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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?

No Two Hips Are The Same: How Anatomical Variance Can Affect Your Range of Motion

The following is an awesome guest article from my friend Dean Somerset. Dean is sort of a hybrid personal trainer in that he knows a ton about strength & conditioning but he also possesses a wealth of knowledge pertaining to corrective strategies and rehabilitation. I have so much respect for Dean and his commitment to the fitness industry – he’s one of the good guys. Dean just released a new DVD called, Advanced Core Training, click on the link if you’re interested. Now for Dean’s article on hip anatomy.

No Two Hips Are The Same: How Anatomical Variance Can Affect Your Range of Motion
Dean Somerset

We’ve all heard it before: hip structures are different so therefore you have to squat differently than someone next to you. This should be pretty common sense, especially when dealing with as broad of a population as there is in the world. What would be a bang-up fantastic recommendation for one individual may be beyond the realm of possibility for someone else, and still so incredibly rudimentary for another person.

Does this have anything to do with training history, time spent under the bar, or simply tissue health? We know joints deteriorate with age and those deteriorations cause reductions in range of motion, however I have a 72 year old client who can still squat his hamstrings on to his calves, and a 20 year old athletic phenom client who can barely crack parallel. Some of my initial consults squat like a rusty hinge, regardless of whether they’ve exercised a day in their life or not, and similar consults can hit the floor with ease.


Looking even at very elite lifters, some prefer to take a much wider stance during a squat whereas others may get away with an almost parallel and shoulder width squat stance. Some deadlifters prefer conventional whereas others prefer an extremely wide sumo stance. It begs the question of whether there actually is one optimal stance or just what may be optimal for the lifter?

Let’s even look at individual differences in size. Look at a high school football team and you’ll see a huge difference in player physical size and shape, sometimes massively so. These physical differences showcase the simple fact that we’re all different, and this fact continues on to the shapes of our joints and how much and where they can display range of motion.

Looking at simple anatomical variance, there can be a massive difference between individuals in the shape, alignment, positioning, and relative angles of attachment of specific bones and joints, meaning their ability to move will be entirely different than someone who has a different set up.

One basic tenet to understand when it comes to the available range of motion a joint may have is this: You can’t stretch bone into bone without something going wrong. If your joints run out of room and wind up pressing one bone into another, you can’t get more range of motion out of them without causing some trauma to the joint or to neighboring joints. Therefore, the shape and position of your joints will directly dictate when and where you develop this bone to bone contact, and will ultimately be the main limiting factor for the ultimate amount of mobility you can use.

Let’s focus on the hip for this discussion because hips are cool and squats are awesome.

Commonly the femoral neck angle is the most known individual difference. A femoral neck angle is usually classified into 3 categories: coxa valga (a more vertical angle inserting into the pelvis), coxa vara (a more horizontal angle inserting into the pelvis) and what is considered a more “normal” angle of roughly 40-50 degrees. The funny thing is the normal angle occurs with less frequency than the combined angles of coxa vara and valga, meaning it’s somewhat more rare to see.


Not as commonly known is the degree of retroversion or anteversion those femoral necks can make. The shaft of the femur doesn’t just always go straight up and instert into the pelvis with a solid 90 degree alignment. On occasion the neck can be angled forward (femoral head is anterior to the shaft) in a position known as anteversion, or angled backward (femoral head is posterior to the shaft) in a position known as retroversion. Zalawadia et al (2010) showed the variances in femoral neck angles could be as much as 24 degrees between samples, which can be a huge difference when it comes to the ability to move a joint through a range of motion.


Consider someone who has a femoral retroversion will likely have a bone to bone contact sooner in a flexion range of motion compared to someone who has more of an anteversion alignment, and if that difference is 20 degrees or more, that could be the difference between squatting above parallel and sitting your hamstring comfortably on your calves.

We’re not done there, though. The acetabulum itself could have a variety of alignments, all of which could affect the range of motion of the joint and affect the movement capacity of the individual.

The acetabulum could itself be in a position of anteversion or retroversion, and this difference itself could be more than 30 degrees. This means the same shaped acetabulum would give someone who has the most anteverted acetabulum 30 extra degrees of flexion than someone who had the most retroverted acetabulum, but would give them 30 degrees more extension than the anteverted hips.

The shape of the hip socket could also be different too! Some people would have a more flat shaped cup socket, but as Fern & Norton showed, there could be a focal positional change in how the socket is set, and also the shape of the socket itself. Occasionally, someone may have a focal versus global retroversion or anteversion, which makes the hip socket look more like an oval or C-shaped cup.


