Bridging the Gap Between Fitness and Medicine, the Importance of Movement Proficiency

Fitness and medicine are often viewed as two separate realms of health and wellness.  We view exercise as a way to improve our body composition, strength, and/or endurance.  But, if we have joint pain, then seek medical attention to get it fixed.  Fixed usually means medical or surgical interventions to alleviate the pain.  Once our joint pain is fixed, then we go back to our fitness training. 

In my opinion, fitness and medicine are not two separate realms of health and wellness.  The dichotomy that has evolved is a huge misconception.  What is viewed as fitness and what is viewed as medicine (not including trauma) are simply part of a larger movement continuum.  Moving efficiently should be the basis for health, fitness, and performance.  It should be the foundation for our general physical preparedness (see picture on right).  However, the vast majority of people working out never even consider it.

Often, joint pain and injuries are the final manifestation of chronic muscular-skeletal deficiencies and compensation.  But, we never know if we have any deficiencies and compensation because movement proficiency is never assessed or even considered.  What is movement proficiency?  Movement proficiency is how we choose (or can) move.  For example, how do you get up from a chair?  Do you set your feet, balancing the pressure evenly through both feet, lean forward slightly, maintain your knees in line with your toes, and rise up with a smooth combination of hip and knee extension, and torso stability?  Or, do you throw your torso forward, shift your weight to your toes, squeeze your thighs together, extend your knees prior to your hips fully extending?  The first description is an efficient movement pattern and demonstrates adequate: mobility, stability, coordination, and strength.  The second pattern demonstrates an inefficient movement pattern.

The inefficient movement pattern would more likely be associated with lower back, knee, and foot pain.  If you displayed these inefficient movement patterns and have joint pain, what do you do?  Do you seek medical intervention?  Do you just work around it?  What model do you fit into, a medical or fitness model?
Both models may fail to help you.  They both view and address your problem from different perspectives.  Although, a movement continuum model would help you detect inefficiencies and give you a starting point for intervening. 

My training philosophy is based on moving efficiently.  Whatever your goal is, fat loss, increased strength or performance, or just get healthier, it all starts with addressing your movement proficiency.  All training is in the context of improving or maintaining movement proficiency.  It takes more time to individually assess and evaluate each client, but it is worth it.  More than ever, the average adult presents with poor posture, mobility, stabiity, strength, and/or endurance due to their sedentary lifestyles.  I estimate that one out of every two clients I work with has at least one or more issues.  Luckily, the movement continuum model is a powerful tool to improve your movement efficiency, alleviate joint pain, and help you reach your fitness and performance goals.

Don't Follow the Hype: What the New Client Needs and Doesn't Need.

"Early Specialisation at an intense level does not seem to produce an enduring athlete..."

- Yuri Verkhoshanksky, sports scientist

Hype sells in the fitness field.  I know, but refuse to give into it.  That is not how I have run my business over the last five years, and don't intend to change that.  Every month, I am contacted by someone selling some supplement/energy drink.  And, I tell them all the same thing.  I don't endorse any supplements.  Yeah, a few may be helpful, but most are at minimum a waste of your money; while some can even be dangerous.  For most people, lack of nutritional supplementation is not the crux of their problem, anyway.

Exercise training is also very hyped.  So many programs are marketed as "Intense", and "Killer" workouts, ironically to the most out-of-shape individuals.  They promote sweat, fatigue, soreness, and vomiting as barometers of effectiveness.  Workout programs like "Insanity" and "Bootcamps" are ubiquitous.  Not to mention the prime-time television reality show, The Biggest Loser.  They give the impression that if you aren't dying every workout, then you are wasting your time.  While intensity is an important principle of exercise training, it must be applied appropriately.  It is often not.

So many of these programs (again geared towards sedentary people and those with little training experience) incorporate advanced exercises like plyometrics, easily push people to extreme fatigue, rarely teach proper techniques (many instructors don't even know proper technique themselves, let alone coach properly).  It is a recipe for disaster.  And, I should know.  I see so many clients AFTER they have participated in these programs. 

