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9S: STRENGTH & SUPPLENESS

9S: STRENGTH & SUPPLENESS Course Manual

9S: STRENGTH & SUPPLENESS Notice of Copyright & Medical Disclaimer Copyright © 2016 by Z-Health® Performance Solutions, LLC Published and distributed in the United States by: Z-Health® Performance Solutions, LLC 8380 S. Kyrene Road, Suite 101 Tempe, AZ 85284 www.zhealtheducation.com All rights reserved. No part of this book may be reproduced by any means or in any form whatsoever, nor may it be stored in a retrieval system, transmitted or otherwise copied for public or private use – other than as referenced material in articles and/or reviews - without the written permission of the author. 2nd Edition: April 2016

Disclaimer The information provided by Z-Health Performance Solutions, LLC (“Z-Health”) is strictly intended for your general knowledge and for informational purposes only. The information contained in this or any Z-Health material, publications, or website (collectively “Z-Health Products”) is not to be construed as medical recommendations, medical advice, diagnosis, treatment or as professional advice, nor is it intended for use as a substitute for consultation with or advice given by a medical practitioner, health care practitioner, or fitness professional. Before beginning this or any exercise or nutritional program, you should consult with your physician. Neither Z-Health, its affiliates, agents nor any other party involved in the preparation, publication or distribution of the works presented herein is responsible for any errors or omissions in information provided in this or any Z-Health Product. Z-Health makes no representation and assumes no responsibility for the accuracy of information contained herein or in any Z-Health Product. Z-Health specifically disclaims all responsibility and shall not be responsible for any liability, loss or risk, injury, damage, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use or application of any of the material contained in this product or any Z-Health Product. Z-Health does not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this product any Z-Health Product. Z-Health shall not be responsible or liable for the content, use, information, or products and services of these resources. Additionally, Z-Health shall not be held responsible for the conduct of any company, website or individual mentioned in this product, associated websites, or any Z-Health Product. You are encouraged to confirm any information obtained from or through this product or any Z-Health Product with other sources, and review all information regarding any medical condition or treatment with your physician. Should you have any healthcare-related questions, please call or see your physician or other healthcare provider immediately. You should never disregard medical advice or delay in seeking it because of something you have read here or in any Z-Health Products. The opinions expressed in this publication represent the views of Z-Health Performance Solutions, LLC.

9S: STRENGTH & SUPPLENESS Legalities Here are the basics that you need to understand about this course. All physical activity carries certain inherent risks. This is true of every drill and technique taught in this course. You must exercise your own judgment, in conjunction with feedback from your client and their chosen healthcare professionals, about which drills to apply in training them. You must also maintain a high level of awareness of your athlete’s general physical condition day-to-day and moderate their work rate appropriately. Remember, one thing that sets Z-Health apart is our laser-sharp focus on constant attention and re-assessment! Understand that this course is a COACHING course. A coach provides information, drills, motivation, and inspiration to his or her athletes to promote positive, powerful performance changes. Every skill set in this course should be viewed from that standpoint. You are responsible for understanding the applicable laws in your state with regards to what you can legally do under your licensure. If you have questions, contact an attorney. We will do our very best to provide you as much information as possible in this arena, but ultimately the responsibility to practice your profession ethically and legally falls on you. Do not, under any circumstances, countermand the orders of your client’s physician. Unless you are legally licensed to do so, do not, under any circumstances, tell a client that they have a specific disease process. This course is NOT training you to diagnose medical conditions, nor are we training you to provide medical advice. Remember that you must protect your business and professional employment first and foremost and that sports training can result in severe injury – particularly when athletes attempt to progress too quickly. In training yourself and your clients, go slowly, be careful, and exercise superior professional judgment in what you do and what you allow your athletes to do.

Welcome to 9S: Strength and Suppleness! Thank you so much for choosing to attend 9S:Strength and Suppleness. As you know, both the Z-Health system and company are constantly evolving. This current iteration is a compilation of emerging research and concepts that have been studied, developed and tested over the last ten years. The development of Strength and Suppleness that MATTERS is the primary goal of this certification. This is a tricky area of science and application so I encourage you to keep an open mind and to cultivate a willingness to play with this information. The design of this course is primarily focused on the PRACTICAL application of the information so I hope that you came prepared to work! My hope for you is that this course will bring a tremendous level of clarification to your own training as well as the work the work you do with your athletes. Let’s get started.

9S: STRENGTH & SUPPLENESS Table of Contents Strength and Suppleness as Threat Modulation .................................................... 5 Neurology 101: Basics of Strength and Suppleness .............................................. 6 Neurology 102: Voluntary Movement and Reflexive Stabilization ......................... 7 Neurology 103: The 8 Levels of Assessment Model .............................................. 15 Key Training Principles for Strength & Suppleness ................................................ 19 Assisted Contractile Mapping (ACM) – Mastering the Art of Isolated Tension ...... 21 Loaded Mobility – Mastering the Art of Tension During Movement ...................... 49 Blood Flow Restricted Exercise (BFRE) – Strength Training Shortcut #1 ................ 55 The Ligament Link – Strength & Suppleness Shortcut #2 ...................................... 63 Suppleness Training................................................................................................ 69 Recovery Practices.................................................................................................. 77 Strength and Suppleness Programming ................................................................ 83

STRENGTH AND SUPPLENESS AS THREAT MODULATION When we begin training our athletes using a brain-based perspective, strength and suppleness training can be viewed in a whole new light. Rather than focusing on the biomechanical process and result, we can reformat our thinking into understanding that every exercise is a form of brain stimulus. With this in mind we can use strength and suppleness training to reduce threat or increase threat based on what our athlete needs. Generally speaking, if an athlete is in pain or suffering from some type of injury (poor strength, mobility, etc) that is interfering with their practice and performance – they need threat reduction or modulation. On the other hand, if an athlete is training in order to improve their overall fitness and performance, they need threat inoculation or adaptation. As you know by this time, some pain or poor performance “chunks” require a precise stimulus to break. If this is the case, our knowledge of the different neural weaknesses our athlete may have can make it much easier to offer appropriate exercises or make appropriate referrals. However, as we move from threat reduction into threat inoculation and threat adaptation, the priorities begin to change. Rather than working so hard to find and remediate a neural weakness, the job now changes to loading the nervous system in a context that improves the athlete’s performance in sports or life. To summarize this concept, understand that all assessment and training is viewed in Z-Health from two distinct perspectives:

Practically speaking, what this means is that if your client is suffering from a neural deficit creating an ongoing movement threat; deal with that first, regardless of that particular skill’s applicability within their sport or activity. Only after that do we want to switch our focus to more sports-oriented training processes. The simple phrase to help remember this concept is: Threats first. Performance second.

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NEUROLOGY 101: BASICS OF STRENGTH AND SUPPLENESS To set the stage for understanding strength and suppleness training from a brain-based perspective we always want to remind ourselves of the basics of Neurology 101. The nervous system is orderly, not chaotic – we just need to understand it. Here are our basic rules: 1. The nervous system does 3 primary things: A. Receives Input (Afferent) B. Decides What the Input Means and What to Do About It (Processing) C. Creates Motor Output (Efferent)

2. The Right Cortex A. Controls Voluntary Movement on the Left Side of the Body Via the Motor Cortex B. Sets the “Tone” of the Right Side of the Body Via the PMRF (Ponto Medullary Reticular Formation) 3. The Left Cortex A. Controls Voluntary Movement on the Right Side of the Body Via the Motor Cortex B. Sets the “Tone” of the Left Side of the Body Via the PMRF 4. All sensory input eventually goes to the contralateral cortex, except smell.

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NEUROLOGY 102: VOLUNTARY MOVEMENT AND REFLEXIVE STABILIZATION Voluntary Movement Pathways One of the key points in all Z-Health courses is that everything that we do is applied neuroanatomy. In the context of Strength and Suppleness it is important to have a fundamental grasp of how neurologically complex movement is, as well as a clear picture of the anatomy behind many Z-Health tools and assessments. If you think about the vast majority of strength and suppleness training drills you can easily see that they are composed of two distinct, but intertwined, types of movement: • Voluntary Motor Activity • Reflexive Motor Activity AND Stability To better understand both of these systems we will begin by looking at how voluntary movement is built neurologically. 1. Cortex – The cerebral cortex decides and implements voluntary movement. If a ball is coming toward you the cortex does four things: A. Has the THOUGHT to catch the ball. B. DECIDES to perform the movement. C. CHOOSES the appropriate movement (catch it with my hand? Foot? Body?) D. Chooses the GOAL of the movement. 2. Basal Nuclei (Ganglia) - Many movement theorists refer to the basal nuclei as the “architect” of voluntary movement. The basal nuclei: A. IMPLEMENT the decision made by the cortex. B. CONSTRUCT the movement (contract the arm, forearm, etc). C. Develop the SPECIFICITY of the movement (contract and relax individual muscles in a specific way). D. DELIVER the movement plan back to the cortex. 3. Cerebellum – As we have discussed in multiple courses, the cerebellum is responsible for the ABC’s (accuracy, balance and coordination) of skilled movement. On a deeper level you can think of the cerebellum doing the following: A. SUPERVISING the movement by checking on the performance of each muscle, comparing it to the plan. B. ALTERATION of the movement if there is a deviation from the plan. C. CORRECTION of the movement until the original goal is achieved or abandoned.

