This past weekend Dave and I attended a course with Eric Cressey titled “Making Movement Better”.  Eric is a renowned strength and conditioning coach in the United States who provides a lot of terrific, thought provoking content through blogs, social media, newsletters and associated products (www.ericcressey.com).  You may find it odd that 2 chiropractors wanted to attend a strength and conditioning seminar, but both of us utilize exercise as a central tenet to our therapeutic approach.  No harm is done by attending courses that are tangential to one’s own field.  In fact, of our continuing education planned for this year, four entire courses are strength and conditioning based.

It was quickly apparent that Eric was very well read in both the strength and conditioning field and the therapy field allowing him to speak on a level that interested both audiences (who were well represented in the audience).  We both picked up a number of points and new exercises that we will incorporate within our practice.  The best way to review this course is through a series of quotes that seemed to hit home with us.

Eric’s approach is what I would describe as a reductionist model where he attempts to break down complex movements by reducing them to their constituent working parts.  He incorporates both static postural and dynamic assessment models, finds asymmetries and movement faults, then either provides mechanical assistance (for example manual assistance to an aberrant scapula movement), or coaching cues to change the asymmetry or aberrant movement and subsequently alter the clients pain.  Here are the top 10 quotes that hit home with me from this weekend.

1)   “I think if an athlete does not have a SLAP tear they have not had the structural pathological changes needed to be successful”

This was following a series of slides showing body parts and how imaging findings potentially mean very little in clinical presentation.  This is one idea that we certainly have in common (see our recent blog on MRI’s and low back pain).  Eric’s world is professional baseball players.  He suspects most have imaging findings of torn labrums or rotator cuff pathology.  The above quote is an even more extreme view stating that some ‘pathological’ changes may even be necessary structurally to compete at the highest level.  We have known this for certain ‘pathologies’ (think humeral retroversion, and some GIRD issues), but Eric took this even further.

 

2)   “Flexion TO neutral is much different than flexion FROM neutral.”

One of the more common themes from the weekend was chronic extension faults (think people with a very rounded back and protuberant buttock and abdomen while standing).  We are so conditioned that flexion is bad, however in some people with extension based patterns it may be an important aspect of your assessment.

 

3)   “Don’t stretch the shoulder unless it is completely necessary.”

This was again in reference to overhead throwing athletes.  In this population the shoulder has likely adapted with humeral retroversion and soft tissue contracture in the posterior shoulder creating pseudolaxity anterior.  Therapists cringe when pitchers stretch further into horizontal abduction, extension and external rotation.  Of note, Eric is not a big fan of the sleeper stretch as research shows a cross body stretch to be superior anyways.

 

4)   “What happens when you load a bad pattern?  You get REALLY good at sucking.” 

This better captures Eric’s feeling about an individualistic approach to exercise.  To be clear, one of the central tenets of Eric’s approach is that there is no perfect kinematic pattern for any movement.  Based on adaptive and structural variability, no two people will have the same optimal movement pattern.  One bad pattern for one person may be a decent adaptive pattern for another.  Eric did not seem a fan of ‘one size fits all’ assessments or exercises.

 

5)   “You’re better off doing NO arm care then BAD arm care.”

This quote captures the feeling of many progressive therapists after clients or patients come in with pre-printed “rotator cuff rehab” exercise sheets that their prior therapist has likely given to 100 clients regardless of what is causing their arm pain.  As a general rehab approach Eric actually prefers closed chain exercises first and showed a lot of great examples.

 

6)   “Has scapula down and back cueing actually hurt more shoulders then it has helped?” 

This was a great talking point about a coaching cue that most coaches and therapists still rely heavily upon.  Eric’s opinion is that in all functional and sport specific activities, the shoulder blade has to move freely to allow appropriate arm motion Proper scapula kinematics should include good upward rotation and posterior tilt however this does depend upon the sporting demands of the upper extremity.  Cueing down and back can negate this and at most should be a subtle cue with very little movement.  And worst is the scenario where someone keeps the shoulder blade down and back throughout any specific movement pattern.  This cue also will often result in the athlete arching their lumbar spine in an effort to plant the scapula against the rib cage.

 

7)   The best bang for rotator cuff work is at end range external rotation in abduction with a low level activation.  This creates control at the most troublesome position.”

Simply put: we need to adapt tissue and get stronger at the angles where the majority of injuries occur for each joint.

 

8)   “The weaker you are the higher relative effort it will take to perform a task.”

This may seem obvious, but is often lost in athletes and therapy clients.  This is the basic reason why EVERYONE requires strength training and motor control exercises as a proactive measure to prevent injuries.  Essentially each tissue in your body can only take a certain amount of load prior to failure and that is when injuries occur.  There are only 2 ways to modify this – be exposed to less load (very difficult for most) or increase your tissues ability to accept load (MAKE IT STRONGER!)

 

9)    “First of all this is an absolute refer out situation.  Any numbness or tingling – refer out.”

The audience at the course was roughly 60% strength coaches/personal trainers and 40% chiro/physio/athletic therapist.  This was a great and refreshing point for everyone to hear hammered home.  For all professions it is important to know our limits.  Eric was performing a case example with some odd findings revolving around vascular findings and numbness and tingling when he said this.

 

10)    “Every exercise is an assessment.”

A good practitioner will constantly be assessing movement quality at every opportunity to see the tissue under load/stress.  This quote summarized the entire course.

Continuing Education courses tend to adhere to the law of diminishing returns whereby the more you take, the less points you take home that you will incorporate in practice.  Eric’s course was refreshing as we both took home concepts and exercises that we have carried over into clinical practice that have exceeded many past seminars.  Eric was exceptionally approachable, even staying at the end of the seminar for an hour until he had to leave for the airport.  He also emailed course notes, and talking points to all attendees the week after the seminar.  The course could have used more hands on exercises, although with so many attendees the structure did not fully allow for this.  Making Movement Better was worth the price of admission and we would not hesitate to attend another course with Eric Cressey.