Category Archives: Ethical Considerations

Rehabilitation vs. Athletic Performance Enhancement Training: Are we Asking Questions that are Already Answered?

Rehabilitation vs. Athletic Performance Enhancement Training: Are we Asking Questions that are Already Answered?

Robert A. Panariello MS, PT, ATC, CSCS
Professional Physical Therapy
Professional Athletic Performance Center
New York, New York

Throughout my career as a Physical Therapist (PT), Certified Athletic Trainer (ATC), and Strength and Conditioning (S&C) Coach I have been witness to many trends that have transpired upon these related professions. The evolution of the internet has been a significant venue for the conveyance of these trends with much of this information comprising assorted material of pertinent substance, some without; nonetheless the internet has offered many professionals their own claim of “notoriety” and in some instances financial gain. I am personally not opposed to capitalism as I am in private business myself. Like many others I also acknowledge various practitioners who evolve as “experts” in their professional field of choice and have mentors whom I very much respect. Presently there is an abundant amount of information and products available to the practicing professional where as the boundaries for the specific application of some of this information is often clouded if not altogether disregarded.

Buddy Morris

Performance Enhancement Training Trends

One current training trend appears to be the application of the principles of Sports Rehabilitation (SR) into the S&C setting. Certainly there is an “overlap” so to speak with regard to these two professions, however, it should be noted that these are two distinctly different professions. The application of various SR principles as related to the practice of S&C although practicable at times is becoming alarmingly close to providing a disservice to the training athlete.

Rehabilitation concerns often articulated include the “dreaded” type III acromion, upper trap dominance, the deep squat, disregarding bi-lateral leg exercises, the reluctance to utilize heavy weight intensities, and the list goes on and on. When pathology, anatomical abnormality or medical concerns are present; wouldn’t communication between the rehabilitation and S&C professionals take place to design a training program with all pertinent modifications? When these concerns are NOT present why is there still the intention to train the athlete as if they do exist? Is this due to the rehabilitation principles publicized for the training environment? In the S&C environment is optimal athletic performance as well as the prevention of athletic injuries best achieved with the application of rehabilitation principles or by optimally enhancing the physical qualities required for the sport of participation?

As an example the concern of the previously mentioned type III acromion appears to be commonly communicated. Is the expectation to x-ray every athlete training to confirm if the type III acromion morphology exists? Type III acromion morphology is substantiated to be present in the minority when compared to the type I and II. This evidence is often overlooked thus is the intent to have the minority manipulate the majority and prohibit overhead exercise performance? During my recent trip to the University of North Carolina at Chapel Hill to visit with my good friend Head Basketball S&C Coach Jonas Sahratian, some of his players demonstrated split jerking 100 – 100+ Kg of weight intensity overhead. These players had no complaint of shoulder, back, hip or knee pain, and demonstrated no limitations in range of motion (ROM), strength, neuro-muscular timing, or any other often stated clinical rehabilitation concerns. These basketball athletes lifted weights overhead for enhanced athletic/basketball performance as well as to survive the physical confrontations that occur under the boards during repetitive practice days and game day competition. Is there as much publically stated concern for the weaker athlete situated against a stronger opponent in the confined area under the boards? Isn’t it possible that these dominated weaker athletes are placed at risk of injury?

Why is it necessary to perform an abundant number of rotator cuff exercises when this muscle group is confirmed to be strong, neuro-muscular timing is appropriate and research attests this small muscle group has an active role during the execution of many upper body exercises? Why is there failure to mention the documented consequences due to excessive rotator cuff fatigue that transpires due to unwarranted exercise performance? When no deficiency in muscle activity nor neuro-muscular timing is noted during a pain-free technically proficient exercise execution, why is it necessary to “activate the muscles” prior to the actual exercise performance? Isn’t the most precise muscle “activation” for a specific activity an appropriately executed progression of the actual activity? This is not to imply that a warm-up isn’t warranted, however, if an athlete desires to become a better baseball pitcher wouldn’t they practice pitching? To become an improved golfer wouldn’t they golf? Therefore to become a better back squatter wouldn’t they actually have to back squat? Doesn’t form follow function? If this were not true why is practice necessary? Why not workout and just play the game?

The deep squat results in various joint(s) stresses that all professionals should be aware as isn’t this knowledge (science) required for prudent training? Investigations have established the deeper knee bend positions demonstrate the greatest lower extremity muscle activity, thus without the presence of a contra-indication why would an athlete not assume the most beneficial position during the exercise performance? If the deep knee bend position is so detrimental to the athlete why are there no noted medical community demands for the abolishment of the catcher’s position in the game of baseball?