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The physical anatomy that allows all of the above to occur comes from the activity of multiple neural pathways. They are detailed on the following pages:

1. Corticospinal Tracts 2. Corticopontocerebellar Tracts 3. Cortico-olivo-cerebellar Tracts 4. Frontal-Basal Nuclei Circuits

Corticospinal Tracts The medial and lateral corticospinal tracts are primarily concerned with creating the movement of muscles leading to voluntary skilled movements. You can think of the corticospinal tracts as the engines that drive voluntary movements of the body by creating muscle motor activity.

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Corticopontocerebellar Tracts These tracts, which originate primarily in the premotor areas of the cortex, send a movement plan to the contralateral cerebellum which will then receive signals from moving body parts on the ipsilateral side of the body. This allows for error detection of skilled movements.

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Cortico-olivo-cerebellar Tracts Slightly more obscure, but incredibly important, these tracts seem to be responsible for managing the TIMING of motor activity. As a result, they are highly instrumental in motor learning.

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Frontal-Basal Nuclei Circuits This complex array of pathways is involved in action selection – helping to choose between several different movement behaviors that could be performed at any given time. Additionally, these circuits contribute to movement specificity by alternating inhibition and activation of movement controls.

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Reflexive Stabilization Pathways Let’s now turn our attention to the reflexive stabilization side of the strength equation. To begin our discussion of stabilization it is most useful to look at basic cortical output pathways and percentages. Here’s a chart to help demonstrate this process. As you can see in the diagram approximately 90% of cortical outflow is ipsilateral into the brainstem and pontomedullary reticular formation or PMRF. The PMRF is a fascinating and vital area of the brainstem that is responsible for regulating an amazingly diverse and complex set of activities in the body. The PMRF is a huge contributor to postural stability in all forms of training due to its regulation of posture, muscle tone, and pain as well as autonomic processes.

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The PMRF Does Not Work Alone! The PMRF has two primary partners in the complex tasks of maintaining and correcting posture and resisting the pull of gravity. These two partners are the vestibulospinal tracts and the tectospinal tracts. See the diagrams below to understand where these tracts live and what neurological and anatomical structures they affect. Reflexive stabilization is immensely important and requires a great deal of unconscious attention and tuning that makes use of input from the visual, vestibular and proprioceptive systems. This makes it critical as an elite coach that we maintain a high degree of awareness of our athletes’ ability to stabilize the body in motion. It also means that training the reflexive stability of the CNS is a potentially powerful tool in our quest for improved strength of all types as well as improved range of motion, flexibility and coordination.

The Vestibulospinal Tract The vestibulospinal tract contributes to reflexive stabilization primarily through the lateral and medial vestibular nuclei. These are stimulated by the otolith organs and the semicircular canals from within the vestibular system. In turn, they create greater tone and motor activity for the spinal cord extensor muscles. In I-Phase we introduced the Vestibulo-Spinal Reflex, which is the result of this pathway at work.

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The Tectospinal Tract The tectospinal tract travels from the superior colliculus, through the pons and medulla, into the cervical spinal cord. There it activates motor neurons of the cervical musculature to reflexively effect head and eye position in response to sudden stimulus (e.g. the startle reflex).

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NEURO 103 - THE 8 LEVELS OF ASSESSMENT MODEL In the constantly evolving Z-Health curriculum, perhaps the most important framework produced in the last decade is called the 8 Levels of Assessment Model. Modified from Dr. Frederick Carrick’s 7 Levels of a Lesion, this model is so useful because every concept, assessment and tool found in the Z-Health curriculum can be categorized and successfully applied using it. More importantly this framework allows you to analyze and apply EVERY tool, exercise and approach in your entire coaching arsenal and improve your results! We have discussed many times from the Neuro 101 perspective that the human nervous system does 3 things:

• Receives Input • Interprets the Input & Decides What to Do About It • Creates an Output The 8 Levels of Assessment Model is the anatomical framework for how this occurs. In order, the 8 Levels are:

1. Receptors 2. Peripheral Nerve 3. Spinal Cord 4. Cerebellum 5. Brainstem 6. Thalamus 7. Insular Cortex 8. Cortex The first, and most useful, portion of this model is that it provides a clear understanding of where things can go right and wrong in the neural loops of the body. As an analysis tool, it is unparalleled. For example, if a client is experiencing knee pain during squatting this model can immediately direct your thinking.

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Problem Example: Knee Pain in Squatting 1. Receptors – Does the athlete need local receptor activation? If so, what type? Mechano? Thermo? Baro? Vibratory? 2. Peripheral Nerve – What muscles are most active during the painful movement? What nerve innervates those muscles? Could that nerve be entrapped? Would T-Phase neuromechanics solve the problem? 3. Spinal Cord – Are there dural adhesions within the spinal cord itself? Would modified neuromechanics help? Are there mobility issues in the spine that might be causing dysfunction in the peripheral nerve or receptors? 4. Cerebellum – Is the knee unstable during the movement? Do they have postural or vestibular issues? 5. Brainstem – Is the knee pain coupled with low muscle tone on the same side of the body? Does the athlete have a history of injury ipsilateral to the knee pain? Do they have visual movement deficits? Vestibular deficits? 6. Thalamus – Does the athlete have poor technique? Do they appear to not understand or be unable to perform important movement cues? 7. Insula – Does the client seem to have trunk instability issues? Is there a great deal of “fixation” on the pain itself? 8. Cortex – Does the athlete have noticeable deficits in eye movements or visual function? Hearing deficits? Poor sensation or evident proprioceptive deficits? As you can see from this simple example, the 8 Levels Model offers a heuristic approach to making realtime analysis and decisions, and allows you to create the greatest value in a training session for a client.

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The 8 Levels of Assessment: Practical Tools This chart should give you some practical assessments to use when narrowing the list of possible issues for a client or athlete. Use the tools listed, along with the assessments from the other Z-Health courses, to work through an assessment flow and find (as specifically as possible) where the break in efficiency is located.

8 Levels of Assessment 1. Receptors 1. Mechano a. Light Touch b. Vibration 2. Baro a. Deep Pressure b. Occlusion 3. Thermo a. Warm/Cool 4. Nociceptors a. Sharp/Dull 5. Visual a. Visual Resolution b. Eye Movements c. Depth Judgment d. Peripheral Awareness 6. Vestibular a. Semicircular Canals b. Otolith Organs 7. Interoceptive a. Fascial Network b. Respiration c. Pelvic Floor d. Throat/ Tongue e. Visceral Organs

2. Peripheral Nerves 1. Cranial Nerves a. Sensation b. Strength 2. Peripheral Nerves a. Sensation b. Strength c. Neuromechanics

3. Spinal Cord 1. Cross Cord Reflexes 2. Neuromechanics 3. MultiPlanar Mobility

4. Cerebellum 1. Midline a. Postural Stability b. Extensor Tone c. Eye Movements 2. Intermediate a. ABC’s Proximal Joint Movements 3. Lateral a. ABC’s Distal Joint Movements b. Movement Visualization

5. Brainstem 1. Cranial Nerves 2. Gait 3. Posture 4. Muscle Tone 5. Pain Inhibition 6. Autonomics

6. Thalamus 1. Contralateral Sensation 2. Hypersensitivity 3. Autonomics

7. Insula 1. Respiration 2. Visceral Function 3. Pelvic Floor Function 4. Vestibular Function 5. Fascial Mobility 6. Tongue Strength & Sensation

8. Cortex 1. Frontal Lobe a. Eye Movements b. Gait/Armswing c. Distal Joint Movements 2. Parietal Lobe a. Sensation b. Proprioceptive Accuracy c. Eye Movements

3. Temporal Lobe a. Sound Processing b. Vestibular Function 4. Occipital Lobe a. Visual Function b. Hemifield Testing

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KEY TRAINING PRINCIPLES FOR STRENGTH & SUPPLENESS As a brain-based practitioner, in addition to understanding movement neurology, there are 4 core principles that must be understood to build more effective training programs.

1. Strength is mastery of the skill of creating tension. 2. Suppleness is mastery of the skill of creating relaxation. 3. Strength and suppleness skills are SAID specific and must be developed with attention to 4 critical components. A. Force B. Vector C. Speed D. Endurance

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4. The three most important THREATS we must create in training to cause significant adaptation are: A. Neuromechanical Tension B. Muscular Microdamage C. Metabolic Stress/Hypoxia

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ASSISTED CONTRACTILE MAPPING (ACM) – MASTERING THE ART OF ISOLATED TENSION Assisted Contractile Mapping, the drill formally known as Find the Muscle, is one of the most powerful and useful drills in the Z-Health arsenal. It takes advantage of multiple neurologic and biomechanical factors to quickly improve both pain and performance. At its most basic level of description it can be thought of as a drill designed to improve an athlete’s contraction and relaxation brain maps.

