. M., Barrentine, S. W., & Andrews, J. R. (2001). A three-dimensional biomechanical analysis of the squat during varying stance widths. Medicine and science in sports and exercise, 33(6), 984-998.

Flanagan, S. P., & Salem, G. J. (2007). BILATERAL DIFFERENCES IN THE NET JOINT TORQUES DURING THE SQUAT EXERCIS. The Journal of Strength & Conditioning Research, 21(4), 1220-1226.

Gullett, J. C., Tillman, M. D., Gutierrez, G. M., & Chow, J. W. (2009). A biomechanical comparison of back and front squats in healthy trained individuals. The Journal of Strength & Conditioning Research, 23(1), 284-292.

Hartmann, H., Wirth, K., & Klusemann, M. (2013). Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load. Sports medicine, 43(10), 993-1008.

Knutson, G. A. (2005). Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & osteopathy, 13(1), 1.

Lamontagne, M., Kennedy, M. J., & Beaulé, P. E. (2009). The effect of cam FAI on hip and pelvic motion during maximum squat. Clinical orthopaedics and related research, 467(3), 645-650.

Ninos, J. C., Irrgang, J. J., Burdett, R., & Weiss, J. R. (1997). Electromyographic analysis of the squat performed in self-selected lower extremity neutral rotation and 30 of lower extremity turn-out from the self-selected neutral position. Journal of Orthopaedic & Sports Physical Therapy, 25(5), 307-315.

Nuckols, Greg.  http://strengtheory.com/how-to-squat/. 2016

Paoli, A., Marcolin, G., & Petrone, N. (2009). The effect of stance width on the electromyographical activity of eight superficial thigh muscles during back squat with different bar loads. The Journal of Strength & Conditioning Research, 23(1), 246-250.

Pereira, G. R., Leporace, G., das Virgens Chagas, D., Furtado, L. F., Praxedes, J., & Batista, L. A. (2010). Influence of hip external rotation on hip adductor and rectus femoris myoelectric activity during a dynamic parallel squat. The Journal of Strength & Conditioning Research, 24(10), 2749-2754.

Schoenfeld, B. J. (2010). Squatting kinematics and kinetics and their application to exercise performance. The Journal of Strength & Conditioning Research, 24(12), 3497-3506.

Steven, T. M., & Donald, R. M. (1999). Stance width and bar load effects on leg muscle activity during the parallel squat. Med Sci Sports Exerc, 31, 428-436.

Swinton PA, et al (2012) A Biomechanical Comparison of the Traditional Squat, Powerlifting Squat, and Box Squat. The Journal of Strength & Conditioning Research 26(7):1805–16​​

The False Reality of the FMS

The Functional Movement Screen (FMS) is a popular screen used by coaches and sports medicine professionals as a screen for movement competency.  It is composed of 7 movements and scored on a 0-3 scale, where 0 = pain, 1 = couldn't perform the task, 2 = performed task with compensation, 3 = performed task correctly.

The scores from the 7 movements are combined into a final score out of 21.  The score is supposed to predict injury and performance and it is even suggested that scores under 14 predict a greater risk of injury.

The FMS claims to identify compensatory movement patterns that are indicative of increased injury risk and inefficient movement that causes reduced performance.

That's a pretty big claim and one the FMS has NOT lived up to.  

First and foremost, the FMS is supposed to be a SCREEN and unfortunately practitioners far out-reach the boundaries of a screen when applying the FMS.  The FMS places labels on people and their movement and with anything that places labels, we certainly hope there is some strong evidence that supports these labels.

This is tremendously important because when someone scores poorly on a test, they get told their chance of getting injured is high and their performance is decreased. This only implants fear and guarding in the client, rather than confidence and overall is a great way to build fear of movement and sport.  Coaches and those in sports medicine NEED to get beyond telling clients that because they score poorly on a test, they'll get injured - this isn't beneficial to anyone.

Again, the FMS is supposed to be used as a screen, NOT a diagnostic tool… it doesn't and should NOT be used to diagnose things.  Yet, I hear people all over, use the FMS to diagnose supposed dysfunction.

It is a baseline screen, and honestly only scratches the surface of what else needs to be assessed. I have heard of athletes who performed the FMS on them, and then get told rash diagnoses and/or put fear in the athlete basically saying that it's a miracle they can even make it through a day of school with all the dysfunction's they have.