"One workout is not going to make an athlete, but one workout can break an athlete."
-Vern Gambetta, Functional Path Training

So, what does your average, sedentary beginner need?  Often, they come to me with a main goal of weight loss.  Body weight is their main indicator of health and fitness.  In their minds, decrease the number on the scale to a desired level (by any means possible) and now you are healthy and fit!  Not so fast.  That is the message we are spoon-fed from the media.  That is what the doctor can measure.  Though, that mentality will only send you to the orthopod before the cardiologist. 
As, I teach my apprentices, the trainer needs to explain that for any long-term exercise program to work, the primary focus needs to be on moving well.  Weight loss can't be the sole/primary goal. The trainer needs to take the new, motivated client and teach them proper exercise training, not beat them into submission. 

Here is what I feel people, who have been sedentary and out of shape, need to learn/address during their first six months of training:

1. You Can't Out-Run A Donut:  The main variable for achieving fat loss is your diet.  Exercise, sleep, hormones, and stress, influence your body composition significantly.  Though, what and how much you eat is still the main factor.  You won't see a continued, significant fat loss without improving your diet somewhat.  You don't need to start an extreme diet, but small changes do make a large difference over the period of months.  That I why I use my Food Rules to educate clients on smart, effective, long-term nutrition strategies for fat-loss.
2. Your Posture is Bad and You Move Poorly: The average adult spends more time than ever sitting.  This seemingly benign activity causes a gradual negative cascade of soft-tissue stiffening, muscle-weakening and inhibition, and creep into poor joint alignment.  Fixing many of these posture and movement problems should be a primary focus.  You should be assessed by a trainer so he/she has an idea where you are starting.  Mobility exercises, stretching, foam rolling, and other light exercises are appropriate for most people before more strenuous exercises can be implemented. 
3. Lots of Time To Master The Low-Level Basics:  Basic exercises (like push-ups, pull-ups, rows, squats, step-ups, lunges, bridges, etc.) are good exercises if performed correctly.  Most often, people really don't know how to properly perform these exercises.  This is where I spend most of my time with a new client.  It is very coaching-intensive, but important for long-term success.  Though, I see people (and trainers) by-pass this all the time.  Some clients need many weeks and months to gain proficiency, especially if they have not formally exercised or played sports.  Amazingly, even among people who have exercised for years and decades, most have never been properly instructed or critiqued on their exercise technique; and it shows!
4. Appropriate  Intensity: Beginners can make significant improvements without heavy resistance or high-intensity exercises.  Running and jumping (often used in boot camps)  present the body with a huge stress it often can't handle.  It is not uncommon to see a "Bootcamp" class having over-weight individuals jumping on boxes and running extensively (usually without proper instruction or regard for fatigue).   Beginners can continue to get stronger with intensities as low as 40-60% of their maximal strength (more advanced lifters need more), and should perform exercises that enhance joint stability, body control, and strength over ones that put 2-6 times their bodyweight forces onto their joints (like running, cutting, and jumping).
5. Keep It Simple:  So often clients (and trainers) unnecessarily makes things too complex.  Clients need time to develop movement proficiency, stability, and strength.  You will need to "practice" exercises often and only need to progress one factor (reps, or duration or resistance) at a time .  Not uncommonly,  I will see someone performing a deadlift with a couple light dumbells, then the next thing you know they are performing circuits with a heavier barbell, on one leg, on a BOSU ball, with burpees in between. 

If you are a beginner, invest your time in building your body so it can handle more vigorous exercise.  Don't follow the hype.  Even though a more vigorous exercise will burn more calories, it often is just short-term gain, long-term loss.  Proper exercise training for a beginner shouldn't be very intense.  It should be carefully taught and performed consistently.  Gradually, the intensity can increase over time for positive adaptation, enjoyment and long-term success.

How Do You Choose Which Exercises to Use? The Art of Exercise Programming.

I was asked this question a few times, just today. So, I thought it would be a good idea to review how I choose which exercises I use when training various clients. Like a carpenter or surgeon, an experienced trainer has many, proven tools in his/her training tool box. What tools end up in that tool box are a result of their experience and training philosophy.

Tools (exercises) work in the context of a training program, which is a specific plan customized to an individual to help him or her achieve a training goal. A workout is just a random selection of exercises without consideration of an individuals short or long-term goals. You should have good reason why you are selecting an exercise. How does that exercise fit into your training program?

Many new trainers and those new to exercise training are at a disadvantage because of their limited experience. It takes time to see all the pros and cons of each type of exercises on various clientele. Often the inexperienced trainer or new exerciser will simply choose what they see others using, or what the gym has to offer, or the latest fitness gizmos. Most commerical gyms are not outfitted with the best tools. They are outfitted with what will attract the most people to join the gyms.