Neural Threat Continuum ACM, when performed correctly, is a very “low threat” drill initially. This makes it an ideal tool to use regardless of the level of compromise or expertise of your client. When looking at all pain relief and strength training approaches we can view them through a neural lens that allows us to evaluate them based on how much brain activity they are generating. Here’s a chart that describes this graphically:

ACM is initially performed unilaterally (after testing) and utilizes primarily isometric tensions in combination with physical and verbal cues to minimize skill requirements. Additionally, ACM can be performed using uniplanar variations. When viewed together this makes ACM an ideal low-threat approach to beginning the path to tension mastery.

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The Basic ACM Protocol 1. Look at a picture of the muscle. 2. Visualize the action from full stretch to full contraction. 3. Prime the sensory nerve endings of the entire muscle via skin stimulation or vibration. 4. Palpate both ends of the muscle. 5. Have your client begin by going into the FULL STRETCH position using an EXTERNAL TARGET. 6. Next continue palpating at both ends of the muscle as your athlete performs 2-3 moderate to hard contractions of the target muscle moving through the full range of the action. (Make sure they use an external target each time they move to the full stretch position.) 7. Perform 2-3 more repetitions as you perform a tactile “search” of the entire length of the muscle noting areas of high tension and areas of low tension. 8. Next, have your athlete perform 2-3 near maximal repetitions, moving through the full range and action of the target muscle. During these contractions, you will have your fingers on the O&I of the muscle. You will give your athlete the verbal command – “Bring my fingers together!” 9. Finish the drill by performing 2-3 additional contractions. In this portion of the drill, use your fingers to facilitate any remaining areas of low tension in the muscle.

Target Stretch Process When performing ACM a key piece of the drill is having the athlete move into a full stretch position for the muscle in question. However, based on the GOALS of ACM it is essential to have your athletes approach the full stretch position differently than the fully contracted position from a mental standpoint. Modern findings in motor learning research indicate that an external focus promotes a decrease in intramuscular activity while an internal focus raises it. This is a PROFOUNDLY IMPORTANT concept in improving active ranges of motion in any portion of the body. Most of our athletes have been trained/instructed to focus on FEELING a stretch whenever they are performing movements designed to increase a given range of motion. Unfortunately, when they follow this advice the mental TARGET of the exercise mentally becomes “feeling” the stretch rather than improving the range of motion. This internal focus actually has the potential to increase intramuscular tension – hence putting the brakes on range of motion improvement. The simple solution for this issue is to use visual targets OUTSIDE OF THE BODY to direct the “full stretch” portion of the ACM drills. In many instances, this will maximize the available range of motion AND allow the development of a full contraction map when you reverse the process for the contraction portion of ACM. So, the simple rules are: 1. For the full stretch position, use an external focus/target. 2. For the contraction portion of ACM, use an internal focus to maximize internal tension. This is so simple to explain, but may be one of the most important concepts you will ever learn as a brainbased movement coach!

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ACM Variations Because ACM is designed to maximize your athlete’s contractile map clarity there are multiple variations of the drill that can be extremely useful. Here’s a list: 1. 2. 3. 4. 5. 6.

Long-Hold Isometrics – Internally Generated Long-Hold Isometrics – Against External Resistance Yielding Long-Hold Isometrics – Against External Resistance Overcoming ACM + Banded Reflexive Stabilization on Opposite Side of Body Explosive Isometrics Stabilization ACM

Remember that to take full advantage of ACM and insure that you are creating maximal functional carryover, all ACM variations should be explored in 3 primary isometric positions: 1. Full Stretch 2. Mid-Range 3. Full Contraction

ACM/Find the Muscle Contraindications While ACM is, generally speaking, a very safe method of loading the body there are a few critical concerns that should be addressed. Most of these should be familiar from R-Phase: 1. 2. 3. 4. 5. 6. 7. 8.

Joint Hypermobility Joint Effusion/Swelling Inflammation from Autoimmune Condition Malignancy of Bone Bone Disease Current Fractures Total Joint Replacements (Most concern is with older hip replacement) Post-Surgical – Wait until released for exercise from surgeon.

Most of these are RELATIVE. If in doubt, always obtain doctor’s approval prior to working with an athlete.

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Special Considerations for ACM – The Spine A number of the neck and spine ACM drills involve a combination of cervical extension with cervical rotation. There is a VERY SMALL NUMBER of people annually who experience strokes from this combination of neck positions because it can compromise the vertebral artery. There are reports of this type of injury from many different forms of manual therapy as well as martial arts practice and even having hair washed in a beauty salon. The odds of this happening are staggeringly low, but we want you and your athletes to be as informed as possible so that you can approach training safely.

Our Recommendations for Neck and Spine ACM 1. If your client has a history of stroke, carotid surgeries or significant vascular disease avoid neck ACM exercises. 2. If your client is on blood thinners also avoid neck ACM exercises.

General Safety Recommendations ACM can be a very intensive form of exercise when performing hard contractions – particularly in constrained body positions. When performing or teaching ACM you should think sequentially and progressively: 1. For complex muscles, use the most basics movements of the ACM sequence at first. 2. Keep tension levels low – 3 out of 10 intensity – until the movement becomes comfortable. 3. Add tension to the contraction slowly over individual training sessions – allowing the necessary weeks or months necessary to perform truly maximal contractions.

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Sternocleidomastoid Attachments: • Manubrium of Sternum • Medial 1/3rd of Clavicle • Mastoid Process of Temporal Bone

Nerve Supply: CN XI Spinal Accessory Nerve

Palpation

Sternocleidomastoid Full Stretch Position 1. Extend Lower Neck 2. Flex Upper Cervical Spine 3. Laterally Bend Neck Contralaterally 4. Rotate Head and Neck Ipsilaterally 5. Depress Clavicle and Sternum

Full Stretch

Sternocleidomastoid ACM Sequence 1. Flex Lower Neck 2. Extend Upper Cervical Spine 3. Laterally Bend Neck Ipsilaterally 4. Rotate Head and Neck Contralaterally 5. Elevate Clavicle and Sternum

Full Contraction

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Scalene Group Attachments: • Anterior – 1st Rib to Transverse Process C3-C6 • Middle – 1st Rib to Transverse Process C2-C7 • Posterior – 2nd Rib to Transverse Process C5-C7

Palpation

Nerve Supply: Ventral Rami of Cervical Spinal Nerves C4-C6

Scalene Full Stretch Position 1. Extend Neck 2. Laterally Bend Neck Contralaterally 3. Rotate Head and Neck Ipsilaterally 4. Depress 1st and 2nd Ribs

Full Stretch

Scalene ACM Sequence 1. Flex Neck 2. Laterally Bend Neck Ipsilaterally 3. Rotate Head and Neck Contralaterally 4. Elevate 1st and 2nd Ribs

Full Contraction

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Longus Colli Attachments: • Transverse Process and Anterior Vertebral Bodies T3-C1

Nerve Supply: Ventral Rami of Cervical Spinal Nerves C2-C6

Palpation

Longus Colli Full Stretch Position 1. Extend Neck 2. Laterally Bend Neck Contralaterally 3. Rotate Neck Ipsilaterally

Full Stretch

Longus Colli ACM Sequence 1. Flex Neck 2. Laterally Bend Neck Ipsilaterally 3. Rotate Neck Contralaterally

Full Contraction

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Longus Capitis Attachments: • Transverse Process C3-C5 • Occiput and Anterior Vertebral Bodies T3-C1

Nerve Supply:

Palpation

Ventral Rami of Cervical Spinal Nerves C1-C3

Longus Capitis Full Stretch Position 1. Extend Neck 2. Laterally Bend Neck Contralaterally

Full Stretch

Longus Capitis ACM Sequence 1. Flex Neck 2. Laterally Bend Neck Ipsilaterally

Full Contraction

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Splenius Capitis Attachments: • Nuchal Ligament C3-C6 • Spinous Processes of C7-T4 • Mastoid Process • Lateral 1/3rd of Nuchal Line

Nerve Supply:

Palpation

Cervical Spinal Nerves

Splenius Capitis Full Stretch Position 1. Flex Neck 2. Laterally Flex Neck Contralateral 3. Rotate Head and Neck Contralateral

Full Stretch

Splenius Capitis ACM Sequence 1. Extend Neck 2. Laterally Flex Neck Ipsilateral 3. Rotate Head and Neck Ipsilateral

Full Contraction

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Semispinalis Capitis Attachments: • Transverse Processes of C7-T6 • Medial 1/3rd of Occipital Bone

Nerve Supply: Dorsal Rami of Spinal Nerves C1-T12

Palpation

Semispinalis Capitis Full Stretch Position 1. Flex Neck (Primary Action) 2. Laterally Flex Neck Contralateral

Full Stretch

Semispinalis Capitis ACM Sequence 1. Extend Neck 2. Laterally Flex Neck Ipsilateral

Full Contraction

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Suboccipital Group Attachments:

Palpation

• Rectus Capitis Posterior Major – Spinous Process of C2, Lateral ½ of Nuchal Line of Occiput • Rectus Capitis Posterior Minor – Posterior Tubercle of C1, Medial ½ of Nuchal Line • Obliquus Capitis Superior – Transverse Process of C1, Lateral Occiput • Obliquus Capitis Inferior – Spinous Process of C2, Transverse Process of C1

Nerve Supply: Suboccipital Nerve (Dorsal Ramus of C1)

Suboccipital Group Full Stretch Position 1. Flex Head 2. Retract Head 3. Rotate Head Contralaterally at Upper Cervical Spine

Full Stretch

Suboccipital Group ACM Sequence 1. Extend Head 2. Protract Head 3. Rotate Head Ipsilaterally at Upper Cervical Spine

Full Contraction

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Trapezius (Upper, Middle, Lower) Attachments: • • • • • •

Palpation

External Occipital Protuberance Medial 1/3 of Nuchal Line Nuchal Ligament Lateral 1/3 Clavicle Medial Acromion Process Upper Crest of Spine of Scapula

Nerve Supply: CN XI (Spinal Accessory Nerve & C3-C4)

Upper Trapezius Full Stretch Position

Full Stretch

1. 2. 3. 4. 5. 6.