Throw into the mix the fact that hip sockets can also have varying depths and femoral necks can have varying thicknesses, and you have some significant evidence that ranges of motion through the joint can and will be significantly altered based simply on the genetic gifts of the individual in question. A deep socket with a thick neck is going to limit range of motion much more than a shallow socket with a thin neck ever would. The “cone diameter” is essentially the overall range of motion a ball and socket joint would have given their socket depth and neck thickness.


Now to throw even another monkey wrench into the problem, there’s the simple fact that your left and right hips can be at different angles from each other! Zalawadia (same guy as before) showed that the angle of anteversion or retroversion of the femur could be significantly different from left to right, sometimes more than 20 degrees worth of difference. This means trying to train for symmetry could be inherently wrong, and using parallel stances or symmetric set ups (both feet turned out 20 degrees, etc) could be wrong as well, depending on the individual.


Now I know some people out there are saying that this doesn’t really matter and is just an excuse for people to not squat to their full potential, or that everyone should be able to squat ass to grass. Well, I would say if they have the hips to do so, give it hell and work hard at it. However, if they don’t have the hips for it, they will likely develop some signs of impingement, such as anterior hip pain when squatting or doing anything involving hip flexion.

In significant cases of impingement, the individual could develop cam or pincer lesions on the bones of the femoral neck or acetabulum, respectively. This happens when repeated compression of bone into bone occurs and a callous begins to form. The only way to get rid of this is to not do flexion acitivities and probably surgical removal of the callous with the hope the labrum isn’t damaged. Even then, the outcomes could be more related to the type of hip you have.

Fabricant et al (2015) showed that 37% of asymptomatic individuals had clinically significant markers of impingement related structural changes in their hips, and this number skyrocketed up to 54.8% in athletes. He also found that post op recovery was best in patients with retroversion versus anteversion for removal of pain, recovery of strength and range of motion, and speed at which they restarted their desired activities.

There’s even a link to SI joint pain based on the type of hip set up you have. Morgan et al showed the radiographs of people with a history of SI joint pain had a 33% occurrence of cam impingements and 47% had what would be classified as deep hip sockets. Range of motion restriction at the hip affecting the nearby SI joint? You don’t say.

Now with the variations in hip structure, alignment, size, and position, comes the obvious questions of how much influence does any of this have on squat depth and performance? I’m not aware of any studies that have looked at these characteristics, but I would be open to collaborate on them. From my experience with my own training and working with my clients, I have found those who have a more anteverted positioning tend to have no problems squatting to depth whereas those who have more of a retroverted positioning tend to struggle with depth, but rock out with extension. People with more of a lateral positioning of the acetabulum tend to require a bit of a wider stance than those with a more inferior location, and tend to struggle mightily with their feet closer together.

Similarly, those who have very small cones of motion tend to be incredibly stable and rarely have their hips fatigue, likely meaning they have deeper sockets to help support their weight. If one hip is more anteverted and one is more retroverted, it may be that the individual has to stand in a slightly rotated stance to allow a squat depth to be reached. One foot may have to be turned out slightly compared to the other, which seems to commonly be the right foot.

Now how can you use this information to work in your favour? First, you don’t need to have multiple radiographs of your hips to figure out what alignment you’re dealing with or what positions would work best for your squat or hip hinge. There are some active tests you can do that are simple and very indicative, plus very practically useful for helping to determine optimal squat stance and positioning.

  1. Supported Squat

This is a simple way to determine what your best squat depth can be. Using a solid object that isn’t going to move, and ideally within sight of a mirror so you can see whether your low back is rounding or whether your hips are going through a posterior tilt, squat down as low as possible using the support for balance. Find a position where you are as deep as possible without letting your low back round. If you get to a point where your back rounds, that’s essentially the limit of your hip flexion in that position, and going further produces the dreaded butt wink.

While at the bottom, open your feet to a slightly wider position and see if you can get lower into the squat than before, then turn one foot out and in and see what happens. Narrow your stance and repeat, but concentrate on which position gives you the best depth without flexing the lumbar spine or creating pain in the front of the hip. If you can’t squat because of hip pain, get that addressed first.

Once in a position where you achieve your deepest squat, find a way to maintain a vertical posture while slowly letting go of the support, and then stand up without assistance. Use the support to lower back into the same squat position and repeat, then lower into the squat without assistance. The movement should feel fluid and easy, without obvious strain or tightness preventing you from getting to the bottom position.

