Does mobility training prevent injuries?

Over the last few years, mobility training has become all the rage on social media and in the fitness world. Passive flexibility is out; active range of motion is in.

Many supporters of this style of training tout it as the holy grail. It's believed to prevent injuries and make you a better mover. And if your mobility isn't up to snuff, well, you better "check yourself before you wreck yourself."

Being my inquisitive self, I was interested in what the research said about typical differences between active and passive range of motion. After taking a deep dive, I was surprised to find there was very little direct evidence for what even constitutes "typical" vs. "atypical."

Now, as the saying goes, absence of evidence isn't the same as evidence of absence. But for mobility training to prevent injury and improve movement, there at least has to be a plausible mechanism.

I teamed up with my friend Jenni Rawlings​, who's also been seeing these trends in the yoga world, to explore whether mobility training can possibly confer all the benefits it's been claimed to – or whether it should just be one part of a more comprehensive approach to training.

Here's what we came up with:

https://jennirawlingsblog.com/blog/end-range-training-does-closing-the-gap-between-active-and-passive-rom-prevent-injuries

Why Distance Doesn’t Tell the Full Story During Hop Testing

Over the last year or so, I’ve taken a keen interest in how rehabilitation professionals qualify athletes to resume sports participation following injuries (“return to play”). It’s a natural area of research for me, as it’s essentially the bridge between rehabilitation and performance training.

One of the biggest conundrums in rehabilitation is the high rates of re-injury -- and whether current return to play testing protocols are even helpful for reducing re-injury risk.

One injury with alarmingly high re-injury rates is the ACL, or anterior cruciate ligament. Return to play testing protocols during ACL rehab typically consist of measures of range of motion, single-leg strength, and hops for distance.

Four different hops for distance

Much of the debate centers on which hop tests should go into the testing battery, as there are about a million and one options: single hop, triple hop, triple crossover hop, six-meter timed hop, side hop, etc.

But there’s relatively little talk of a simple way to derive way more information out of whichever hop tests are used.

My friend Tim Rowland and I teamed up to shed light on this subtle addition to testing procedures that we believe can have a major payoff for return to play decision-making:

https://www.physio-network.com/why-distance-doesnt-tell-the-full-story-during-hop-testing/

Is Your Inability to Crawl REALLY Killing You?

As children, we’re taught that “sticks and stones can break our bones, but words can never hurt us.” While a nice sentiment, the more I learn, the more I realize that old adage simply isn't true. Words do have the potential to harm. And the way some movement and rehabilitation professionals have chosen to wield them is doing just that.

For example:

• “If you can’t roll, crawl, and squat like a baby, you’re destined for pain and dysfunction. Take my course to learn how.”

• “If you do bench dips, upright rows, or behind-the-neck presses, you’ll wreck your shoulders. Buy my book to learn about optimal movement.”

• “If you don’t learn how to breathe, you’re gonna die! Come with me if you want to live.”

Okay, so maybe that last one about breathing is literally true, but still. 

WTF is “Load Management"?

Since the turn of the century, the San Antonio Spurs are the winningest team in the NBA. No doubt, a lot of their success can be attributed to having had a bevy of current and future Hall of Famers on their rosters. But perhaps no single person has been more influential in their success than head coach (and famous curmudgeon) Gregg Popovich.

Under Popovich, the Spurs have run off a stretch of 18 straight 50-win seasons and 22 consecutive playoff appearances. Obviously, Popovich is a brilliant basketball strategist; you don’t win that many games by accident. But his brilliance appears to extend off the court, too -- specifically, to the human body and its need for rest and recovery. (Note: he likely also has the help of a world-class sports medicine team.)

Case in point: in 2012 Popovich famously rested his four best players on the night of a nationally televised game. It was an unfortunate decision for fans around the country who were stuck watching the Spurs’ B-squad. Although the Spurs ended up losing the game, the move proved to be the right one for them in the long-run. They won the championship that season.

The Two Most Common Misconceptions about the FMS

Over the past three years as part of my PhD, I’ve been researching the relationship between movement and injury. A recent Twitter discussion reminded me that people on either side of the great FMS social media debate are still confused. I figured I’d put my research efforts to good use to clear up a couple of common misconceptions.

Misconception #1: The FMS composite score can predict injury.

When the FMS first became popular in the late 2000s, its creators touted it as an injury prediction tool [1,2]. The trouble was, at the time they had zero scientific evidence to back that claim up.

