A friend sent me this article that talks about an exercise effect that is rarely discussed: changes to our bones.
The short version of the article is that sprinters tend to develop thicker shins and tennis players can develop a thicker racquet arm, while swimmer’s and cyclists tend to have no such effect. The article also notes that children who walk sooner have thicker shins than those who walk later. The other side is true as well, which is why astronauts lose bone mass while in space.
This is Wolff’s Law in action. In a nutshell, Wolff’s Law states that if the body feels it is not set up to continue to support the pressure it is put under, it will create new bone to help. We can see this in the feet of ballet dancers, and in the pelvic shape of teenage girls who play sports. Sometimes these changes are not the result of exercise, but of daily living. People with obesity develop thicker femoral heads (the top of the thigh). Yet another example of how amazing the human body is!
The article notes that this effect is smaller in older populations, suggesting that studies have not shown large changes in bone mineral density in the elderly. The author suggests this may be because we can’t produce as much force as we age. This is an interestingly timed comment for me, as I just had a client report back to me this week that her rheumatologist reported that her bone mineral density has increased again – the second time she has had an increase since starting strength training with me.
I found myself questioning the conclusion that the effect is smaller in seniors. I followed the link in the article for “elderly people”, which led to this study abstract which makes no mention of smaller effects in seniors. It does mention that “the effects of age and starting age on the osteogenic effects of exercise are not well known. It also appears that exercise interventions are most effective in physically inactive people or counteracting conditions of disuse such as bed rest”. I would argue that suggests that they don’t really know the effect on seniors, but if we’re talking about inactive seniors, the study suggests a big potential impact on bone strength.
In fact this US Physical Activity Guidelines Advisory Committee Report from 2008 provides a review of studies on the topic. The results very clearly show improvement in bone mineral density (BMD) among seniors, including one to two percent increase in lumbar spine density per year from resistance training. From the report: “Although a benefit of 1 to 2 % per year may seem small, this is roughly equivalent to preventing the decrease in BMD that would typically occur over 1 to 4 years in postmenopausal women and elderly men”. 
As my friend who sent me the article said, “Like I needed another reason but really drives home the importance of an active lifestyle for kids- impacts the rest of their lives.”
In other words: walk away from the computer and go run, jump, play, or lift weights. Just tell your boss it’s a crucial medical intervention.
Elsbeth Vaino is an engineer turned personal trainer in Ottawa who loves discussing the geeky reasons for exercising. In fact if you’re a personal trainer on the west coast, consider coming to see me speak at the NSCA BC Provincial Clinic on May 28th. I’ll be talking about structural variations between individuals and their effect on exercise.
It is not too late to get yourself fit for summer sport season, although you’re definitely cutting it close.
This is a great option for you if:
You usually get yourself to the gym before the season starts, but you have a new couch and there’s stuff on TV.
Every year while coughing up a lung during your first game, you promise yourself that next year you’ll spend some time in the gym before the season starts.
You never did pre-season training before and you did fine. And in completely unrelated news, you aren’t 25 any more.
You do work out pre-season, but you’d prefer a more structured program that is geared toward athletic performance, a fantastic workout environment, and feedback from a coach on your form.
Still reading? Here’s what we’re offering:
Two 60 minute group training sessions each week (pick 2 of Mon 530pm, Wed 730pm (FULL), Saturday 10am (FULL). UPDATE: WE NOW ONLY HAVE SPOTS OPEN FOR THE MONDAY SESSION, SO IF YOU REGISTER, IT WILL BE ONE SESSION PER WEEK, NOT TWO.
Sessions will address strength, power, mobility, and conditioning.
Program lasts 6 weeks, starting the week of April 4th and finishing the week of May 12th (just in time for City of Ottawa field opening).
$180+HST. UPDATE: SINCE WE NOW ONLY HAVE AN OPTION FOR ONE SESSION PER WEE, THE PRICE IS REDUCED TO $100+HST
Availability is limited: there are only 10 spots total, and each class is limited to 7 people.
All sessions take place at Custom Strength, which is located at 939 Somerset St. W
NOTE: if you are dealing with an injury, please be sure to mention that when you contact us. Depending on the nature of the injury, this option may not be available for you. We do have training options for everyone, but group training is not typically a great option in the presence of an injury. Send in an email though with an indication of what the injury is, and any guidance your physical therapist/athletic therapist/chiropractor has provided in terms of readiness.
Send me an email with the form below to register or if you have questions.
An article on Yahoo Sports today quotes Tiger Woods’ caddy suggesting his injuries have been because of his dedication to gym work: “I guess when [Tiger] looks back, he might question some of the activities that he did, some of the gym work that he might have done that, you know, had all these injuries escalate“. I suppose that’s possible, but is it likely?
Maybe it is more likely that this level of injury is normal for someone who has golfed for hours each day for 38 years? The 40 year old Tiger was doing the talk show tour showing off his golf skills when he was 2. In golf age, he is much older than 40. Is this perhaps a sign that early specialization eventually takes its toll, even on the exceptions who make it big?
Maybe it is because he is in his 40s. According to this Golf Channel article, “Less than 10 percent – just 20 of 216 – of all majors were won by players 40 and over. It does happen, especially at the British Open (the last three British Open champions were all 40-somethings). But since 2000, only one golfer – 41-year-old Vijay Singh – has won a Masters, U.S. Open or PGA Championship.”
Anything is possible, and thus it is possible that Tiger Woods’ back woes are the result of his training. But the limited body of evidence related to training and golf suggests otherwise. A Sports Health review of the scientific literature on golf injuries notes that “the majority of injuries sustained by professional golfers relate to overuse“, and that “simple modifications reduce the incidence of injuries, such as using a bag cart and performing a 10-minute warm-up before game play. Other studies have identified that increased hip flexibility can be helpful as well. Additional factors that increase the risk of sustaining a sports-related injury include decreased static trunk strength, delay in trunk muscle recruitment, and limited trunk endurance.”
