The Functional Movement Symposium (Coffee, Wafels & Argentinian Steak).

This is an overview of The Functional Movement Symposium hosted by Human Motion, that was held just outside of Amsterdam on Sunday 13th October.

The speakers on the day were Kyle Kiesel, Lee Burton, Mark Scappaticci, Behnad Honarbakhsh, Craig Liebenson and Gray Cook.

Firstly, I have to say Amsterdam is the friendliest city in the world and really does live up to the stereotype, everyones on a bicycle or tram, every other shop is a coffee shop (normal ones and special ones) or a bar. It also appears to be where Supermodels are harvested from. So after spending the first day wandering around the town with my colleague Nick and my girlfriend Tiss, drinking coffee, eating cake, partaking in several local beers, eating a very tasty Argentinian steak (why are there so many Argentinian steak houses in Amsterdam?), having a wafel with cream on, getting lost and being constantly rained on it was time for an early night to catch the shuttle bus the next morning at 7am to the symposium venue.

As my notes on the day were taken through a haze of sleep deprivation, caffeine and micro brewery beer any mistakes or mis-quotes are my own fault.

Coffee and Cake Amsterdam style (Nick 'our man in Amsterdam' Heasman on the left)

First talk of the day was Kyle Kiesel & Lee Burton - A Systematic Approach For Exercise Design.

Kyle Kiesel kicked off the presentation (he had been standing in the doorway of a hotel in central Amsterdam with us at 7am waiting for the shuttle bus too).

It started with a brief overview of the Functional Movement Screen, which I won't repeat here as I am assuming you are familiar with it. Then Kyle did a live FMS screening on a guy from the audience, he scored a 13, which is below the cut off point of 14 (I think the guy may have scored higher if he wasn't wearing supertight Euro skinny jeans!). Interestingly, even though the guy said he wasn't in pain, because of his borderline score, lack of smooth movement and high threshold strategies (grimacing to do simple movements) Kyle then did some additional SFMA screening. This was interesting stuff, but I think most of us want to know what we then do with the screen information, how do we construct a program with this information?

Lee Burton then took over, and went through a simple checklist. What do they (the client) not need? Correctives? Conditioning? What do they need? What do they not want? What do they want?

Using the example of a young American football player, Burton then went through the other information you need, such as medical history. This was good to see, as all too often people can become obsessed with the minutiae of movement assessment and forget about the case history of the person in front of them. Have they had previous injury or surgery, what goals do they have? In the case of the American football player, previous shoulder surgery, his age (17), positional needs are all addressed in the program even if the screen presents as non painful and symmetrical.

It was good to hear Burton talk about give and take with a client as well, as any of us who design programs all day know, you have to give the client a bit of what they want, a little bit of what they need and challenge them enough without breaking them down and equally not spend an hour doing correctives if its not needed.

In the case of the young football player a circuit of mobility exercise including T-spine rib rolls and Turkish Get Ups were put into his warm up. Mobility or motor control work can also be supersetted with strength work, so Burton still had power cleans, box jumps and kettlebell strength moves in the young athletes program.

Bag to prove I actually went to it

This whole concept is expanded on further in the DVD The Future Of Exercise Program Design - which I only watched yesterday. If you are involved in program design or writing programs in anyway I think this DVD is required viewing, especially the Alwyn Cosgrove section, as he uses several real world examples of clients and their movement screens and how you use this in conjunction with other information to construct a program.

Other points of note from this talk were

• The re-tear rate of ACLs after surgery is 20-30%!
• Back pain can be because of excessive core activation, not a weak core, a motor control issue
• Lack of mobility can = instability

The next presentation was by Mark Scappaticci, entitled Functional Integrated Therapy - Optimising Performance.

 I must confess I had never heard of this guy before, which goes to show some of the best people in the world aren't promoting themselves on the internet and social media all day long, because they are out there working with clients and athletes on a daily basis.

I enjoyed this presentation, even if by Scappaticci's own admission, it's something he only put together a few hours earlier. But hey, when a guy has been to the last 6 Olympic Games with the Canadian team and consulted with the GB Olympic team it's worth listening to what he says.

Scappaticci's background is a chiropractor, and was there treating Donovan Bailey when he broke the 100m world record. He has his own assessment system, and like all good systems whether it be FMS, DNS (Dynamic Neuromuscular Stabilisation) or Scappaticci's FIT - they have more things in common than they don't.

His first point was to asses the body as a global structure and look for areas of increased tension/ forces. It is surprising that assessing as a global structure is still really not part of mainstream physiotherapy in the country (UK), it is still very much look at the injured area in isolation, whereas Osteopaths, DNS, FMS, NKT etc all seem to assess globally first.

He then outlined his systems theory - the sphere of optimal performance needs:

Optimal biomechanics

Optimal nutrition (at this point Mark informed us that if you go into any Olympic village food hall two thirds of the track and field athletes are in the line for McDonalds. Yes, sorry to disappoint but genetics is a factor and even elite athletes are not optimal)

Optimal rest

Optimal program design

Optimal technical skill

Optimal mental focus

Optimal adaption to stress

Optimal restoration

And we don't want to wait for the first injury, we want to be able to predict it and prevent it before it happens.