It turns out scoring low on the FMS does increase a person’s risk of injury slightly [3,4], but it doesn’t guarantee it. In other words, while low scores are associated with injury, the FMS does not predict injury on an individual basis. Big difference [5].

Specifically, when the FMS is conducted on a large group of people, as in a scientific study, we tend to see a lot of false negatives (people who score high but still get injured).

The fact that the FMS can’t predict injury actually isn’t that surprising. There’s no one thing that predicts injury [6]. This is because injuries aren’t caused by just one factor. Instead, they’re the result of a complicated web of interrelating factors -- a web that’s different for every person based on the types of activities they do [7].

Bittencourt NFN, et al. Br J Sports Med 2016;50:1309–1314.

What is Pain, and How Should We Manage It?

Today's post is written by a very special friend of mine, Dr. Fred Goldstein. Dr. Goldstein is a Professor of Clinical Pharmacology at Philadelphia College of Osteopathic Medicine. Dr. Goldstein and I go WAY back to when his daughter and I played in the same basketball league as kids.

The topic of today's post is pain, which Dr. Goldstein is a true authority on. He's been teaching about and researching pain for even longer than I've been alive! I learned a ton from reading his article, and I think you will, too. -Travis

WHAT IS PAIN, AND HOW SHOULD WE MANAGE IT?

Frederick J. Goldstein, PhD, FCP

Professor of Clinical Pharmacology

Philadelphia College of Osteopathic Medicine

What is pain? Toothache? Sprained wrist? Broken femur? Myocardial infarct (MI)? Obviously, all such conditions are “nociceptive,” meaning they send signals from pathological sites to brain areas for interpretation. Simultaneously activated are emotions which can certainly increase the intensity of such cellular indicators of tissue damage.

However, it is also known that circumstances exist where pain is attenuated or, in some cases, not even felt. A person who has experienced three MIs over the years will probably feel less alarm with a fourth one than the first. Soldiers in a fierce battle may not even be aware of severe wounds until that firefight has ended.

Of course, there is also psychological pain which occurs upon losing a loved one or receiving news that the cancer which has been discovered is, unfortunately, terminal.

Thus, there is always an interplay between physical and psychological aspects of pain.

What 3 Hybrid Physical Therapists and Strength Coaches Want You to Know About Pain, Exercise, & Movement [Physio Network]

A couple weeks ago, I had an idea. I contacted three of my friends in the rehab/strength and conditioning world and asked them if they'd be keen to help out. My idea? A "roundtable" on pain. Specifically, the misconceptions that abound surrounding pain, exercise, and movement.

I wanted to put something together for trainers, coaches, clinicians, and exercise enthusiasts that would clear the air on a lot of the myths being espoused lately by a few supposed industry "experts."

My friends graciously obliged, and this article resulted:

>>https://www.physio-network.com/blog/what-3-hybrid-physical-therapists-and-strength-coaches-want-you-to-know-about-pain-exercise-movement/<<

In the roundtable format, they each gave their take on the five most pressing questions/misconceptions about pain that are currently plaguing the health and wellness field. If you're not too familiar with the research on pain, their answers may surprise you.

The (Inconvenient) Truth About the FMS and Injury Rates

The Functional Movement Screen (FMS) is a series of seven bodyweight tests designed to rate human movement quality/competency. Each test on the FMS is scored on a 0-3 scale. A perfect total or "composite score" would be 21 points.

The FMS's relationship with injury has been studied extensively in athletes. The thinking is that scoring low on the FMS (usually 14 points or lower) puts an athlete at increased risk for injury, which the research bears out to an extent.

When all the studies were pooled together (in 2015), scoring 14 or below did increase injury risk by about 50%. However, for every 100 athletes that got injured, the FMS only managed to correctly identify about 25 of them as being at risk. For this reason, the FMS should not be used to predict which athletes will get injured on an individual basis.

Despite the fairly conclusive evidence against the FMS's ability to predict injury, new studies keep coming out investigating this same tired research question. In the past two years alone there have been at least nine such studies on rugby, soccer, cricket, handball, volleyball, and basketball players.

Based on this continued proliferation of research, clearly not everyone has gotten the memo about the FMS's inability to predict injury. For this reason - and in an attempt to help put this issue to rest - my colleagues and I just published a critical review of the FMS. I break down the results of our review below.