"You shouldn't squat based on your OH Squat assessment; 

your core is sooo weak; you have tight hamstrings - you shouldn't sprint; 

you have an asymmetrical rotary stability score - you will get injured if you don't improve it"

Given all radical leaps in faith the FMS asserts, let's take a closer look at various aspects of the FMS and their claims

The FMS claims to identify compensatory movement patterns that are indicative of increased injury risk and inefficient movement that causes reduced performance.

This is the big one I'll address because it claims an awful lot, and as you'll see, without much scientific support.

In order for the FMS, or any screen for that matter, to be a valid indicator of injury or inefficient movement in sport, it is logical that the compensatory movement patterns that are tested during the screen must be the same or similar to those that are performed in sport - which the FMS does not (Beardsley)

• Dossa et al. (2014) studied junior level hockey players to see if the FMS could predict injuries throughout a season.  The researchers concluded the FMS could NOT be recommended as a screening tool for injury prevention.

• McCall et al. (2015) reviewed the scientific level of evidence of three of the most commonly-reported risk factors, screens, and injury prevention exercises in a previously published survey of 44 premier league soccer teams. The FMS was one of the identified screens. They assigned the FMS a grade D, where D = insufficient evidence to assign a specific recommendation.  

• Parchmann et al. (2011) studied the FMS to evaluate whether it was related to sport performance and found there were NO significant correlations between the higher FMS scores and on-field sports performance.

• Even the founders of the FMS did a literature review on the FMS and stated “the use of a total FMS score for predicting injury risk should be avoided, as the individual components of the test are not correlated with one another and are therefore not measuring the same underlying variable" (Cook et al. (2014)).

• Several researchers have assessed FMS scores on athletes of different ability levels to see if higher performing athletes scored higher on the FMS compared to lower level athletes.  They found there to be no difference between FMS scores and the level of the athlete.  This shows that the FMS does not and cannot predict performance. (Fox et al. 2013; Grygorowicz et al. 2013; & Loudon et al. 2014). 

• Lockie et al. (2015) found very little correlation between FMS scores and multidirectional speed and jumping tests in healthy male subjects. 

• In addition, many investigations have been performed to assess the correlations between sprinting, jumping, throwing and agility performances and FMS scores and most have found no relationship between any measure of athletic performance and FMS score (Okada et al. 2011; Parchman et al. 2011; Lockie et al. 2015b).

• When it comes to predicting injury, Dallinga et al. (2012) reviewed the literature in respect of the tests that could predict a greater risk of injury.  They reported that general joint laxity, the Star Excursion Balance test, age, a lower hamstring-to-quadriceps strength ratio, and a reduced hip abduction range of motion could all predict a higher risk of lower body injuries.                        To test an aspect of this injury prediction model, Paszkewicz et al. (2013) investigated the association between total FMS score and Beighton and Horan joint mobility index (BHJMI) in adolescent athletes. They found no correlation between total FMS score and BHJMI index.  We also know the FMS can't target any of the other aspects shown by Dallinga et al. (2012) as being predictive of injury. 

• A major flaw with the FMS is it's ability or lack of ability to distinguish between athletes. Shouldn't we assess individual variances between athletes in different sports?  A baseball player should definitely be assessed differently than a cross country runner or an offensive lineman in football.  Each one of these athletes will exhibit markedly different mechanical adaptations based on the demands of their sport and position.  Whose to say these adaptations are wrong or bad?  "Faulty" movement patterns do not always lead to pain or injury and in many cases these adaptations are what make athletes better performers in their sport.  Guess what, tissues positively adapt and get stronger based on the stresses placed on them… this is why a pitcher's arm will be very different from others - and this IS NOT a bad thing.  Poor posture does not mean its pathological nor does it mean that person will suffer from more musculoskeletal problems.  So can we please STOP TELLING ATHLETES THIS

The FMS Can Predict Injury

Short answer - NO IT DOESN'T

• Schneiders et al. (2011) looked to find normative values in the FMS with young athletes.  They evaluated the FMS based on the assumption that identifiable biomechanical deficits in fundamental movement patterns have the potential to limit performance and render the athlete susceptible to injury.  In this study, the researchers found that healthy individuals and previously injured individuals had the same scores.  So the FMS could not even detect differences in injured individuals compared to healthy ones.  This is of concern as past injury is a main risk factor of future injury. If FMS cannot detect any sign of recent injuries, it seems unlikely that it can detect future risk, let alone be used as a basis for a specific therapy.