Why is there such concern with appropriately programmed heavy weight intensities? Is it because these weight intensities exceed those utilized in the rehabilitation setting? It is documented that game day competition and practice days are the environments where the highest incidence of athletic injuries occur as weight room injuries have been noted to occur at a rate of less than 1%. There are circumstances where specific exercises and heavy weight intensities may be appropriately prohibited from the athlete’s training program design. However there are also instances at the time rehabilitation is completed and all contra-indications are resolved, yet an apprehension continues to exist with regard to these same exercises and weight intensities. Isn’t this suitable programming necessary to prepare the athlete for the stresses of repetitive team practice, game day competition and the physical confrontation of an opponent? Why on occasion does there appear to be less concern with returning the athlete to the field of competition, the initial cause of the athlete’s problem? When appropriate exercises and weight intensities are deemed prohibitive isn’t it fair to inquire if they are truly contra-indicated or are the principles of rehabilitation for a pathology which no longer exists continually being applied?

Most professionals would agree that not every exercise, principle, and application of heavy weight intensity is appropriate for every individual. However, isn’t the athlete’s exercise selection and training programming part of the “art” of both SR and S&C? Why is the “art and science” of coaching often ignored by the reader of an article or the attendee of a conference at the time the rehabilitation based questions of “what about this, what about that” arise? Is this due to the clinical rehabilitation information that is delivered via various public forums? If abnormalities and medical conditions are acknowledged why is it assumed they will not be properly addressed during training?

They are Different Professions

Ask yourself why do the majority if not all Professional Sport Teams, Colleges, and Universities have both an Athletic Training Medical Staff and an S&C Staff? Why are there two distinct departments? In most circumstances would the Athletic Training Staff be designated to Athletic Performance Enhancement Train an individual or team for a Championship? Would the S&C Staff be appointed to rehabilitate a post-operative World Class athlete or any athlete from day one? Why not just employ ONE of these professional staffs to both rehabilitate and train all athletes? Imagine all the money saved by eliminating an entire professional staff/department. This does not occur because these are two distinctly different and respected professions. This statement is not intended to be disparaging as I respect and practice both in my vocation. Many of the concerns and principles deemed appropriate and utilized in one profession may not be a concern or appropriate for utilization in another. There are certainly professionals qualified to practice both, however this is the exception and not the rule. In our 44 Orthopedic and Sports Physical Therapy clinics as well as our 20,000 square foot Athletic Performance Training Center we accept more than 180 physical therapy, physical therapy assistant, athletic training, and S&C student interns annually. In review of the curriculums of these student interns it is substantiated that they are quite different in both educational content and clinical requirements.

My good friend Hall of Fame NFL S&C Coach Johnny Parker told me a story about a former NFL Assistant and Head Coach whom I am familiar named Al Groh. Coach Groh was an assistant on Head Coach Bill Parcells coaching staff with the NFL New York Giants, New England Patriots, and New York Jets. These teams were persistently in the playoffs winning Super Bowls and Championship games. These three organizations had one thing in common; they were all not very successful prior to the arrival of Coach Parcell’s and his staff. This coaching staff was not elaborate and avoided the trends and hearsay of the “outsiders”. They just applied the fundamentals specific to the game of football and worked very hard. On one occasion Coach Groh turned to Coach Parker and stated, “You know JP I think I have this thing figured out. Get the team organized, get them disciplined, get the team in condition, have a plan, follow that plan and let the losers eliminate themselves”. During my 10 years as the Head S&C Coach at St. John’s University Hall of Fame Basketball Coach Lou Carnesecca had the same ”no outside nonsense” and work hard philosophy. Coach Carnesecca won 640 basketball games during his coaching career.

Rehabilitation and S&C Coaches are well respected professionals that are vital to the athlete’s and team’s success. Although there is overlap between these two professions, these are two distinctly unique vocations requiring very different knowledge and skill sets. Every athlete in training should be treated as an individual and the S&C Professional has a choice to incorporate an S&C philosophy or a rehabilitation philosophy. The performance training road paved will eventually be one of success or one of consequences as with athleticism and skill being similar it is the stronger and more powerful athlete that will usually prevail. The terms “Rehabilitation” and “Strength and Conditioning” are not interchangeable and are as different as the principles and skill sets utilized in each respective profession. If this were not true why aren’t these professional staffs/departments interchangeable?

Strength & Conditioning Needs More Grit and Fewer Cowards

In watching these Presidential candidate debates, I can’t help but wish that the Strength & Conditioning industry could have regular debates amongst the experts. Debates are a healthy and productive part of the learning process; they’re vital for settling differences, they generate hypotheses which can be tested, and they remove the veils so that everything is transparent. They’re important in every scientific field, including sports science.

S&C will never have this because you don’t demand it. You make excuses for cowards and don’t hold your leaders to high standards.