Given the body of evidence on training and golf, and the statistics on golf performance and aging, the more likely scenario is that the caddy is wrong.
Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa who is not a huge fan of people making unsubstantiated (and likely untrue) statements in the media.
I just read this great post from Tony Gentilcore about bear crawls. It piqued my interest because it’s an exercise I love to use with my clients (so busted for seeking out articles that support my bias). He lists some great reasons for people to do them, but I wanted to elaborate on one: motor learning (the first reason #2 that he lists).
I have used bear crawls for a long time, but became especially interested in them a few years ago after reading this article written by physical therapist John D’Amico. John works with a lot of golfers in Florida, and has developed an interest in “accessing the nervous system through manual therapy and exercise as a means to attaining better mobility in my middle-aged to senior golf fitness clients.” So he did a little test:
Did initial range of motion tests on 10 male golfers (average age 68)
Taught them how to do a standing cross-crawl pattern
Had them perform 20 repetitions of the standing cross-crawl pattern five times per day
Re-tested range of motion on the same joints three days later
Here is a video of what his clients did:
He saw impressive improvements in great toe dorsiflexion, ankle dorsiflexion, hip extension, hip internal rotation, and hip flexion. From standing in place lifting up the opposite arm and leg. Huh. Give John’s article a read for the full results as well as his discussion.
I had previously used bear crawls as part of our warm-up when I coached the Ottawa Junior ultimate team, and I remember being surprised at how difficult the crawl movement pattern was for many of the kids. These were skilled teenage athletes, but many of them initially had a very hard time moving opposite arm and leg at the same time. It was as though their body didn’t know how to do it. Before seeing John’s post, I had read about benefits from acquiring a lost cross crawl pattern, although nothing with much scientific merit. In other words cool theories but not backed up by much. John’s post isn’t hard science either, but in my opinion, it is compelling. And given how little time it takes and how many other benefits there are (as Tony notes), bear crawling as an exercise is kind of a no-brainer.
If you’re interested in trying them, take a look at this great demonstration video by Joe Bonyai. He includes forward/reverse bear crawls as well as a stationary bear crawl with hold, which he refers to as “bear paws”.
Today is the five year anniversary of my first Custom Strength client. I’ll be honest that I am very proud of myself for the business I have built since the first client I trained under my own business name.
Like most entrepreneurs, I tend to deflect accomplishments to others when they are brought up. Instead of accepting the compliment, I mention all the great people around me; that I couldn’t have done it without the support of my friends and family; or that my amazing clients make it so easy. All true. But the other truth is that I had a great vision and then worked my ass off to build that vision. And now I’ve got this thing I call Custom Strength; this place I go to every day; this thriving community of amazing people working hard to be better; and it’s awesome. And the reason this awesome thing exists is because one day I decided to quit my lucrative consulting career to pursue my passion.
This is the point in the story where people often say they never looked back. I’m here to tell you that those people are liars. We all look back. Every time things get shitty – and I don’t think there’s an entrepreneur in the world who hasn’t been through a shitty period – we look back. I have often thought about how my life would be if I had stayed in the engineering consulting world. The money was sure good, as were the hours, and those combined for some fantastic vacations. Those thoughts still lead me to the same conclusion though: opening Custom Strength was one of the best decisions I ever made. I say this 5 years in, at a point where I still take home less money than I did before making this change. Although 2016 is looking like it will be the year where my hard work and vision reap financial rewards that surpass those levels. *knocks on wood while typing this*
Deflection of accomplishments isn’t the only thing that prevents entrepreneurs from tooting their own horns and acknowledging success. Relativism is the other. I almost succumbed to it. Not only is Custom Strength five years old, it is also healthy and growing. Despite that, I almost stopped myself from celebrating this accomplishment because there are so many businesses that are bigger and more profitable than mine. Some have been around longer, some started with money (I started with a huge debt from a previous business), while some are newer and also started without money. In other words if you look for it, you will find an example of someone who has done better than you. I’m excited that I have finally reached the level of entrepreneur where I can celebrate my success in relation to my hopes and goals instead of in relation to what others have done. I’m quite certain I’m not the only entrepreneur who struggled with this.
Five years! It has been both a fun and challenging ride.
The fun mostly involves what I actually do, which is training clients. People often talk about thankless jobs. I have a thankful job. It’s amazing. At least a couple of times a week someone tells me about the things in their life that are better because of their training with me.
It’s a good thing the highs have been so great, because the lows really, well, sucked. Like that time I came back from a Christmas trip to find out that the gym space I was renting had flooded from a leaky roof and the landlord decided he wouldn’t fix it until April. I’m not talking about a slow leak here; I’m talking fills-a-bucket-in-an-hour leak. Good times.
Then there was the time – just 9 months ago in fact – that I almost bankrupted my business. Imagine how you would feel when you did the books and realized that the numbers don’t actually add up and that if you don’t fix your spending, and increase your revenue right away, you won’t survive another month. That was my introduction to tracking churn rate. I had always prided myself on tracking business metrics, but it turns out the metrics I was tracking were insufficient for growth periods. I moved into a bigger and more expensive space in 2014, which required financing for moving costs, some new equipment, and a 2.5 time increase in rent. When I looked at my numbers, some were hidden by extra money I had borrowed to cover those expenses, while net revenue shortcomings were easy to explain by the temporary new expenses I had incurred. The big lesson I learned there: Never look for a way to explain revenue shortfalls; look for ways to uncover what they really mean. It’s a very minor but crucially important difference in perspective.
