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Learn what you forgot.

In my last blog post I wrote how the gluteus medius is an important muscle when it comes to the health and proper function of the many structures in dynamic movement (walking, running, jumping, and etc). While it is very true that the strength, pliability, and overall physiologic and neurologic health of the gluteus medius is important it is not the only solution to all problems when we think of increasing healthy functional mobility. We have to step back and look at the whole picture of the athlete or client and ask ourselves why is the gluteus medius and/or other muscles and structures moving in a way that is causing inefficient mobility and wear and tear? The answer to that question is neurologic movement patterns. To answer that you must know what are neurologic movement patterns or movement patterns are.

Movement patterns are synchronized and coordinated firing of nerves from the central nervous (CNS) to the peripheral nervous system (PNS) system to elicit a group (large or small) of muscles to perform a specific task. In the CNS there are learned muscle firing patterns that can be accessed very fast to cause a skilled movement. For example, when you are going to go from standing still to walking your body has to rapidly tell the core to contract, the limb that is staying planted to the ground to now contract the gluteus (medius, minimus, and maximus) in order to get ready and brace for the loss of support of the other limb that is starting to lift off the ground and swing forward, relax the hip flexors on the stance limb (limb still in contact with the ground), and go through the motions to push off and swing through. Now the other limb that is moving is also receiving a cascade of signals for forward motion and just as fast become the stance limb. When this happens there are thousands if not millions of pieces of information being sent back and forth like timing, force being produced and received, tecture of the ground, and the list goes on and on.  

Now we don’t just wake up one day and say I am going to go for a walk - never mind run and jump. We had to learn that skill when we were a baby watching everyone around us use their legs to get around. When a baby learns to walk he/she goes through a phase that is generally 8 - 14 months or so learning how to control all those muscles. This learning takes an enormous amount of energy and hard facts of what movement patterns work and what ones do not. All this information is being processed and stored in the brain for rapid recall for when it is needed.

So if a person learned to walk and run when he/she was a child why when they are an adult do they injure themselves running and not have the proper movement patterns? The answer to that is because we grew up and stop being fun. Really, we stop going outside and running around all day, playing sports and reviewing the muscle movement patterns that we learned when we were kids. Now we sit typing boring explanations about butt muscles or making a living.

So, how do you fix this? You have to first see what is wrong with our movement patterns that is making it difficult to move like we should. Next when you have discovered the dysfunctional movement patterns we must know what movements must be learned first in order to advance to the more skilled movement like running and jumping. Once we become proficient at the remedial movements then we can move to more skilled movements. This is very much like a teacher teaching a new subject matter like math, literature, or history to students. The teacher does not go first to the advanced subject matter like quantum physics, pieces of literature with subtle deep meanings, or the specific battle plans of Admiral Nimitz using the tides and curvature of the earth to his advantage when preparing for a surprise attack on the Imperial Japanese Navy. The teacher starts the students with the basics and builds on the foundation of knowledge learned. The teacher then builds up to more skilled lesson that requires mastery of the prerequisite subject matter. Human movement is very similar and requires mastery of the foundation of more fundamental movements. And like lessons and skills learned in school if we do not practice them regularly we will forget them and when we attempt to take a course on advanced physics and have not practice physics in 20 years we will fail. Movement is the same. We must practice it everyday. If we have not practiced them daily find out what we forgot and relearn what we use to know but forgot.   


The gluteus medius and the foot

Recently, I was at a seminar on youth athletes and injuries associated with youth athletics. The speaker got me thinking about the similarities of growing young athletes and my general clientele that are past the growing phase in their life. Part of the discussion focused on foot, knee, hip, and lower back injuries that plague growing athletes especially the female athlete. Though this is not new information the focus for solving most of the chronic issues that plague many of the young athletes where strengthen the gluteus medius. It was interesting to rehash how one muscle in the hip solves mild flat feet, shin splints, knee pain, hip pain and bursitis, as well as lower back pain.

You maybe asking what is the gluteus medius besides a ‘butt muscle’ and how can it solve flat feet and why did my doctor have me buy inserts if the problem is in my butt. Well, for the first part of the question the gluteus medius is the part of the ‘butt muscle’ that is on the side of your hips. This muscle when working correctly stabilizes the femur (large thigh bone) to the hip when you bear weight on your feet. Without this muscle your hips could not bear weight and the knee would rotate inward when standing. Think of a person after they may have had a few too many cocktails on the weekend and have ‘rubber legs’. Their knees almost always rotate inward or internally rotate. This is because the alcohol slows the messages to the muscles causing the gluteus medius, as well as all other muscles, to be weak and not contract properly.