You may only be able to get to 90 degrees of hip flexion with your thighs parallel to the floor, and that’s okay. You might be able to squat so low your hamstrings are pressing into your calves, and that’s okay. There’s no right or wrong, just looking at your individual abilities.

If you have the ability to squat to the floor, working on hip mobility drills and squat accessory movements is pretty much a waste of time. You’re there, and you can get there at the drop of a hat. They’re good to use as a warm up, but you won’t gain any more mobility from them. Likewise, if you can only get to parallel with support, there’s likely no squat mobility drill in the world that done thousands of times will produce the ability to squat to the floor. You might squeak out an extra millimeter or two, but that’s about it. Working more on your squat depth may actually produce low back pain, SI pain, and potentially hip impingement.

From a performance basis, if you have a limited amount of hip flexion, you might have trouble getting a neutral spinal position during conventional deadlifts. A more stable position may be a modified sumo stance or a full sumo stance. Potentially, depending on the relative asymmetry of the hips, you may require one foot turned out or the other, and you might even require having one foot posterior of the other relative to the bar.

  1. Hip Bridge Test

This one should be fairly straight forward. Lay on your back with bent knees and drive your hips up as high as possible without arching your low back and see how much extension you can get. Most people will get to neutral, and maybe slightly more than that to about 10 degrees. Some people can get incredibly far into extension, as judged by the line from the middle of the thigh through the torso. A straight line denotes neutral, whereas a position of slightly flexed is a negative angle of extension, and a position where the hip is ahead of the torso is a positive extension angle.

If you can get to extension beyond neutral, congratulations, you have more range of motion than I do in that regard. I can barely get to neutral on a good day.

For individuals who lack extension to or past neutral, developing anything that would resemble a good kick in sprinting would prove challenging. Likewise, hip thrusts would be a bit of a struggle to get to a solid lockout, and would always look like a short range of motion.

  1. Goalie Stretch

This is a great test of the lateral capability of the hip joint in a somewhat passive manner. On hands and knees, try to open the knees as wide as possible without ripping yourself in two. When you get as wide as possible, try to sit back as far as possible without letting your low back round.

This gives an idea of how wide your stance for squats and deadlifts could be at it’s widest part. This may not be where you would have your deepest position, but just where the very outside edge of your ability would be. If you barely get your hips to make a 90 degree angle with each other, your odds of taking a very wide sumo stance or squat stance is likely pretty slim without causing some serious hip pain or discomfort.

These three tests will give you a lot of information:

  • What position gives you the best squat depth, and what your actual ability to go into hip flexion is from that depth.
  • How much hip extension you have in a gross sense.
  • How much lateral mobility you have.

From this you can determine whether you have a lot of mobility, a specific directional limitation, or are built more like the Tinman from the Wizard of Oz, always looking for the oil can.

Let’s break down a couple of scenarios and see what positions would be best for you.

  1. Low flexion, low extension, low lateral movement: You’re the proverbial Tinman. Getting to depth is always an issue, so doing higher squats to a box may be your reality. Likewise, deadlifting from the floor may be an aggressive amount of flexion, so taking somewhat of a modified sumo stance may be required to prevent low back involvement and possibly rack or block pulls. In fact, conventional pulls from the floor may be your deficit deadlift. The good news is you can carry and hold anything forever. You’re a prized infantrymen for hiking through rough terrain with a combat pack because you’ll never break down.
  2. Good flexion, low extension, low lateral movement: You can squat well, but sprinting is a challenge to get any kind of kick without having your low back do all the work. Shoulder width stance is awesome, but going much wider than this causes some lateral hip discomfort. You prefer conventional pulls to sumo, and can pull from the floor well.
  3. Good flexion, low extension, high lateral movement: You can pick your squat stance from a wide array of possibilities. Sprint extension is tough, but the lateral mobility makes you look like a ninja at times.
  4. Low flexion, low extension, high lateral movement: You can squat deep, but need to have a country mile between your feet. Wider is better for you, so sumo pulls and very wide stance squats are best to hit depth. When you move to slightly wider than shoulder width, you lose any depth and wind up feeling tight.
  5. High flexion, high extension, high lateral movement: You’re some kind of sick mobility Cirque du Soleil freak who can pretty much do any movement possible. You also likely have trouble with the odd bit of tendinitis here and there as your muscles try to provide stability that may not be present in your hip sockets, but it’s manageable.

