Gray Cook's Concept

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anoopbal -> Gray Cook's Concept (July 7, 2005 4:02:00 AM)
I have read Gray Cook's book and I think quite a few people agree with his concepts. Just thought I will start a discussion around it. Below is the post I made in another forum which argued about how posture is linked to pain. I am sure Jason will chime in. But fixing posture by fixing tight and weak muscles doesn?t cause the underlying neural mechanisms and coordination factors to be fixed. And this is what I personally seems to be the problem. We all and even PT?s (and its changing for good) tend to think everything in isolation. We look specifically at muscle length and muscle strength of individual muscles but forget about how the body works as a whole. A good example would be the overhead squat test in your article. We can fix certain problems just be stretching, like stretching the calves to keep the heels down a certain extent. But there are other motor memory problems. For example, some people never know the difference between hip flexion and spinal flexion. They will flex the spine even after the spine is stretched and strengthened when they squat. This is exactly why many physical therapists say how they have strengthened and stretched every weak and tight muscle just to see the patient come back with same posture in the next visit. Why bcos they dint re-educate the motor programs. Another example would be to ask some to do a lunge: they will always take the stride with same leg all the time, even if they use lunge on both legs equally. Why? Because its not just a muscle problem, these are problems generally with limb dominance (right or left handedness which are by birth) and certain movement habits which could have very weel resulted from tight or weak muscles. These factors all together make up posture and movement. To make it worse, there are disimiliar motor patterns for every movement. And this the conceptual model of Gray Cook (a PT and a strength coach) in his functional movement screen. Since he can?t fix all movements which will be encountered in sports he goes for some basic movement patterns which are rudimentary in terms of human locomotion. He believes in analyzing movements of the whole patient rather than muscles of individual body parts in fixing injury or potential injury problems as is done in postural fixing. He talks about how quite a few athletes have failed in theses basic movement pattern tests just to show its not about strength, stabilty nor about tight and weak muscles. We all talk about functional movements and how we should train movements. But we never bothered to improve the ?quality? of these movements. Cook?s screen is all about improving quality and then worrying about quantity. But his assumptions are just theoretical which are not proven I believe. His concepts are well respected by many in physical therapy. But, more important to this discussion, he doesn?t make this sound like you gonna fix every pain and ache in the body. His exercise recommendations are hence rightly included only in warm ups and cool downs. Why? Just because he has enough knowledge in this field not to write so decisively and also knows pain is not really well understood to prioritize training accordingly Thanks Anoop

JLS_PT_OCS -> Re: Gray Cook's Concept (July 7, 2005 5:06:00 AM)
I have found his movement screens helpful. Not a panacea, and he certainly doesn't advocate them as such, but a different way to look at the function of the system as a whole and not put blinders on for the joint in question. J

coreconcepts -> Re: Gray Cook's Concept (July 7, 2005 7:30:00 AM)
Anoop, Awesome discussion topic. If I can scrape up enough scratch, I might invest in a copy of one of his books or DVD's. I just went through Ken Kinakin's book "Optimal Muscle Training". It comes with a DVD that goes through exercise techniques, muscle testing and assessments. Not very useful at all. The muscle testing protocols were very basic, and likely substitution patterns and postural deviations were not addressed. Do not waste $30+ on this book if you were thinking about it. In response to this quote of yours; "But fixing posture by fixing tight and weak muscles doesn?t cause the underlying neural mechanisms and coordination factors to be fixed. And this is what I personally seems to be the problem. We all and even PT?s (and its changing for good) tend to think everything in isolation. We look specifically at muscle length and muscle strength of individual muscles but forget about how the body works as a whole." I think applying a holistic movement approach is paramount in any rehabilitation/conditioning model. Having said that, I believe that most forward thinking physios and personal trainers do in fact adapt this strategy, and do not focus solely on isolation and treatment of tight/weak muscles. I'm sure it depends on the type and degree of pain/dysfunction, but do you not think there could be an argument for both isolation as well as movement pathomechanics retraining in certain circumstances? Using the inner unit as an example - I have clients doing both TA isolations in addition to teaching them proper core contraction while performing exercises. Likewise with certain tonic, postural muscles. What's your approach to facilitating weak links in your clients/patients?