How to Train More Without Getting Hurt [SimpliFaster]

Training for peak performance is tricky business. Push too hard, and you get hurt. Don’t push hard enough, and you still get hurt (from being unprepared for the rigors of competition).

Luckily, there’s a new way to measure how hard you’re working. And amazingly, the research shows it actually protects against injury. That’s right: sports scientists have finally figured out How to Train More Without Getting Hurt.

I break down all the latest research -- and show how to implement it -- in my brand new article for SimpliFaster:

https://simplifaster.com/articles/train-more-without-injuries/

The Plank Variation That Saved All the Puppies

If there’s one exercise that sets the foundation for all others, it’s the front plank.

Think about it.

What’s a push-up? A moving plank. What’s a pull-up? A moving plank. What are we doing with our torsos during squats and deadlifts? Maintaining the flat back posture characteristic of, you guessed it, a plank!

Yet if there’s one exercise that’s notoriously butchered, it’s also the plank.

People often attempt to hold it for way too long (e.g. several minutes on end). And when they do, it’s usually ugly. They lose proper position (a straight line from head to heel) and, therefore, the desired training effect. They also kill all of the puppies in the process.

Over the last few years, likely in response to the puppy-killing plank epidemic, the RKC plank has emerged as a potential solution.

Adapting and Overcoming [Travis Mash's Barbell Life]

What’s the one thing that could be better than having one Travis on a podcast? Having two!

Thanks to Travis Mash​ of The Barbell Life Podcast, we were able to make this dream a reality.

In this podcast, we discussed

• My life story (or at least the cliff notes version)
• My quest for the Paralympics and how it led me first to personal training and now to my PhD
• How I approach new clients
• Advice on growing an internet presence
• The most important skills trainers should have
• And much more!

The episode is available for your listening enjoyment on iTunes and Spreaker:

Listen to "158 - Adapting and Overcoming with Travis Pollen" on Spreaker.

How to Spot a Fitness “Coach" Who Doesn't Actually Train People

I'm a firm believer in practicing what I preach. After all, who am I to make the liberating recommendation to wear two different socks if I’m not damn well doing it myself?

(Full disclosure: I usually just wear the sock on my prosthetic foot until it falls apart. My prosthetic foot doesn’t care if its sock is dirty.)

Relatedly, since I started my PhD this past September, I’ve continued to train people in person at least once a week. I fancy myself something of a Batman figure in this regard, leading a double life as both researcher and practitioner. I don't have a cape, though (yet).

The fact of the matter is, when it comes to being a fitness professional, I don’t think you can keep your head in the game and stay informed on relevant issues if you aren't actually doing and living that #trainerlife (at least as often as your schedule permits).

For this reason, it irks me to no end when I see people giving out nonsensical workout advice that can only be indicative of them having never actually trained anyone (besides maybe themselves).

The issue of these imposters masquerading around the web claiming to train real people when, in fact, they do nothing of the sort is a serious one. And I'm calling bullshit.

Because it can sometimes be a challenge to identify said phonies, here are a few red flags to keep an eye out for.

11 Things Every Personal Trainer Should Be Doing For Their Clients

They say one bad apple spoils the whole bunch. Unfortunately, when it comes to the personal training business, there’s no shortage of bad apples. And it’s true: they give the rest of us a bad name. To raise the standard and elevate the field, I implore you not to be one of the bad apples. Luckily, doing the 11 things below will put you well on your way to being the Honey Crisp of personal trainers (i.e. the best!).

1. Base the training program on your client's goals.

Personal training isn’t about you or your goals. It’s about the client’s. That’s why it's called PERSONAL training.

For example, just because YOU are a powerlifter, that doesn't mean all your clients wants to squat, bench, and deadlift as heavy as possible. If they just want to "tone up," then by golly your sole job is to help them do it.

Or, just because you think big quads and boulder shoulders are sexy, that doesn't mean every client feels the same way. If your client doesn't want bigger quads and wider shoulders, then keep the quad and shoulder training to a minimum (within reason).

4 Things It’s Not Okay to Do as a Fitness Professional

As a personal trainer and movement scientist, I often get asked for advice on fitness. (Go figure!) Whether it’s a friend, a family member, or a stranger on the internet with a cartoon character for a profile picture, I’m more than happy to share my two cents.

Of course, when I first started out in the industry I thought I needed to have all of the answers. I thought that if people came to realize I wasn’t all-knowing, they’d think less of me as a professional.

