Q&A from 5.11

This is Q&A session we conducted with Phil Stevens and Lift 4 Hope a few months ago.  I think mostly everything is still consistent except that little job thing.1) I was wondering if you could share your story as to how/why got you started in the physical therapy field?I think like many of us in our profession, I began as an athlete playing ice hockey and baseball through high school. I enjoyed weight training, and I found it cool to be strong. It was something that just came fairly easily as I began training with my dad. I used typical young bodybuilding approaches and had success at that time. Going into college, I played baseball, but I knew that was done after college. To stay in sports, I eschewed being an orthopedic surgeon since even though I was very good at carrying or moving large objects, I wasn’t very good at putting them together. So I became set on being a Certified Athletic Trainer and go on to graduate school. My undergrad was the same Premed program for the ATC program, so that also gave me all the prereqs for physical therapy school. My advisor said I could still do everything I wanted to do as an ATC even if I went to PT school, and it would make me more marketable and have a good backup plan as well. So I graduated undergrad in ’96, got my ATC in ’97, MSPT in ’99, and DPT in January of 2010.In the summer of ’98, I was working as a PT aide, and one of the referring physicians asked the owner of the PT office if they knew any ATCs interested in working with a minor league basketball team coming to the area. I got that job while still in PT school, and after graduating, the connections from that minor league job got me to the New Jersey Nets for the ’99-00 season. From 2000-03, I was a Head Athletic Trainer in the USBL, IBL, NBDL, which also included responsibilities of Strength Coach, Equipment Manager, and Travel Secretary. In ’03, I got back to the NBA with the Philadelphia 76ers as Game Day Athletic Trainer and Rehab Consultant. At that point, the 76ers did not have a Strength Coach, so given my build I think the players found some confidence lifting with my guidance. That earned me Head Strength Coach and Assistant Athletic Trainer for the 76ers through 2006. After not getting renewed in Philadelphia, I moved to my home area in NJ where I became Director of Sports Performance and Physical Therapy @CentraState Sports Performance, which was a hospital-owned sports training center where we trained and rehabbed folks as PTs, Personal Trainers, and Strength & Conditioning Coaches all as one entity. Currently, my job title is Lead Physical Therapist for Marine Corps Special Operations Command (MARSOC). At Camp Lejeune, NC, I am responsible for contributing and managing programming for both rehab and general physical preparedness for the PERRES program, which is MARSOC’s Performance and Resiliency Program.2) Looking back at your training/Physical therapy career, were there any things you did that you know look back and think, "Wow, that was really stupid... What the heck was I thinking?"Just like everybody else, I had shoulders, back, leg, and arm days, used machines, did crunches every way possible, and rehabbed with ultrasound, ball squats and yellow theraband exercises. Some of the early things that I learned and really identified with like The McKenzie Method and cross-friction massage are still big parts of how I think and what I do.I think all of us should have a laundry list as an answer this question. One day I hope to look back at what I do today and think it was silly too.3) On a similar breath, what are the biggest changes you've seen in physical therapy during this time period?The biggest change for me during my career is the progression from segmental joint based point of view to movement to neurological.I think the most contemporary train of thought that is probably a big change is the primary reliance on the neurological system for all types of human performance training. The target organ of everything we do is the brain. Credit my friend Dr. Craig Morris in Los Angeles for this brilliant line.4) Do you feel that unstable surface training has a role in the training of an already healthy athlete?Yes, I do think it has a role, but not a very large one.The most important piece to understand is that using these tools 1) does not "get you more core," and 2) do not magically improve your balance.It is correct that there is a shift to stabilizing tonic muscles when using unstable surfaces. That being said, if you can not achieve a standard on the stable ground, there is minimal chance that all of a sudden making the environment more challenging is going to click everything into place.And to the bogus research that says using TheraBand wobbles increases EMG of specific core muscles, 1) the research is total trash when it is done by the company and thinly veiled as independent, and 2) EMG doesn't lie, but it doesn't always tell the whole story. A big EMG isn't always the answer. When it comes to spinal stabilizing muscles, co-contraction may mean a