Robert A. Panariello MS, PT, ATC, CSCS
Professional Physical Therapy
Professional Athletic Performance Center
New York, New York
In a recent conversation with my good friend Hall of Fame Strength and Conditioning (S&C) Coach Johnny Parker, he commented on his recent visit to a D1 University where in discussions with this University Head S&C Coach regarding the review of the football team’s weight room program design, it was stated that approximately 80% of the program design placed emphasized toward athletic performance and approximately 20% placed emphasis on “prehab” and injury prevention. A breakdown of this football training program design revealed a 50%/50% split of the program exercise volume for both athletic performance and prehab/injury prevention and not the assumed 80% to 20% originally stated.
Coach Parker and I had previously spent time together at a D1 University to present on the topic of program design for the S&C staff at this institution with an emphasis on football program design. We also observed and made recommendations during the football team’s participation during their off-season training.
During our first “classroom” session with the football S&C staff, they were asked to list in order of importance; the exercises they felt should best be incorporated in their football program design. The top 2 exercises listed were the squat and the Olympic lifts. A breakdown of this particular D1 football program design revealed that approximately 10% of the total program volume was dedicated to the squat exercise performance and approximately 12% was dedicated to the Olympic lifts. Just as in Coach Parkers recent visit, you could imagine the surprise of this D1 football S&C staff when the actual numbers presented were very far below the program design perceived squat exercise and Olympic lift volume of work. These examples of the misconception of the actual work performed occur more often than assumed. Why does this incident of perception vs. reality of program design exercise (athletic performance) volume occur? Before I proceed I would also like to mention that these two D1 programs have excellent Head S&C Coach’s and staffs. These S&C coaches have the respect of their players, football coaching staff, and university administration. They are very organized and run outstanding and successful programs, i.e. conference championships, bowl game appearances, etc.
Why does Perception vs. Reality in the Program Design occur?
With all of the available training information presented at conferences, in books, articles, and videos, as well as the gazillions of internet articles and blogs, etc. available, the S&C Professional is faced with a significant dilemma, which exercises to include and which exercises to omit from the athlete’s training program design. What appears to transpire is that the S&C Professional attempts to include everything they can in their program design i.e. as many exercise’s as possible for athletic performance and prehab/injury prevention. This seems to occur because the S&C professional is faced with the concerns of (a) if I don’t include all of these exercises am I cheating my athletes from being the best that they can be and (b) If I don’t include everything in our training program design and my competition does, do my opponents now have an unfair advantage over our players?
This trend also occurs in the field of rehabilitation as I have witnessed less experienced physical therapist’s and athletic trainer’s who will appropriately add more advanced exercises as their patient’s/athlete’s condition progresses, yet do not remove the easier basic rehab exercises performed at the initiation of care. As this tendency continues over time the total volume of work performed by the patient/athlete may become excessive and may lead to the risk of overuse type pathologies.
With regard to the S&C program design, how does the S&C Professional determine which exercises to include and which ones to omit?
Establish a Training Philosophy
It is important for the S&C Professional to establish an athletic performance training philosophy. Once this philosophy is established, regardless of the type of philosophy, the S&C Professional should adhere to this philosophy to allow enough significant time for this philosophy to make its impact upon the athlete regardless of all the “outside noise” of additional exercises of which the coach may continue to be bombarded. Now does this infer that the S&C Professional should not continue to strive to progress and improve to achieve the best training program design as possible? Of course not as to do so would be certainly be foolish and limit the positive outcomes of the athlete during the training process. However, with that said the S&C Professional should not ignore the successes of the past.
As an example when establishing the selection of the specific strength and power type exercises to incorporate into the athlete’s program design the S&C Professional should review the exercises that are performed by some of the strongest and most powerful athletes in the world. Arguably the most powerful athletes in the world are the Olympic Weightlifters and Track and Field Throwers. A review of these competitive athletes training programs would include exercises such as the squat, Olympic lifts, and overhead pressing and jerking type activities.
The next question that may be asked is why are these specific exercises utilized? The answer obvious answer would be because they work. These exercises have been utilized for athletic performance for over 100 years and are still being utilized by the best athletes in the world today. Why would this occur as there are so many other training exercises to choose from? Unlike some of the exercise fads that have come and gone through the decades, these exercises have passed the stringent test of time, over a century of time. When something passes the test of time it’s because it has value and obtains results.