If any of you have met me in person, then you know I don’t take myself too seriously. I know I don’t have all the answers, and I’m actively seeking knowledge just like you. However, I also know when someone out there is full of b.s., acting out of jealousy, or has ulterior motives. I know when someone hasn’t collected the necessary data, when someone hasn’t put in the toil that goes into adequately knowing something, when someone goes against the research, and when someone fabricates their own pseudoscience.

Over the past several years, I’ve challenged four individuals to debates – all guys who were publicly badmouthing me or pissing on the good name of science (see Grill the Guru archives). None of them accepted, and their excuses were utterly pathetic.

I want to show you how legitimate scientific experts operate. Today, I text messaged my friend Alan Aragon out of nowhere, challenging him to a debate. Exactly thirteen minutes later, he accepted the challenge. You can tell by his response that he welcomes the debate and would relish the opportunity to show off his knowledge. For the record, I don’t disagree with Alan on this topic, nor would I really debate him on it as he’s my go-to guy for sports nutrition research. But do you see how easy it is to interact with true professionals?

This is how men handle things...no smoke, no mirrors, no ego.

This is how men handle things…no smoke, no mirrors, no ego, just a mutual desire for truth.

Whenever someone in the academia/educational world refuses a debate challenge, it almost always means that they’re a charlatan. They’re frightened to death that their ignorance will be exposed. If these individuals were confident and comfortable with their knowledge, and if they were truly interested in honing in on the truth and advancing science, they’d gladly accept the challenges. But instead, these types continue to run their mouths but then back down like common cowards when push comes to shove and they’re challenged by formidable opponents.

What baffles me is that their followers seem to accept backing down and don’t expect more. S&C doesn’t have debates because you guys don’t demand them. You’re okay with your experts running their mouths without having to back them up in a debate. It’s up to you guys to demand more. If someone you follow gets called onto the carpet because they were talkin’ smack, let them know that you expect them to man up and accept the challenge. If they back down, remind them of it incessantly. Don’t be fooled by smoke and mirrors.

There are numerous badass coaches in the trenches doing amazing things in Strength & Conditioning. That said, the trendy/popular S&C expert scene is in dire need of more cojones and fewer namby-pambies. In the next couple of days, some needed grilling is going to take place here on my blog. I, personally, won’t ever back down in the good name of science – it’s not in my blood.

You won't find much of this in S&C these days...

You won’t find much of this in S&C these days…

 

Ignorant and Incompetent People Aren’t Aware of Their Ignorance and Incompetence

If you are heavily immersed in the fitness industry like I am, then I bet you never cease to be amazed at some of the ignorance and incompetence displayed by various members of our community. It’s all over the place, and you simply cannot escape it. Scrolling through Facebook and reading the comments might make you want to do this:

bang

Ignorance comes in many forms, and sometimes it’s hard to imagine that the ignorant person is serious. I’ve found myself on numerous occasions reading various comments on social media and saying to myself, “This guy has got to be trolling.” But it turns out that many times the ignorant commenters aren’t trolling; they’re just really dumb. But ignorance isn’t exclusive to your casual social media commenter; the experts are guilty of it too. We have a myriad of seemingly scientific writers engaging in cargo cult science – it might look and feel like science, but it’s not science. These types are unwilling to doubt their own theories, which is counter to the essence of a true scientist.

One would think that ignorant and incompetent people would know that they are ignorant and incompetent, and that they would therefore remain humble and willing to learn from others. Unfortunately, this is not the case.

The Curious Case of McArthur Wheeler

In 1995, a man by the name of McArthur Wheeler decided to rob a bank. Don’t worry, he was sure to cover his bases. Knowing that lemon juice can be used as a type of “invisible ink” by applying it to paper, letting it dry, and heating it, Wheeler applied lemon juice to his face prior to robbing the bank to conceal his identity. When Wheeler was arrested later that night and shown a video tape of him committing the crime that clearly revealed his face, he was shocked. “But I wore the juice,” he remarked.

wheeler

Prior to robbing the bank, Wheeler tested his hypothesis by applying lemon juice to his face and snapping a Polaroid picture of himself. Apparently, his face didn’t turn out in his trial pic. The detectives later speculated that this circumstance probably occurred on account of bad film, a poorly aimed photograph, or simply a case of lemon juice in the eyes, which partially blinded Wheeler and prevented him from properly seeing the photo.

The Dunning-Kruger Effect 

Here is a case where scientists made lemonade out of lemons. Wheeler’s case sparked Cornell University social psychologist researchers Justin Kruger and David Dunning to explore the relationship between actual competence and self-assessment of competence. As it turns out, ignorant/incompetent people are really bad at knowing that they are ignorant/incompetent.