Optimal biomechanics need the neurosensory system, soft tissue and joint all to be working optimally.

An injury will result in different compensations in different people, for example an ankle injury may result in a different sensorymotor adaption depending on the individual (for example, the glutes switch off to protect the ankle resulting in hip or knee issues - my words here) and world class athletes are masters at compensation. Poor mechanics result in increased stress on tissue.

"Outcomes are only as good as your ability to assess." - Scappaticci

Another interesting point is to separate the clinical diagnosis from the causative diagnosis. For example, in my field, you have been diagnosed with a disc bulge at L4/L5 but what caused it? The weak link breaks but the structures away from it may be the things that are not working. (Joint by Joint theory anyone?)

Scappaticci also went through the injury mechanism - injury leads to reduced oxygen level in the area, an increase in alpha procollagen which causes scar tissue. This may show up as abnormal tension in the fascia long after an injury has 'healed'.

The fact that someone is afraid to move may drive pain signals was another point that resonated with me, I see this all the time with chronic back pain or people afraid to squat because their knees hurt.

Scappaticci stated that you need to have a treatment strategy 'power of intention, what are your goals?'

Other points

• Poor posture is a a barrier to optimal performance
• Do sports specific testing where appropriate. A poor assessment doesn't mean they are poor at their sport.
• Can I do something to enhance performance, if not I might leave it alone
• Taping  (like kinesio, rocktape) affects the nervous system
• Use whatever tools you've got - dry needling, fascial abrasion (a tool invented by Mark, to me it looks like a bit like a gua sha or graston thing, though Mark assured us it was different, but at 690 euros for the tool set I think I might follow Leon Chaitow's advice from when I saw him talk 'use a jam jar lid!')

At the end Mark got the guy on stage who had previously done the FMS with Kyle at the start, his active straight leg raise had been asymmetrical with the left leg no where near 90 degrees. Mark did some dry needling in the guys sacro-illiac area for literally about 10 seconds and then retested the guys leg which went up about another 30-40 degrees. Would it stick? Mark said he didn't know. What makes the best the best is they are also humble, sometimes you don't know why something works, it just does, but you gotta have a system. And you've gotta assess and test, treat then retest..

Next up was a practical session with Behnad Honarbakhsh (who also happened to be standing outside the central Amsterdam hotel at 7am waiting for the bus) called Reset Techniques for the Thoracic Spine.

First point form Behnad was to define a reset technique as 'anything without the active participation of the client'. And any change you do manage to make has to be set. And the technique you use should be based on your diagnosis.

I believe Behnad is a Canadian Osteopath and also teaches the SFMA course. I got the impression quite a few people in the room had taken the SFMA course during the week as Behnad asked certain questions about anatomy of the ribs and spine; the Symposium was the culmination of a week of courses including FMS, SFMA, dry needling and so on. This practical session was very much aimed at the manual therapists in the room, as it involved manipulation and visceral techniques. So if you are a Chiro or Osteo you can do this stuff, if you are a coach you can't. (my girlfriend is in her 4th year at Osteo school and currently one of her electives is visceral manipulation, so this is very much her field).

The session started by doing an assessment on a guy attending the symposium. If you aren't involved in manipulative techniques then this is still interesting for a couple of reasons. Firstly, 'the opportunity for compensation is greatest standing' and 'mobility takes precedence over motor control'. Which means, yes, looking at standing posture but then look at other postures and see if things change. If a problem is coming from the head and neck down, it will still be there in a seated position, an asymmetrical head position will stay asymmetrical, if it is coming from the feet up it will disappear during seated posture. So it gives you an idea where your treatment or corrective exercise strategy should start.

Behnad then went through reset techniques for breathing, ribs and visceral manipulation. To be honest learning practical techniques in these type of sessions is almost impossible, as what you need to do is observe and then go away and practice. Also, I think for a lot of the group it wasn't relevant, as like me they aren't going to do visceral manipulation. And even things like breathing resets which can be quite simple still take time to learn and practice (as I know from DNS).

Take home points were though-

• Don't discount the viscera referring pain, we tend to think in musculoskeletal issues and forget about the major organs and how for example the liver is attached to your diaphragm, so can influence breathing
• The driver of a problem is the thing that changes the other one. For example, if you manipulate a rib and breathing improves, then the rib was driving the breathing disorder.

Next up was Craig Liebenson - Building a Durable Athlete - Introduction of the Prague School and athletic development.

For me (and my colleague Nick) this was the stand out presentation of the day. Although, I have heard audio interviews with Craig Liebenson talking to Stuart McGill, I have never seen an entire lecture from him or seen him in person. It was one the most galvanising and inspirational talks I have seen.

And I almost didn't go to this one, as I have done DNS courses A, B and C and have a fair grasp of what the Prague School does. But this talk wasn't really about the Prague school, it was about bringing everything together, a call to arms if you will.

DNS and all that jazz source: rehabps - facebook page

A few key quotes from Liebenson

"Pain is not an early warning system, its already too late, the damage is done."