anoopbal -> Re: Gray Cook's Concept (July 7, 2005 9:37:00 AM)
Hello coreconcepts I am not a physical therapist.And just started recently reading about muscle and movement imbalance. I joined this forum so that I could learn more. And its been working dso far.So take my comments for what its worth. I think as you said both has a place. I think isolating a body paret is only good unless the cordination paterns are intact when it is worked synergically with other muscles. And its not the case for many as Cook suggests. I think stretching would do musch in changing the tissue properties but not much in chaning the neural tone of the muscle which determines the tightness or stiffness or shortness. I have read Dr.Ken Kinakin book and seen the DVd. Just some basic stretches and muscle testing. I got it from the liobrary so no money wasetd. I think physicial therapist and strength coach Gary Gray has some good conecepts. Is anyone familiar with his work? And to be frank,I am pretty uncmfortable discussing topics like these in here considering the depth of knowlede you guys exhibit. Thanks Anoop

JLS_PT_OCS -> Re: Gray Cook's Concept (July 8, 2005 3:43:00 AM)
Don't worry, anoop, I regularly flail around uselessly on some strength and conditioning forums, they are good enough to help the rehab guy understand some of their concepts, we are happy to do the same for you. Core- I like Cook's concept of "reactive neuromuscular retraining", meaning that instead of talking to the patient about how they might move more efficiently, I give them something to push against to reinforce that motion. I use bands quite a lot for this. For example, for people who have difficulty with proper femoral movement in the squat(meaning they don't ABD/ER as they should) I use a light band placed under the knees they push against to encourage the movement. I have found this MUCH more effective than giving verbal feedback or demonstration. I do have a squat handout I could email if anyone's interested. Just PM me your email address if you want it. J

anoopbal -> Re: Gray Cook's Concept (July 8, 2005 7:23:00 AM)
HiJason From the file I have noticed you talk about how to keep the weight on the heels and I do and make my clinets do the same. If I have interrupted right, but from the Gray cook's videos he doesnt want the weights to fall ont the heels. He feels the weight on the heels causes the glute and ITB band to cotract and thereby pronating the feet and he wants the adductors and abs to contract instead.Or what makes the feet pronate? Thanks Anoop

JLS_PT_OCS -> Re: Gray Cook's Concept (July 8, 2005 9:31:00 AM)
I respect Gray's opinion on that issue. It has been my experience in rehabilitating patients with chronic knee pain (the primary group of my patients who get the squat training) is that they have a similar pattern of squatting: 1. Straight spine, driving knees past toes, sometimes called "ankle dominant" squatting 2. Weight on forefoot, poor gluteal activation and primarily quad dominant in ecc and con actions, which of course aggravates their knee pain. I find that changing the form to train away from those problems helps them squat normally and without pain. I have a feeling Gray's video is not specifically aimed at chronic knee pain patients, but more the movement in general (haven't seen the video so don't know for sure), so that may explain much of the difference. J

JLS_PT_OCS -> Re: Gray Cook's Concept (July 8, 2005 9:33:00 AM)
On what makes the feet pronate.... boy, that's a question that an entire chapter in a kinesiology book is devoted to. I find also many of the chronic LE pain people I see have lost their ability to pronate, such that they hold the foot in supination when squatting or doing other activities, which can perpetuate the painful patterns also. So I actually want people to pronate a little when squatting. J

anoopbal -> Re: Gray Cook's Concept (July 8, 2005 1:34:00 PM)
[QUOTE]It has been my experience in rehabilitating patients with chronic knee pain (the primary group of my patients who get the squat training) is that they have a similar pattern of squatting: 1. Straight spine, driving knees past toes, sometimes called "ankle dominant" squatting 2. Weight on forefoot, poor gluteal activation and primarily quad dominant in ecc and con actions, which of course aggravates their knee pain. [/QUOTE]I totally agree and I am of the same opinion. I guess this is the general guideline for squatiing. Basically you "sit into" squats. I have seen ankle squatting a lot in my clinets. I think it;s mainy because they are not familiar with the concept of hip flexion or pushing ther butt back. Mosttend to break their knee rather than flex their hip before the begin squatting. I make most start with body weight fron t squats and then move into back squats which are bit more tougher. How do you make them shift their weight to the heels and not push with thir toes? In the video he talks about how athletes shoulda void the pronation in squatting bcos everytieme you jump and land and make foot contact you are pronating your feet which can risk injury and loss of efficeieny. And Jason For the knee coming in, he uses a long foam roller in between the knees and asks the client to squeeze it. This he says relaxex the abductors and makes the abs fire better. What is the reasoning behind it? And I assume you use the bands for the same function. So what do you thin is the differnec in using bands and the roller. Thanks. I wish you could see the videos. I have quite a few questions and need somebody to hel me out. Wish you wrer nearby and I could borrow the videos and you could teach me in return.Life is tough I guess :) Thanks Anoop