Depress Scapula Protract Scapula Downwardly Rotate Scapula Flex Head and Neck Laterally Flex Head and Neck Contralateral Rotate Head and Neck Ipsilateral

Middle Trapezius Full Stretch Position 1. Protract Scapula

Lower Trapezius Full Stretch Position 1. Elevate Scapula 2. Protract Scapula 3. Downwardly Rotate Scapula

Upper Trapezius ACM Sequence 1. 2. 3. 4. 5. 6.

Full Contraction

Elevate Scapula Retract Scapula Upwardly Rotate Scapula Extend Head and Neck Laterally Flex Head and Neck Ipsilateral Rotate Head and Neck Contralateral

Middle Trapezius ACM Sequence 1. Retract Scapula

Lower Trapezius ACM Sequence 1. Depress Scapula 2. Retract Scapula 3. Upwardly Rotate Scapula

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Rhomboids Attachments: • Spinous Process of C7-T5 • Medial Border of Scapula from Spine to Inferior Angle

Nerve Supply:

Palpation

Dorsal Scapular Nerve

Rhomboids Full Stretch Position 1. Protract Scapula 2. Depress Scapula 3. Upwardly Rotate Scapula

Full Stretch

Rhomboids ACM Sequence 1. Retract Scapula 2. Elevate Scapula 3. Downwardly Rotate Scapula

Full Contraction

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Latissimus Dorsi Attachments: • • • • • •

Palpation

Spinous Processes T7-L5 Posterior Sacrum` Posterior Iliac Crest Ribs 8-12 Inferior Angle of Scapula Medial Lip of Bicipital Groove of Humerus

Nerve Supply: Thoracodorsal Nerve

Latissimus Dorsi Full Stretch Position

Full Stretch

1. Flex Arm at Shoulder Joint 2. Abduct Arm at Shoulder Joint 3. Externally Rotate Arm at Shoulder Joint 4. Posterior Tilt Pelvis 5. Contralateral Lateral Tilt Pelvis 6. Elevate Scapula 7. Contralateral Spinal Lateral Flexion 8. Contralateral Spinal Rotation

Latissimus Dorsi ACM Sequence

Full Contraction

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1. Extend Arm at Shoulder Joint 2. Adduct Arm at Shoulder Joint 3. Internally Rotate Arm at Shoulder Joint 4. Anterior Tilt Pelvis 5. Ipsilateral Lateral Tilt Pelvis 6. Depress Scapula 7. Ipislateral Spinal Lateral Flexion 8. Ipsilateral Spinal Rotation

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Gluteus Maximus Attachments: • • • • • •

Palpation

Posterior Iliac Crest Posterolateral Sacrum Coccyx Sacrotuberous Ligament IT Band Gluteal Tuberosity

Nerve Supply: Inferior Gluteal Nerve

Gluteus Maximus Full Stretch Sequence

Full Stretch

1. Ipsilateral Hip Flexion 2. Ipsilateral Hip Internal Rotation 3. Ipsilateral Hip Adduction (Upper Fibers) 4. Ipsilateral Hip Abduction (Lower Fibers) 5. Knee Flexion

Gluteus Maximus ACM Sequence 1. Ipsilateral Hip Extension 2. Ipsilateral Hip External Rotation 3. Ipsilateral Hip Abduction (Upper Fibers) 4. Ipsilateral Hip Adduction (Lower Fibers) 5. Knee Extension

Full Contraction

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Gluteus Medius Attachments: • External Surface of Ilium • (Just Inferior to Iliac Crest) • Greater Trochanter

Nerve Supply: Superior Gluteal Nerve

Palpation

Gluteus Medius Posterior Fibers Full Stretch Sequence 1. Ipsilateral Hip Adduction 2. Ipsilateral Hip Flexion 3. Ipsilateral Hip Internal Rotation 4. Anterior Pelvic Tilt 5. Ipsilateral Pelvic Lateral Tilt

Gluteus Medius Anterior Fibers Full Stretch Sequence

Full Stretch

1. Ipsilateral Hip Adduction 2. Ipsilateral Hip Extension 3. Ipsilateral Hip External Rotation 4. Posterior Pelvic Tilt 5. Ipsilateral Pelvic Lateral Tilt

Gluteus Medius ACM Sequence Posterior Fibers 1. Ipsilateral Hip Abduction 2. Ipsilateral Hip Extension 3. Ipsilateral Hip External Rotation 4. Posterior Pelvic Tilt 5. Ipsilateral Pelvic Depression

Gluteus Medius ACM Sequence Anterior Fibers

Full Contraction

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1. Ipsilateral Hip Abduction 2. Ipsilateral Hip Flexion 3. Ipsilateral Hip Internal Rotation 4. Anterior Pelvic Tilt 5. Ipsilateral Pelvic Depression

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Quadriceps Femoris Group (Vastus Lateralis, Intermedius, Medialis, Rectus Femoris) Attachments: • ASIS • Linea Aspera of Femus • Tibial Tuberosity

Nerve Supply: Femoral Nerve

Palpation Quadriceps Full Stretch Sequence 1. Ipsilateral Knee Flexion 2. Ipsilateral Hip Extension (RF) 3. Pelvic Posterior Tilt (RF)

Full Stretch Quadriceps ACM Sequence 1. Ipsilateral Knee Extension 2. Ipsilateral Hip Flexion (RF) 3. Pelvic Anterior Tilt (RF)

Full Contraction

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Tibialis Anterior Attachments: • • • •

Lateral Tibial Condyle Proximal 2/3rd Anterior Border of Tibia 1st Cuneiform Base of 1st Metatarsal

Nerve Supply:

Palpation

Deep Fibular Nerve (Deep Peroneal Nerve)

Tibialis Anterior Full Stretch Sequence 1. Ankle Plantar Flexion 2. Foot Eversion

Full Stretch

Tibialis Anterior ACM Sequence 1. Ankle Dorsiflexion 2. Foot Inversion

Full Contraction

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Extensor Digitorum Longus Attachments: • Lateral Tibial Condyle • Proximal 2/3rd Anterior Border of Fibula • Dorsal Surface of Middle and Distal Phalanges 2-5

Nerve Supply:

Palpation

Deep Fibular Nerve (Deep Peroneal Nerve)

Extensor Digitorum Longus Full Stretch Sequence 1. Flex Toes 2-5 at MTP and IP 2. Ankle Plantar Flexion 3. Foot Inversion

Full Stretch

Extensor Digitorum Longus ACM Sequence 1. Extends Toes 2-5 at MTP and IP 2. Ankle Dorsiflexion 3. Foot Eversion

Full Contraction

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Extensor Digitorum Brevis Attachments: • Dorsal Surface of Calcaneus • Lateral Side of Distal Tendons of EDL Toes 2-4

Nerve Supply: Deep Fibular Nerve Deep Peroneal Nerve

Palpation

Extensor Digitorum Brevis Full Stretch Sequence 1. Toe Flexion at MTP, PIJ & DIJ of Toes 2-4

Full Stretch

Extensor Digitorum Brevis ACM Sequence 1. Toe Extension at MTP, PIJ & DIJ of Toes 2-4

Full Contraction

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Extensor Hallucis Longus Attachments: • Middle 1/3rd Anterior Border of Fibula • Dorsal Surface of Distal Phalanx of Big Toe

Nerve Supply:

Palpation

Deep Fibular Nerve (Deep Peroneal Nerve)

Extensor Hallucis Longus Full Stretch Sequence 1. Flex Big Toe at MTP and IP 2. Ankle Plantar Flexion 3. Foot Eversion

Full Stretch

Extensor Hallucis Longus ACM Sequence 1. Extend Big Toe at MTP and IP 2. Ankle Dorsiflexion 3. Foot Inversion

Full Contraction

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Extensor Hallucis Brevis Attachments: • Dorsal Surface of Calcaneus • Dorsal Surface of Proximal Phalanx of Big Toe

Nerve Supply: Deep Fibular Nerve Deep Peroneal Nerve

Palpation Extensor Hallucis Brevis Full Stretch Sequence 1. Big Toe Flexion at MTP

Full Stretch

Extensor Hallucis Brevis ACM Sequence 1. Big Toe Extension at MTP

Full Contraction

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Biceps Brachii Attachments: • Supraglenoid Tubercle • Coracoid Process • Deep Fascia Overlying Common Flexor Tendon • Radial Tuberosity

Palpation

Nerve Supply: Musculocutaneous Nerve

Biceps Brachii Full Stretch Position 1. Extend Forearm 2. Pronate Forearm 3. Extend Arm 4. Adduct Arm – Long Head 5. Abduct Arm – Short Head