"Assess without expectation"

All too often we have a preconceived idea about what we will find or what a client wants or needed. But it's not about us, it's about that persons quality of life.

"Ensure competency before adding capacity"

And don't be "a prisoner to protocols". Liebenson was very much in the camp of movement philosophy and similarities between the likes of Janda, the developmental model and the FMS. Yes, the assessments may be different, but there are some underlying principles of movement that drive everything. You assess and then you analyse and then he gave us the classic Karel Lewit quote

"He who treats the site of pain is lost"

Maybe they should write this above the door of every physio department in the country.

Then Liebenson gave us some stats on MRI and CT false positives. For example 30% of 30 year olds will have a discogenic issue on an MRI but will not have pain. And also a Korean study I don't have the reference for - basically quality of life must match quantity, there is no point living longer if our functional capacity dramatically decreases and your levels of pain go up. Our job is to get people moving better and more often.

Other key points from Craig

• After injury tissues heal but muscles learn. An echo. Guarding.
• Ankle sprain -brain switches off the glute to allow ankle to heal
• A  fine line between building and breaking
• Get Strong first, he referenced Pavel Tsatsouline here
• And adopt a middle way.

Liebenson then quotes another person I had never heard of, Henk Kraaijenhof, but turns out to be a famous Dutch coach and another person too busy being awesome to bother writing a book I guess

"Train as much as necessary, not as much as possible. As much as is necessary in order to improve."

and then another Lewit quote

"The first treatment is to teach the patient to avoid what harms him."

This very much echoes Stu McGills advice and something that is easily forgotten in our rush to use fancy techniques and exercises. And then Janda again

"The brain thinks in terms of movements, not individual muscles."

Old Vlad Janda was ahead of his time. Then there was a quote from Laird Hamilton, the big wave surfer. I forgot to write it down. But it was very much in the vein of movement quality and authentic movement. What I liked about this lecture was Liebenson brought all these disparate sources together, whether it be Laird Hamilton, Greek Philosophers, Dutch coaches, Lewit and Janda from the Prague School or Pavel with the kettlebells and showed the thread that connected them all. Authentic quality movement is writ large in all their philosophies. And I like the fact that someone like Liebenson is constantly learning and remaining humble and in wonder at the human body like us all (he said a couple of years ago he didn't know what a deadlift or kettblebell swing was). A true renaissance man for the new rehab renaissance.

A final quite from Janda

"Time spent in assessment will save time in treatment."

And then echoing the DNS approach - every exercise is a test.

DNS - everything is connected. Source: rehabps, prague school facebook page

And then Craig made us all stand up, and reach for the ceiling, decompress the spine, and breathe to engage the core and bring the ribs down (it is always surprising that on most fitness courses and lectures you spend all your time sitting down in a terrible posture, doing exactly what you tell your clients not to do).

And lastly a call to arms

"The world has stopped moving."

Sedentarism (did Liebenson just make this word up?!) is this generations smoking. People aren't moving and its killing them.

To finish a clip from www.designedtomove.org



And up last, the big man himself Gray Cook - Cooking with Gray.

At this point I think we are all flagging. The symposium has been going since 8.30am, its now pm and we got up at 6am (5am UK time).

Gray Cook

Gray Cook has the ability to bring it back to basics, to reduce it all down to its essentials. To make you think about the very basis of it all.

In the lecture Cook went through the principles of movement as outlined in his book Movement. You need principles, a checklist, a system.

"Movement is a behaviour."

If you are in a gym or fitness facility you are 'the front line of defence, we do fitness a little differently here'. Never forget that if you are doing this stuff you are still in the minority. Maybe there were 50 or so people in the room listenening to this lecture, that's 50 people in the whole of Europe. Yes, if you use these things you are in the minority. To echo what Alwyn Cosgrove says in the Future of Exercise Design - if you are in this room and continually learning, or doing this stuff you are in the top 0.5% in the country.

Anyway back to Gray, some key points

• You need two perspectives - movement & performance or movement and impairment
• Mobility before motor control (as stated in previous lectures)
• What is dysfunction? We talk about it all the time, but whats the definition
• If we compensate the workout may be harder but not efficient. If you can't squat, trying to get someone to do 20 loaded squats is going to be hard for them but is just going to break them down or injure them or produce a load of inflammation and cortisol which may be detrimental to their goals such as weight loss.
• Total body tension doesn't over stress joints - such as in the deadlift
• Core may not be globally weak, it might be how it responds in one pattern
• Don't overkill corrective exercises.
• Delete the insulting movements
• They could be too sedentary or too specialised

And that was that. A video clip from the Erwan Le Corre and Gray Cook video, in which my girlfriend wondered if Erwan was single.

Any questions? Of course, at this point I couldn't think of any, no one else could either. Afterwards I thought of some questions
1) Will the movement screen always be the same 7 movements or will some get added or deleted?
2) Behnad had mentioned a breathing screen/assessment earlier - will it get added in?
3) And a question from my colleague Nathan - why no hinge pattern in the FMS assessment? There is a squat movement but no deadlift movement, why only multi segmental flexion in the SFMA not in FMS?