srcase -> Re: Gray Cook's Concept (July 8, 2005 2:13:00 PM)
Hmmm, I haven't seen the videos, but this sounds strange to me. Why would you want to relax the abductors? Sounds like Cook is promoting firing the adductors with the squat (squeezing the foam) to inhibit the abductors (antagonistic muscles can't both fire at the same time). The adductors can help facilitate the lower abdominals, but I would just cue the patient to pull the belly-button in. Usually, in a squat, you see the knees coming together and want the patient to fire the abductors and external rotators to prevent this and precent excessive pronation (when the knees come together, the feet pronate). I would try a band around the thighs and have the patient keep tension on it during the squat. I think Jason was describing using the band differently, in front of the knees to resist the squat? To answer your other question about how to cue people to shift their weight to the heels, I have them stand in front of a wall or table and squat while trying to touch the object with their "tailbone". I usually say "stick your butt out", it's crude but this usually works. I also have them reach out with both arms in front when squatting to counter balance at first, so they can learn the motion. Sarah

Randy Dixon -> Re: Gray Cook's Concept (July 8, 2005 9:02:00 PM)
I agree with Sarah that the bigger problem seems to be the knees bending in, the answer to that is to place a light theraband loop around their knees which they have to keep up while squatting. I teach people to drop their butts by placing them in front of a wall, about 1 foot from it and facing it, hands behind their heads and squatting without touching it. If they lead with their knees or bend too much at the waist they can't do it. I think the pronation issue is similar to the knee buckling, that is it is the same problem.

Randy Dixon -> Re: Gray Cook's Concept (July 8, 2005 9:04:00 PM)
of course, you can also instruct them to pull their toes up (dorsiflex) when squatting.

anoopbal -> Re: Gray Cook's Concept (July 9, 2005 7:02:00 AM)
[QUOTE]Hmmm, I haven't seen the videos, but this sounds strange to me. Why would you want to relax the abductors? Sounds like Cook is promoting firing the adductors with the squat (squeezing the foam) to inhibit the abductors (antagonistic muscles can't both fire at the same time). The adductors can help facilitate the lower abdominals, but I would just cue the patient to pull the belly-button in. Usually, in a squat, you see the knees coming together and want the patient to fire the abductors and external rotators to prevent this and precent excessive pronation (when the knees come together, the feet pronate). I would try a band around the thighs and have the patient keep tension on it during the squat. I think Jason was describing using the band differently, in front of the knees to resist the squat? [/QUOTE]Jason is doing the same by having a band around the thighs and trying to push against tthe band, therby not letting the knees go in. From What I understood, Cook never wants the feet to pronat or have any kind of rotary stress which can risk injuries while running and jumping. And I dont think he really cares much about the knees over toes problem.His suggestions are more leaning tpwards athletes.But he is still advocating methods to prevent injury. I think ankle flexibilty or mobilty plays a big part in making clinets perform the squat. Usually most tend to feel like falling back when they come close to parallel squat. They are getting all their the weights on the hips rather than having the weight in the middle or inebtween their knees and hips. But they are unable to bring their knees forward to shift the C.G to the moddle bcos of the lack of mobilty in ther ankles and hams. By keeping a heel block their C.G is much more forward and their weight is not totall on the hips. Also, they have better mobilty in their ankles. But the down side of this practise is that kness goes well past the toes. So the they have to get that right point where the weight is not fully on their hips nor on their knees. I think by keeping the leg a bit wide and pronating the feet we are minimizing the knee flexions which naturally accompanies the hip flexion. Hope it made some sense Thanks Anoop

JLS_PT_OCS -> Re: Gray Cook's Concept (July 11, 2005 9:30:00 AM)
For "sitting back" into the squat... get a large loop of tubing, and place it on their lower sacral area. Hold the other end while standing in front of them. To get them to squat back I say, "stretch the band". To get them to unlock the hips, I put a small band below the knees which encourages hip ER/ABD motion also, which helps. A closer stance encourages more knee motion, a wider stance encourages more hip motion. That's helpful also, depending on the patient. Those who have trouble with hip motion, I widen the stance for a few workouts, until the motor pattern improves, then slowly narrow it to return more emphasis to the knee motion. I have found the less I talk and the more I use that kind of reactive feedback, the better people do. I have found some pronation to be almost required in the squat, it's the overpronation I want to avoid. Often the injured side is staying fully supinated, which will affect knee and patello-femoral mechanics also, many times for the worse. In two legged activities such as squats, I have found far more chronic knee people with underpronation than overpronation. I remember Gray using the foam roller squeeze to inhibit the back extensors to allow better toe-touching, but don't see it's applicability to the squat. I got lost there... J