lower EMG at the muscle you are looking at may mean more balance or more to go around for some of its neighbors.To me, it's just laughable that if you can't do something (balance), making it harder will help you achieve your goal. Watching someone struggle mightily and shift all over the place in the name of BS "ankle proprioception" is just shameful.Now, there are major pieces to Janda's training methodology that utilize unstable surfaces. The commonality to the different wobbles or rockers and sandals is that the foot still has a normal flat contact to the surface. The surface underneath has an angle that causes the instability. The foot is still in it's normal position and has an opportunity to react and feed the chain positively. This is very different than demanding the foot to claw or grip onto a rounded Bosu or Dynadisc. These are very poor choices. Yes, the Bosu is flat, and that side fits the bill, but the wobble is so great for 1-leg that few people can be proficient.I also think for skilled lifters, doing 1-leg work like 1-leg squat and Split Squats can be done to an Airex pad as a deload week or phase. It's a different kind of hard, but again, it should not be considered corrective.5) I know the use of ultrasound for injured athletes is a debated topic amongst various physical therapist. What's your take on this modality?Ultrasound generates heat on the continuous mode. That is not debatable. So it can be justified for a thermal or pain-relief effect. But so does rubbing your hands together and touching the body like Mr. Miyagi.With pulsed mode, my opinion is that it does absolutely nothing other than some tactile sensation or proprioception. That in itself can be very valuable, but it's obviously not what most people think is happening.I don't know if the hands-free models ever got much traction, but I would much rather use those than sit there wheeling around a handle. I would much rather do manual therapy for any amount of time I would dedicate to ultrasound.The theory of ultrasound is very sound which is why Shockwave holds my favor. It is ultrasound, just really jacked up. So when ultrasound was made up, the biophysics and therapeutic expectations held a lot of water. But now with technology advancing, the same biophysics applied through Shockwave is probably the legitimate effect we are looking for.6) What's your thoughts on training barefoot? Useful or hype? Does it matter what kind of exercise they're doing?Definitely not hype at all. Barefoot training is an excellent addition to a corrective or conditioning catalog. Unfortunately though, I am seeing this more in theory than in practice. Just because it is a good thing doesn't mean it's a good thing for everybody. If indeed it is deemed a good thing for you, it also may just not be a good thing for you......yet.People like to do. They like to add and complement. No one likes to be told to stop or told that there are things that they can't do. So in terms of barefoot training, it has a positive mental attachment of doing something that will help, so everybody tries it. But this is without screening or assessment when. This is a major mistake. Barefoot training is a great tool, but it must be instituted with attention and progression.When mobility and stability are proper, even the deconstructed sneakers have some level of stability. With a stable barefoot, there is brilliant proprioception sent up the chain creating reflexive stabilization elsewhere. Consider the homunculus of the brain, where we see the feet holding larger surface area of the motor cortex than other areas outside of the face and hands. When the foot does the right thing, lots of good things happen in the brain.Training barefoot in itself may be the access point for proprioception to improve function. Or it may not, and I think this is the more likely senario. Not everybody should be wearing Vibrams just yet, and certainly nobody should be taking them off the shelf and going into big cleans and 10 mile runs.Barefoot training is like walking a tightrope. Sometimes the tightrope might actually be the challenge that someone needs to stabilize. The barefoot collapse can be a very adequate form of RNT. Unfortunately most of the time people fall off the tightrope. Technical proficiency and recovery from a movement or exercise is the line you draw for whether barefoot or Vibrams are a good idea.7) For an injured athlete, is there any specific credentials they should look for when selecting a physical therapist?Certainly people's training and credentials are huge pieces to look for in terms of things like FMS, SFMA, ART, and I'm sure the list can go on forever.Maybe something more important to look for as a credential is a referral from a like clinician that you trust. The most important thing to me in who I would send someone else to is that I know how they think and practice. Just because someone has SFMA Level 9 and is certified to do Dry Needling on the moon doesn't mean that's actually what they do when you get there. If you know someone and like what they