• Frost et al. (2013) questioned the ability of the FMS to assess dysfunction. They looked at 21 firefighters who initially performed a standard screen followed by a repeat screen 5 minutes later, but on the 2nd trial participants were given a verbal description of the grading criteria before performing each test. All firefighters improved their scores within minutes of being told what movement patterns were required - The average score improved from 14.1 ± 1.8 to 16.7 ± 1.9 points; remember in just 5-MINUTES.  Therefore, changes in FMS score may not be due to actual improvements in mechanical efficiency such as mobility, stability or coordination of an athlete but rather simply a knowledge of what the task requires.   This isn't the first time this outcome has been shown, as there are indications that subjects may deliberately alter their movement patterns during the FMS test in order to score higher (Teyhen (2012); Schultz (2013)).  This is supposed to be a reliable screen?

• To piggyback the last bullet point - The FMS sum score appears to be very reliable between raters (inter-rater) and within raters for a video of the same test (intra-rater). However as we just discussed, test-retest is less reliable, indicating that the same subjects may score differently on different occasions, despite there being no biomechanical changes made (Beardsley).

• Okada et al. (2011) studied the relationship between FMS scores and "core" strength on actual sport performance.  To keep beating a dead horse, it was found "core" strength and FMS scores are NOT strong predictors of sports performance… yet PT's continues to tell clients/athletes core strength and quality FMS scores are important for performance and pain.

• As I said earlier, it has been suggested that scores under 14 predict a greater risk of injury.  BUT, O'Connor et al. (2011) demonstrated that scores of 18 or more were more at risk for injury than those who scored less than 18 in 874 marine officers.  Scores above 14 are supposed to have decreased risk of injury, not the opposite, especially with a score so close to being perfect. 

These 7 Tests Predict Global Movement?

At the end of the day, it is a far stretch to think these 7 tests somehow can predict an athletes global movement, especially when the athlete is under load, speed, chaos, and fatigue.

Yet, some believe that these slow, safe, pre-planned, mostly static tests will predict dynamic movement.   It's one thing to do tests in a very controlled, passive type of environment compared to dynamic. I've seen a lot of good things in table assessments or FMS type screens, only to go to HELL under speed or load… Let this be clear, while these screens can have some benefit, they tend to have absolutely NO transfer to dynamic, reactive, and chaotic environments such as sport.

For example, what do we gain from the Overhead Squat (OHS)?

Let's be real here, using the OHS as an assessment of general movement ability, is like using a tennis serve to test coordination (Quote from Dr. Cobb of Z-Health).  The OHS is arguably the most complex version of a squat.  So instead of starting with a baseline test and a more basic squat version, we skip A-Y and go straight to Z. In addition, squatting while reaching overhead is not something that humans are designed to do. It is a skill, and anybody, the first time you ask them to perform something that is completely new to them will struggle.  Chances are, the faults you find in the OHS are due to a lack of performing this specific task as opposed to a lack of good general movement patterns.

Also, why are no other squat assessments used, such as adding a counter-weight (clarify mobility vs stability needs), taking a wide stance, letting toes track outward, using an asymmetrical stance, etc.

Nope, instead the FMS forces everybody to take a shoulder width stance with toes forward and discounts the fact that everybody's hip anatomy is different and to say that you need to be able to OHS with a shoulder-width stance, with toes forward is absurd… how are still on this? Take a look at the pictures below and tell me if these people should be judged on the same squatting scale given their vastly different anatomical structures.

It's like trying to fit a square peg into a round whole when we say you should be able to squat in this stance - to this depth and apply it to the whole population.

In Closing

This isn't to say that the FMS is useless, but let's be real, anybody with a grasp of anatomy and biomechanics can clearly see the gaps in reasoning in using solely the FMS as an assessment tool.