Full Stretch

Biceps Brachii ACM Sequence 1. Flex Forearm 2. Supinate Forearm 3. Flex Arm 4. Abduct Arm – Long Head 5. Adduct Arm – Short Head

Full Contraction

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Brachialis Attachments: • Distal ½ of Anterior Humerus • Tuberosity of Ulna • Coronoid Process of Ulna

Nerve Supply: Musculocutaneous Nerve

Palpation

Brachialis Full Stretch Position 1. Extend Forearm

Full Stretch

Brachialis ACM Sequence 1. Flex Forearm * Note: Works best if forearm is pronated

Full Contraction

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Posterior Deltoid Attachments: • Spine of the Scapula • Deltoid Tuberosity of Humerus

Nerve Supply: Axillary Nerve

Palpation

Posterior Deltoid Full Stretch Position 1. Flex Arm 2. Adduct Arm 3. Internally Rotate Arm 4. Horizontally Flex (Adduct) Arm

Full Stretch

Posterior Deltoid ACM Sequence 1. Extend Arm 2. Abduct Arm 3. Externally Rotate Arm 4. Horizontally Extend (Abduct) Arm

Full Contraction

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Anterior Deltoid Attachments: • Lateral 1/3rd of Clavicle • Deltoid Tuberosity of Humerus

Nerve Supply: Axillary Nerve

Palpation

Anterior Deltoid Full Stretch Position 1. Extend Arm 2. Abduct Arm 3. Externally Rotate Arm 4. Horizontally Extend Arm

Full Stretch

Anterior Deltoid ACM Sequence 1. Flex Arm 2. Adduct Arm 3. Internally Rotate Arm 4. Horizontally Flex (Adduct) Arm

Full Contraction

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Middle Deltoid Attachments: • Spine of the Scapula • Deltoid Tuberosity of Humerus

Nerve Supply: Axillary Nerve

Palpation

Middle Deltoid Full Stretch Position 1. Adduct Arm

Full Stretch

Middle Deltoid ACM Sequence 1. Abduct Arm

Full Contraction

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LOADED MOBILITY – MASTERING THE ART OF TENSION DURING MOVEMENT In our earlier discussions of the neurology of strength and suppleness training one key point was that to maximize results we need to impact both the voluntary and reflexive control processes of the nervous system. Additionally, we discussed the idea that because strength training is ALSO AND PRIMARILY brain training that novel, challenging movements are an essential component of any training program. While we can accomplish these goals by multiple methods, one of the simplest ways to do so is to incorporate loaded mobility activities into our training. Although there are many ways to load mobility drills the use of elastic bands has proven to be a very effective and practical way to do so. The addition of bands to standard dynamic joint mobility drills can offer a powerful strength and hypertrophy stimulus by increasing local and systemic nervous system demands. Plus, as one of our primary goals in training is to increase the quality and consistency of movement maps, it is important to maintain good movement under load too! Many joint specific movements are unavailable or unsafe when using more conventional equipment but easily accessible with bands.

Key Principles to Consider: 1. Safety First A. Latex allergies and skin reactions to bands are not uncommon. You MUST be certain your athlete can handle skin contact with the bands. In the case of a true latex allergy you can purchase latex-free bands and ribbons. B. Check the integrity of the bands EVERY SESSION. The easiest way to do this is to run the band through your fingers looking for a loose flap of band material or any kind of rips or tears. We recommend that you run the band through your fingers in both directions. If you find a damaged area on a band, please discard and replace it. It is not worth it to have the band break during an exercise and potentially injure you. The bands we recommend in this program are extremely hardy, but over time and with use damage can occur so please do not forget this step. C. Attach the band correctly. Most injuries from bands come from having them improperly attached or held.

2. Attachment Method A. Self-Attached – The easiest and most practical form of band training uses the athlete’s own body as the anchor point for many exercises. Virtually all R and I-Phase drills can be performed this way. B. Externally Attached – When bands are available along with solid and safe anchor points, the usefulness of bands increases dramatically. External attachments allow for multiplanar loading at every joint and an almost endless variation of exercises to be performed.

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3. Unique Band Properties A. Mild Instability – As you know by now, the cerebellum and frontal lobe are in constant communication when the body is moving in order to identify and correct errors. The mild instability that comes with more difficult band exercises theoretically can increase the demands on this loop. B. Increasing Force Curve – One of the greatest advantages to using bands is that the force required to stretch them INCREASES at the end ROM. This is in direct contrast to what must happen with most weight training equipment, which must be decelerated at the end of a lift unless they are being thrown. When working with athletes it is important to realize that in most sports there is a need to accelerate at the end ROM – making bands potentially a more sport specific tool. C. End ROM Work – As we have discussed in other courses, most injuries and threat responses in the body occur at end ranges of motion. Bands provide a unique method for safely exploring and strengthening movement maps in this much needed area.

4. Practical Applications & Usage (Demonstrated on the following pages) A. B. C. D. E. F. G. H.

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Axial Loading for Reflexive Stability & Postural Training R-Phase Drills – Self Attached & Externally Attached I-Phase Drills – Self Attached & Externally Attached Rotational Drills – Standing, Kneeling, Seated, Lying Resisted Multiplanar Movements Perturbation for Cerebellar Stimulus End ROM Terminal Flicks Axial Load Reduction for Injured Areas

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Loading with Bands

Practical Application & Usage for Loaded Mobility R-Phase Drill Examples: External Attachment and Self-Attached

I-Phase Drill Examples: External Attachment and Self-Attached

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Practical Application & Usage for Loaded Mobility Rotational Drill Examples: Standing, Kneeling, Lying

Standing Rotation

Kneeling Rotation

Standing Woodchop - Bottom to Top

Standing Woodchop - Top to Bottom

Lying Rotation

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Practical Application & Usage for Loaded Mobility Perturbation for Cerebellar Activation Load Reduction for Injured Areas

End ROM Terminal Flicks

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Loaded Mobility Programming The use of bands in any training program can take many forms from warm-up and supplemental exercises to being the only equipment used. Rather than working too hard to figure out how to place bands into a training session – instead focus on your clients’ movement maps under load. Where you see deficits consider whether band exercises would be an easy “fix” and implement from there.

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BLOOD FLOW RESTRICTED EXERCISE (BFRE) STRENGTH TRAINING SHORTCUT #1 BFRE is a type of training in which belts or tourniquets are applied to the proximal points of the four limbs in order to restrict the flow of blood during exercise. The formal practice of BFRE originated over 40 years ago in the work of Dr. Yoshiaki Sato, a Japanese bodybuilder. Through massive experimentation and then formal study, Dr. Sato developed his own method of BFRE that he terms KAATSU – which means “added pressure.” While it sounds astonishing on the surface, BFRE is an incredibly effective training tool capable of increasing strength and muscular hypertrophy with extraordinarily low intensity exercise. Additionally, as research in this field has continued to grow there are an apparent host of powerful benefits from BFRE including: 1. Large increases in muscular hypertrophy and strength – similar to or better than standard high intensity exercise. 2. Sprain, strain and fracture rehabilitation. 3. Acute pain relief 4. Increased bone metabolism. 5. Improved recovery speed.

How Does It Work While it is not yet fully understood how BFRE training creates results there are a variety of proposed mechanisms that are the most prominent. The four mechanisms below appear to act together to produce an environment that is favorable to muscle growth with low intensity BFRE training. 1. Fiber Type Recruitment (Fast twitch fiber recruitment) 2. Accumulation of Metabolites (Increased lactic acid environment which causes increased GH & IGF-1 secretion) 3. Inhibition of Cortisol Secretion 4. mTOR Pathway Activation (Which is known to increase protein synthesis, leading to hypertrophy) 5. Cellular Swelling Although significant research is still needed to fully understand the mechanisms, at its most basic level BFRE can be a remarkably effective form of training that deserves a place in every coach’s toolbox and almost every athlete’s program.

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BFRE Basics The basic concept behind BFRE is to artificially restrict VENOUS return in a working limb during exercise using appropriately applied bands or tourniquets. Earlier studies on BFRE also occluded arterial flow to the working limb, but that practice has been discontinued.

Band Placement 1. Bands should be placed as high as possible on the proximal working limb. 2. In practice you should adhere to the recognized teaching standards of performing BFRE either on the upper body or lower body SEPARATELY. Do not place bands on all four limbs. 3. Bands should be applied over snug clothing – not directly on the skin.

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How Tightly to Apply the Band In KAATSU training a great deal of emphasis is placed on finding the optimal band tightness for each athlete and each limb. From a practical perspective, here is the easiest way to approach this: There are two primary measures that will allow you to identify the ideal band tension on a day-to-day basis: 1. Capillary Refill Time (CRT Testing) 2. Exercise Respone

1. CRT Testing 1. Test your athletes capillary refill time in the appropriate area prior to placing the bands.

2. Next, place the bands and tighten. 3. Wait 20 seconds and then retest the capillary refill time. If it takes more than 3 seconds to see the blood return, the bands are too tight and should be loosened. If there is no change in the refill time from the first test, add pressure.

4. You can also ask the athlete if they feel a strong or increasing pulsation under the band. Usually a stronger pulsation is felt the closer you are to an optimal level of tension. 5. Note – the pressure of the bands should not create any numbness in the working limb. 6. During training the color of the working limb should be pink or red. It should not turn white or blue.

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2. Exercise Response The goal of BFRE is to create localized hypoxia and fatigue in the working muscles. To that end, BFRE when correctly performed should create significant fatigue, which can be used as a clear indicator of appropriate band tension. The general training guidelines are: 1. 2. 3. 4. 5. 6. 7.

Perform 3 Sets of Chosen Exercise with 20-40% of 1RM Set 1 should allow the completion of 25-40 repetitions. Rest period should be 15-30 seconds. Set 2 should allow the completion of 10-20 repetitions. Rest period should be 15-30 seconds. Set 3 should allow only 5-15 repetitions. Each set should end at close to or complete muscle failure.

If your athlete is capable of performing 25-30 repetitions in each set then it is likely the bands are not tight enough.

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Training Protocols Because BFRE has a tremendous range of uses, we will begin by looking at the basic strength/hypertrophy protocols that are well explained in the literature.

Strength/Hypertrophy – Upper Body 1. Set a timer for 15 minutes. 2. Prime the Pump – In KAATSU training a great deal of emphasis is placed on a priming procedure for the working limbs prior to beginning the training session. This is accomplished by tightening the bands for 20 seconds followed by a 5 second release for 4-8 cycles. Each tightening of the band should be progressively more intense. Conceptually, they believe that this improves the local venous and capillary tone which enhances the effect of the exercise. 3. Fully tighten bands to the level described above. 4. Perform 3 sets of biceps curls using a weight equivalent to 20% 1RM. A. If the bands are correctly tensioned your first set should be 25-40 reps. B. Rest 15-30 seconds and start set 2. C. Your rep range should decrease to 10-20. D. Rest 15-30 seconds and start set 3. E. Your rep range should decrease to 5-10. 5. Repeat step 4 with pushups from the knees 6. Repeat step 4 with dumbbell lateral raise. 7. Do not release pressure on the bands until the end of the full training period. 8. Do not leave the bands on for more than 15 minutes. 9. Each set of each exercise should be taken close to or to complete failure for maximal results. 10. This training program can be performed 3-6 days/week. 11. The exercises can and should be changed to focus on different areas.

Strength/Hypertrophy – Lower Body 1. 2. 3. 4.

Set a timer for 20 minutes. Prime the pump Fully tighten bands to the level described above. Perform 3 sets of squats using a weight equivalent to 20% 1RM. A. If the bands are correctly tensioned your first set should be 25-40 reps. B. Rest 30 seconds and start set 2. C. Your rep range should decrease to 10-20. D. Rest 15-30 seconds and start set 3. E. Your rep range should decrease to 5-10. 5. Repeat step 4 with calf raises. 6. Repeat step 4 with toe raises. 7. Do not release pressure on the bands until the end of the full training period. 8. Do not leave the bands on for more than 20 minutes. 9. Each set of each exercise should be taken close to or to complete failure for maximal results. 10. This training program can be performed 3-6 days/week. 11. The exercises can and should be changed to focus on different areas.

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Rehabilitation of Soft Tissue Injuries 1. Perform BFRE 2x/day (One session should be less intense – allowing for 20-30 repetitions during all 3 sets) 2. Use the hypertrophy protocols above but focused on muscles supporting the injured area. 3. Make sure to prime the pump.

Athletic Development One unique advantage of BFRE training is that it can be applied during technical training drills. For elite or competitive athletes training 2-3x/week consider using BFRE training for 15-20 minutes during skill development drills. Some examples are: • • • • • •

Sprint Technique Cutting Drills Boxing Kicking Cycling Technique Swimming

BFRE Walking In compromised individuals, BFRE walking can be a fantastic tool. The protocol is very simple to apply. You simply follow the initial steps listed above in the lower body hypertrophy section. Once the bands are applied and primed, have the athlete walk for 15-20 minutes. This is particularly effective in individuals who are new to exercise or are rehabilitating dysfunctions from disuse.

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BFRE Contraindications 1. 2. 3. 4.

Pregnancy Anyone taking blood thinners History of arterial aneurysm or stroke Post-Surgical – Kaatsu should not be done for 4-6 weeks after major surgery. It is often possible to perform Kaatsu within 1 week of smaller surgeries (e.g. arthoscopic procedures on the knee).

BFRE Notes 1. It is quite likely that some of your clients will have petechiae form when they first use BFRE. These look like red pin pricks below the level of the band and will typically disappear within 48 hours. This is an indication of decreased capillary flexibility, which will improve with the BFRE training. 2. You should warn your clients in advance that there arms will change color during the exercise and that this is normal. 3. What should you tell clients about how it works? A. BFRE mimics the effects of high intensity weight training by decreasing oxygen to the working limbs. B. This more quickly recruits Type 1 muscle fibers which are usually the HARDEST fibers to recruit with normal training. C. The local hypoxia also increases secretion of hormones that are associated with the positive effects of exercise including: growth hormone, adrenaline and IGF-1. There is also evidence that BFRE training reduces cortisol levels. D. Finally, there is also some research that indicates that BFRE can mimic the effects of high altitude training and mildly increase hemoglobin levels in the blood – making for a more efficient cardiovascular system. E. While you will feel most of the “work” happening locally, the effects of BFRE are body-wide. This means that you will see effects on the core muscles of the body as well as the extremities.

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THE LIGAMENT LINK – STRENGTH & SUPPLENESS SHORTCUT #2 One specific type of body tissue that is of extreme importance in our discussion of strength and suppleness are ligaments. Ligaments, as you know, are tough bands of connective tissue that generally connect bones to other bones. They are the largest contributor to stretch resistance in the human body and because they are highly innervated they are primary “threat receptors” in most movements. Because ligaments are responsible for the transmission of vital mechanoreceptive and nociceptive input to the CNS, they make excellent targets for assessment and drills in order to improve strength and range of motion as well as reducing pain. There are two very simple procedures that can be applied: pinning and spreading. 1. Pinning - In most slow movements ligaments are primarily stressed at their bony insertion points. Because these insertion points are a joining of two different types of tissues this is the location of greatest tissue weakness. Neurologically this means that the bony insertion areas of ligaments are primary sites of threat signals to the CNS. One very helpful process to reduce these threat signals it so manually “pin” the ends of the ligament, using either your hands or appropriate tools, to the underlying bone while the athlete performs the challenging movement. Often, this simple application of pressure will decrease dysfunction. If this proves successful, the athlete can be taught how to replicate the procedure at home, or tape and other tools can be applied.

2. Spreading – When you evaluate the structure and function of ligaments, what you will find is that during the stretch of a ligament it narrows longitudinally. It is this narrowing that causes firing of both mechanoreceptive and nociceptive nerve endings within the ligament. As with the technique above, manually “preventing” the longitudinal narrowing of the ligament as the athlete moves can also be an amazing tool for improving results. This process can be performed manually or with appropriate tools.

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Ligament Anatomy & Palpation While these techniques appear to be valuable in all accessible areas of the body, in this course we will focus on four primary areas:

1. Knee – Medial and Lateral Collateral Ligaments

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2. Ankle - Medial and Lateral Ligaments

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3. Shoulder – Coracoclavicular Ligaments

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4. Elbow - Medial and Lateral Collateral Ligaments

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SUPPLENESS TRAINING “The level of joint mobility generally relates strongly to sporting proficiency. The higher the level of sporting proficiency, the greater is passive and active flexibility. Static and passive stretching enhance passive flexibility, but only moderately improve active joint mobility, which is by far the most important flexibility quality needed in sport.” — Mel Siff, Supertraining On the other side of the strength continuum lives the second major topic of this certification course: Suppleness. Suppleness means that something yields or changes readily or is adaptable to new demands. This term was chosen very specifically in the Z-Health curriculum to emphasize the quality of movement and NOT simply flexibility. Traditionally in Z-Health we have defined suppleness this way:

Maximally efficient motion performed on demand, in any direction, at any speed, characterized by smooth transitions between movements. When you break this definition down, it provides a great deal of insight into the different facets of building and improving suppleness and makes it obvious that to be supple requires: • Excellent motor control and coordination, which requires high functioning of the voluntary and reflexive stability motor loops in the nervous system. • Speed of movement and transition control, which is most often a reflection of strength in the required positions and ranges of motion. • Full ranges of motion for required activities in all directions, which requires a blend of anatomical flexibility combined with the ability to control muscular tension and relaxation. If you simplify the above, what you see is that being supple requires 3 things: 1. Motor Control 2. Strength 3. Anatomic Flexibility Now, here is where things get interesting because, like all qualities of the body, suppleness tends to be very task specific. We have talked about the SAID Principle many times before and the same tenets still hold true. While we can generally identify people who are more “flexible” than others, this does not necessarily make them more supple when it matters!

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How Do We Identify Suppleness Deficits The identification process begins with basic movement analysis including: 1. 2. 3. 4.

Gait Analysis R-Phase Drills Functional/Athletic Movement Drills Activities of Daily Living

If you remember the concept of Arches vs. Angles from both R-Phase and S-Phase assessment processes, you already have the idea because generally where we see “angles” in movement, we are seeing a lack of appropriate suppleness.

How Do We Fix Suppleness Issues In this certification we are going to recommend that you approach suppleness deficits using the hierarchy mentioned previously: 1. First, improve motor control and coordination utilizing appropriate mobility drills at END RANGES OF MOTION. 2. Second, improve strength in the newly rediscovered ranges of motion or movement patterns utilizing isometrics, bands or other low threat approaches. 3. Finally, apply specific flexibility drills to areas that are unresponsive to the above, or in areas where anatomical tension appears to be the limiting factor. Because we have addressed the first two approaches in other courses, let’s shift our focus to number 3 and follow a brain-based approach to improving flexibility.

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Flexibility Defined There are generally 3 primary forms of flexibility discussed in the training literature: Dynamic Flexibility - Dynamic flexibility (also called kinetic flexibility) is the ability to perform dynamic (or kinetic) movements of the muscles to bring a limb through its full range of motion in the joints. Static-Active Flexibility - Static-active flexibility (also called active flexibility) is the ability to assume and maintain extended positions using only the tension of the agonists and synergists while the antagonists are being stretched. For example, lifting the leg and keeping it high without any external support (other than from your own leg muscles). Static-Passive Flexibility - Static-passive flexibility (also called passive flexibility) is the ability to assume extended positions and then maintain them using only your weight, the support of your limbs, or some other apparatus (such as a chair or a barre). Note that the ability to maintain the position does not come solely from your muscles, as it does with static-active flexibility. Being able to perform the splits is an example of static-passive flexibility.

Dynamic

Static Active

Static Passive

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Observations on Flexibility Based on extensive research into each type of flexibility over many years, there are some useful conclusions that can be drawn: 1. 2. 3. 4.

5.

6. 7.

8.

Dynamic flexibility is the most useful form of flexibility in most sports. Flexibility is speed specific and position specific. There is a low correlation between static and dynamic flexibility – approximately 40%. There is often a very large gap in athletes between their Active and Passive flexibility, which is called the Active Flexibility Deficit. The active flexibility deficit is the difference between passive and active ranges of motion. For example, if an athlete has a passive leg flexion range of motion of 150 degrees and an active leg flexion range of motion of 100 degrees, then the active flexibility deficit is 50 degrees. This gap is of great concern for several reasons because the gap represents: A. Range of motion that is available primarily thru momentum. B. An active contractile map deficit or weakness. C. Area of high potential threat because of sub-optimal predictive ability. D. Increased injury risk. The goal of most flexibility training should be to CLOSE THE GAP. Unfortunately, the vast majority of research into improving flexibility shows that there is very limited improvement in pure anatomical flexibility from most approaches. A. The Cochrane Database states that clinical stretching has limited contribution to the recovery of movement range in many musculoskeletal conditions: i. Immediate increase in ROM: 3° ii. Short-Term increase in ROM: 1° iii. Long-Term increase in ROM: 0° B. The primary reason for this poor response is that it is very difficult to ACTUALLY stretch most of the tissues of the body intensely or long enough in a typical training environment to create plastic deformation. The tissues that appear to be the limiting factors on our anatomical flexibility are: i. Joint Capsule 35-47% ii. Muscle 41% iii. Tendon 10% iv. Skin 2-11% Most studies at this point indicate that the majority of improvement in ROM from stretching is PRIMARILY DUE TO AN INCREASE IN STRETCH TOLERANCE as opposed to any significant change in tissue length.

With all of the above in mind it is vital to consider improving flexibility in a new light – it needs to be position, speed and activity-specific and the primary target of stretching is our PERCEPTION of the stretch which lives in the brain.

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“Fixing” Flexibility Based on the above information there is a 3-pronged approach to improving flexibility that has proven remarkably useful: 1. Use the 8 Levels of Assessment Model to increase or decrease stimuli as needed. 2. Use an external target reaching strategy. 3. Strengthen in the new found range of motion using multi-directional isometric drills. Let’s break each one of these down into practical steps.

Using the 8 Levels of Assessment Model to Improve Stretch Tolerance If one of our primary goals in stretching is to improve stretch tolerance, we need to remember the basics of Neuro 101 as well as the 8 Levels of Assessment Model. Let’s use an example of someone that wants/ needs to increase right hamstring flexibility. When an athlete stretches to the point of discomfort this activates nociceptors in the stretching limb. These sensations will be carried in the spinothalamic tracts AKA the anterolateral system to the sensory cortex of the parietal lobe. Knowing this pathway allows for a wide array of different stimuli that can be applied JUST BEFORE OR DURING A STRETCH in order to decrease the impact of the nociceptive signals. Some examples are: • • • • •

Vibration Light Touch Deep Pressure Visual Stimuli Vestibular Stimuli

Target Reaching In modern motor learning theory there is an extensive body of research examining which cues athletes best respond to during motor learning processes. One of the most important concepts to arise is that the use of external targets and movement cues often results in far better outcomes than being internally focused on the process of any given movement. This holds especially true for stretching. A simplified range or motion strategy: 1. Choose the ROM to be developed/recovered. The goal here is to actually PRACTICE the desired movement! 2. Use visual targets to guide flexibility challenges, making sure to use different initiation and return-to-start strategies.

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Target Reaching (continued) ROM Loss

Practice the task (Functional Training)

Goal of Rehab (Pain Free, Full ROM)

Practice a different task (Extra-Functional Training) Image is adapted from Eyal Lederman DO PhD, Therapeutic Stretching: Towards A Functional Approach, 1st Edition

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Strengthen Exercises Using the New Range of Motion As discussed in other areas of this course, isometric exercises are invaluable, low-threat but high-payoff drills. In terms of increasing and stabilizing new ranges of motion, isometrics are invaluable. Current research indicates that isometrics are highly useful as they decrease pain sensation and also increase stretch tolerance through a variety of mechanisms. The process is very simple. 1. Use other techniques to achieve the desired new range of motion. 2. Perform multiplanar long-hold isometrics for 30-90 seconds in each direction. A. Flexion B. Extension C. Abduction D. Adduction E. Internal Rotation F. External Rotation

How Much & How Often The final concept to address in this section concerns the two primary factors required to create long-term change in ranges of motion and movement patterns: repetition and specificity. Repetition - When we look at the major challenges we face in increasing ROM for an athlete we are often simply looking at a time and repetition challenge. For example if your athlete has decreased hip extension on the right during gait – a few minutes of work on those unruly hip flexors per day is unlikely to create significant long-term improvement. Practically speaking this means we need to create opportunities for our athlete to achieve hundreds or thousands of better steps each day. This has been the focus of Z-Health from the very beginning and why we have always said there is far more to flexibility than just stretching the tight stuff! Specificity – Flexibility and mobility are, like all fitness factors, task specific. This means that the fastest and most successful route to improving these attributes for our clients is perform flexibility work that is very movement and/or position specific. Based on current research there appears to be little transfer for stretching techniques and exercises that are dissimilar in goal and movement characteristic. In other words, if we want to create a long-term flexibility or range of motion improvement we should focus on exercises that are very similar to the desired task. As an example, consider an athlete with decreased hip extension during gait on the right side. A highly repetitive and within-task flexibility drill would be to have the athlete walk while actively working to increase hip extension by keeping the heel in contact with the ground for longer than normal. If the athlete walks 3km with a focus on this every 100 steps, the resulting number of repetitions will be extraordinarily high in comparison to what can typically be achieved in a training session.

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Suppleness Best Practices 1. Perform daily dynamic joint mobility to maximize motor control and coordination. 2. Add daily dynamic stretching to improve athletic ranges of motion. This can be achieved by maximizing joint ranges of motion using standard R & I-Phase drills. 3. For specific flexibility deficits use: A. Brain-Based approaches to improve stretch tolerance (e.g. Hands-on work, taping, wrapping, neuromechanics, visual drills, vestibular drills, etc). B. External targeting to improve ranges of motion. C. Isometrics to strengthen and improve stretch tolerance in the new found range. D. Use of ACM drills 4. Add in daily movement practices to achieve a high number of movement specific repetitions.

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RECOVERY PRACTICES One of the most overlooked areas of training for most athletes is the recovery process. Logically, most health and fitness professionals understand that the actual adaptation and growth from any training session comes during the recovery period that should follow. However, in practice, far more attention is placed on the training than on the recovery process, which increases injury risk, decreases results and harms compliance. Good recovery work can make EVERYTHING work better for your athletes and for YOU!

Every Day is Kidney Day There is an old bodybuilder maxim that states that “every day is kidney day”. What this little saying means is that recovery is a full-body process every day. And, most importantly from a Z-Health perspective, we are always recovering from LIFE – not just TRAINING. One of the more frequent statements I hear from coaches is, “My athletes really don’t train hard enough to need much recovery.” And, in some cases that is absolutely true. However, in most cases it is totally false. Think about the many things that enter our threat bucket every day:

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Threat Bucket Based Recovery When you look at this laundry list of potential threats it should be evident that your clients may need more recovery than you think. An athlete with a constantly inflammatory diet, poor vision, and a stressful relationship may not be working that hard in the gym, but they may still need a professional level of recovery in order to make progress. Once it is understood that we need to take recovery seriously, there are two major topics that arise: 1. How do I know if my client is overtraining? 2. What do I do about it?

How Do I Know if My Client is Overtraining? There is a massive push around the world currently to quantify and understand training loads, adaptation and overtraining in athletes and in the general public. To date, while many methods have been tried there is no single tool or measure that can guarantee that our athletes are always training with optimal load for improved results. Based on decades of research and experimentation here is what we currently recommend: 1. 2. 3. 4. 5. 6.

Daily Physical Assessments Gait Cerebellar and Brainstem Testing (Include visual and vestibular tests) Balance Range of Motion Strength

Physical assessments are only useful if you develop a baseline understanding of your athlete and their habitual patterns. Obviously, if you are doing your job correctly, their baseline should shift in a positive direction over time.

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Tracking Journals One of the most consistently successful means of tracking athletes and their readiness for load is the chronic use of a tracking journal. A good journal will track multiple physical function factors as well as the athlete’s overall energy levels and mood. The key piece of using a journal of this type is consistency: in filling it out AND in reviewing it on a daily and weekly basis. Here is one example of a journal that has been used with great success:

Weekly Readiness Tracker

All measurements should be taken in the morning and are on a 1-5 scale (except for sleep hours) where 1 is the “worst” and 5 is the “best.” Make sure you fill it out in this way or else the daily total will not make sense. Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Hours of Sleep Sleep Quality Soreness Fatigue Mood Joint Stiffness Water Retention Sinus Congestion Puffiness Under Eyes Bloating Dry/Itchy Skin Daily Total

(Not Including Hours of Sleep)

How to use the WRT: 1. Possible scores range from 10 - Worst to 50 - Best. 2. Remember that this is a subjective measurement process so there is no normative data available indicating an ideal score. 3. Use the tracker as an individualized tracking tool that you CORRELATE with what you see in training. 4. Some athletes will always give themselves a high score despite what you see in training and the reverse is also true.

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Weekly Readiness Tracker (Continued) 5. As you collect and analyze data over time (usually 2-4 weeks) you will find a “sweet spot” at which the athlete performs well or where you see performance degrade. 6. In general, we find that most athletes do relatively well in moderate-to-intense training with minimum scores of 33-35 out of 50. Finally, while the use of HRV and other autonomic tests are extremely interesting there is not yet enough data to support the sole use of technology to determine exactly what your athlete needs for today’s training session. Hopefully that technology is coming, but until then a practical approach using physical assessment and journals is a fantastic path to follow.

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What To Do About It – Recovery Practices For our purposes in this certification we are going to keep this simple. Think about recovery using the 3S approach. 1. Sleep 2. Sustenance 3. Stress Management Sleep – In our high-energy world, sleep is becoming more problematic for many people and there is a great deal of information available about the long-term effects of sleep deprivation. There are also many schools of thought about how to best improve sleep, from behavior modification techniques, to meditation, environmental modifications and drugs. Experientially, there is no one answer that works for everyone. Plus, many people will often report feeling more tired or worse when increasing their sleeping times. So, from our perspective sleep as a recovery tool is more about the quality than the quantity. Improving sleep often requires a multi-pronged approach over time to maximize the benefits. Sustenance – The topic of food in relationship to recovery is a huge one and beyond the scope of this particular class. Suffice it to say that a better diet that improves metabolic function and absorption of key nutrients is essential to improving an athlete’s response to training. Stress Management – This is an extremely broad category of tools that include many different aspects of life some of which lend themselves to specific practices while others are lifestyle habits. Different proven tools include: • • • • • • • • • • • • • •

Active Rest Rehydration Mobility Work Music Sun Exposure Massage/Bodywork Saunas Epsom Salt Baths Contrast Showers/Baths Breathing Exercises Pets Inspirational Movies/Comedy Sex Family Time

The key to improving recovery practices is to START SMALL! What we often see in the training world is an all-out blitz approach that usually backfires. Rather than starting with something as complicated as sleep, it is often advisable to work on 5 minutes of breathing twice per day or two Epsom salt soaks weekly. Unless you are working with a professional athlete who is able to spend their entire life training and recovering it is advisable to not add additional threat by adding too many recovery drills to the training week. Typically, once your client can feel the difference that a small change can make in how they feel they will often have the energy to add more recovery practices over time.

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STRENGTH AND SUPPLENESS PROGRAMMING – TRAINING THE 99% Proper programming begins with answering two key questions: 1. Who are you training? 2. What do they want?

Who are you training? To make this a useful question we are going to divide ALL clients into 2 separate categories: 1. Non-Competitive Athletes (General Public) 2. Competitive Athletes (Anyone competing in specific sports or events on a timeline)

Non-Competitive Athlete Goals While everyone is “different” we know that clients typically utilize training services for three basic reasons. 1. Look Better (Body Composition Change) 2. Feel Better (Pain Relief & Injury Prevention) 3. Perform Better Interestingly, general fitness athletes often present the biggest challenge for coaches because they want to look good while also developing and maintaining the elusive anytime, anywhere and “any type” fitness. The real challenge here is that often non-competitive athletes want better bodies – not better skills. They do not understand that the SAID Principle means that fitness is task specific. The great news here is that you can give these athletes both want they WANT and what they NEED utilizing a brain-friendly approach.

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Building Better Brains While You Build Better Bodies The vast majority of our clients will always need ONLY what is known as General Physical Preparation or GPP. In GPP, athletes work on general conditioning to improve strength, speed, endurance, flexibility, structure and vital movement skills. GPP performed from a brain-based perspective combined with a better diet will create: 1. 2. 3. 4. 5.

A more athletic and fit looking body. Improve the ability to create isolated tension and relaxation. Improve the ability to create tension and relaxation during movement. Increase motor coordination and basic “anytime” athleticism skills. Encompass a widely varied and novel movement curriculum that will create ample opportunities for long-term neuroplastic change – supporting better overall physical, mental, cognitive and emotional function.

What Does Z-Health GPP Include? Here is a list of basic movement GPP skills that you can and should include in most of your programming. • • • • • • • • • • • • • • • • • • • • • •

Squatting Lunging Vertical Push Vertical Pull Horizontal Push Horizontal Pull Trunk Rotation Trunk Flexion Trunk Extension Stabilizations (Single Leg, Kneeling, Bridging, Rolling) Moving Over, Under and Around Obstacles Multiplanar Reaching Under Load Standing to Kneeling Standing to Prone Standing to Supine Standing to Side-Lying Prone to Stand Supine to Stand Side-Lying to Stand Jumping (Up, Forward, Backward, Sideways, Rotations) Rolling (Forward, Backward, Sideways, Log Rolling) Ground Flow Sequences

As much as possible, once competency has been established in a given category, that movement pattern should be challenged using combinations of the above.

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Movement Challenge: I-Phase Squats & Lunges To assist your GPP programming, we’ve built a map of squatting pattern challenges using the I-Phase Movement Template:

I-Phase Squat Template Foot Positions 1. Full Foot a. Internal b. External c. Neutral 2. Ball of Foot a. Internal b. External c. Neutral

Lunge Positions 1. Anterior 2. Anterior 45 3. Lateral 4. Posterior 45 5. Posterior 6. Width a. Narrow b. Medium c. Deep

Trunk Positions Neck Positions 1. Neutral 1. Neutral 2. Right Rotation 2. Right Rotation 3. Left Rotation 3. Left Rotation 4. Right Lat. Flexion 4. Right Lat. Flexion 5. Left Lat. Flexion 5. Left Lat. Flexion 6. Flexion 6. Flexion 7. Extension 7. Extension 8. RR + RLF 8. RR + RLF 9. RR + LLF 9. RR + LLF 10. LR + LLF 10. LR + LLF 11. LR + RLF 11. LR + RLF 12. Additional 12. Additional Combinations Combinations

Arm/Limb Positions 1. Down 2. Up 3. Front 4. Back 5. Sides 6. Int. Rotation 7. Ext. Rotation 8. Elbows Flex. 9. Elbows Ext. 10. Wrist Flex. 11. Wrist Ext. 12. Fingers Flex. 13. Fingers Ext. 14. Combinations

Squat to Ground 1. Backward 2. Side 3. Front/Sprawl

3. Full Foot + Ball of Foot Mix

Eye Positions 1. Up 2. Down 3. Right 4. Left 5. Up Right 6. Down Right 7. Up Left 8. Down Left 9. Neutral

Squat to Jump 1. Forward 2. Backward 3. Diagonal 4. Sideways 5. Vertical

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Training the 1% - Competitive Athlete Goals While it is always exciting to consider training elite athletes, the truth is that there are only a few rules that you need to know to be highly successful: 1. Do not let them get hurt! Most elite athletes become elite because of their ability to show up to practice and competitions day in and day out for years. Rather than trying to come up with some amazing new program for them – first focus on decreasing as many movement threats as possible and moderate their training intensity. 2. Teach them how to train and practice more intelligently. Either through discussion, reading or simple practical examples in training introduce them to the concepts of deep and deliberate practice. 3. Help them learn to recover more efficiently. 4. Finally, when all of the above is in process, analyze their movement strengths and weaknesses and use ACM, Loaded Mobility, BFRE and other tools from this course to enhance their ability to perform.

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