Thankfully my friend Pete and I were talking about our businesses and he mentioned that one of the reasons investors were so interested in his company was that their customer churn rate was so favourable. He then asked what my churn rate was. I didn’t know, but I was confident it was good because our clients mostly stick around for a long time. The next day I pulled the relevant data together and calculated it. I also looked at client acquisition rates, and used the two together as a predictor of growth or decline. That was eye-opening! It turns out there had been a two month period just before we moved where we lost quite a few clients. They were all for normal life reasons, like moving out of town, as opposed to dissatisfaction with training, so I hadn’t really given it much thought. But that followed a period where I did no marketing because I was so focused on moving and getting the new space running the way I wanted, and then because everything appeared to be running so well in the gym, I focused my attention on two side projects: my hip training ebook and preparing presentations for a few seminars where I would be speaking. In other words, we lost clients and then spent the next six months not replacing them.
While doing churn rate calculations, I also dug deeper into all of my business financials, which lead me to realize that I had to make changes to some of my expenses or I wouldn’t survive. Even if I increased revenue, my monthly expenses were just too high for this to ever be a strong business. That meant making some difficult decisions, which was no fun. Had I been tracking churn and acquisition rate, I would have realized that I had lost those clients and hadn’t replaced them, and I could have addressed it before it became a problem. Knowing my churn rate allows me to predict if a revenue drop is coming, which allows me to address it before impact. Had I also done a better job of splitting out investment money from revenue, I would also have come to the same conclusion earlier than I did.
I’m still slightly embarrassed that my inability to properly assess my financials almost cost me my business. I mean, I’m a numbers person! I use the expression playing with Excel instead of working with Excel. How on earth did I not see this coming? I was so embarrassed that I contemplated not including this in this post. After all this post is really about a celebration. But then I remembered reading stories like this from other entrepreneurs and how helpful it was to me when I was feeling overwhelmed. So there you have it – the lows in my entrepreneurial process included a big dumb mistake that almost prevented me ever getting to this five year mark.
Five years! Since that financial debacle there have been far more ups than downs, and business is good. That scare forced me to do what I had to in regards to expenses and to put more time into marketing such that we are growing at a good but manageable pace, which means I’m not celebrating that my business has survived for five years; I’m celebrating that my business is successful five years in. In addition to allowing myself to feel pride in this accomplishment, I also decided I should buy myself a five year Custom Strength anniversary gift. A new pair of skis seems like a good gift. Here’s hoping Mother Nature will help me celebrate by providing some snow!
I have a client, whom I’ll call Jim, who suffered a concussion during an ultimate game this summer. He has had concussions before, and suffered post-concussion symptoms for many weeks. He took 5 or 6 weeks off from training with me during the post-concussion period while he was under the care of athletic therapist and osteopath Richard Gregory. Richard is the head therapist at Ottawa Osteopathy & Sports Therapy and is one of the best manual therapists in Ottawa. I learned a lot from him when he used to be my boss, and I continue have a great relationship with him.
Jim returned to training once his post-concussion symptoms were gone. He enjoyed several weeks of training that felt great, but then after one session, some of the symptoms returned: By the time he got home he felt nauseous and had to go to bed. This happened again the following session.
I wasn’t sure what to think so I reached out to Richard to see if he could suggest anything. The following emails share some context and Richard’s amazing explanation of what was likely going on and some guidance on addressing it:
Email from me to Richard Gregory:
Jim was in Tuesday and again last night and both times ended up with post-concussion symptoms returning. He had had several training sessions prior to that without problems. Tuesday I think he was fine during training but then felt a bit off that night and very off the next morning.
Thursday we talked about it and the plan was to backtrack to the workout he had done the previous time, which had been fine, but by the end of his power section (kb swings and push presses) he was done.
Any thoughts? I was wondering if it might be one or more of:
Maybe the rapid vertical to almost horizontal head movement in swings is complicit? (he has been doing them without problems for a while – with no weight increase). He’s also been doing single leg RDLs which of course have that same vert to horiz motion. But those are also not new this week.
Tuesday we upped the intensity on a few of his exercises a bit. I put him on a protocol called 5-3-1, where basically set one is pretty easy, set two is moderate, and then set 3 is hard as you do as many reps as you can with good form at that weight. Then we use that to calculate future weights. It’s cool as it is very responsive to fluctuations in ones energy/strength/ability. And the calculations use 1RM percentages but applied to 90% 1RM weights, meaning they are not aggressive. His reps ended up in the 8 to 12 range on the last set. Maybe too much volume? Or maybe the intensity of ‘as much as possible’ was too much?
Maybe it’s combined volume of work over the week that is now putting him over the edge? He’s doing twice weekly and I think playing Frisbee once and maybe biking etc? Hopefully he’ll clarify. If this is likely, should we go with either less intense both days, or do 1 intense day, 1 easy day?
He mentioned that he stopped doing the vestibular exercises once he no longer had symptoms – so maybe 2 months ago? Is it worth bringing those back in and then planning to do them in some maintenance capacity even after he feels fine?
I welcome any thoughts that could help with Jim’s programming/training so he can train at the optimal level and with reduced likelihood of more symptoms.
Richard Gregory’s response:
Here’s my DIY sleuth guide for getting rid of post-concussion symptoms. The symptoms are sometimes very specific and sometimes very vague. Hopefully this info will help you figure out what the issue was.