With this information, you can choose your exercises based on what works well for you and what doesn’t, and avoid banging your head against a wall trying to form your hips into a range of motion they may never get. With this new focus you can train hard and keep your focus on the stuff that’s going to get you the best bang for your training time, without wasting copious time spent on minimal benefit drills. Train hard, train smart, and train to get the best results possible.

Advanced Core Training

If you’re interested in learning more from Dean about core training, click HERE and check out his recent DVD. It’s just over 4 hours long and provides .7 CEC’s for NSCA members (trainers from other organizations can petition them to see if they can be granted CEC’s as well).  In the video, you’ll see/learn:

  • Detailed outline of core and hip function plus what the results of the assessment mean
  • Simplified walkthrough of the approach to core training that can be used for everyone from rehab to elite performance
  • Simple changes to variables like breathing and speed that can help change an exercise from a mobility drill to a speed and reaction drill and even to a max strength drill
  • Tons of practical takeaways and coaching cues to help viewers implement the exercises and techniques immediately.
  • Even some voodoo stuff that actually works.

The Hands-Free Hip Thrust: A Simple (Yet Very Effective) Hip Thrust Teaching Tool

The Hands-Free Hip Thrust: A Simple (Yet Very Effective) Hip Thrust Teaching Tool
By: Ben Bruno

I use hip thrusts extensively with virtually all of my clients, and one of the things I like most about them is that they’re relatively easy to learn and there’s a fast learning curve so most clients can get the hang out if quickly.

Still, there are a few issues that I tend to see arise repeatedly.

  1. It takes people a little while to figure out the proper bar position on the hips, and until you find that sweet spot it can be awkward and uncomfortable.
  1. The name “hip thrust” could imply a fast explosive movement, but I actually prefer that they be done in a controlled fashion with a brief pause at the top of each rep. Sometimes stronger clients start to let their form slip as the weight on the bar increases and they start to try to thrust up violently, often failing to achieve full hip extension at the top. I tell my clients that if they can’t pause at the top, the weight is too heavy.
  1. I notice that a lot of clients tend to go into anterior pelvic tilt and overarch the lower back, especially as the weight gets heavier. This not only takes the stress off the glutes, but it’s also potentially injurious for the lower back. In all fairness, I must say I’ve never seen or heard of anyone getting hurt from hip thrusts (another reason I like them), but it’s still a concern. For both effectiveness and safety it’s important to keep a neutral spine, or if anything even a slight posterior pelvic tilt as you thrust up.
  1. Some clients tend to push harder through one foot than the other, which is easy to spot just by looking at the bar.

As a trainer, I can queue clients ad naueseum when I see form flaws, but whenever possible, I prefer to give drills or exercises that teach them to do the exercise correctly without me giving them too many things to think about.

Enter the hands-free hip thrust.

I’ve found that for clients who struggle with the aforementioned hip thrust issues, doing them hands-free can clear them all up very quickly.

Here’s a video of what it looks like in action.

When you don’t have your hands to hold the bar in place it forces you to find the right positioning on your hips. Just be sure to keep your hands close to the bar in case you need to grab it quickly for whatever reason.

Furthermore, if you thrust up too fast and don’t control the weight, or if you push more through one foot than the other, there’s no way you’ll be able to balance the bar on your hips. Likewise, if you overarch the lower back, the bar will slide down your hips, giving you immediate feedback. In order to keep the bar positioned correctly, it requires you to keep a neutral spine with a very slight posterior pelvic tilt at the top.

In this sense, the hands-free hip thrust is a lot like the hands-free front squat, which I also love and use as a teaching tool.

Form issues with front squats tend to be similar to those with hip thrusts; people struggle to support the bar, and they also tend to rush the reps and lose proper body positioning and fold forward. By going hands-free, it teaches you to support the bar on the shoulders instead of relying on the hands, and it allows forces you to stay upright and do the reps in a controlled fashion.

It’s the same idea for hands-free hip thrusts.


As a teaching tool, I recommend doing sets of 8-10 reps. I actually like doing something similar to what I do with front squats which is going hands-free for a few warm-up sets and then switching to regular hip thrusts as the weight gets heavier. Interestingly, I’ve noticed that my clients are often stronger with their normal hip thrusts after warming up with the hands-free version.

Now it’s important to note that while this may be a good teaching tool, it’s not a beginner exercise. I wouldn’t start off teaching hip thrusts hands-free. But for clients who have some experience with hip thrusts but either complain about feeling them in the lower back, or for clients who’ve gotten stronger but done so at the expense of good form, this method is a great way to take a step back and reset the form before continuing to add more weight.