Now, the FMS and those who use it, do a wonderful job of marketing and "scaring" athletes/clients into thinking that because they scored poorly, they need additional training.  I mean, it's a beautiful system in a business sense, although as I've shown, it lacks support from research to do what it claims to do.

So a word of caution to athletes/clients/parents - usually those promoting the FMS have something to sell.  They'll show you where you're "lacking" and probably have some program that will "fix" these problems.

A word to coaches and professionals - come up with your own assessment that is based in science and evaluates the athlete not only statically, but dynamically and in a manner that is the same or similar to those that are performed in sport.  Also, please use tremendous caution when telling athletes/clients they are "broken" or dysfunctional or on their way to injury.  This is bad business and psychologically damaging to the athlete/client and only creates fear of movement.


Check out our Elite Performance Podcast for a little breakdown of what goes into our assessment process (Starting at 4:00-14:00min)




Go Get 'Em!


References:

       Beardsley - https://www.strengthandconditioningresearch.com/functional-movement-screen-fms/#CONT

       Cook, G., Burton, L., Hoogenboom, B. J., & Voight, M. (2014). Functional movement screening: the use of fundamental movements as an assessment of function-part 2. International journal of sports physical therapy, 9(4), 549-563
     
       Dallinga, J. M., Benjaminse, A., & Lemmink, K. A. (2012). Which Screening Tools Can Predict Injury to the Lower Extremities in Team Sports?. Sports medicine, 42(9), 791-815

       Dossa, K., Cashman, G., Howitt, S., West, B., & Murray, N. (2014). Can injury in major junior hockey players be predicted by a pre-season functional movement screen–a prospective cohort study. The Journal of the Canadian Chiropractic Association, 58(4), 421.

       Fox, D., O’Malley, E., & Blake, C. (2014). Normative Data for the Functional Movement Screen™ in Male Gaelic Field Sports. Physical Therapy in Sport.

       Frost, D. M., Beach, T. A., Callaghan, J. P., & McGill, S. M. (2013b). FMS™ scores change with performers’ knowledge of the grading criteria-Are general whole-body movement screens capturing” dysfunction”? The Journal of Strength & Conditioning Research.
       

       Grygorowicz, M., Piontek, T., & Dudzinski, W. (2013). Evaluation of Functional Limitations in Female Soccer Players and Their Relationship with Sports Level–A Cross Sectional Study. PloS one, 8(6), e66871

   
       Lederman E. The Myth of Core Stability. Journal of Bodyworks Movement Therapy. 2010 Jan;14(1):84–98.       

       Lockie, R. G., Schultz, A. B., Jordan, C. A., Callaghan, S. J., Jeffriess, M. D., & Luczo, T. M. (2015). Can selected functional movement screen assessments be used to identify movement deficiencies that could affect multidirectional speed and jump performance?. The Journal of Strength & Conditioning Research, 29(1), 195-205

       Loudon, J. K., Parkerson-Mitchell, A. J., Hildebrand, L. D., & Teague, C. (2014). Functional movement screen scores in a group of running athletes. The Journal of Strength & Conditioning Research, 28(4), 909-913

       McCall, A., Carling, C., Davison, M., Nedelec, M., Le Gall, F., Berthoin, S., & Dupont, G. (2015). Injury risk factors, screening tests and preventative strategies: a systematic review of the evidence that underpins the perceptions and practices of 44 football (soccer) teams from various premier leagues. British journal of sports medicine.

       Okada, T., Huxel, K. C., & Nesser, T. W. (2011). Relationship between core stability, functional movement, and performance. The Journal of Strength & Conditioning Research, 25(1), 252-261
    
       O’Connor, F. G., Deuster, P. A., Davis, J., Pappas, C. G., & Knapik, J. J. (2011). Functional movement screening: predicting injuries in officer candidates. Med Sci Sports Exerc, 43(12), 2224-30.

       Parchmann, C. J., & McBride, J. M. (2011). Relationship between functional movement screen and athletic performance. The Journal of Strength & Conditioning Research, 25(12), 3378-3384.
  
       Paszkewicz, J. R., & Cailee Welch McCarty, D. (2013). Comparison of Functional and Static Evaluation Tools Among Adolescent Athletes. The Journal of Strength & Conditioning Research.