My training philosophy has been shaped over the last 14 years. It can be summarized in a couple sentences: Get people moving well by developing adequate joint range of motion, stability, and control. Then build a maximal strength foundation, as it improves all movement capabilities and tolerance. Then, develop specific needs. Make the process enjoyable. I use exercises that allow for free-motion. That is, the client needs to know how to move properly and must maintain that form. Free weights, such as: barbells, dumbells, kettlebells, and body weight (calisthenics), along with the free-motion cable column are my tools of choice. Fixed-path machines allow you to move the lever in any manner, not emphasising ideal biomechanics.

Additionally, there are some other basic principles that must be known. First, there are a lot of good tools (exercises), but they must be applied appropriately, or they become less than ideal tools (exercises). Second, always assess the client so you know their specific needs/deficits. Third, know the client's goal and keep them moving in that direction.

Once I know where a client is starting and where they want to go, the next step is to apply a training program template.
A basic template that I use has six categories:

A. Leg/Hip Bilateral Strength

B. Pulling

C. Pushing

D. Single Leg Stability

E. Shoulder Stability

F. Torso Stability

Within each category, I have a list of many possible exercises. I try to pick the most appropriate exercise (or modification of that exercise) in each category. This template makes it quick and easy to develop a program for a new client. Once this program is started, I can always make some minor changes as I see appropriate. I use this new training plan for 4-6 weeks. I want a client to get comfortable with each exercise and be able to progressively overload (add more weight or reps) their body before changing the program significantly. While variety can be good, a good program makes only subtle changes (you were choosing the best exercises, so some exercises will be done for a long, long time).

How much weight, how many reps, how many sets, how often, and how much rest are other important variables that will have to be addressed in separate posts.

Rating Strength Levels for Women: Squat, Press, and Pull-Up

Strength is a fundamental quality for all movement. Greater strength allows you to perform those movements easier, as you are working at a lower percent of your maximum strength. Simple enough. However, strength is often overlooked, especially with women. Sure, many women, exercise; and, often with activities that are thought to build strength- yoga, Pilate's, body sculpting, etc. However, the reality is that very, very few women are actually strong or even train to actually build strength.
I work with numerous females of all ages and of various backgrounds. Some are sedentary, some are life-long exercisers. Again, very few are strong.

Many will ask, "what do you consider strong?" That is a very good question. We do need a way to quantify strength. Strength is maximum force output. Strength can be evaluated in many ways. In rehab, manual muscle testing is an assessment technique where muscle groups can be tested by having a therapist apply force to a limb with his hands. But, often it is very focused, such as on a single joint. While this information can be very useful during rehab (and for beginners in a fitness program), often force output, or strength is via multiple joints. That is, multiple joints and muscles come into play during movements. This is a more practical evaluation of strength in healthy individuals. While there are many basic movements or when free weights are used, basic lifts. Recently, many clients have been focusing on a few. I often cycle the lifts we focus on for maximal strength. During the current cycle, our focus is the barbell back squat, the standing overhead barbell press, and the pull-up. I make it simple for my female clients to get strong: learn the proper technique, focus on these three lifts, and gradually add weight to the bar. It is pretty impressive what many of these women are able to achieve with consistent training and encouragement.

After supervising lots and lots of female clients training these lifts, I have been able to get a good idea how to rate female's strength levels (none are elite level athletes, but many are recreation athletes or fitness enthusiasts). While there is a lot of variability in body size, most women don't have a lot of strength, especially in the upper body. Interestingly, some of my strongest women clients are the smallest and leanest.

Back Squat (to a parallel thigh level):
Level 1: 65 lb
Level 2: 95 lb
Level 3: 135lb
Level 4: 185lb
Level 5: 225lb

Standing Press:
Level 1: 45 lb
Level 2: 60 lb
Level 3: 80 lb
Level 4: 95 lb
Level 5: 110 lb

Pull-Up (palms facing away, aka prone grip):
Level 1: 80lb *
Level 2: 110 lb *
Level 3: 130 lb *
Level 4: 150lb *
Level 5: 170 lb *

* This weight equals the effective or net body weight lifted, that is body weight minus (with band assistance), or plus (external resistance, i.e. weight plate).