But of course, none of  that got asked. And before you know it, we're all back on the shuttle, including Gray and the FMS guys (I thought Gray might drive us all in the movement bus, like the equivalent of the Scooby Doo Mystery Wagon but no such luck).

In my mind this was well worth going to, for 149 euros. A chance to meet like minded people, realise 'you are not alone' and inspires you to carry on.

And before we knew it, we were lost in the Amsterdam rain again and then drinking Heineken in a small bar.

Micro brewery beer menu - I guess there is a reason this picture is blurred

Take home messages

• If you're not assessing then you are guessing
• You gotta have a system, principles are more important than methods
• Dutch women (and men) are hot
• I can't read a map

So Many Mobility Exercises So Little Time. Which Ones Should You Do?

There are hundreds of mobility exercises, and some are better than others. With limited time, which ones should you do? Which ones will achieve the most in the time available? A quick straw poll amongst the trainer and coaches I know, revealed the following three to be our current favourites.

Of course, these aren't the only mobility exercises or drills we do and depending on your individual needs, injuries and goals there may be better choices for you. With that caveat in mind, here are three mobility exercises you or your clients should try.

Cat Camel



Why Should You Do This?

If like most people you spend much of your day sitting, or driving or stuck in one position your back gets glued up and stuck. The cat/ camel can provide some active flexibility for the back with minimal loading. It is often a starting point for people with back pain. It is proven to reduce the viscosity (makes it less glued up and reduces friction) in the spine & torso (McGill, 2002 & 2007). Before you work out or anytime during the day when you have been stuck in one position jump down and do some cat camels to get the back moving more efficiently. The beauty of the cat camel is just about everyone can do it

How To Do It

On all fours, hands under shoulders, knees under hips. Then get the whole spine to move up and down - neck, middle back and lower back. Note this is not a stretch, in the video above you can see Nathan starts with a very small range of movement. There should be no grimacing or pushing into the end part of the movement. You only need to do 6-10 of these to get the effect of reducing viscosity in the back, there is no need to do anymore.

What Can Go Wrong?

Some people, especially those who have had or do have back pain can find it very hard to move their spine. They think they are moving their back up and down but they are not, their spine has turned into a breeze block. Look for compensation in the arms and shoulder blades. It is possible for someone to have no spinal movement and literally be bending their arms and shrugging, this has no benefit.  The person who does this is going to need extra cuing and coaching.

Also some people with sciatica may find the flexion (arching up) part of the movement increases their symptoms (McGill, 2002), they need to reduce the movement. As always, all movement should be pain free, look out for the pain face and breath holding.

Lastly, generally avoid any spine bending first thing in the morning when the back is at its stiffest and the discs have re-hydrated overnight. Otherwise, you can do this exercise any time of day.

Boot Strapper Squat




Why Should You Do This? 

I have found that this exercise is one of the quickest ways to improve someones squat depth and technique. I think Dan John probably invented it, but don't quote me on that.

There is something about the movement pattern that the body responds to. It could be because it combines a hip hinge/ deadlift movement with a squat movement. It could be because this is the way humans move when developing as babies, we generally pick weights up off the floor using a deadlift movement and when we learn to squat it is from a bottoms up position. As babies we crawl, then bear crawl and then get into a squat position and stand up.

Even if this movement has nothing to do with developmental kinesiology, it does work. I've seen clients who couldn't squat to anywhere near to parallel without knee collapse and loss of control, get to a below parallel good position squat after less than 10 repetitions of bootstrappers.

How To Do It

Grab a kettlebell by the horns, as in the video. There is something about the kettlebell shape and the way the weight pulls downwards that makes it conducive to this exercise.


Then drop into a squat position, there is a good chance you or your client will not be as mobile as Nathan is in the video clip above. Just drop as low as possible with good technique - neck neutral, lumbar spine neutral, knees pushing outwards. It's also best to do this barefoot, so you can see any compensation in the feet or ankles (trying to lift up or turn out excessively).The next stage is to push the kettlebell backwards low through your legs and push the hips up and back at the same time. You end up in a hip hinge, RDL position, again the spine is neutral, as is the neck (no cranking on the neck or looking up) and the knees are slightly bent, you should feel the tension in the hamstrings. And then slowly drop back into a squat and bring the kettlebell back up to the goblet squat position. The depth and quality of the squat should improve as you do the repetitions.

I have seen several video clips of people doing this exercise fast and for high reps, using it more as a conditioning exercise. I prefer to do it as in the video I filmed above, a smooth, controlled tempo, doing up to 10 repetitions as a mobility drill before a workout.

What Can Go Wrong?

This is one of those exercises that doesn't work well in a group training environment. You will demonstrate it, and then when you look around the class to see what people are actually doing you will cry.

Most common is for people to round their back, not hip hinge, crank their head forward and up and anything else you can think of that is wrong. Therefore, I would generally only do this exercise one to one with a client, that way you can correct and cue as needed.