       Schneiders, A. G., Davidsson, Å., Hörman, E. & Sullivan, S. J. (2011). Functional movement screenTM normative values in a young, active population. International Journal of Sports Physical Therapy, 6(2),75.

        Shultz, R., Anderson, S. C., Matheson, G. O., Marcello, B., & Besier, T. (2013). Test-Retest and Interrater Reliability of the Functional Movement Screen. Journal of athletic training, 48(3), 331-336

       Teyhen, D. S., Shaffer, S. W., Lorenson, C. L., Halfpap, J. P., Donofry, D. F., Walker, M. J., & Childs, J. D. (2012). The Functional Movement Screen: a reliability study. The Journal of Orthopaedic and Sports Physical Therapy, 42(6), 530-40

       Unsgaard-Tøndel M, Fladmark AM, Salvesen O, Vasseljen O. Motor Control Exercises, Sling Exercises, and General Exercises for Patients With Chronic Low Back Pain: A Randomized Controlled Trial With 1-Year Follow-up. Phys Ther. 2010 Jul.

Cupping and Other Olympic Shenanigans

The Olympics are awesome, I mean truly incredible, but every four years the Olympics brings with it pseudoscience and pseudo-performance enhancements that the TV announcers/networks love to exploit.

I mean we still hear announcers talk about getting rid of lactic acid, and that myth has been long debunked.

In the Olympics, winners and losers are literally separated by hundreds of seconds; minuscule differences can be the difference between gold and not-placing, so athletes will do ANYTHING to gain a slight edge, whether that means using evidence-based practices or not.

This means the Olympics are home to pseudoscience techniques "designed" to gain that extra edge for Olympic Gold performance. Four years ago in the London Olympics, it was kinesiotape (hint hint - not an effective treatment of pain (3)); this year it's cupping (see picture below).

Photo Credit: www.people.com

Photo Credit: turnthere.blogspot.com

So what is cupping?

Cupping was used thousands of years ago in ancient china (may not be true), and in today's modern use, it is basically a suction cup designed to increase blood flow, remove toxins, and enhance recovery to selected body parts.

Just watch the swimming portion of the Olympics and you'll be sure to see some "info" on cupping - usually lacking any actual evidential statements. At least USA Today did some decent investigative journalism, debunking the whole cupping thing.

One thing the media continues to promote is the "fact" that cupping was used in ancient chinese medicine, so it HAS to be legit…right?

I still can't see how this is a reason to do cupping… I see it as more of a reason NOT to do cupping.

How is the "fact" that something was used thousands of years ago, a good reason to use it now?
If we used many of the practices from thousands of years ago, where would we be?
Heck, if we used some of the sports performance/sport medicine practices from a couple of centuries ago, many would laugh.
So let's not use this as a reason for it's use.

Now, if we look at the actual literature on cupping, we find a very uncompelling story. In fact, a meta-analysis reviewed all randomize controlled-trials (RCTs) and found that while cupping may be a beneficial treatment for herpes zoster and other specific conditions, it's efficacy as a treatment for pain or for enhanced performance are unfounded (1).

Basically, a systematic review of all cupping studies show two things. 

1. The effectiveness for cupping in a sporting environment has not been found.  It is NOT an effective treatment for pain or performance and elicits NO physiological benefits for an athlete.  The athlete may receive psychological benefit (aka placebo), but actual positive physiological responses are unfounded. 
2. The few studies showing benefit of cupping have come from China, which have been known to have extreme bias and un-reliable results, not to mention the actual studies are very spotty (2)

If we actually think about cupping, physiologically, we can understand why it may be a poor modality choice.  

First, why would we want to place an extreme form of stress upon the athlete? Cupping damages the surrounding tissues, which is NOT something we'd want for an athlete looking for acute recovery.  

For an event such as the Olympics, where recovery from day to day is imperative - we want to preserve tissue health and restore parasympathetic nervous system function… NOT provoke it, which cupping very well can.  

As for myself, I've gone through cupping, and it is not comfortable, not relaxing, and can leave burning/sensitive skin for sometime after.  

Light massage, contrast baths, traction, meditation, light ART or joint manipulations, that won't stress the CNS or surrounding tissues, are all better options.  

Not to mention the BEST recovery and performance modalities in the tool kit are... 