Lessons from a legendary football coach: “Know what is important and don’t worry about the rest” and the “Birthday Rule”
Through the years of working many off-season training periods with Coach Parker and his football players during his tenure as the Head S&C Coach with the NFL New York Giants not only did I learn a tremendous amount from him but I also met and over time developed a friendship with NFL Hall of Fame Football Coach Bill Parcells. Coach Parcells is a very wise man and over the years he has also been instrumental in teaching me many lessons with regard to working with players and coaching. One of the many lessons I received during my conversations with Coach Parcells, as well as with Coach Parker was “Know what is important and don’t worry about the rest”. In regard to the performance training of athletes this would necessitate, based upon the training philosophy, the selection of the exercises that are most important for the athlete’s development and performance and don’t worry about the other exercises. The S&C Professional may ask “but what about all my prehab and injury prevention work?” I do get this question often and will address this topic a little later.
Coach Parcells also had an instituted a rule called the “Birthday Rule”. His birthday is August 22nd and this rule stated that no additional football play was ever to be placed into the NY Giant playbook after August 22nd. Why? Because the Giants were going to master and be proficient in the running the plays in that playbook by repeatedly working and practicing these selected plays that were important to them. Opposing teams were going to have to beat the Giants at their game. The NY Giants didn’t add fancy plays during the course of the season to beat teams; opponents were going to have to beat the NY Giants. If you ever watched one of Coach Parcells football teams play, there was not a lot of trickery or fancy plays. Parcells’s teams were physical with their opponent. They did what they did best time and time over the course of the game. Coach Parcells knew what was important and he didn’t worry about the rest. The S&C Professional should place emphasis upon the exercises that are most important for the development of their athlete’s physical qualities and performance, and train the athlete to become proficient when executing them.
The relationship between Science, the Program Design and the connection to Athletic Performance, Prehab, and Injury Prevention
Science and research will provide the S&C Professional with valuable information for athletic performance training as well as for the prehab/injury prevention of the athlete. Three of the various topics of my personal interest in exercise science and sports rehabilitation are the joint biomechanics and forces that occur during exercise performance, muscle activity during exercise performance, and the effect of muscle fatigue upon exercise performance. How does this information assist in the program design of the athlete? When incorporating exercises for athletic performance as well as prehab/injury prevention, the S&C Professional must acknowledge both the risks and benefits of each exercise selected as well as the relationship of the similar muscle activity that is present during the performance of these two exercise categories. This concept is often ignored during the process of the program design development. In the establishment of a sound program design wouldn’t the exercises performed during the training for athletic performance enhancement include many if not all of the same muscles/muscle groups and muscle activity that are incorporated during the application of prehab/injury prevention exercise performance? There certainly are situations where additional isolated prehab/injury prevention exercise prescription may be necessary, but this should be determined on a case by case basis.
As an example many prehab/injury prevention programs I have reviewed incorporate the performance of numerous rotator cuff and deltoid muscle exercises for the prevention of shoulder pathology in football players. This was also the case in both D1 program examples mentioned above. When considering the muscle activity during the performance of overhead weight type exercises the anterior and middle deltoid, rotator cuff and scapular musculature have been demonstrated to be very active. The addition of rowing/pulling type activities to the program design will likely include all the necessary components for optimal shoulder development and shoulder health. Depending upon the athlete, the sport and position played, as well as the athlete’s medical history, it may be necessary for the athlete to perform additional rotator cuff exercises as part of the prehab/injury prevention portion of the training program. That said does the athlete have to perform TEN different rotator cuff exercises? If exercises such as overhead pressing and pulling type activities demonstrate high deltoid muscle activity is an additional exercise prescription with the intension to both isolate and train the deltoid musculature of the shoulder also necessary to prescribe?
By attempting to incorporate “everything” presented in discussions and lectures, read, and seen with regard to the training of athletes, the following is likely to occur:
- The volume (percentage) of work performed with the exercises considered the foundation and most important for athletic performance is likely diluted by the overprescribed volume of additional training exercises as well as the prehab/injury prevention exercise performance, thus the appropriate exercise volume for the foundation and advanced athletic performance exercise program design being performed by the athlete becomes a perception and not reality.