It turns out my thought process couldn’t have been further from the truth. In actuality, it takes a great deal of maturity and self-awareness to admit to your own limitations. People respect that.

Moreover, you can only parade around pretending to be smarter than everyone else for so long. Eventually, that shit catches up with you. Before it does, though, you’ll likely have no trouble dishing out plenty of unproductive — and potentially harmful — advice.

Which leads me to my motivation for this post. Lately, I’ve noticed a number of fitness professionals on the wrong end of the law in this regard. While this problem certainly isn’t a new one, it’s come to a head lately, to the point where I feel compelled to speak out against it.

I figured a constructive way to tackle this would be to provide a few examples of what’s NOT okay to do when you’re in a position of authority. I solemnly swear never to commit the offenses described below, and — for the sake of the people we educate — I beg of my peers to make the same promise hereafter.

The Three Dirtiest Words in Fitness

The three dirtiest words in fitness these days are "Functional," "Movement," and "Screen" -- especially when used in that order [1].

For anyone who's unfamiliar, the Functional Movement Screen (FMS) is a series of seven functional movements (e.g. squat, push-up, lunge) designed to screen (i.e. check for) for pain, movement quality, and injury risk.

By providing objective criteria for scoring the various movements (‘0’ for ouch, ‘1’ for shitty, ‘2’ for passable, and ‘3’ for perfection -- all my words, not theirs) the FMS enables practitioners to establish a movement "baseline," as well as to identify mobility/stability deficits and side-to-side asymmetries, which can then help guide program design.

The actual FMS scoring system

Sounds like a great idea, eh? In theory, yes. But it’s created a whole crap-ton of controversy.

Some trainers are diehard proponents of the FMS [2], using it on all of their clients at intake and follow-up assessments for comparison to baseline. Others think it's complete garbage, citing studies that have found the FMS’s injury prediction capabilities to be moderate at best.

It’s true: in many of the populations that have been tested, the FMS doesn’t do a very good job of separating people who are at risk for injury from people who aren’t. Potentially due to having too few data points (7 screens × 3 points = 21 total points possible), it fails to do what it was designed to do. Yikes!

Why not just change the scoring criteria to better differentiate between performance on each test, one might wonder? Instead of scoring from 0 to 3, why not make it, say, 0 to 5?

It turns out that by increasing that number, you actually decrease the reliability of each score. This is because when there are 5 possible points it’s much harder to come to a consensus about what a ‘1’ is versus a ‘2’ or what a ‘3’ is compared to a ‘4.’

Even the most skilled testers may not give a particular movement the exact same score on a scale from 0 to 5. At that point, chaos would ensue, and the results of the screen would have even less meaning than they do now. No bueno.

Planning Your Attack on Recovery [ExerciseGeeks.com]

Like most men his age, Joe (age 45) keeps very busy. He works late hours and hustles to get to the gym three evenings per week while still making time for his wife and kids. With his busy schedule, Joe's lucky if he gets a consistent 6 hours of sleep per night.

Joe tries to eat well, but he has a few downfalls (primarily ice cream, beer, and soft pretzels). He knows a home-cooked meal is a better choice than fast food, but given his time constraints, sometimes he just doesn’t have any other option. The one thing he does well is drink plenty of water (and craft beer).

Joe’s always been a man on-the-go, but lately he’s been feeling more tired than ever. He wants to shed the extra pounds he gained over the holidays, build his chest and biceps back up to what they once were, and be able to keep up better with his vivacious children on the playground.

Seemingly, he’s doing everything he can in the gym to meet those goals. Yet he finds himself spinning his wheels -- and even going backwards in some respects. Lately, he’s been struggling just to get his shoes on in the morning, his flexibility limited after tweaking an old back injury while shoveling.

Why is it that Joe just can’t seem to make any progress? It’s likely because he’s barely considering the yin to the yang of hard training: recovery.

In our new article on ExerciseGeeks.com, we break down everything Joe (and you) need to consider when you’re “Planning Your Attack on Recovery:”

>>http://exercisegeeks.com/2016/02/07/planning-your-attack-on-recovery/

What It Means to Be Evidence-based [ExerciseGeeks.Com]

“Do you have a study to back up that claim?”

These are the oft-repeated words of know-it-alls the world over. From my training as a biomechanist, I get it. When it comes to scientific writing, you can’t just throw statements out there without justification. When you make a claim, you have to back it up with evidence.