Brettzel

As invented by Brett and Gray Cook. Hence, I have embedded their videos here as they can explain it better than me.



Most of your clients are going to look more like Brett Jones doing the exercise above. In other words, they are going to find the position hard and are going to need some props. Some might have good mobility like the video below with Gray Cook demonstrating with someone who has good mobility.



Why Should You Do This?

Did you not watch the videos above? This is going to work on your T-spine mobility, hip flexor/quad of the down leg and the lateral hip muscles of the top leg. Plus, you can work on your diaphragmatic breathing while holding the positions.

How To Do It

Like in the videos above! Most people are going to have to use some props under their knee and under their head, use whatever you have to hand, towels, yoga block, foam rollers.

What Can Go Wrong?

Some people will not be able to grab their lower leg and put it into a stretch position. In which case, a band or strap could be used, careful though, this causes some people to tense up and lose upper body positioning. These clients may be better off not trying to grab the lower leg; they should try a rib roll to begin with, just focusing on the T-spine and middle back.

Someone says they feel it in their lower back? Check the front knee/ leg position. Their hip might need more flexion and they may need that leg up on a prop to stop twist in the pelvis if they are tight in that area.

Also, look out for the pain face again. This might be a challenging mobility exercise, but you shouldn't be grimacing or holding your breath. Some people want to be martyrs and refuse to use props. Remind them this is not cheating, but actually making the movement better. No forcing, no bouncing into the movement and no pain!

Wrap Up

Try these if you haven't already done so. And if you have any mobility exercises or drills that you think are essential or should be in a program let me know.

References

McGill S (2002) Low Back Disorders: Evidence Based Prevention & Rehabilitation
McGill S (2007) Ultimate Back Fitness & Performance
Cook G & Jones B Kettlebells From The Ground Up DVD

Club Swinging Essentials DVD - A Review

This is a review of the Club Swinging Essentials DVD featuring Brett Jones, Gray Cook and Dr Ed Thomas. I purchased this DVD from dragondoor.com

It looks like this

Cost and what you get for your money

The DVD costs $79.00. International delivery was not cheap and cost another $20 to ship to the UK. On the plus side Fed Ex delivered the DVD a mere 4 days after it was shipped from Dallas Texas, which is quick, on the minus side British customs charged me VAT on top! Which means delivery and VAT cost me almost as much as the product itself.


The DVD is approximately 1 hour and 27 minutes long and also comes with a 72 page colour spiral bound manual. The manual is particularly useful when you are teaching yourself the moves without the DVD in front of you, at the gym or in the garden. The manual covers many of the discussion points from the DVD, as well as photos of the movements, there are also some extra points about  functional movement screening and  historical material about clubs in the manual.

A small point, the word movment (sic) is spelt wrong on the front of the DVD cover, some proof reading may have helped here.


Content in brief

The DVD starts with an introduction discussion with Gray Cook, Brett Jones and the humble Indian Club Master Ed Thomas. It then moves on to Brett Jones discussing safety and grip, then the five movements are explained and demonstrated by Ed Thomas standing and then Gray Cook in tall kneeling and open half kneeling postures. After these five essential moves, three more advanced moves are demonstrated by Ed Thomas. We then move onto a demonstration of club swing by Ed Thomas and finally a discussion about the history of clubs, fitness and the philosophy of fitness.

You must grow a moustache before you start swinging clubs

Paradigm Shift

In the introductory section Gray Cook explains that he sees Indian Clubs as the upper body equivalent of the jump rope, expanding on his idea of self limiting exercise. Both skipping and club swinging demand technical proficiency, unlike running for example, which is easy to do badly with poor posture.

Ed Thomas then explains his background and where he learnt Indian Clubs, after his explanation of clubs as both a healing and martial tool, his time spent in Burma and elsewhere learning the clubs, and his self effacing attitude you are in no doubt that Dr Thomas is the real deal.

The idea of neural training is introduced and then Ed lists the three concepts that are needed to move well

1. Joint Integrity
2. Mobility
3. Efficiency

Dr Thomas them covers some more profound ground. Making the point that every time you do a movement you do it differently, you are a different person and

"every breath you take, you're a different person"

He then covers the concept of rational training, every movement you do either makes you better or worse off.

The dynamic between Gray Cook and Brett Jones is great, as it is on all the DVDs they have done together that I've seen, and Dr Thomas complements this nicely. At this point, you know you are getting much more than a list of Indian Club exercises or a fitness DVD. The fundamentals of exercise are being addressed.

It feels like you are watching the development of a paradigm shift in exercise, away from the mindless treadmill running and 'we must smash our clients into pieces because that's what they expect' attitude towards what Dr Thomas calls 'Mindful Movement'.

Having the brain and the body in the same place at the same time. This is very much in the martial arts tradition, as well as Yoga and Tai Chi Chuan schools.

It gets better, with Dr Thomas explaining that people need to learn to move, when they come to the gym we need to teach them something. People need to

"go to the gymnasium to learn to workout"

With this point I think he hits the nail on the head, this is something I've been trying to evolve towards in the way I coach people.