- The NCAA regulations allow the S&C Professional only 8 hours of performance training per week. Isn’t this important and limited training time better spent with the athlete on the more substantial facets of training vs. the overprescribed and excessive additional volume of exercises including the prehab/injury prevention type activities?
- Incorporating “everything” into the athlete’s training program increases the overall exercise volume. This increased exercise volume may produce excessive muscle fatigue, especially in smaller muscle groups such as the rotator cuff. Therefore while the S&C Professional may be of the perception they are preventing injuries with this high volume of assistance and/or prehab/injury prevention exercise prescription, the execution of these types of exercises in conjunction with the corresponding muscle activity that occurs during the athletic performance based exercise execution may actually be setting the athlete up for overuse type injuries.
Don’t forget the guys with the rings
Three of my very good friends are now retired Hall of Fame S&C Coach’s. Together they have 15 Professional Championship rings including 10 World Championships. These S&C Coaches are Al Miller, Johnny Parker, and Al Vermeil and all are leaders in the field of S&C. They are all very successful S&C Coaches and all have won Professional and/or World Championships during the 1980’s and 1990’s. Presently we are now in the year 2014 so one may ask why are the successes of long ago so important at this time. During the 1980’s and 1990’s these three S&C Coaches did not have the information that is available to the S&C Coaches of today. However these coaches where very successful with the information available to them at the time they were coaching. Although these three Hall of Fame professionals coached different professional teams, they all won championships (Al Vermeil is the only S&C Coach in history to win both a Superbowl and 6 NBA Championships) and their program designs were very similar. They all achieved their goal of getting their athlete’s strong and powerful and kept them strong and powerful throughout the competitive season. What about the “prehab/injury prevention” programming? Well although these coaches were very serious about injury prevention and protecting their players from injury, the term “prehab” likely didn’t exist at that time.
To win championships a team not only has to have players who have championship caliber talent, but these talented players must remain healthy to play day in and day out and survive the stresses of a long physical season, the playoffs, and championship games. These three coaches time and time again led their respected league with the lowest team injury rates and if they were not the best (led the league); their respective teams were always in the top 5 in this particular category. How did these S&C Coaches achieve this accomplishment if they didn’t focus on “prehab/injury prevention” type exercises? They achieved this landmark by developing athletes who were very strong and powerful as acquiring optimal strength and power also assists to prevent injury.
I am not insinuating that injury prevention and the incorporation of “prehab” type exercises are not an important aspect of the training program design. I also am aware that some individual athletes may need more of this type of training than others. However the S&C Professional should remember that many exercises incorporated for the foundation of athletic performance also work the same muscles during the execution of “prehab” type activities. The S&C Professional should also remember that the successes of the past can assist to lead to the success of the future, and when developing the training program design, to remember what is important and to forget the rest. The S&C Professional should develop a training philosophy, and based upon this philosophy, select the best exercises that will optimize your athlete’s performance on the field and don’t worry about including “everything” else in the program design. There are certainly many instances where incorporating everything may lead to achieving nothing or as my good friend Derek Hansen and Charlie Francis would state, “You wind up creating a junk pile.”
Very informative article that kind of reaffirms what I have found. Doing the big important lifts properly (emphasis on properly) is great prehab in itself. Just learn to move well and get strong, muscular, and powerful and you will be successful and injury-resistant. Again, great article.
Not if the big lifts leave you with muscular weaknesses it won’t – weak rear Delts, weak biceps, weak thoracic extensors etc… You must have small special exercises to cover what the bigger ones dont
Really good article with some solid points, thanks. In all seriousness, what do you think of the use of whole body vibration platforms?
Logan and BCC, thank you for the kind words. BCC There is research supporting the use of whole body vibration (WBV) and some that has not. In my experiences as a training modality I personally have been impressed with the increased joint range of motion that occurs with the use of WBV for brief periods of time. As a “neurostimulus” to the body I personally have not experienced the same success. I have had friends in the NFL, NBA, NHL, MLB, and Track and Field who swear by the machine and those who are of the opinion that they can stimulate the nervous system just as well performing plyos as part of their athlete’s warm up. Unfortunately as with many exercise disciplines, the marketing of this product may have also diluted the science.