SLEEP, NUTRITION, & HYDRATION.  

Yes, I know, not very sexy, not article worthy, no network specials here...but it's the truth. 

At the end of the day, although compelling, we know sports celebrities are poor sources of reliable performance information, and just because Michael Phelps (cupping) or Kerri Walsh Jennings (Kinesiotape) use a certain modality doesn't mean it has any efficacy. 

Sure, Phelps may receive some psychological and mental benefit from cupping - which is fine and dandy - most athletes have some form of ritual or superstition they use as a placebo for performance, but I'd wish networks and broadcasters would give a "warning" to those watching at home that these methods are unsupported and to ONLY perform under an experienced practitioner. 

This herein lies the problem I have with these types of things - cupping, kinesiotape - is now every HS and college Joe Schmo will want to get cupping treatment.  

We saw the response with Kinesiotape from the last Olympics - You can now see it at every youth, HS, and college sporting event - being applied by un-qualified practitioners, sometimes even by the athlete themselves.  

We will now see it with cupping, and the problems is not necessarily the fact that cupping lacks efficacy, it's in the fact that cupping, done by unqualified practitioners can, in fact, be harmful.  Left on too long, used with too much heat, done on those with sensitive skin - and you'll see irritations, rashes, infections, bleeding, etc.  

Not to mention you can get cupping kits on on Amazon for ~$20.  So now, stupid athletes and parents will by applying cupping, expecting to be like Michael Phelps, only left to be disappointed. 

Also, here's what can happen when cupping goes wrong…

Photo Credit: (nextshark.com)

So while, cupping may help Phelps gain a psychological edge on his competition, let it be known it does not provide a physiological benefit.  Also note that he has WORLD CLASS sports medicine and practitioners applying this method. 

I just wish networks and broadcasters would take some responsibility on this front, and not continue to promote such methods, and for once get out of the "Olympic Cinderella" mode and not try to make a fairly tale story out of every thing at the Olympics.

As for you athletes out there - please heed HEAVY hesitation before deciding to get a cupping treatment.  Save your money, and instead invest it in your sleep, nutrition, hydration, and a good foam roller (which has as much efficacy as cupping, but it's not as sexy).

Go Get 'Em!



References:

1. Cao, H., Li, X., & Liu, J. (2012). An updated review of the efficacy of cupping therapy. PLoS One, 7(2), e31793.

2. Lee, M. S., Kim, J. I., & Ernst, E. (2011). Is cupping an effective treatment? An overview of systematic reviews. Journal of acupuncture and meridian studies, 4(1), 1-4.

3. Parreira, P. D. C. S., Costa, L. D. C. M., Junior, L. C. H., Lopes, A. D., & Costa, L. O. P. (2014). Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal of physiotherapy, 60(1), 31-39.

Wanna Throw Cheddar? Then Get Stronger!

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Overhead actions dominate many sports; everything from pitchers, quarterbacks, volleyball players, tennis, swimming, to handball players, they all have huge requirements for OH actions.  With all of these actions, the major goal is to increase the velocity of the implement used - we want to increase throwing velocity, throwing distance, serving power, stroke power, and spiking power - Overall we want to increase the high stinky cheddar!

Well how do you improve OH power and velocity?  

Previous research has reported that high-velocity throwing begins at the lower body (1).  OH power is driven through leg/hip movements and this power progresses up through the torso/core, to the shoulder and finally through the arm where it gets put to work on the given implement.  A stronger and more stable lumbopelvic-hip complex contributes to higher rotational velocity (3).

Roach and Liebermann indicated that 90% of the work for throwing power is generated at the hips (1).

Yes, 90%!

Look at anybody who thrives in an OH sport and they'll have a solid lower half.

It makes you wonder why we see all these special devices, bands, and weighted balls designed to improve throwing velocity, when the reality is that the best way to improve throwing velocity is to improve your lower half.  Trying to increase throwing velocity by focusing on strengthening the shoulder or arm is akin to putting new tires on a car - it will look good and give some performance benefits but if the engine isn't there, it really doesn't matter.

We love to use med balls and some of the devices mentioned above to develop and cement the rotational sequencing, but it's important to understand they are just a small tool and are not as effective for increasing throwing power as strength training.