anoopbal -> Re: Gray Cook's Concept (July 12, 2005 4:23:00 AM)
[QUOTE]For "sitting back" into the squat... get a large loop of tubing, and place it on their lower sacral area. Hold the other end while standing in front of them. To get them to squat back I say, "stretch the band". To get them to unlock the hips, I put a small band below the knees which encourages hip ER/ABD motion also, which helps.[/QUOTE]Cook uses some of these techniques. He uses the loop on both sides just so that the client can appreciate the extremes of both problem. I will have to try on of those. [QUOTE]I remember Gray using the foam roller squeeze to inhibit the back extensors to allow better toe-touching, but don't see it's applicability to the squat. I got lost there...[/QUOTE]He uses a long foam to keep the knees wider than usual (than the stance to be specific). This supposedly will make him squat with the knees as the same width as his stance when he does a squat without the foam. Kind of like the NRT I suppose. I think this helps them not to put too much force for AB/ER when they come back to the regular squats and pronate thie feet.Not sure though. But he also tells them to squeeze it and it appears this helps fire the abs better and relax the ITB and glutes. Anoop

anoopbal -> Re: Gray Cook's Concept (July 12, 2005 4:27:00 AM)
A few questions: 1) I have a client who hyperextends her low back when I ask her to do a long lunge. I belive that this is because she is not able to do proper hip extension and her low back is hyperextending to substitute for the hip extension. Anyone know how to fix it? 2) Jason, I am curious to know what all exrcies you make your cleints do. I know that it depends on the client. But usually what all basic functional exercies do you make them perform? What all hip dominant exercises do you reccomed? Thanks in advance Anoop

JLS_PT_OCS -> Re: Gray Cook's Concept (July 12, 2005 6:27:00 AM)
Anoop, 1. That may be the problem, without seeing her I couldn't be sure. I would try first an easier single leg activity such as a split squat to help ingrain the motor pattern. A few weeks of that before the lunges might help a lot. 2. Wow, large question. Hard to address well, also. I think of hip motion and dominance as important, but exercises for patients and those for fitness clients can be very different. Could you be more specific? J

anoopbal -> Re: Gray Cook's Concept (July 12, 2005 9:52:00 AM)
[QUOTE]1. That may be the problem, without seeing her I couldn't be sure. I would try first an easier single leg activity such as a split squat to help ingrain the motor pattern. A few weeks of that before the lunges might help a lot. [/QUOTE]I will try that and see. [QUOTE]Wow, large question. Hard to address well, also. I think of hip motion and dominance as important, but exercises for patients and those for fitness clients can be very different. Could you be more specific? [/QUOTE]I am trying to make up an exercise plan for my older clients( not with dysfunctions). I usually have all my clients do the basic functional exercises like push, pull, hip and knee dominant and then do some specific exercises depending on the goal like climbing stairs, working on their golf swing. So I was thinking do you do any kind of exercies which is basic for everybody or do you reccomend exercies which you think everyone should include in their routine? Thanks Anoop

JLS_PT_OCS -> Re: Gray Cook's Concept (July 12, 2005 11:04:00 AM)
I definitely make it individualized for that person's rehab and their requirements. I don't see fitness clients, that's my wife's side of the house. :) I think if you are exercise planning for older clients and you give them lower leg strength and balance, and focus on both hip and knee dominant exercises that are functional for the tasks they need to perform and/or are at risk doing, then I doubt I could add anything worthwhile. Seems like you've got your bases covered. J

anoopbal -> Re: Gray Cook's Concept (July 12, 2005 12:16:00 PM)
Thanks Justin. Perhaps you can help me here or anybody who has some good ideas. I am thinking od adding more specific exercies like which will be helpful for all older clients like, step ups to imitate stair climbing, shrugs similiar to carryng shopping bags, calf raises and toe raises to devolop ankle strength and ankle mobility, some xtra back exercies bcos most have muscular imbalances seen from posture, squats holding a ball in front to imitate lifting a kid and so on. Can anyone contribute anything else or consider mght be well worth to be included? Thanks Anoop

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