This piece of equipment can be very pricey and the S&C Professional will have to determine, based on their budget, if this is a priority piece of equipment for their athletes.
Just my opinion, thanks for posting.
Rob Panariello
I agree with Logan that proper form on the big lifts is all that is needed to be injury resistant. I think pre hab is bullshit.
While a good program consisting of the big lifts is very balanced:
Reach the age of 40 and you will change your mind.
Have a desk job and you will change your mind.
Perform in a (usually imbalanced) sport and you will change your mind.
Have some – even slight – anatomical deviations from the ideal and you will change your mind.
Or you just look at the science based evidence – that will change your mind 🙂 .
Will and Chris,
Thank you for your comments. If you review this article it is information intended for the S&C Professional, especially in the collegiate environment where the NCAA has a time restriction on the allotted training times. The 40 year old and the desk worker are certainly different animals and where not included in the content of this article.
I also stated that I do not to totally exclude assistance type exercises or “prehab” type exercises, but does the S&C professional have to include as many of these types of exercises that I’ve seen prescribed and take valuable time away from the exercises that lay the foundation for athletic performance.
I first had my “ah ha moment” with regard to the content in this article from an experience that occurred in the 1990’s while at the Hospital for Special Surgery in New York City. Florence Kendall, who had a 75-year career as one of the most prominent physical therapists in history was a guest lecturer. She was lecturing about manual muscle testing (MMT) and common dysfunctions and weakness found during the physical examination. She would always call up the biggest male in the room and demonstrate their weaknesses and how she as an older female at the time could “break them” so to speak. Well she called up my partner Tim who was a competitive Olympic style weight lifter at the time and tested him for what she stated was one of the most common muscle weakness, lower trap. When she tested Tim she couldn’t break him and she was shocked. She even laughed when Tim responded, “want to do a few pull-ups off that arm Florence?” She brought up another friend of mine who was a weight lifter and she couldn’t break him either. This experience certainly had a profound influence upon me.
I then purchased what was called a Nicholas manual muscle tester (NMMT) and performed MMT on isolated muscle groups on my athletes at St. John’s University where I was the Head S&C Coach at the time. I couldn’t break my athlete’s with many isolated MMT’s either. My athlete’s at SJU were not performing a lot of isolation work or prehab work at that time as well. So if athlete’s become strong and powerful and when tested manually with a documented device (NMMT) and no deficits in strength are found where is the need for extra/excessive assistance or prehab weight work?
We found that the primary exercises performed for athletic performance did not result in weaknesses in the rotator cuff, posterior deltoid, biceps, etc… as the biceps IMO is not a major contributor to athletic performance (unless you’re a body builder). Orel Hershiser and John Elway are two of the many great athlete’s who ruptured the long head of their biceps on their throwing arms, never had them repaired, and went on to illustrious careers.
In regard to “imbalances” and “even slight anatomical deviations” Rehab and S&C Professionals and coaches who work with high-level athletes will tell you that they all have anatomic deviations and in fact it is very often these anatomic deviations that make them exceptional athletes. We are all “imbalanced” and asymmetrical; if this were not true why does right hand or left hand dominance exist? Does having right or left hand dominance make everyone prone to injury?
In review of the research you will also fine that proper training will eliminate many “anatomical deviations” and dysfunctions as “form follows function”. Have an athlete perfom a physical test, don’t train them and just have them practice the physical test alone. You will find that the test score will improve. Try having your most asymmetrical athlete’s perform some Javorek complexes for 2 to 4 weeks with 10% to 15% bodyweight on the barbell and not perform any “assistance or pre-hab work”. Then test them again; you may be very surprised with your post-test results.