In fact a study from way back in 1994 showed this; medicine ball training alone had a neutral effect on throwing velocity, while a strength training group produced a significant increase in pitching velocity (4).  This is not to say strengthening the shoulder or the use of certain devices isn't warranted, they have a time and place, but they shouldn't be the vocal point in training programs and unfortunately that's exactly what we often see in many OH training programs.

As many can attest, we feel the best approach is a combination of different tools, but first and foremost is a good base of strength.  With this base is place, the other tools can be more effective and transfer to sport to greater degree. 

What's even more interesting about developing the lower body is that Lehman et al found that power in the frontal plane (lateral movements) correlated most to throwing velocity; more so than vertical jump, sprinting speed, and vertical med ball power (2).  

What's this all mean?

It means that throwing velocity is specific and training demands needs to follow suit.  Traditional squat, deadlift, clean, snatch, and bench alone don't cut it.  Training elements need to be in place to focus on frontal plane movements and developing power in this manner.

When I first read this study a year ago, I decided to study many of my athletes on these same tests.  Specifically, I evaluated unilateral lateral jump and throwing velocity.  After compiling 25 samples, I found the same result - those athletes with the longest lateral jump, threw the hardest.  The graph below shows the obvious trend; you not only need great power and strength in the lower body and hips, but it also has to be specific to lateral movements.  

X-Axis = Lateral Bound; Y-Axis = Throwing Velocity

How to Throw Cheddar?

First and foremost, get strong and powerful, especially in the frontal and transverse plane.  This means applying many of the tools used below.  If you haven't seen some of these or performed drills in this manner, then you're short-changing your ability to throw that high stinky cheese.  Take a look.

Finally in terms of OH training, we really hammer away at hip and pelvis stability and control.  Burkhart et al demonstrated that poor gluteus medius strength and control can effect "up the stream" and place increased stress on the shoulder.  These researchers reported that approximately 44% of athletes presented with SLAP (superior labral anterior-posterior) tears also exhibited gluteus medius weakness (5).  Another interesting study showed that pitchers showed lower glute and hip strength/control compared to position players (6).  This may contribute to explain why pitchers tend to have greater occurrence of arm injury when volume is equated.

Weak glutes and hips will not only effect leg drive and force put through the body, but it also effects position and mechanics through different OH movements.  When we look at pitchers, during balance point, if the hip on the grounded leg sinks or sags it will effect the whole delivery.  We need a strong and stable base in this hip and this means working on glute medius strength through band walks, clams, or side lying leg raises.  We also like to work this stability in the specific manner it is seen in many OH athletes, demonstrated by the drill below.  The band forces the abductors to be highly active to stabilize this position. 

Bring in the Closer

With all the OH athletes we work with, increasing OH power is key and when athletes go through our program that emphasized frontal plane movements, they can tell the difference.  A big squat and deadlift is great, but if that doesn't specifically transfer to lateral and rotational movement, then it's all for not.  We get great feedback from our athletes who feel the transfer of strength, power, and speed during OH movements because of our approach.

So if you want to throw cheddar, get strong laterally and see the results!

Go Get 'Em!


References

1. Roach and Liebermann.  Upper body contributions to power generation during rapid, overhand throwing in humans.  Journal of Experimental Biology, 2014

2. Lehman, G et al.  Correlation of Throwing Velocity to the Results of Lower-Body Field Tests in Male College Baseball Players.  Journal of Strength & Conditioning Research: April 2013 - Volume 27 - Issue 4 - p 902-908

3. Saeterbakken, A et al.  Effect of Core Stability Training on Throwing Velocity in Female Handball Players.  Journal of Strength & Conditioning Research: March 2011 - Volume 25 - Issue 3 - pp 712-718

4.  Newton, R; McEvoy, K.  Baseball Throwing Velocity: A Comparison of Medicine Ball Training and Weight Training. Journal of Strength & Conditioning Research: August 1994

5. Burkhart SS, Morgan CD, Kibler WB. Shoulder injuries in overhead athletes. The “dead arm” revisited. Clin Sports Med 2000;19(1):125-158.

6. Laudner, Kevin G., et al. "Functional hip characteristics of baseball pitchers and position players." The American journal of sports medicine 38.2 (2010): 383-387.