For stronger lifters, hands-free hip thrusts can also function as a great standalone exercise that allows you to get an awesome training effect with lighter loads. In this case, I like doing 1-2 higher rep sets of 15-20 reps after you’ve done your heavier sets. You won’t be able to handle as much weight, but a 20-rep set of these with pauses at the top has my glutes begging for mercy more than almost any hip thrust variation I’ve ever tried.

If you’re the type who enjoys watching others suffer, here’s me doing a 20 rep finisher.

Give these a try and see if it doesn’t clean up the technique and allow you to feel the exercise even more in your glutes and less in the lower back.

About the Author:

Ben Bruno is a personal trainer in Los Angeles, California. He also Ben-Brunopublishes a blog and free newsletter at You can connect with him on social media at the following places:





Four Reasons to Push Press

Four Reasons to Push Press
Robert A. Panariello MS, PT, ATC, CSCS
Professional Physical Therapy
Professional Athletic Performance Center
New York, New York

For decades one of the popular upper body exercises to perform in the weight room has been the bench press exercise. One common question many high school athletes or any athlete may ask their peer is “How much can you bench”? With regard to upper body strength and power when was the last time any Strength and Conditioning (S&C) Professional has witnessed one athlete ask another “How much can you push press”? This inquiry does not usually occur because the push press exercise is not likely performed.

For decades overhead pressing type exercises appear to have accompanied the deep squat exercise as the “outcast” of the weight room. Overhead weight work has been tabooed by many sport coaches as well as some S&C Professionals as many are of the opinion that the performance of such exercises will result in shoulder pathology as well as be detrimental to athletic performance, especially in the overhead athlete.


The following are four (4) considerations for the S&C Professional to include the push press exercise as a component to their athletes (including the overhead athlete) training program design.

1. Strength Development – The apparent reason to perform the push press exercise is to enhance shoulder strength and muscular development. The push press unlike many other overhead upper extremity exercises requires the exercise to be initiated by the legs. Thus, higher weight intensities may be utilized executing the push press when compared to other overhead shoulder exercises that disregard the involvement of the lower extremities.

2. The Rotator Cuff – A rotator cuff (Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor muscles) pathology of the shoulder is a highly overstated false consequence of the push press (or any overhead exercise for that matter), when appropriately implemented into the athlete’s weight room training program design. It is usually an inappropriate program design and/or an excessively prescribed overhead exercise volume, not the exercise itself that may place the athlete at risk of injury. It has been demonstrated that during overhead pressing type exercise performance the rotator cuff is active, with the supraspinatus exhibiting the highest recorded EMG activity of the muscle group. It is also acknowledged that the supraspinatus is the rotator cuff muscle with the highest incidence of pathology therefore wouldn’t the S&C Professional want to place an emphasis on strengthening this rotator cuff muscle?

3. Gleno-Humeral and Scapulo-Thoracic Rhythm – The gleno-humeral joint of the shoulder is comprised of two (2) osseous structures the scapula and the humerus. The ball and socket articulation of this joint is comprised of the head of the humerus (ball) and the glenoid (socket) which is actually a component of the scapula. The scapula also comprises the scapula-thoracic joint at the posterior aspect of the thorax. During overhead sport skills or exercise performance there is a relationship to both the shoulder range of motion and the gleno-humeral and scapula-thoracic joints “rhythm” to maintain the head of the humerus appropriately centered in the glenoid. Disruption to this “rhythm” over time may place the rotator cuff at risk of pathology. Overhead exercise performance with a bench backing will “pin” or “compress” the scapula of the shoulder between the bench backing and the athlete’s thorax including the athlete’s body and barbell weight. Joint compression is synonymous with joint stability resulting in a less mobile scapula. This likely will affect the natural and necessary required scapula movement and rhythm during the repeated overhead exercise performance thus setting the table for possible shoulder injury. The standing overhead exercise performance allows for free scapula movement and proper rhythm throughout the exercise performance.

4. Lower Extremity Power Development – Yes you read this correctly, lower extremity power development. The push press has been documented to produce greater lower extremity maximum mean power when compared to the jump squat exercise. Thus the push press exercise provides a time efficient combination of lower body power and upper extremity and trunk strengthening during the exercise performance. This exercise may not only be utilized in the athlete’s training, but may also be appropriately utilized at end stage upper and lower extremity rehabilitation as well.

Below is a good video demonstrating the push press: