Caveat emptor (Let the buyer beware)

Today’s article is a guest-post by Rob Panariello, a regular contributor to this site. Rob makes some excellent points that we should all be aware of in the S&C profession.

Robert A. Panariello MS, PT, ATC, CSCS

Professional Orthopedic and Sports Physical Therapy

Professional Athletic Performance Center

New York, New York

In recent years increasing quantities of information in the related professions of Strength and Conditioning (S&C) and Fitness Training has evolved and made available to these industries via conferences, books and articles, the Internet, products for purchase, and many other easy and accessible vehicles of distribution. When imparted with these various conduits of information, it is startling how much of this information is “taken for granted” and assumed to be “valid” just because an individual whom may be considered an “authority” of the profession presents it. To be clear this article is not written to disparage any S&C or Fitness Professional (FP), as many well known professionals in these related fields have been successful with the implementation of various training methodologies and products. That said, this commentary is an attempt to advise the S&C and FP to not just “accept” the so called “authority” simply at their word but to examine the information presented for legitimacy. When being offered “training” information and products for sale, the S&C and FP should not be hesitant to assess if the following is also represented.

Does the information presented have a sound scientific evidence basis of support?

The “training” material rendered may sound effective and appear to make perfect sense but in reality have no scientific basis of support, as the evidence necessary to substantiate the information presented may be non-existent. This is certainly not to state that one “proven” methodology should always be implemented by the athlete or client nor does one exercise technique “fit all” so to speak. However, information such as the biomechanics of a specific exercise performance (including the resulting joint forces and muscle activity), anaerobic vs. aerobic energy systems, the effect of testosterone and cortisol upon the body, ascertaining the squat exercise is not detrimental to the ligaments of the knee, determining the stretch shortening cycle (SSC) is a critical component to plyometric activities, etc., were all validated by science. Utilizing this information is the art (talent) of coaching and it is the responsibility of the S&C and FP to determine, based upon this confirmed information, which training methodologies, exercise techniques, etc. are best suited for their athlete/client.

To present “empty” statements and “made up” exercises that are without substantiated scientific evidence may deem this information simply as “opinion”. An opinion is much different than “fact” and should be treated accordingly. This is not to say that empirical evidence (experience) does not play a role in training. There is certainly an “experience” component with regard to the aspect of coaching and training. However “experience” without the inclusion of a proven scientific evidence basis of support, may leave the S&C and FP with only opinion and assumption.

When scientific information is presented in support of a training methodology, exercise performance, or product for sale, the material sited should be reviewed in regard to its investigated “Level of Evidence”. There are five (5) levels of research criteria described by the scientific community.  These 5 “levels” are as follows:

Level I Evidence – High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals. Systematic review of Level I randomized clinical trials (and study results were homogenous).

Level II Evidence – Lesser quality randomized trial (e.g. less than 80% follow-up, no blinding or improper randomization). Systematic review of Level II or I studies with inconsistent results.

Level III Evidence – representing reports that are not based on scientific analysis of clinical outcomes. Examples include case control study and retrospective comparative study. Systematic review of level III studies.

Level IV Evidence – Case series (i.e. an individual is trained one way with no comparison group of individuals trained in another way).

Level V Evidence – Expert opinion

These descriptions may sound like a foreign language to the S&C and FP, as these professionals are not to be expected to become experts in the “Levels of Evidence” for the evaluation of scientific literature. However, the S&C and FP should be aware that Level I evidence is the preferred level of support for any training information and/or product presented with level V being the least preferred (lowest). They should also be aware that often times the material sited in support of the presented training information and/or product endorsement is at a Level of Evidence IV or V, and that the Level V “expert opinion” may be the presenter themself.

Are there contradictory statements in the content of the material presented?

There may be circumstances where the information presented is contradictory in nature. Conflicting comments such as “don’t squat deep because it’s detrimental to the knee” and then later be informed “one of our valued assistance exercises is the pistol squat” and “don’t overhead press due to the risk of rotator cuff impingement that may occur with a shoulder and upper extremity position that transpires with the arms fully extended overhead” and then later be informed “we are big advocates of the pull-up exercise for upper body strength”. Isn’t a pistol squat a deep single leg squat? Isn’t a fully extended shoulder and arm position assumed with a properly performed pull-up? If the information provided is conflicting in nature, then how practical is it?

Does the information and example(s) provided correlate to each other?

If the example(s) provided does not correspond to the information presented, then how does this information reasonably apply to the training process? As an example, one common training commentary that is frequently presented is “The athlete should strength train on one leg because they run on one leg”. This may sound rational but to my knowledge there is nothing in the scientific literature to support this interrelated statement. Running is a high velocity movement whereby the ground contact time (GCT) is very low (fractions of a second) as the ground reaction forces (GRF) produced at high speeds are notably from the athlete’s elastic abilities. The GCT that occurs during weight loaded single leg strength exercise performance not only greatly exceeds the runners single leg time on the ground, (prolonged multiple seconds) but the GRF are due to slower muscle contractions that produce more of a “mechanical” vs. an “elastic” response. A strength exercise also has a higher coactivation index (CI), or greater contribution from the joint antagonist muscle groups for the purpose of joint stability while high speed joint activity requires a lower CI or “relaxation” of the antagonist joint muscle groups to allow for enhanced high velocity force production by the agonist (synergist) muscle groups.