Cerebral BP Changes:
Post-concussion brains lose their ability (temporarily) to regulate the blood flow (pressure) to the brain amidst rapidly fluctuating body blood pressures. The control of cerebral blood flow (cerebrovascular autonomic regulation) is run on both negative (factors that decrease brain BP) and positive (factors that increase brain BP) feedback loops. If HR spikes too rapidly, pressure sensors in the aorta and the brain’s middle cerebral artery adjusts and dials down blood flow to the brain. The reverse also happens. After a concussion, abnormal blood flow control gives the owner of this brain a very vague malaise feeling of just not feeling right. The recipe to make this go away is to train the vascular system to be more efficient. As you exercise at lower or moderate intensities for steady state (no intervals), you get new arterial growth in the brain (arterioles). This allows a larger number of vessels to provide the same brain tissue with blood flow thus decreasing irregular flow issues. Additionally, the regular steady state cardio (ideally 5/week for 20-35 minutes) “resets” the ability of the brain to regulate blood flow amidst changing body BP. Setbacks which occur months after the concussion usually happen for the following reason.
Brain owner says “I feel good. Thank God that rehab is done. I did at least 4-5 weeks of cardio like 5/week. Now I’m gonna just live my life.” Frisbee happens, a couple of workouts but the steady pace cardio fades off. The effect of the auto-regulation can fade but over time, the more consistently that cardio is trained (over weeks and months), the fade of efficacy of the auto-regulation will stop happening.
How to test it:
Smart way – start doing cardio steady pace at least 20-30 minutes 5 days per week and wait 3-4 weeks before doing heavy weight days or cardio intervals. If you feel better, that was likely the issue. You’ll also know it was the issue if you relate to the brain owner that did considerably less cardio than during the rehab stage at the time you felt the set back. Remember to avoid the breath holding when you go back to the weights and the interval workouts.
Painful way – go to Els’ gym. Do no warm up, drink a Rockstar energy drink to prime your adrenaline. Do 5 sets of heavy squats with lots of breath holding. Then immediately lie down. Feel the wave of nausea wash over you. Feel crappy the rest of the day and possibly the next day. (I don’t recommend you do this). If you feel not so good, you have a temporarily altered cerebral auto-regulation.
I recommend completing the “Smart way” of 3-4 weeks of cardio.
The improved vestibular dysfunction attained from completing a methodical and specific vestibular rehab program often needs to be reinforced. If the concussion happened several months ago and you did vestibular rehab for about 3-5 weeks, then you may need to “top up” your neuro-vestibular synapses. It is common to achieve a normal or sometimes even greater than normal level of vestibular function but then have this function fade imperceptibly over the course of 2-6 months. This can leave you feeling vaguely nauseated and very low energy. If this is the case, do the following test:
Vestibular test: (Jim knows this test)
Stand in place with eyes focused on a spot, rapidly turn 180degrees and stare at a spot straight ahead of you. Repeat the same test 2-3 times on each side with about a 10-20 second break between reps.
Video of the test:
If you feel woozy, your field of vision feels like it’s moving but you’re standing still or you see blurry, your vestibular function isn’t up to snuff. You can play the same game from lying to sitting rapidly or standing to looking at the floor. Jim only had a rotational dysfunction at the time we tested for it so it’s unlikely that a new vertical issue arose and also unlikely that the rotational dysfunction was stimulated by the gym exercises. Regardless, this is a harmless test and is worth doing. The rehab is to repeat the test for 3x2minutes at a pace that is sustainable and doesn’t provoke symptoms. Do this daily for 5-10 days. I got concussed in 2012 and I still break out a little spin-o-rama 3x2minutes every 8-12 months. I feel like it fades, then I do it for like 2-3 days and it pops back to normal. The need to top up my vestibular function has significantly decreased over time and I feel normal for 12 months at a time. This is not a finding that is available in the literature yet but leading researchers and concussed athlete practitioners (like me) have observed it in the clinic.
Additional vestibular training exercise video:
Global Neural Fatigue:
The concussed brain doesn’t distinguish well between too much exercise, too much work or too much emotional stress. It just knows when it’s been too much. Some researchers are using the term brain bucks. Every time you do work, exercise or experience an emotional stress, the brain pays using a finite amount of brain bucks. The better you sleep, the better you eat (fish oils, healthy fats, low simple sugars) the more brain bucks you get. If you’re sleep deprived, drinking lots of alcohol and eating poorly, then you might have a few less brain bucks. The workout may have been the same, the intensity may have changed only slightly but there may have been other factors such as travel for work, perceived emotional stress etc. Try to think back and see if you felt perhaps you worked a bit more, slept a little less or had other factors that might have made the same well thought out workout cost the last available brain buck. This would leave you feeling like you’re just done and you really don’t want to do the next set. If you think this was the issue, the solution is to monitor your overall brain expenditure by doing a little less (when possible) on the days you’re going to work out. You can also significantly increase your brain’s function and ability to tolerate stress, sleep better, get more out of relaxing etc by doing 10 minutes of mindfulness training. I particularly like Headspace. It’s easy, realistic and doesn’t require wearing silk pants and chanting. Not that there’s anything wrong with that. It’s also been shown that changing one’s perception of negative stress (distress) into a positive stress (eustress) which will embolden you for future stresses can significantly lower the correlated cortisol spike, BP spike etc and consequently, it would cost you less brain bucks to live through the same life stress. Cool Ted talk on this here. Kelly McGonigal: How to make stress your friend.
These are the three most common issues I see that cause setbacks in my post-concussion athletes. Hopefully, you’ll find a solution to the issue. If you hit a barrier you can’t get past, give me a ring. Sorry for the essay.
Hope you guys had a good weekend!
My email back:
“Wow, that was amazing. Thanks for the essay! So really this is:
1. back to cardio for 3 to 4 weeks and no gym (what about Frisbee?)
2. Figure out a good frequency to continue some vestibular test/training – likely will need less often over time.
3. Sort out if there is a stress/perceived stress aspect.
4. Start back at the gym again in 3 to 4 weeks with a similar approach, although perhaps this time we hold off on intervals a bit longer and probably if it will be twice weekly, we make one a light day for a while.