I have been both a S&C Coach and physical therapist and athletic trainer for over 30 years. I am a founding partner and the Chief Clinical Officer of our physical therapy company where we presently have 27 facilities and are on pace to perform over 400,000 patient treatments in 2014. When we rehabilitate our post-op athletes, as they progress in their rehab, once it is noted that they no longer need isolated type exercises, we DC them in favor of more complex movement exercises that will further stess the nervous system as well as allow for heavier loads, thus better preparing the athlete for their return to either off-season performance training or their return to sport. The same applies to the thousands of athletes that we have trained at all levels of competition at our 20,000 square foot athletic performance training center. If this philosophy were detrimental to both our patients and athletes, then how could we have grown to 27 physical therapy facilities and established a multimillion dollar training center?
I can certainly acknowledge the skepticism to such a philosophy, and I also am quite comfortable in knowing that we can all agree to disagree. Thank you both again for your post and enjoy the rest of your weekend.
Best,
Rob Panariello
I tend to agree with this philosophy. It’s human nature to try to add in the latest exercises to try to eke out that last bit of benefit, but there is a cost for everything added, and very often lifters fail to re-assess their overall program.
Great article. Thanks Rob.
Thank you for the kind words Dunkman
Rob,
Another greta post as usual. Related to the MMT story, have you any experience with NKT? The whole world of MMT is interesting in that I sometimes think it’s more about selling something, establishing a need for a service, or a Medieval Sorcerer’s act than it is to truly help someone. To your point about program design and it’s ability to iron out structural imbalances or eliminate the need for prehab exercises, do you think it has a similar effect on the need for an extensive assessment with an athlete who is symptom-free? Somewhere along the line the definition of training has evolved to include all this somewhat extraneous stuff.
Rich,
I am somewhat familiar with David Weinstock’s work (I assume that is of whom you are speaking) but mostly through conversation with other professional’s. To be totally transparent I have not attended his seminars nor purchased his book. Muscles can “shut down” so to speak via trauma whether on the field of play or due to a tourniquet at the time of surgery as there are many reasons for this to occur. The techniques I use are likely similar, and have been taught to me by various professional throughout my career.
I agree with your statement on selling product. I personally have nothing against capitalism as I am in business for myself. However, up to this point in time in my career I do not publicly promote or sell products i.e. MMT devices. I’ve had my opportunities and offers, but I don’t sell or endorse any products so at the times I am asked and do provide my opinion, there is no financial gain involved and you know I truly believe in what I say. This doesn’t mean there aren’t some very good products available for consumer and professional purchase; I just don’t endorse them publicly or for financial gain.
I am of the opinion that some type of assessment should be performed when working with an athlete. How else would you determine an individual’s strengths and weaknesses? We know that there are always “abnormalities” found, especially with the high school athletes. The question is do these abnormalities need to be “corrected” or are these abnormalities what make the athlete special? That is the talent of the Rehab/S&C professional. For instance would you try to “correct” the increased shoulder ER in a baseball pitcher? Since this increase in shoulder ER is what makes them successful why would we change this “abnormality”? This increase in ER is also likely contributed via humeral retroversion, so you couldn’t correct it completely if you tried and what would happen if you tried to “force” it so to speak? Also remember this when evaluating your athlete, movement patterns change with load and velocity, thus IMO when appropriate, your evaluation should reflect as much as well.
Symptom free beginner athlete’s IMO need to be prepared to train, this is where I like to utilize something like Javorek’s complexes for a brief period of time. The repetition of a sequence of exercises that utilize the whole body will assist in restoring/establishing mobility, strength, exercise technique, and work capacity. As I stated previously, when the anatomy will allow, “form follows function”. Once the athlete has been prepared to train they may now progress to safely perform appropriate exercise volumes and weight intensities. All too often we will be told an exercise is bad/too stressful for an anatomical part of the body i.e. the low back in relationship to squatting, the rotator cuff in relationship to overhead pressing, and instead of preparing the body for a particular valuable exercise, we discard it.
Just my opinion
Rob Panariello
This a great reminder to stay grounded. I’m working on my philosophy right now and exercise volume is always an area that I have to inform clients about. They want to go “hard” so I find myself trying to balance that out by prescribing more pre-hab exercises. Like you said, having a philosophy will keep you grounded.
Rob,
Thank you for writing this article. It is a must read for any aspiring S&C coach. You have been a tremendous influence on me and the direction my life took. I owe you a tremendous debt. Thank you
Best Regards,
Sean Waxman