I mean, imagine a scientist claiming gait training cures Parkinson’s because it supposedly worked for his great uncle, twice-removed, back in the 40’s. That wouldn’t be very credible.

In general, being evidence-based is a good thing, albeit painstaking. For scientific writing, the evidence must take the form of previously published peer-reviewed scientific papers (oftentimes the more you cite, the better), such as case studies, experimental studies, reviews, and meta-analyses.

This is where things get interesting, because not all evidence is created equal. For example, only weak conclusions can be drawn from a case study of one subject. The best research designs include large numbers of subjects, randomization of those subjects to experimental and control groups, and blinding (subjects are ignorant as to which group they’re even in). Reviews and meta-analyses represent the strongest forms of evidence since they amalgamate the results of many similar studies.

The problem is that science isn’t perfect. Try as they may, researchers are not without their biases, and statistics can be made to bend the truth. Moreover, there can’t be a systematic review that precisely pertains to every unique real-life situation and population.

Evidence-based or Shmevidence-based

The fitness industry is currently at war. It’s the evidence-based guys versus the bro scientists, and both sides will stop at nothing to shove their methodology down your throat.

The war is over how best to consolidate science and practice. The evidence-based camp evaluates the entire body of knowledge in order to form an opinion on an issue. In hierarchical order by level of evidence, this includes all meta-analyses, review papers, randomized clinical trials, and case studies on the topic. After all these options have been exhausted, expert opinion and anecdotal evidence are considered.

Meanwhile, bro scientists don’t feel the need to wait around for the lab coats to tell them what they already know. In order to form their opinions, they generally pick from the bottom rungs of the evidence ladder (anecdotes and expert opinion), often shunning real science in favor of guruism. They feel that their own experience, based on decades of work with thousands of real people, is superior to any laboratory study. 

The evidence-based approach excels in its acknowledgement and avoidance of biases in search of deeper truths, like the mechanisms behind why particular practices works. The bro scientists, on the other hand, are typically content with an ‘if it works, it works’ mentality, even as new research flies in the face of their age-old, tried-and-true practices.

The scientific method is not without its shortcomings, however, and anyone who calls themselves “evidence-based” had better recognize its limitations. Statistics lie. Authors of reviewer papers are not without bias. External validity, or the degree to which the findings of a study can be generalized, can be suspect. That is, just because something worked in the lab setting with a specific target population does not guarantee it can be applied equally well out on the gym floor to another group of people.

Furthermore, say, for instance, a study compares two different types of training and shows no difference between the two. What this really means is that, on average for a group of people, the two types of training do not differ significantly. What this doesn’t mean, though, is that one type of training wouldn’t necessarily be better for a particular individual. This individual variation is exactly what makes training an art in addition to a science.

Both sides of this battle clearly have their strengths and their weaknesses. Likewise, they each tend to get carried away with their own approach -- the evidence-based practitioners demanding that every claim be backed by a peer-reviewed journal article (or three) and the bro scientists selectively ignoring high-quality research if it contradicts their own strongly held views.

While both the evidence-based and bro science approaches have their imperfections, neither extreme should be foolhardily rejected nor embraced. The more sensible approach is to take the middle ground -- to merge the science and the art. The good news? Industry leaders like Alan Aragon, Bret Contreras, Brad Schoenfeld, and Nick Tumminello are doing just that – fusing their knowledge and keen understanding of the science with their own decades of experience in order to inform on practicable gym floor applications.

Here are a few ways we can take cues from these scholarly individuals:

1. Considering all the levels of evidence, not just the highest or the lowest.
2. Being simultaneously open-minded yet skeptical. We must consider viewpoints besides our own, while also taking everything with a grain of salt, no matter how smart or credentialed the informant.
3. Reading the scientific papers (entire papers, not just abstracts!), assessing the merits and limitations of the studies, and coming to our own conclusions. We can’t simply take someone else’s word for it.
4. Gathering information from a variety of sources, not just one or two of our favorite fitness professionals. Expert opinion is just that: opinion. Plus, even the experts disagree, so it’s vital to expose ourselves to multiple perspectives, not just the ones we always seem to agree with.
5. Trying everything out -- first on ourselves, and then on our clients -- before pronouncing anything bunk. Only after embracing something completely can we be certain as to whether or not it really works.

By following these steps, we may one day end this ugly war and seamlessly intertwine the science and art of training.