Dunning-Kruger

What they found through their research was that for any given task, an incompetent person will tend to:

  • overestimate their own level of skill,
  • fail to recognize genuine skill in others, and
  • fail to recognize the extremity of their inadequacy

Dunning and Kruger’s research has led to the dubbing of The Dunning-Kruger Effect, which is readily apparent in any field, especially fitness. 

Are We All in Various Stages of Denial?

Anosognosia is a condition whereby a disabled person suffering from a brain injury is unaware of or denies the existence of his or her own disability. These individuals have a serious self-awareness deficiency, which can be neurological or physchological in nature, and it occurs even in the presence of obvious impairments such as blindness or paralysis. What we now realize is that in a way, all humans suffer from anosognosia, since we’re not always equipped with the knowledge needed to identify ignorance/incompetence.

Denial

To quote David Dunning, “If you’re incompetent, you can’t know you’re incompetent. The skills you need to produce a right answer are exactly the skills you need to recognize what a right answer is.” Though their research is fairly modern, the phenomenon relating to self-confidence and competency has been discussed for quite some time. Confucius stated that, “Real knowledge is to know the extent of one’s ignorance.” Charles Darwin noted that, “Ignorance more frequently begets confidence than does knowledge.” And William Shakespeare wrote, “The fool doth think he is wise, but the wiseman knows himself to be a fool.”

Take-Home Message

As you can see, fools don’t know they’re fools. Coming from someone who sifts through up to a hundred journals per month and spends considerable time reading and conducting research, I can tell you that quite often there’s more to the story than meets the eye. To answer a particular question, we often need to conduct multiple studies and bring in expert researchers from different fields. The fool isn’t aware of this; he thinks his intuition is sufficient. This is why we have a multitude of individuals presenting themselves as experts on topics that they’re actually clueless about, and this includes exercises they’ve never performed, methods they’ve never experimented with, tools and instruments they’ve never used, and concepts they’ve never researched or reviewed.

Next time you’re on social media perusing comments, see if you can spot the overly-confident fools versus the true experts. It’s not always easy to spot, since the fool is typically guided by a more lax code of conduct. The fool will often go for the jugular and use logical fallacies to increase his chances of appearing right. Finally, always make sure to keep yourself in check and question your own beliefs – lest the fool be you! 

Research

My more savvy readers will likely want to read up on the Dunning-Kruger Effect, so here are links to full papers that you can download: 

Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments

Mind-Reading and Metacognition: Narcissism, not Actual Competence, Predicts Self-Estimated Ability

Why the Unskilled Are Unaware: Further Explorations of (Absent) Self-Insight Among the Incompetent

Difficulties in Recognizing One’s Own Incompetence: Novice Physicians Who Are Unskilled and Unaware of It

Why People Fail to Recognize Their Own Incompetence

A Discussion With Paul Carter on Anabolic Steroids

I recently asked Paul Carter if he’d be willing to jump on Skype and record a discussion on the topic of anabolic steroids with me. We ended up talking for nearly 2 hours. The information contained within won’t be anything ground-breaking for serious lifters who have been around the block. However, for those who are ignorant and naive on the topic of steroids, you’ll definitely learn a thing or two.

Paul and I are not experts on the topic of anabolic steroids; we’re not medical doctors/endocrinologists and we aren’t involved in research on anabolic steroids, so take our advice with a grain of salt. Personally, I would like to see more discussion on anabolic steroids emerge over time in our field as it tends to be a taboo in strength & conditioning media. Here’s the video (my apologies, I don’t have an MP3 file for you):

Here are the various questions we tackled:

  1. What are the ethical issues involving anabolic steroids?
  2. What are the different types of anabolic steroids?
  3. What are the effects of testosterone/anabolic steroids?
  4. What other drugs are typically used in powerlifting/bodybuilding?
  5. What are some limitations of the literature involving anabolic steroids?
  6. What are some of the biggest misconceptions out there involving anabolic steroid usage?
  7. What are some of the more extreme anecdotes that we’ve witnessed in terms of great responders and poor responders?
  8. Why are there non-responders – what’s happening?
  9. What are typical ranges of testosterone levels for natural men?
  10. What are typical dosages for men taking TRT?
  11. What are typical dosages taken by average powerlifters and bodybuilders?
  12. What are extreme dosages taken by elite powerlifters and bodybuilders?
  13. What are some of the more well-known side-effects of anabolic steroids for men?
  14. What are some of the lesser-known side-effects of anabolic steroids for men?
  15. What are some of the side-effects of anabolic steroids for women?
  16. Would the same powerlifters and bodybuilders be dominating their sports if anabolic steroids didn’t exist?
  17. Would sports performance be highly influenced if anabolic steroids didn’t exist?
  18. Do anabolic steroid users need to train differently than natural lifters?
  19. What is some advice for those considering taking anabolic steroids?
  20. Where can people find out information about anabolic steroids?

phil