Single leg strength exercise performance is simply another exercise category available for strength development. As in any strength exercise utilized in the training process, the single leg exercise has both its risks and rewards and when deemed appropriate, has its suitable application in an individuals training program.

Does the individual providing the information actually have experience training athletes and/or clients?

The ability to provide information in the present technological society in which we live is escalating. Access to the Internet and other additional means to distribute information is becoming insurmountable. Many individuals may provide training information via the Internet with nothing more than a “screen name” where as the identity, qualifications of the individual, and the substance behind the information presented remains a mystery.

It should also be noted that a “qualification of experience” does not necessarily mean the training of elite and/or professional athletes. For example, High School S&C Professionals work with what is likely the most difficult population of athletes, those that have limited or no experience with regard to training. In this era of both social media and video game popularity, the high school athlete may be sedentary for many hours throughout the day resulting in a number of presented physical deficits to resolve during the training process. Training the high school athlete requires significant skill levels and instructional abilities from the S&C Professional.

Does the content of the information presented include a product to sell?

When attending a Medical/Health Care Professional conference the first presentation slide at each lecture is one of “disclosure”. This “disclosure” slide and presenter’s statement of “disclosure” reveals all of the companies who pay the presenter royalties for their services as well as products the presenter may own and/or endorse. In other words, the presenter is informing the audience of their professional and business relationships for additional resources of financial income. The reason for “disclosure” is fairly obvious. As the presenter is expressing to the audience that his or her product, or a specific company’s product is the “best product on the market”, they are also letting it be known that they are (financially) profiting from these relationships and products as well.  Think of how many S&C and Fitness conferences that you have attended and how often have the speakers started their presentation with a statement of “disclosure”.

The presenter may have confidence in the company and/or endorsed product as being the best on the market, but if it is not, will the presenter publically admit that? In the event a competitor introduces a new product, one that is proven to be superior to the product endorsed by the presenter, will the presenter then admit this new product is superior, or are they now “locked into” their statement and financial rewards? Have you ever attended a conference where a presenter endorses a product and at the conclusion of the presentation the attendee may immediately seek the vendor table selling the endorsed product? Have you ever read an article and at the conclusion of the article there is an advertisement for a product related to the information provided in the article?

Caution must also ensue when a research publication is used as an endorsement for a product to be sold and then further investigation reveals that the authors of this research document are also the proprietor’s of the product being sold. An additional “red flag” also occurs when published scientific evidence is employed to endorse the sale of a product and the company that manufactures the product is the financial supporter the research study. This is not to say that the research in the aforementioned examples may not be legitimate, but simply that caution should be utilized when reviewing and interpreting the results of these types of scenarios.

Final thoughts

I certainly am not against capitalism, as I am also in business for myself. I also acknowledge, as in any profession or occupation, there are certainly well deserved and noted “experts and authorities” in their respected field of practice. This certainly holds true in the S&C and fitness professions as well. There are many ethical and well respected S&C and FP who provide valued information, some who also provide effective educational and training products. However, there is also much information that is presented to the S&C and FP industries that is unsubstantiated and comprises some of the concerns mentioned in this article.

There is nothing unsuitable with the desire to become a businessperson and thriving to enhance one’s own financial security. I applaud those who take the risk. However, there is also nothing inappropriate for a professional to scrutinize the information presented to them and not just “accept and follow” the “presenter of authority” based on their perceived status in the industry. One should also remember that the S&C and fitness industry is a multi-billion dollar industry with a lot of money to be made. There is good reason why the aforementioned “disclosure” is a requirement for each presenter at a medical conference.

Any information desired by the S&C and FP is available to them. Researchers want their work to be known, and there are certainly many avenues available to obtain reliable and valid information. Based on my personal experiences, most S&C and FP’s will also share their experiences and knowledge with a professional who takes the time and effort to inquire. I recall the words of my friend Dr. T. Moorman the Director of Sports Medicine at Duke University who told me many years ago, “To excel in Orthopedics and Sports Medicine, one must also get a callus on their butt at the Medical Library”.  As S&C and Fitness Professionals the calluses on our hands from the barbells we lift is not enough, often times we need one on our butt as well. I conclude with the words of Russian Weightlifter, Powerlifter, and Strongman Mikhail Koklyaev when asked by one of my good friends in a private conversation of what secrets he could provide to increase strength and power? Koklyaev smiled and responded, “The only secrets are the ones that can be sold.”