Sound right? Thanks again Rich. Obviously this is helpful for Jim, but this is also super helpful for me to get this great explanation and insight.
Richard’s email back: “Hey Els,
I suggest 2-3 weeks of no heavy lifts, no strength tests, no max reps, no valsalva etc. I suggest cardio 5xweek for about 20-35 minutes steady pace. If the ultimate has been feeling fine, then continue. I’d suggest the ultimate be played as a poachy D and handler and possibly skip the odd point while taking one of the weaker players to cover on D. Gym can probably continue at lower intensities in 1-2 weeks depending on how Jim feels. Also worth doing the vestibular tests as they’re easy and safe.
My guess is that it’s a BP issue that just needs a bit of priming. Let’s let Jim chime in on how he feels and go from there.
Have a good day guys. “
“A Huge Thank You to both of you for taking the time to discuss this with me and with each other. I honestly can’t put into words how much I appreciate it. It feels really good to know that you both care enough about how I’m doing to take the time to exchange all these ideas by email. I know it takes a lot of time to write all this down and it would be easier if I just made appointments and came into the office, so I appreciate the time spent on these emails a lot!
I suspect the reason for the relapse is just what Richard said: “I feel good. Thank god that rehab is done. I did at least 4-5 weeks of cardio like 5/week. Now I’m gonna just live my life.”
From early March until late April I had a really good routine of doing my vestibular pen-following and rotation exercises. From mid-April until late May I had a really good routine of 4-5x per week cardio for 20-30 minutes – a lot of bike rides along the canal in the morning or evening. I wasn’t a huge fan of the pen-following/rotation exercises and was happy to let them go, but I really enjoyed biking along the canal. The only reason I stopped biking was a customer event that required me to be at work much earlier and later than usual each day for the last month, which made it hard to find time for biking during reasonable daylight hours. That customer event is over now, and I’m happy to get back to biking in my free time.
Until last week, I was feeling really good. I was playing ultimate once per week, having two really solid workouts with Els, and doing some interval training 1-2x per week on my own. Last week for the first time I felt symptoms again – super barfy and dizzy after workouts with Els. On Friday night I “tested” myself with one set of 60 seconds of pen-following, and I could only make it through 30 seconds before I got barfy and dizzy and I had to lie down. The good news is that last night I was able to do two sets of 60 seconds with no ill effects.
I will get back to my cardio bike rides (which I really enjoyed anyway), and more of the vestibular exercises to top that up.
Thank you both, again, so much!
PS “poachy D and handler and possibly skip the odd point while taking one of the weaker players to cover on D” – that sounds like a lot of fun, I should try that!”
Richard’s reply: “Good luck with the barfy exercise. You’ll bounce back way quicker the second time around. Keep your eyes peeled for a tiny relapse in another few months and do the cardio and the barfy thing again.
I came to the conclusion that I still preferred the FMS, but I have issues with some aspects of it. Initially I hesitated to make changes to address these issues. This is a reflection of my engineering background: If I’m going to modify a system, I want to be sure I have really thought it out. It’s now two months after that post, and I have thought about it. And I have officially moved to implementing a modified FMS instead of the FMS. This post shows the changes I made, and the rationale. I would love it if the FMS would address some of these aspects going forward, although I would understand if they didn’t. There is something to be said for maintaining a consistent system, especially one that has widespread use across different organizations. That said – no system is ever perfect from the start, and sometimes it makes more sense to make the difficult decision to change than it does to stay the course.
Here are the modifications I now use, and the ones that would be made if I was involved with the FMS:
These changes are listed in the order that the FMS test is done.
1. Replace the Deep Squat test with an Arms Crossed Squat. I don’t think anything would be lost with this, as the In Line Lunge, Shoulder Mobility, Trunk Stability Push Up, and Rotary Stability tests still provide plenty of insight into upper back and shoulder mobility and stability. I also removed the requirement for feet straight ahead and replace it with a requirement that feet stay within 10 degrees of straight to fit more people’s anatomy. I recognize the challenge in set up for that, but I know a great engineer turned trainer who loves problem solving who might be able to come up with an idea.
2. Keep the Hurdle Step as is. I know some complain that everyone gets bilateral 2s on this, but that’s not quite true, and the qualitative information one can draw from this is meaningful, including balance and hip flexion quality. That said, if there was a desire to drop a test, this would be my pick.
3. Keep the In Line Lunge test as is, making sure the scoring and set up are clear. I think they are now, but there was a period where many practitioners, including myself were not clear on some of the details of the scoring. This might be the fault of us as practitioners, but I personally have a motto that if most of my clients misunderstand my instruction, the fault is mine, not theirs.
4. Keep the Shoulder Mobility (SM), but adjust the corrective hierarchy to accommodate close scores. The FMS says to address SM first if there is an asymmetry, but I would suggest changing that to: “Address SM first if it is 1s or an asymmetry involving a 1, or a 2/3 asymmetry where the difference is more than one inch. A 2/3 asymmetry where the difference is less than an inch would still take precedent over other 2/3 asymmetries, but not over 1/2 or 1s in other tests.” Maybe that wording is too clunky, but I think you get the idea.
5. Keep the Active Straight Leg Raise (ASLR), but add a Passive Straight Leg Raise as a secondary test in the event that the person scores a 1. This helps to differentiate between whether the problem is range of motion or stability. This is what I currently do, and plan to continue. While I noted in the earlier post that I think the ASLR is not a great screen for whether someone possesses the movement to deadlift, I do think it provides valuable insight into hip stability and mobility.
6. Keep the Trunk Stability Push up as is.
7. Adjust the Rotary Stability test as follows. Keep the “2 position” test, where the test involves the opposite arm and leg, and replace the “3 position” test with either a bird dog with 5 reps of 5 second holds (or 3×5 would probably suffice) or a side plank. For more on why I like this approach, read To FMS or not to FMS: That is the Assessment.
8. Add a Hip Hinge test. I use a dowel held horizontally at the waist and ask them to bend over by pushing their hips back while keeping their back straight and shoulders back. I recognize that this is contrary to the notion of not coaching the test, and I accept that maybe it should remain an add-on. My goal with this is to determine whether or not a deadlift variation is a viable strengthening exercise for the client. The FMS proposes that the ASLR is the clearing test for deadlifts, but it does not address whether someone has the movement comprehension to deadlift. I have had many clients who score 3s on the ASLR but have a hard time doing a hip hinge. They are cleared to deadlift, but they are not deadlift capable. I see this most among people with desk jobs, runners, cyclists, and those who practice yoga. (Note that wasn’t meant as a knock against athletes in those sports; it is just an observation. My guess is that it’s the result of movement patterns or prolonged postures that are similar but different). Sometimes those who aren’t deadlift capable require a lot of coaching to get them there. In these cases, I would much prefer to program a hip hinge as a corrective exercise and do a different hip dominant exercise to strengthen their posterior chain so that they can start getting stronger in the backside right away.
Side note: For the past six months or so I have been doing passive hip rotation range of motion tests as part of my assessment for all of my clients. I look at passive hip internal and external rotation range of motion with the hips flexed and extended. It’s something I was initially doing for my own curiosity, and I am now starting to come up with why and how this might be meaningful for programming. I presented my preliminary findings and suggestions about in my talk about variations in anatomy and their impact on exercise at the Women’s Fitness Summit at the end of August. I’ll share the results as a blog post soon.
I’m in the process of hiring a personal trainer (or two) for Custom Strength, to avoid having to turn new clients away. But it’s a fine balance, as our clients expect a certain level of knowledge and ability from their trainer. It thrills me that our clients expect this, and I love that it keeps me on my toes and keeps me learning so that we can continue to provide great training. It does, however, make hiring a challenge. There are some great trainers out there, but most are already enjoying a rewarding career elsewhere (although if you’re a great trainer in Ottawa who is no longer enjoying your career, please shoot me an email). There are also many not so great trainers out there, and then there are the new or soon to be trainers.
The new or soon to be trainers may be great from a personality and potential perspective, but they just don’t possess the knowledge and experience necessary to work with my clients. I’ve come to the realization that in order to grow Custom Strength, I need to help develop some trainers. And I’m happy to do so as I love to teach, especially to those who are keen to learn. Unfortunately I’m very busy, which means I have to be somewhat discriminating with my time. This may be a good thing, because it means I have to pre-screen who I am willing to help. I was reminded of this recently when I interviewed a few potential trainers, and then took them through a couple of training sessions to get a feel for their training and movement knowledge and ability. There were a couple of people I really liked in the interview, but their knowledge just wasn’t there. It is true that I can teach it, but I actually don’t think that’s the right start. Instead I am putting the ball back in their court. Here’s my response to an email from one of these individuals, who had expressed frustration in the circle of not having experience, but not being given the opportunity to get experience:
“To your frustration, I get it. And I would like to help, but I guess I need for you to have a bit more knowledge first. That said, you may be able to get that outside of work. There are some books and a website that I can suggest that will help you learn some of the basics that strongly influence how Custom Strength works. Unfortunately this stuff is not taught in the certification you took. The good news about that, is that learning this can catapult you way ahead of where you are now.
Training Resources I wish all Trainers would read:*
1. Movement or Athletic Body in Balance by Gray Cook
2. Advances in Functional Training or Functional Training for Sport by Michael Boyle
3. Any Core Performance book by Mark Verstegen
4. Any New Rules of Lifting book by Lou Schuler and Alwyn Cosgrove (the Women’s one is co-written by the amazing Cassandra Forsythe)
5. A membership to StrengthCoach.com. Read articles from it, and follow the forum threads. This is a gold mine of knowledge. Also members can download a free ecopy of Advances in Functional Training.
6. Ignite the Fire by Jon Goodman. This one is about the personal training profession, including things like how to market yourself. From the perspective of your frustrations about not being able to get experience without having experience, this will be especially helpful.
This is not an exhaustive library, but rather what I would consider a solid introduction to the style of training that we do at Custom Strength. More importantly, it’s an introduction to what I believe is a solid approach for how a trainer should look at the needs of the body. As you read these books, you’ll notice common themes. That commonality is the underlying body of knowledge that I want any trainer who works for me to have. I’m happy to help develop and train it further for the right person. But please understand that training and developing someone to help them be the best trainer they can be takes time and energy. Before I will commit my time to helping develop someone further as a trainer, I need that person to commit to their own self-improvement. I want to invest my energy in the kind of person who will see this list, and excitedly go buy them (or get them from the library) right away.
Put another way: If you’re looking for work in a field where you don’t have a lot of experience, you’re effectively asking to be assessed on things like personality, potential, drive, and enthusiasm. Your actions in response to the reading list above speaks volumes about drive and enthusiasm.
Once you’ve spent a month or two reading, email me back and let me know that you’re ready to meet again. Just be ready to talk about what you’ve learned. I don’t expect you to have memorized anything, so don’t stress. Think of it as an opportunity to talk about what you’re learning, to ask questions about things you didn’t quite get, and to even bring up anything where you disagree with the authors. Here’s the real point of this (on top of you learning): I am a geek when it comes to training, and I will happily offer my time to help someone else who is interested enough in training that they want to read and then talk about what they read. The flip-side of this: if you’re not much of a reader, then realistically, you are going to have a hard time becoming a trainer. If that is the case though, definitely pick up Ignite the Fire as a minimum. It alone won’t help you get work at Custom Strength, but it is a great resource to help you get work and clients.
Lastly, while you’re reading, try to apply the training principles you learn to yourself and to your friends. You can try to do this by coaching yourself, or by following one of the training programs in one of the books above, or hire a great coach who is experienced in the type of training these books espouse. If you’re in Ottawa, you could consider getting trained at Custom Strength for a while. Or if it would feel weird to hire me and then apply to work for me, there are other great choices: The Athletic Conditioning Centre, John Zahab at Continuum Fitness, and Jonathan Chant at Fitness for Freedom. Note there are other great training options in Ottawa where you can learn, but I didn’t list them because I’m not as familiar with the approaches of others or how similar or different they are from what we do at Custom Strength.
Good luck with your learning and I hope to hear from you in a month or two.”
Elsbeth Vaino, B.Sc., CSCS, is eager to find great people to join the team at Custom Strength. Those great people don’t need to have experience if they are willing to put in a little effort.
* Note that the links to the books and website above are all affiliate links. I don’t have any reservations about earning a few bucks for recommending solid resources. If, however, that bothers you to be a part of the whole affiliate system, then instead of clicking the links above, open a separate browser tab and search for the book title or website directly. I won’t know the difference, and if I did, I wouldn’t be offended.
This is the second part of a two-part post about personal training client assessment options. Check out part one here where I talk about why I was looking for alternatives for the FMS and what I was looking at.
For the past ten weeks I have put new clients through a dual assessment: the FMS as well as the alternative assessment I shared in part one. Note, I understand that the FMS is designed as “a screen” and not an assessment however I think that distinction is founded in the context of a medical assessment. As a trainer, when I say assessment, I am not referring to a medical assessment, but rather a tool for collection of information about a client that I can use to help guide the exercise program I will create for them. A review of a few dictionaries confirms this as a valid use of assessment.
I ran 15 people through the dual assessment. As mentioned in part one, I made notes after the assessments about what I learned from each for each person, but then I didn’t look at it again until this week as a means to reduce any pre-judgement I might have.
Ten weeks after starting this test drive, I have decided to stick with the FMS, with a few additions. I know part one had a tone that suggests I would be parting ways with the FMS. I wrote that before I started testing the alternative, and at the time, I thought I would end up dropping the FMS. Even though I felt that way, I am an engineer at heart, and that means I don’t make decisions like that without a proper evaluation. Given my conclusion, I’m thankful for that.
Here are the main contributors to my decision to stick with the FMS:
1. The things I like about the alternative assessment were related to how well they set me up to coach exercises we would be doing during my client’s first training session, but it didn’t have much impact on selecting the exercises. Practically speaking, I was just taking part of the first training session and doing it as part of the assessment. I’m not sure that’s actually a gain.
2. As I ran new clients through the alternative assessment, I realized it wasn’t giving me as much clarity in regards to corrective exercises as the FMS does. I am certain I could map the movements of the new assessment to appropriate corrective exercises, so the new assessment could accomplish this in time. But I am already able to do this with proficiency using the FMS, so at best this falls into the category of different but not better.
3. There were three areas where I like the alternative assessment so much that I will continue to do them after the FMS. In fact they almost won me over to the new approach:
Hip hinge: I mentioned in part one of this post that I was moving toward the thought that the Active Bent Leg Raise (ABLR) would be a better predictor of deadlift ability than the Active Straight Leg Raise (ASLR). In practice, it wasn’t. Almost everyone can do a decent ABLR (maybe obvious to some, but it wasn’t to me). The hip hinge on the other hand was very useful.
I think this really demonstrates Dr. David Frost’s point about transferability of movement quality to actual movement (part one for more). Whether or not someone can lift their leg beyond a certain angle does not mean that they can deadlift safely. A score of 2 or 3 on the ASLR means they have the hip range of motion to deadlift safely, but a deadlift also requires movement coordination and stability. There are a fair number of people for whom the hip hinge movement is foreign, and for these people, programming a deadlift as their main hip dominant strength exercise in their first training program is a missed opportunity. This is because we’ll spend too much time teaching, and until it looks good, we will have to limit the load. The hip hinge test allows me to see who is actually capable of doing a deadlift which, in conjunction with the ASLR, helps me to decide who gets a deadlift pattern as a starting strength exercise and who will gets an alternative like a hip lift while working on the hip hinge as a corrective exercise.
The other reason I like the hip hinge in the assessment is that, further to Dr. Frost’s point, I’m no longer convinced that a score of 1 on the ASLR is necessarily a sign that someone doesn’t possess the movement required to deadlift. The ASLR would be a good choice to screen for whether someone possesses the movement to straight leg deadlift, but that’s not an exercise I use. I have clients doing conventional deadlifts (from risers if warranted), Romanian deadlifts (like the straight leg but slightly bent legs), rack pulls, and single leg Romanian deadlifts.
Admittedly a 1 on the ASLR likely means a person won’t be a good candidate for conventional deadlifts from the floor, but that is not the only deadlift option I’m considering. I do like the ASLR because it will help me to determine which deadlift patterns are more likely to be good options – once I have determined with the hip hinge that they are candidates for a deadlift at all.
Arms crossed squat: Watching people do the arms crossed squat made it very clear to me that I don’t like the Deep Squat (DS) as a screen for whether someone has the movement to squat well. I saw many people perform poorly on the DS who had a very nice arms crossed squat. Testing the arms crossed squat allows me to decide whether a goblet squat is a viable option for someone’s first program, whereas the DS is sometimes unclear for this.
I love split squats as a first program squat option, but there are some people for whom it is a gruelling exercise. Usually (but not always) these are people who struggle with the In Line Lunge (ILL) in the FMS. For these people, I would prefer to work on the split squat as a corrective and build strength with a squat version that more suits their current body.
The practical reality is that I want my assessment to help me determine what knee exercises make the most sense for my client initially. Unfortunately the combination of the DS and ILL don’t always succeed at that. If someone scores a 2 or 3 on the deep squat, I can feel confident that they will be a good candidate for the goblet squat. But if someone scores a 1, I don’t know whether or not this would be a good choice for them. I want to know.
Bird dog: The bird dog is similar but different from the Rotary Stability (RS) test. I really like the bird dog as a test because it tells me whether someone has the stability for the exercise, and by asking where they feel it, it gives me insight into how well they’ll do at lateral/rotary core exercises like Pallof presses, and side planks. I think a side plank could achieve the same thing.
Lateral core stability is an interesting topic for me at the moment. Ever since I started asking clients where they feel rotary and lateral core exercises, I have heard some responses about their shoulders and backs, while others thankfully say core. It turns out many of my clients were looking good while doing exercises to train rotational stability, but they weren’t getting that stability the way I hoped. Finding this out changed the way I program for rotary core stability, and as such, I like either the bird dog or side plank in the assessment.
At the same time, I also don’t care for the more challenging part of the RS test. In fact, if I had my way, I would use the FMS but replace the same side elbow to knee touch test with a bird dog where they perform 3 reps for 5 second holds with one arm leg combination and then repeat with the other. The problem with the stability part of the RS test is that it’s too hard for most of the population, meaning the result provides very information.
Doing the bird dog in addition to the opposite side arm/leg rotary stability test in the FMS would tell me everything I want to know. The opposite arm leg RS part tells me about range of motion (and stability to an extent), and the bird dog part tells me about their ability to stabilize. Adding the “where do you feel it” question makes it a complete picture.
4. There were two other parts of the alternative assessment that have me thinking:
Push-up: I saw people perform poorly on the FMS Trunk Stability Push Up (TSPU) but then do well on a “normal” push up. I still like the TSPU because I think it provides valuable insight into core stability. For example, one such client scored a 1 on the TSPU but could hold a plank for two minutes and could do regular push ups relatively easily. Upon closer examination, his spinal erectors looked like huge metal rods while doing both regular push ups and the plank, which suggests to me that the TSPU did do its job in that it told me that something is off. The regular push up combined with the plank also told me that, but less efficiently, requiring two tests instead of one.
Split squat: The split squat is the one exercise that I think often looks right but is actually wrong. Since noticing this with my clients, I now always ask where they feel it, and their response helps me decide how to coach it for them. While I think this is important, I’m not sure it belongs in an assessment. By using the split squat in the alternative assessment, I knew going in to the first training session whether I would need to overly coach the movement. I’m just not sure how helpful that is. Especially in light of my decision to add the arms crossed squat to my assessment. By looking at someone’s ILL and their arms crossed squat, I can easily decide whether split squats are a good strength exercise for them, or whether it makes more sense as a corrective at first. In my mind, this renders the split squat part of my alternative assessment less valid. It’s true that I’m picking two tests over one, which I frowned upon for the push up. In this case, I am getting more bang for my buck though because the ILL also contributes to my understanding of how their thoracic spine and shoulders move, which I value.
5. I have been adding single leg squats to a bench with my clients in addition to the FMS for years, but I think adding the arms crossed squat may render it unnecessary. The single leg squat tells me if the person has decent hip stability, while also pointing out if there is a strength deficit on one or both legs. The arms crossed squat will show me the hip stability part via hip shifting or knee alignment. It won’t necessarily show me the granularity of strength deficit that the single leg squat does, but that won’t affect my programming much. If someone has a significant strength deficit, I will have see it in the ILL, and a minor strength deficit is not going to affect my programming.
Summing it up:
I’m not breaking up with the FMS after all. This experiment has shown me that I want to keep using it as the core of my client assessment. What remains to be seen is whether I continue with the actual FMS with a few extra tests, or whether I start using a modified FMS. I really want to do the latter, but my inner engineer doesn’t like informal system edits, so it’s a tough call for me.
I’ll post an addendum to this in a couple days with the specific modified FMS that I am considering.
People either love coriander and that guacamole without it is an abomination, or they run screaming at first taste when they see the little green bits in their salsa. It’s amazing that an herb can be so divisive. Not that there are other divisive herbs.
Corrective exercises are like coriander in that they too seem to be quite divisive. In particular, they come up as a reason some people have for disliking the FMS (Functional Movement Screen). I have read many a rant about how people who use the FMS are wasting their client’s time because they spend their entire training session corrective movement patterns, and that if they want their clients to succeed, they need to get their clients squatting and deadlifting instead of wasting time with mini bands.
I completely agree. Training clients entirely with corrective exercises and doing no strength training is not great training. In fact every trainer I know who uses corrective exercises would also agree. The assumption that someone who uses corrective exercises ONLY uses corrective exercises is ridiculous. If someone tells you they like coriander, you wouldn’t assume they only eat coriander. Coriander elevates salsas and guacamole to new heights that could never be achieved without it, but without the salsas and guacamole, it’s just a plant.
Corrective exercise is the same way: Its presence elevates the training.
I view the use of corrective exercises as a very efficient way to prepare for the workout. My clients will do a warm-up that lasts between 5 and 15 minutes based on how well they move, how fit they are, and how old they are. The primary goal of my warm-up is the same as it would be if I didn’t believe in corrective exercise: To prepare the body for the work ahead. The only difference is that I accomplish this with specific exercises intended to improve weak or limited aspects of the person’s body instead of general exercises.
Ask any engineer how much they love accomplishing two outcomes with one task and you’ll understand why I love warm-ups built on customized corrective exercises.
Now that the warm-up is done, we move on to the pillars of the workout: power, agility, strength, and conditioning. My clients pick up heavy things and put them down again just like yours do.