do, there's a good chance they know someone that knows someone that knows someone that is like minded. That's the "credential" I'm looking for.Something else to keep in mind is that the PT or chiro that never advertises, has a tiny little office in the middle of nowhere, and no one has heard of might just be the best one around. No one's ever heard of him because his results and word of mouth drive his business, and he is not greedy and trying to have 9 locations in the tri-state area doing bullshit therapy. That mindset extends to his clinical thought process and passion. That's another credential to look for.The stuff I want's not on paper. It's qualitative, not quantitative or nominal.8) Why do you like the FMS?The initial gravity of the FMS to me was when I was in the NBA where at least my focus of strength & conditioning was to keep all 15 guys healthy and as generally peaked for 82 games and the playoffs.As a physical therapist and strength coach at different times of the day, the messages of the FM System has allowed me to put my goals and know how into a tight perspective that I have not found elsewhere in terms of mentoring.It has shaped my way of thinking overall which in turn created a figurative bureau with drawers and shelves for all of the interventions or methods that I know how to do. It tells when to use them, when not to use them, when I am using one too soon, or not enough of.The FM System is really the roadmap for how I go about thinking. In some ways, with no reticence to saying, it is my religion to practice. In its true definition of the word, religion demands repetition, and the FM System is the broad based format and structure that makes the rules. But the coolest part is that the rules are set in to allow for change and dismissal and addition and integration of different tools to Screen, Test, Assess, and Intervene.In terms of the Functional Movement Screen itself, it is what I have found to be the most efficient tool to begin to learn how not to hurt you in terms of training. Maybe it is because I am a PT and ATC, the whole Hyppocratic Oath thing rings in terms of Do No Harm. I like the FMS because it provides the structure and inroads behind it to not allow me to harm you under the guise of helping you. There can perhaps be no worse error on the part of a human performance clinician. The FMS is the check and balance on your wonderful zeal to help.I guess I could go on with what is becoming a spiritually-based answer, but quite honestly, that is what I like and have learned the most from the FM System.9) Specifically around basketball; I'll be transitioning from my winter powerlifting to some spring/summer basketball what movements or prep would you suggest I do?In terms of movement, I would continue to hammer your weak link of the FMS, and to the next level of "movement," I am an enormous proponent of driving the Joint by Joint with tri-planar movements.Steps, Leg Swings, Arm Stretches, Lunges, Jumps, Leaps, Hops, Walking, Running, Shuffling, Skipping, Carioca. All of these movements can be combined with each other in really infinite ways and always be done at least 3 different ways in the 3 planes.I don't support every single nuance in these videos, but in terms of developing athletic movement and agility, this is the style of general movement training that I think all field or court athletes should be doing.https://www.youtube.com/user/Train4TheGame#p/a/u/1/5h-tgsVujYwhttps://www.youtube.com/user/Train4TheGame#p/a/u/2/0V6d-G6XF2khttps://www.facebook.com/video/video.php?v=1608569379970Think ankles, hips, and shoulders. These are the regions that should be moving and propelling.10) .......athletes are expected to be able to RDL what they can back squat. Then there's the old adage of being able to squat a certain percentage (I don't remember if it's 100% or as much as 200%) of one's bodyweight before introducing plyometrics. Do you have any specific standards regarding this idea? And given similar training ages, leverages and competitive natures, should the relative strength levels of a female be comparable to a male?Regarding the back squat and RDL, they are really very different movements, but if your squat is 500, and your RDL is 225, you have a problem. I like being strong in everything all the time, but what does this mean if you can back squat what you can RDL? I'd be interested in the data that he has that translates that correlation to something else even more important. I don't know about that. And is it about correlation, or is it about big and correlation. Amd I happy if a 210 athlete can back squat and RDL 125?I am never looking for strong based on a number. I'm looking for stronger based on progression and improvement. If there is a component of a big indicator lift that's lacking, then we can push through that one to bring up the weak link. Ultimately though I just want improvement and correlation to movement. I'm greedy in wanting it all; I'm not greedy in how many wheels are on the bar.Back to the comparison, the back squat has the bar on your