 Ed Thomas cover his training principles of progression, variety and precision.

Gray Cook adds that much of the exercise variety we have is for entertainment purposes, not for the purpose of exploring how our bodies can move and that the

"solution is not moving more, it's moving well."

For me, this introductory section alone is worth watching over and over again. I don't know if they script this stuff before hand, but the discussion and banter looks natural and spontaneous.

Safety section

Brett Jones then covers safety, just in case you don't know that swinging a club in you house might result in you breaking some stuff. He then goes through the grip, wrist position, elbow and neutral pelvis. This attention to the precision of movement wasn't covered on the power club course I recently attended (see review here).

The five movements

In the next section the five movements are covered, helpfully numbered 1,2,3,4,5. The complexity builds with each new movement.

First Dr Thomas demonstrates the movements in the classic standing posture. A posture I've seen used for classic military pressing and in the original Pilates exercises. Then Gray Cook demonstrates them in tall kneeling and open half kneeling.

Gray points out that these kneeling postures allow for a more reflexive stability, they mimic the developmental sequence (see Pavel Kolar & Vladimir Janda) and help to break bad patterns. They also allow the trainer to see mistakes more easily, as the lower body is taken out of the equation.

The movements are done with what Brett Jones describes as 'Tai Chi slowness' to begin with, and Ed Thomas breaks down the movements as well. Again the details matter. Dr Thomas then comes out with another gold nugget quote

"Do it well before you do it fast."

 There are five movements in total, done in three positions, so that's 15 movements, not counting having to do some with both arms

Gray Cook takes a back seat in this section as he demonstrates the kneeling moves and Brett Jones coaches and talks.

These movements are a lot more complex to learn that the powerclub moves. I personally wouldn't be confident to coach these moves without a lot more practice, as in hours and a few thousand reps! Whereas, powerclubs does have some complex moves, it also has some simple moves that can be coached immediately.

Advanced moves

After the five essential moves, three advanced moves are covered 1) Side stepping lunge 2) Deep knee bend and 3) Wrist Pattern.

It'll be a while before you attempt these moves, but it's worth watching this section for the discussion of the deep knee bend, as Gray Cook says

"people can't squat because they don't squat."

The presenters point out that these are the essential moves, there are an infinite number of patterns after this.

Bonus section - return to the source

Next is a section showing Ed Thomas swinging the clubs, so you can see what can be done. Then there is a discussion between Ed, Gray and Brett.

This is a really interesting section, Ed talks more about the history of clubs, the Turner gymnasiums that originated in Germany, the martial and restorative aspects of clubs and how they can be a weapon or healing device. Ed Thomas then covers off the ground training, and how this is essential as gravity is constantly moulding the human body, so we need to adopt uncommon postures (more on this can be found on the internet). But to give you an idea, we all used to climb ropes in school, I remember there being a ropes in the school gymnasium, but gradually they fell out of favour, no one knew how to teach it properly anymore, safety became an issue and they stopped being used.

One good reason to start rope climbing again!

The point about going to the gym to learn and not workout is re-iterated, you will get a workout in the process. This is a fundamental point that is worth repeating.

Gray Cook then attacks the bootcamp mentality, where everything has to be a full on balls to the wall (my words not his) workout, which is okay if you are 20 and fit but not if your 30 or 40 and overweight and sedentary. You should come out of your workout feeling better than when you started, and then occasionally you test your limits.

The clubs used in the video are only 1 pound (approx 0.5kg), Dr Thomas states that boxers always used lighter clubs, and wrestlers used heavier ones, this is situational correctness, does the club remain therapeutic and restorative, no one begins with a heavier club. Unlike Power clubs, where you start with a minimum of 2.5kg and are using weights in the 4-8kg range quite quickly. Ed Thomas finishes by demonstrating with some 8 pound clubs, which are considered light in the world of power clubs, but the movements are different.


Philosophy

Some fundamental questions are asked by Dr Thomas.
Why do we go to the gym?
What is the purpose?

These questions have got me thinking.

And Gray Cook inadvertently quotes British comedian Harry Hill 'You gotta have a system'! Yes you have.

Conclusion

As you can see from this review, the discussion of fitness, the philosophy and its antecedents interested me as much as the Indian club techniques.

I can recommend this DVD, though the best place to start with Gray Cook and Brett Jones would be Secrets Of The Shoulder or Secrets Of The Hip and Knee. I intend watching Kalos Sthenos next.

There is a definite difference between power clubs and the Indian clubs presented in this DVD. Ideally take the middle way, you can do both. The therapeutic Indian clubs and the more strength basic powerclubs.

If you are doing this at home, I would buy the Indian club DVD . If you are going to be personal training clients then do the powerclub course. I'm somewhat sad to say that the variety of power clubs holds more of an attraction for the average client and putting the time and effort in on a five key moves may be beyond most clients, and the power clubs have some technically easier moves. But you don't have to be that guy or gal! You can teach your clients and they can get a workout as part of the process.

Personally I'm going to use the lighter Indian clubs, and the power clubs, and kettlebells, and Olympic bars, and dumbbells, and bands, and run etc etc etc....................