These ratings will help you quantify your strength with these basic lifts. Most females will start at or below level 1. Level 2 is attainable with a few months of training, while level 3 and 4 may take a year or many years. But, simply moving to level 2 moves you, most likely, to the 90th percentile of all women. Where do you rate?

If The Bar Ain't Bending, Then You Are Just Pretending

I love this saying. It may be viewed as some testosterone-fueled powerlifter mantra, but I think it is very simple and profound for anyone wanting to derive the extensive benefits of strength training.

Strength training is the process of
gradually and progressively overloading the musculoskeletal system to increase muscular strength. It is as simple and straight-forward as that. Though, I see the majority of people in the gym, especially females, not gradually and progressively overloading their musculoskeletal systems and not getting stronger.

It is very easy to see whether your training is working or not; you get stronger. You can gradually add more weight to the bar. As simple of a concept that may be, so many people don't improve their strength much at all.

Most people I see in the gym are not getting significantly stronger with their training. Here are three common reasons:

1. Failing To Progresively Overload: You need an appropriate, progressive stimulus to increase strength. Whether you don't know that principle, simply just neglect it, or have poor technique, you will never give your body the stimulus to build significant strength without a gradual, consistent, progressive overload.












2. Exercises and Techniques Used Don't Allow You To Adequately Load Your Muscles: Today, many trendy exercises are used for strength training, such as unstable surfaces (Bosu ball). While these exercises may be challenging to perform, they also severely limit safe loading of the target muscles, thus limiting strength-building stimuli.












3. Too Much Stimulus/Too Little Recovery:. If three days per week of lifting provides good results, then five days must provide even better results, right? Wrong. To build strength, you need an adequate training stimuli, but your body needs to also recover or you will be chronically sore and never build much strength A lot of people who love to workout and are at the gym everyday (overall, a small minority) fall into this category. While the excessive strength training may help keep body fat levels low, it will also keep strength levels low.

If you want to receive the well-documented, positive effects of strength training, then you have to actually train to get stronger. Gradually, progressively overload the bar so it starts bending, or you are simply pretending to be strength training!

The Importance of Balanced Exercise Programing

Exercise programing or what types, duration, and frequency of exercise training you are doing must be balanced for optimal results and to keep your joints healthy.  The biggest issue I see among people who workout regularly (without my supervision) is the blatant imbalance in exercise programing (180 minutes on the elliptical trainer or 20 sets of anything on a BOSU ball).  What we decide to do when we exercise regularly has a positive and negative impact on our body.  Here are a few examples:

• A 45 year-old male former powerlifter and regular (five days per week) weight lifter was complaining to me the other day that he has been bothered by pain in both shoulders.  He asked me if he should supplement with glucosamine.  You know how I feel about supplements.  But, I have seen this guy train week in, week out.  I noticed a severe imbalance in his exercise training programing.  He performed a lot of curls, chest presses, and shoulder lateral raises.  He is very muscular, but I am sure he would be hard-pressed to move his arms through a full range of motion through the shoulder joint.  He never performs any flexibility or mobility work.  And his job is fairly sedentary.  I recommended to him to work on his shoulder mobility every time he trains to balance out the tremendous volume of upper body strength training.  It would also behoove him to cut down the frequency and volume of his current training and also add some more scapular stabilization and rowing exercises to balance the forces and demands on the shoulder joint.

• A 33 year-old female runner with history of knee surgeries continues to run as her predominant mode of exercise training.  While her overall mileage is down from years past, she continues to suffer from her imbalanced training.  When I got a chance to work with her, I found many deficiencies.  She had poor single-leg stability, a loss of knee range of motion, and hip weakness.  Exercises like body-weight step-ups and single-leg hip bridges were extremely challenging and sometimes painful.  I recommended that she spend her limited training time on knee, hip, and ankle range of motion, single-leg stability, hip strength, and shelf the running for the time being (this is wishful thinking, as runners will run no matter what). 

These are two of many, many examples that I see. Training regularly is good, but as they say, you can have too much of a good thing (especially if it means you are ignoring other aspects of your training).  You need to always move well.  That means developing and maintaining adequate joint mobility, stability, strength, power, agility, balance, endurance, and coordination.  We need to consider our individual background and needs, along with our goals.  Then, program accordingly.  Unsure, of what you need?  Consult a knowledgeable trainer to help you develop a balanced exercise training program.