back, laying on your skeleton in your BOS, and the form is knee dominant.The RDL has the entire load in your hands, relatively outside your lower body BOS, and the form is hip dominant. I'm not at all clear on the strict correlation.In terms of the strength qual for plyometrics, I have never subscribed to that. There's a couple reasons why.1) What if they are a little bit off? So for a 200# athlete that can only squat 375, he's not allowed to jump? Silliness. Black and white criterion just leads to failure in an environment that does not need to be pass/fail. If we can go by technical proficiency and recovery, those are the quals we should demand.2) What does plyometrics mean? Little line drills with bunny hops are technically plyometric every bit as much as an altitude jump into jump and go over 40" hurdles. If you start with plyometric landing progressions where the focus of the drill is to land well more than get up big, then your neuromuscular efficiency will be appropriate as you progress to decreasing ground contact time and going big.So rather than say you have to squat X before you do a big depth jump, how about we progress through deceleration programming AND gett stronger at the same time. When/if the proficiency and timing allow, the big jump will be permissible and excellent.11) ........given that the subject matter is exclusively Olympic Lifting, I would like to know your thoughts/ideas for pre (and/or post) session mobility, which joints you would focus on, and maybe some key movements that target those joints.I'm not sure prepping for an O-Lifting workout should be hugely different than other sessions. Focus on the joint by joint and if it individualized the weak links of your FMS.Here are some ideas that stick out with O-Lifting.........1) Obviously wrist extension dominates in the clean catch much more than in other environments, so some options like quadruped with shoulders ER or active isolated stretching patterns will be useful. You may also want to consider some grip work or fingertip pushups or pull-ups. Similar to the ankle, adding mid-hand stability can be a difference maker in opening up the wrist.2) Especially if you are going to be wearing thos damn shoes when you lift, pay extra attention to dorsiflexion mobilization through ankle work or lunging. Going barefoot is also a good option just to the effect that being completely unsupported complements the extra support you get with the heels and stiff shoes. If you are not training to win an O-Lifting meet, you have no reason to wear the shoes. They help you get down which means an easier deep catch position, but the anterior weight shift deloads the core and voids much of the training effect of the midfoot and ankle interacting uniquely with the ground.3) Get revved up. O-Lifting is strong, fast, powerful. Bridge into that loading with some skips and sprints. O-Lifting is also complex; multi-planar combinations of your locomotion movements I think will complement the CNS's motives to be successful in a great O-Lifting workout.4) Drilling with the empty bar just makes so much sense that it is impossible to ignore. What makes O-Lifting so great is that you must have mobility in the right places to pull and catch efficiently. You can drill easy movements, drive the joint by joint, and work on some swift explosiveness as you progress.Keep these tenets in mind for a warmup of any kind.Specific work - FMS or other algorhythmGeneral work - increase tissue temperature, drive mobility, engage the positions (mostly 1-leg, but obviously not for O-Lifting), fire up the CNS12) In your opinion, is the Kalos Sthenos method of TGU, as outlined in "From the Ground Up" enough to structure what's needed, mobilize what's needed to progress to bigger and better lifts?  Or do you feel that the FMS and other screening processes should be done along that kind of work?The only think that the Turkish Getup doesn't directly address in terms of the FMS is the Deep Squat. But it addresses all of the components of the Deep Squat via the same terms that would drive a long-term FMS corrective algorthym.So if you are suggesting, can you just perfect the Getup and feel confident that you have a strong base to other methods of strength training that carry bigger loads, I think the answer is definitely yes.Also keep in mind that you can load up the Getup as well. Lore would suggest that ancient warriors were not permitted to join the brigades until they could do a Getup symmetrically on both sides with 100# KB.If you use the same policy as the FMS in terms of honoring pain and R/L asymmetries, you will do just fine with the Getup as your Screen.13) Would...the packed neck....be something that I should be adding to my Indian club swings, or would it be just where you would be hip hinging like DL's and swings?Yes, I would recommend the neutral neck in all of the Indian Club techniques. There's good reason to believe that any exercise that demands stability can be restored or will be enhanced with that neck position. Lots of good things are happening.