This weakness in the gluteus medius as stated above when bearing weight causes or allows the thigh and subsequently the knee to rotate internally. This internal rotation at the knee cause what is called a ‘valgus stress’  or ‘knock kneed’. This valgus stress prevents the knee from bending and extending straight and causes excessive stress on the muscles, tendons, and ligaments around the knee. This also causes the kneecap or patella to glide in its’ groove improperly and puts increased friction on the outside of the kneecap as well as the patella tendon at the base of the knee in the front.

Now, because the hip and knee are rotating internally because of a weak gluteus medius it forces the foot to collapse inward or overpronate. This overpronation cause the foot to look flat and when running not allow the stress of hitting the ground to be absorbed properly. This inability to absorb the forces of hitting the ground causes pain and injury in the foot and shins. Though the arch can be somewhat supported artificially by inserts the inserts never correct the arches. Pain may be temporarily relieved in the foot it will not help the knees, hips, or back since the structural problem is in the hips.

So what is the solution? Strengthen the gluteus medius with exercises that focus on that muscle’s actions. This can be done with laying on your side and abducting your leg up, rotating the foot outward, and the hip back. Squats with focus on form over reps and resistance and single leg step ups not allowing the knee and hip to rotate inward. Also, stretch your hip flexors, hamstrings, calfs, and quadriceps regularly to increase your hip flexibility and make it easier for your gluteus medius to perform like it should.

If you have any questions about this topic or any others please feel free to contact me at   



No Machines Needed

What type of workouts are best for increasing strength, coordination, and performance? Workouts that center around exercises that focus on one major muscle group (i.e. quads, biceps, etc.) at a time, like seated leg extensions for stronger quads. Or workouts that focus on large gross muscle movement that target many groups of muscles such as the quads, glutes, calf, erector spinae, and abdominals?

Essentially this question, which has been posed and tested by many coaches, exercise physiologists, Physical Therapists, and Athletic Trainers, is looking to compare what is termed open kinetic chain (OKC) exercises versus closed kinetic chain (CKC) exercises. OKC is when a limb (arm or leg) moves against a force and the distal (end) portion of the limb moves through space (ie. seated leg extensions or bicep curl). CKC is when the distal portion of the limb is fixed and does not move but the rest of the body moves away from the distal portion of the limb (ie squatting: the feet do not move and body and resistance moves up). Okay, that said which group of exercise are best for increasing strength, coordination, and performance and why?

According to the litany of research on this topic and proven improvements in athletic performance by athletes who utilize workouts that are primarily composed of CKC exercises, the answer is pretty clear. CKC exercises have been shown to be much more superior in increasing increasing strength, coordination, and performance. But why? If a seated leg extension machines have the ability to generate more tension on the quads than squats why would that not lead to greater muscle strength and performance? The answer boils down to specificity of motion and the carry over effect1-3. No one will argue that stronger quads will lend to more force production in jumping but if the quads have not been trained to do the jumping motion with resistance it will not carry over to significantly higher jumps for example.

For example, when a person does a squat there is an enormous amount important neural activity happening. Within muscle, tendons, and joints there is an huge array of complexed nerve endings that are constantly feeding the central nervous system (CNS) with information. Depending on their location, diameter, amount of myelination (fatty tissue around the nerve that increases rate at which messages are sent along the axon) and sensitivity, each one of these nerve endings determines what type of information is being sent to the CNS3 . This information, which in summation is referred to as proprioception, if repeated time and time again develop coordination in controlling tension and rate of force production from a muscle on ligaments, tendons, and joints. This increased learned pattern of movement results in increased skilled movement. Increased skilled movement results in increased athletic performance3.

Therefore, a workout routine that works to maximize the benefits of increased proprioception will result in a workout routine that increases the athletes performance. Lower body and to a good extent upper body workouts that contain high amounts of CKC exercises result in the maximum amount of proprioceptive feedback. This in turn results in maximum skilled performance increases. But why do CKC exercise result in more proprioceptive feedback versus OKC exercises? The one word answer is compression.

When a joint is compressed, such as the knees and hips in standing or shoulders in push ups, all those proprioceptors sense the pressure and fire off the muscles needed to either effectively keep your balance in standing or stabilize the shoulder to allow for a push up to be performed4. In OKC movements this is generally not the case. Since OKC movements are not able to generate those similar proprioceptive returns less skilled movements are developed and therefore do little in carrying over to increased athletic performance. Now this is not to say that all OKC exercises are pointless and should be avoided. What this means is that workouts should be designed to increase functional performance, whether it be for everyday activity or for increased performance in an athletic event. And with that goal a heavy but not complete focus of a workout program should be CKC. It is still import to have strong biceps, shoulders, lats, and etc. and some of the best exercises to do that through resistive OKC exercises. But for increases in gross strength, coordination, and performance CKC exercises are the best bet.

Work Cited

  1. Bunton, E. E. . Pitney, W.A.. Kane, A.W.. Cappaert, T.A.. (1998). The role of limb torque, muscle action and proprioception during closed kinetic chain rehabilitation of the lower extremity. Journal of athletic training. , 28(1), 10-20.
  2. Augustsson, J.. Esko, Anders. Thomee, Roland. Svantesson, Ulla. (1998). Weight training of the thigh muscles using closed vs. Open kinetic chain exercises: a comparison of performance enhancement . Journal of Orthopedic Sport Physical Therapy. , 27(1), 3-8.
  3. Nyland, J.. Brosky, T. Currier, D. Nitz, A. Carborn, D. . (1994). Review of the afferent neural system of the knee and its contributions to motor learning. Journal of Orthopedic Sport Physical Therapy. , 19(1), 2-10.
  4. Mcmullen, J.. Uhl, T.L.. (2000). A kinetic chain approach for shoulder rehabilitation .Journal of athletic training. , 35(3), 329-336.


Getting to the Core of the Issue

Pick up any fitness magazine on the shelves and I guarantee that you will find articles devoted to the ‘“new core shredding workout” or “the ten minute abs.” If you didn’t know any better you might conclude that the core is the most important group of muscles to work. But how important is the core when it comes to developing strength training and performance programs for athletes and average gym warriors like you and me? The research on how much time you should dedicate to the core and its resulting effect on athletic performance may surprise you.


Now I do have to say I was surprised by the trend of the results from the research on this topic. I have rarely seen such an overwhelming agreement in opinions of authors and results on a subject. Of all the research on this topic it was made very clear that programs that focus heavily on core strengthening do little to nothing to help increase the performance of athletes and average gym warriors. Now the research is not saying don’t bother with core training. As a therapist and trainer I know firsthand that a strong functional core is necessary for proper posture, which decreases the likelihood of injury. What the research is saying, however, is there is a point where the benefits of extensive and elaborate core training reaps little to no reward.

So, what does this mean for training programs, personal trainers and coaches that insist on spending long hours on core training and, as a result, less time on power and skills? It means that if the athlete or client is able to hold proper posture throughout the event or program, it would be more beneficial to the athlete to spend time on skill training and power training. Since workouts should be designed to grow from base strength/skills to power to performance, programs that spend more time on periodization of those three principles will result in stronger, faster, and more skillful athletes/clients as opposed to being bogged down in rudimentary base workouts.

Throughout the different training stages core workouts should be done by everyone, but in the workout stages when more skilled programs are being performed, the core should be part of the warm up routine. This way the neuromuscular pathways that have been developed in the first stages along with the high fatigue resistant muscle fibers do not become ignored and weakened.
Young, W.B.# uses the analogy of a fine tuned sports car when describing how to best build power in sprinters.

First you have to increase the engine capacity—increased cross sectional area of muscle fibers through squats, etc. Next, increase the power output by optimal timing of cylinders—increase intramuscular coordination by getting all muscle fibers to fire together and hard. Lastly, increase conversion of power from engine to road via an effective transmission—increased intermuscular coordination by increased activation of synergist and decreased activation of cocontraction of antagonists (i.e. getting the hamstrings to relax while the quads fire).

In this analogy you can see that the core plays a minimal role and as long as the client or athlete can hold good posture throughout the event that is all that is needed. Use the warm up time to work on the core, and focus more on power and skill. So, the next time you are waiting to get your haircut or on a long car ride to the South Coast and you pick up the latest fitness or health magazine with the latest ‘core shredding’ workout you can skim past it with the knowledge that it is most likely all fluff and no guts.

Example of workout program progression through different stages of performance development.

Week 1 - 6 General Conditioning Training: Increase Body Tolerance to Activity
3 sets x 8 - 12 Reps Moderate Load Moderate Intensity
Jumping Jacks - High knees - Burpees
Squats - Push Ups - Crunches
Lunges - Pull -ups - Planks
Dumbbell Press - Hamstring Curls - Physio Ball Back Extensions
Bicep Curls - DB Rows - Cable Twists
Tricep Dips - Lateral Raises - Superman’s  
Jogging x 20 - 30 min.

Week 7 -12 Strength and Hypertrophy Training:
3 Sets x 6 - 8 reps - High Load - High Intensity
Jumping Jacks - High knees - Burpees
Crunches - Supermans - Cable Twists - Planks
Squats - High kicks - High knees
Deadlifts - Reverse ball Crunches - Jumping jacks
Chest press - Ball tosses - Bicep curls
Flies - push ups - Dips
Rows - reverse fly - Ball Planks
Lat pull down - Shoulder press - crunch slams

Week 12 - 18 Power “BANG”
3 Sets x 3 - 6  Reps - Moderate Load - High Intensity
Jumping Jacks - High knees - Burpees
Crunches - Supermans - Cable Twists - Planks
Jump Squats - Jogging x 1- 2 min
Cleans - Jumping jacks
Snatches - Ball Tosses
Jogging x 5 min
Broad Jumps - Push ups
Box jumps - High Kicks
Sand Bag Toss - slow jog

*This Program is loosely based on the principles of:
Rhea MR, Ball SD, Phillips WT, Burkett LN., A comparison of linear and daily undulating periodized programs with equated volume and intensity for strength. J Strength Cond Res. 2002 May;16(2):250-5.
and Overreaching and Tapering.

For any questions about this article or others contact


  1. The Relationship Between Core Strength and Performance in Division I Female Soccer Players. Nesser, T.W; Lee, W. Journal of Exercise Physiologyonline Vol 12 Number 2 April 2009.
  2. The effects of short-term swiss ball training on core stability and running economy.  Stanton, R., Reaburn P.R., Humphries, B. Journal of Strength and Conditioning Research, 2004, 18(3), 522-528.
  3. Transfer of strength and power training to sports performance: Young, B.W., International Journal of Sports Physiology and Performance, 2006; 1:74-83.



Which comes first: the stretch or the workout?

Everyone knows that no workout can properly begin without a good stretching session. We all have been told that we should stretch before and after workouts both to decrease the risk of injuries and to perform stronger and faster. This is just common sense right? Well according to a litany of research this is not the case. Actually, stretching before a workout can actually make you slower and decrease your potential to generate power#.

What!! That is just heresy. But the fact of the matter is that stretching prior to a workout, especially one that involves a lot of jumping, sprinting, squatting, and agility drills, can slow you down and reduce your overall performance#. Why have we been told for years from coaches, therapists, trainers, and that big dude grunting like a gorilla while he squats a 1000 lbs that stretching is a must before a workout? The answer can be found by explaining how muscles work, what stretching does (and its benefits), and finally, by determining when it is truly appropriate.

Traditional stretching is traditionally referred to by clinicians as “static stretching.” The way static stretching works is by convincing the individual muscles that they don’t need to have so much tone (the constant non-valitionary nerve pulse to a muscle that maintains a steady level of tension). The muscles decrease tone when they get a signal from the “Golgi Tendon Organ” or GTO signaling that the force being applied to the muscle fibers is not enough to harm the muscle. When tone is decreased the muscle is allowed to be put in a more lengthened position and becomes more pliable#. This new lack of tone is great when you have finished an event, trying to fix posture brought on by tight muscles#, or elevate nagging muscle aches but is bad when you are about to need the maximum amount of tone your body can generate (i.e., sprinting, squatting, jumping, and etc.).  

Researchers have found that if an athlete warms up prior to training or an event with sport specific calisthenic like exercise, going from simple to more aggressive, that the athlete will perform statistically significantly better than if the athlete did the same warm up followed by static stretching2. These results are explained by Nelson, EG and by our current understanding of how muscles work that static stretching reduces muscle tone and that tone is what is needed for maximum performance.

Now, this is not to say static stretching is not important4. Static stretching is extremely important and a necessary portion of any workout routine. Instead, this show that workouts should be thought-out and not just slapped together. So, if you want the most out of each workout and maximum performance then workouts should start with sport/event/activity specific calisthenics or warm-ups and then finished with a cool down followed by a good session of static stretching. Work out smarter - not harder!

Here is an example of what the research shows would be the best way to incorporate a warm up into your pre-workout routine followed by a static post workout stretching routine.

Warm up:

  • Slow jog for about ¼ - ½ mile
  • High kicks crossing x 1 min
  • Jumping Jacks x 1 min
  • Walking lunges 2 x 50 - 75 feet
  • Ball slams 2 x 45’
  • Jump Squats 2 x 15 - 30 seconds
Cool Down:
  • ½ jog
Static Stretching:
  • Quad Stretch: 3 x 30’
  • Calf Stretch: 3 x 30’
  • Hamstring Stretch: 3 x 30’
  • Piriformis Stretch: 3 x 30’
  • Pectoral Stretch: 3 x 30’
  • Neck Stretch: 3 x 30’

If you have any question about this or any blog post feel free to e-mail for more information.   

  1. Acute effects of passive muscle stretching on sprint performance; Journal of Sports Science, May 2005; 23(5): 449 - 454
  2. Does stretching improve performance?: A systematic and critical review of the literature; Clin J Sports Med, Vol. 14 Number 5 September 2004: Shrier, Ian MD
  3. Static Stretching Impairs Sprint Performance in Collegiate Track and Field Athletes: Journal of Strength and Conditioning Vol 22 Number 1 January 2008: Winchester, JB
  4. Effects of global posture reeducation and of static stretching on pain, range of motion, and quality of life in women with chronic neck pain: a randomized clinical trial. Clinics 2008;63(6):763-70