HIP HINGE! Your Body Wants You To

The hip hinge is a fundamental movement pattern. You need it to get out of a chair, squat, pick things up, deadlift, do an Olympic lift and generally spare your spine while moving.

See the video below of how to do a hip hinge.



However, it's surprising how many people can't hip hinge. I've noticed it with a whole host of different populations. When I get a client who has back pain, one of the first things I do is observe them get in and out of a chair. A high proportion of these clients tend to get out of the chair by lifting their hips up high and then unrolling or flexing/ bending  through the lumbar spine. Some can't even get out of the chair without using their hands to push themselves up. A few simple cues and adjustments and then suddenly they can get out of the chair with a neutral spine and without using their hands. Mostly I tell them to bring their feet wider, push their knees out, hinge from the hips, keep the chest up and drive into the floor with their feet - and bingo they get out of the chair with a neutral spine and using their hips.

Chair Squat - start position

Chair Squat - mid point

Why can't people hip hinge then?

If the hip hinge is a fundamental movement pattern, and everyone should be able to do it and use it on a daily basis, why can't people do it. Why do they bend/ flex in the lumbar spine? Why does the thoracic spine round too much?

The body will take the path of least resistance, the least stiff part will move and compensate for the stiff part. In the words of Charlie Weingroff (2010):

"The movement goal is achieved but there is no integrity to the movement."

Which means I asked them to get out of the chair and they got out of the chair, the goal was achieved. The hips and thoracic spine may be stiff so they used the lower back to get out of the chair, they achieved the ultimate aim. Or in the context of weightlifting, one person deadlifts the weight using the hips, while another person uses their lower back - they both got the weight up, and if you're in a competition you can justify it to yourself, but don't train like this, you're going to end up in a world of hurt.

Your body responds and adapts to what you practice most. If you adopt a certain posture 8 hours a day, what does your body do, it adapts to it.

"Prolonged sitting has been cited as a factor in the development of back pain. Cyclists who spend 3 hours riding their bicycles in a position of lumbar flexion have a reduced lumbar curve when compared with control subjects who do not ride bicycles." (Sahrmann,2002:13)

which means

"repeated motions of daily activities, as well as those activities of fitness and sports, may also induce undesirable changes in the movement components." (Sahrmann, 2002:13)

So in most cases the lumbar spine is moving too much. In this context the joint by joint theory espoused by Mike Boyle and Gray Cook makes sense. If the body is a series of joints stacked on top of each other, with some tending to be more mobile and some more stable, a loss of mobility in a joint may affect the ones above or below. So in the case of the hip hinge, if I lose mobility in the hips the lower back will compensate, if I lose mobility in the thoracic spine, the lower back will compensate; the lower back should be stable. In lower back pain rehab we always ended up spending as much time on trying to restore peoples hip mobility and strength and their thoracic spine mobility, as well as lumbar spine stability. When I first read Mike Boyle's joint by joint article in made perfect sense because I was seeing it on a daily basis with people.

And remember, stable doesn't mean static and still

"stability is the ability to control movement in the presence of potential change." (Weingroff, 2010)

So why can't I bend my lumbar spine, it's meant to bend isn't it?

Somewhere in Canada there's a guy called Stuart McGill and if he's not on his yacht or kayaking or cross country skiing or grooming his moustache then he's in his spinal lab at the University of Waterloo. He breaks spines so you don't have to.

It seems the number one mechanism for herniating a disc is fully flexing the spine.

"In fact, herniation of the disc seems almost impossible without full flexion." (McGill, 2002:56)

 And the number of flexion is important, the spine doesn't have to be loaded up, the repeated flexing of the spine with minimal load can cause disc herniation. I like Mike Boyle's analogy of a credit card, if you keep bending it back and forward eventually it will snap, not because you were applying much force but the repetition caused a weakness in the plastic until it snapped.

Imagine this shiny new gym membership card is your spine, eventually it's going to snap

"repeated spine flexion - even in the absence of moderate load - will lead to discogenic troubles." (McGill, 2002:127)

The way to avoid this is to flex at the hips while keep the back in neutral and the abdominals braced for the task at hand. This is the hip hinge. Interestingly,  one group of people who lift some of the heaviest weights are Olympic lifters, they lock their spine into neutral and rotate around the hips (McGill, 2002). Their incidence of back pain is lower than the general population. If you look at the video clip below of the snatch grip romanian deadlift, you can see the spine in neutral and the hips doing the work. The position of the bar below the knee is essentially the same as the start of the second pull in the Olympic lifts. (note: if you ever film yourself doing a lift, then it gives an insight into your technique and will immediately make you lift with better technique).



Hang on, shouldn't I be able to touch my toes?

Toe touch: an assessment not an exercise

Being able to touch your toes is still seen as a measure of flexibility. It appears in Gray Cooks Selective Functional Movement Assessment  as one of the tests you employ if someone is in pain, it's the multi segmental flexion assessment (Cook, 2010).

I think Charlie Weingroffs Core Pendulum theory is a good explanation of this. Charlie explains this in his excellent DVD set Training=Rehab Rehab=Training (go and order it now, it'll change your life for sure! And I don't get any money for saying this). We need to exhibit for flexion and full extension for our spines to know where the middle is, joint centration. If you have a loss of flexion then your neutral spine will be off because your body doesn't know where the middle is, same as if you have a loss of extension. The lumbar spine is meant to flex and extend but going to the end range on a regular basis is not a good idea, its proven to eventually cause disc problems. Remember an assessment is not an exercise you should be doing on a daily basis.

Core Pendulum: If neutral is in the middle(3), then your body only knows its the middle because it can get to the end ranges (1 & 5), if it can't, adopting neutral spontaneously is going to be difficult.

As an example, I never practice touching my toes and I hardly ever stretch my hamstrings passively and my flexibility in this area isn't the greatest and yet I can touch my toes. This is purely from doing hip hinges, kettlebells swings, deadlifts and so on.

Save your spinal flexion for when you need it, on those occasion's when its impossible not to flex, the rest of the time adopt spine sparing strategies such as the hip hinge, squat using the hips or a golfers lift for picking things up.

Golfers Lift: reduce load on lumbar spine when picking up light things

A quick note on the golfers lift: The leg cantilevering behind acts a counter weight, effectively hinging one hip and helps reduce the load on the spine. To train this movement I like to put a kettlebell in the hand opposite to the one on the floor.  For back pain clients who can't balance, it's acceptable to support one hand on a wall or chair or table when picking things up.

Hip hinge common mistakes

In the first video clip below you can see Nick is bending his knees too much and flexing in the thoracic spine. Knees should be about 20 degrees  (if  you happen to carry a protractor or goniometer around with you) this allows the glutes to be engaged more effectively. You should feel a stretch in the hamstrings on every repetition. Cue to keep the chest up but the head neutral.



In the second clip below, you can see the hips hardly move back at all. In fact, Nick had a hard time trying to demonstrate this because he's is so used to hip hinging, his hips are still moving, you'll see some people with no hip movement and all spinal flexion. You can try to get them to push their hips back by standing near a wall and trying to push their glutes (bum) back to the wall and touch, may be a foot length away from the wall at first. The broomstick on the back can also help people feel when the back starts to bend.



Another thing that can happen mainly with women is the lower back has too much curve in it, too much extension. No video of this because neither me or Nick can get that much extension in our backs! Remember neutral is not over extended, it's in the middle of the pendulum swinging.

You can start to weight the movement using a kettlebell once the hip hinge has been grooved in, and some people will naturally start to brace more when they have a weight in their hands, and it helps to get that stretch feeling in the hamstrings, loaded up and ready to contract.




And finally the squat

For most people using a squat that has some kind of hip drive component to it is the way forward. If you're an olympic lifter you are going to drop almost straight down and most probably be in a front squat position. For everyone else, especially the general population, sitting back more is going to be more beneficial.

I've used the bench squat technique (see video below) successfully with back pain clients as well as clients referred to me on GP referral (exercise referral scheme) with knee replacements and hip replacements. It is essentially an unweighted box squat. The client learns to break at the hips first and sit back, keeping a near vertical shin also helps those who have knee pain. The hip hinge is a vital component of this.



When a person can't sit all the way down onto a bench or chair I use a step on risers, and gradually as they get better reduce the number of risers down. Don't think about loading up a squat until someone can do it bodyweight with neutral spine.

In the video below are some common squat mistakes.




On the first repetition - trying to do all the movement at the knees, no hip hinge. A lot of people do this when you ask them to squat. I think it might actually be a misunderstanding, you say squat and they think the knee must bend, they have an image in their head of what a squat is. Sometimes you can correct this immediately with the right cue to use the hips. Thus demonstrating it's not always a muscle or joint issue.

On the second repetition - rounding the thoracic spine and over extending the cervical spine by looking up.

On the third repetition - knees caving in.

To paraphrase Gray Cook (2010) I wouldn't get too caught up trying to analyse why all this is happening, is it because the hips are tight or not working, or the lower back not stable, or thoracic spine being immobile or the ankles being stiff? Possibly all of these, but work on fixing the movement pattern. Sometimes its just because the person just never moves that way, the software isn't in their brain, practice the movement and the nervous remembers it and saves the software for the new improved movement pattern.

And maybe they never challenged themselves before, if you sit in a chair all day you don't need to be very mobile or stable. You only need stability in the presence of mobility (Weingroff, 2010)


In conclusion

You need the hip hinge. You need it to spare your spine and keep your lower back neutral when picking things up at home or in the gym. You need your hips working for you, not against you. Your body remembers what you do most.

Tina Fey: No, don't pick that typewriter up with a flexed spine, hip hinge dammit! Okay, I forgive because you created 30 Rock and you're hot. But if you're ever in England and you have back pain give me a call and I'll see what I can do.

References

Cook G (2010) Movement
McGill (2002) Low Back Disorders
Sahrmann (2002) Diagnosis & Treatment of Movement Impairment Syndromes
Weingroff (2010) Training=rehab rehab=training DVD