Resilient's Dr. Doug Kechijian recently joined the docs of the Doc and Jock Podcast for a great conversation ranging from Air Force Pararescue to Postural Restoration and more. Have a listen by playing the video to the right.
By Doug Kechijian
There was recently a discussion about hamstring injuries on social media during which somebody asked if "extension" can be a contributory factor. This was our answer:
If by "extension" you mean a motor strategy suggestive of lower cross syndrome or anterior pelvic tilt, it might be relevant to this discussion. Different ways of saying the same thing often distract us from the principles that unite commercial movement systems. While hamstring strains are multi-factorial, an extension pattern/anterior pelvic tilt/lower cross syndrome could alter motor control at the pelvis during early stance in sprinting in a way that puts hamstring tissue at risk for injury - which is why it's so hard to differentiate mechanical from neurological archetypes.
Athletes who default to a motor pattern suggestive of anterior pelvic tilt in competition often have limitations in hip extension, which some coaches here would agree might influence sprint performance. Similarly, an anterior pelvic tilt pattern limits hip internal rotation (1), a variable we probably want to prioritize in rotational and field sport athletes before something like FAI manifests as pain. These neurologically-driven biomechanical explanations are empirical, not theoretical.
Many professionals recognize the value of movement-based interventions before athletes reach a painful threshold. We can't label an athlete with something abstract like “extension” without an objective assessment. Hence the value of a systematic method of movement analysis. While movement analysis, which includes orthopedic special tests, can't "predict" injury (nothing can), it allows us to mitigate risk based on known biomechanical and neurological phenomena to program in a way that, along with other information, reduces the cost of training and maximizes the benefit. The relevance of non-painful mobility and motor control anomalies is contingent upon the notion that pain can distract us from more problematic areas.
We know that pain alters motor control and compromises the validity of testing in the vicinity of a painful joint. Presumably the non-painful movement patterns existed before the injury - they are non-painful and thus not in a state of threat - and are worth addressing because they alter motor control and mechanics elsewhere in the body (e.g. the athlete with knee pain who lacks dorsiflexion and rotation at the hip). Knowledge of behavioral states, like an "extension" pattern or lower cross syndrome, help explain on a macro level what a systemic evaluation uncovers on a micro or more local level.
By Doug Kechijian
Part I discussed misapplication of physical efforts associated with military selection courses to team sport athletes and raised questions about what constitutes mental toughness and the degree to which it can be taught. Focusing less on esoteric constructs like mental toughness and more on preparation is a practical strategy for high performers. In sport, athletes whose execution remains steadfast despite changes in the internal or external environment are generally considered to be mentally tough. The distinction between mental toughness and disciplined execution becomes academic when teams take collective measures to maximize preparation. Rather than fixating on abstract qualities allegedly developed during grueling workouts, civilian organizations would be better served implementing the following training and preparatory tenets of the special operations community:
Mental toughness is typically synonymous with qualities like tenacity and grit. Tenacity and grit do not compensate for insufficient preparation at the individual or organization level. The people or teams that are prone to failure in pressure situations may not lack passion, determination, or a hunger to succeed. In some instances, they may care so much that it interferes with execution during critical moments. Many athletes excel because they don’t equate their entire sense of self worth with their wins and losses. Moreover, “the most shocking thing about grit is how little we know, how little science knows, about building it” says the author of a book on the subject. Therefore, while there may be other justifications for grueling workouts that appear grossly dissimilar to one’s sport, the development of mental toughness or grit is likely not one of them.
Mental toughness or lack thereof can be an unproductive label or value judgment. Rather than seeking to breed mental toughness, teams would be better served adopting process-driven behaviors that maximize preparation. Our culture’s infatuation with mental toughness and celebration of hard work satisfy our emotional desire to assume control. The more we care and the harder we work, the better we’ll be, we tell ourselves. That kind of enthusiasm can be detrimental to success when effort for effort’s sake is valued above quality of the process. Our fixation with toughness, therefore, should not come at the expense of attaining a level of preparation commensurate with the stressful conditions we encounter in sport and in life.
This statement is not in itself controversial but as I am limited to 140 characters on Twitter, it warrants further explanation. To begin, this tweet was not a criticism of the strength and conditioning programs depicted in the video. As I was adamant about in a previous post, it is unfair to judge programs based on Internet snapshots, especially when said programs don’t get to control the narrative. The suggested narrative here is that “extreme” training gives elite collegiate football programs an edge over their competitors by cultivating mental toughness. The popular media rarely covers the less sensational, more established training that likely comprises the bulk of these universities’ performance programs. As is generally the case in most fields, the things that really work aren’t always conducive to driving web traffic.
Moreover, the decision to implement “mental toughness” workouts can be mandated outside of the performance staff, often by sport coaches or front office personnel. Even if these types of workouts serve as nothing more than a brief distraction from the monotony of weight training and running, journalistic pieces like this one are not without consequences. When impressionable parents and youth sport coaches see that (insert BCS program of choice) trains like a military special operations unit, they often demand the same thing for their 8th grade son/daughter. It doesn’t matter that said programs might only do this kind of “training” once every few years or when the camera crews are on campus.
To be fair, these types of experiences, if implemented responsibly and infrequently, will not compromise football specific adaptations or put robust 18-22 year old men at risk for injury. Nevertheless, “extreme” workouts should not be classified as training nor do they develop mental toughness. That they can be fun and novel may be sufficient reason to implement them periodically. Effectively though, they serve the same purpose as any other team-based competitive activity. “Extreme” workouts in team sports are often influenced by practices that occur during military selection courses. The difference between selection and training cannot be overstated.
In military selection courses, physical stress is a means to an end. Safely simulating combat in a controlled environment is challenging. Prolonged exertion is an imperfect, albeit an effective and inexpensive method of identifying candidates who possess the physical and psychological aptitude to continue on with operationally specific training whose consequences are much more severe. Even the military cannot objectively determine whether its selection methods develop mental resiliency or merely identify those who already possess it. Regardless, the end result is that the people who remain standing at the end of these courses are typically able to withstand the ensuing technical and tactical training. For military special operators, the real training begins after selection. Selection courses help ensure that the government doesn’t invest taxpayer time and money into candidates who are likely to panic when asked to scuba dive at night, freefall parachute out of an airplane, maneuver on a hostile enemy, or medically treat a teammate with a blast wound. Presumably, Division I football players are selected before they arrive on campus. Consequently, military selection methods would seem to have little training application to athletes who have been specifically selected to play football.
One common rebuttal to this supposition is that “extreme” workouts are valuable for non-physical reasons; they develop mental toughness. Even the military has no way of tangibly demonstrating that their selection courses develop mental toughness. Mental toughness (assuming it can be operationally defined) and stress inoculation are context specific. Novel experiences, like enduring a simulated boot camp, might provide variety and fun but preparedness demands repeated exposure to specific stressors regardless of one’s ability to withstand physical hardship. In this respect, military missions should be viewed through the same lens as other performances, not as something distinct and mystical.
Military members, especially those from the special operations community, are masters of preparation. Preparation breeds confidence and the ability to deliver under pressure. The average special operator is sufficiently prepared, via deliberate practice, to deal with situations that would completely overwhelm most team sport athletes and other performers. The reverse is also true. The typical special operator is completely unprepared to play in the NFL or assume the lead role in a Broadway show despite the “mental toughness” ostensibly acquired during his selection process. In all probability, the special operator would be more physiologically stressed onstage at Radio City or in the UFC octagon than he’d be on the ramp of a C-130 before a night freefall parachute jump or on a real-world mission.
Military training is about much more than muddy obstacle courses, sleep deprivation, and fatiguing workouts. In part II, we’ll discuss specific stress inoculation methods the military uses to maximize preparedness. It is preparedness, and not abstract qualities like mental toughness, that athletes are really after.
Today's multi-part series on stress inoculation and performing under pressure begins with a guest post from Naval Special Warfare veteran and physical preparation specialist Craig Weller: Stress Inoculation Training in Tactical Strength and Conditioning.
For more thought-provoking content from Craig, check out:
Stay tuned to learn more about what does and doesn't constitute "mental toughness" training.
By Doug Kechijian
While even many of his detractors concede that Colin Kaepernick’s recent gesture during the national anthem is his fundamental right, they also suggest that exercising this right is disrespectful to veterans. All veterans don’t share this sentiment. Most veterans aren’t so sanctimonious that they expect people to forego their constitutional rights in deference to voluntary military service. The combat search and rescue teams of which I was a member in Iraq and Afghanistan were tasked with body recoveries, high-risk medical evacuations, and technical rescue scenarios. On numerous occasions, we transported servicemen and women who were mortally wounded, maimed, and disfigured. The thought of these people and the loved ones who continue to mourn them undoubtedly altered how I experience the national anthem and other symbols of national pride.
Hard to detach myself from military service when hearing these words
My personal experiences notwithstanding, freely expressing oneself in the countries to which I deployed could result in execution, torture, imprisonment without trial, and collective punishment for disenfranchised people. Kaepernick’s protest is thus quintessentially American. Whatever caveats exist to free speech are practical and not emotional. Freedom of speech should not incite undue violence or harm but offending one’s sensibilities is hardly sufficient justification for censorship. A quarterback on a team of fifty plus players who silently sits during the national anthem is completely benign. Moreover, Kaepernick did not relinquish his right to free speech once his net worth reached a certain amount as many people have intimated. Fortunately, wealthy abolitionists refused to remain silent in antebellum America. Kaepernick possesses a rare talent upon which our society places a ridiculously high premium. He is only as influential as we allow him to be.
Equating the flag or the national anthem with military service is a fallacy that suppresses meaningful dialogue. One doesn’t need to carry a gun to be of service to the nation. The United States represents much more than its fighting force. We are not a military state, thankfully. Most veterans recognize that virtually everybody supports the troops, even those who oppose the conflicts in which the military is ordered by policy makers to partake. The utilization of the armed forces is a reflection of our national interests domestically and abroad. Military service is a profession and a necessary one at that. It is not a puritanical calling with a divine mission. When in harm’s way, the desire to protect one’s mates and the fear of proving oneself unworthy of them supersedes any sense of mission, no matter how just said mission may be. Determining the ethical plausibility of these interests is a conversation to be had between voters and elected officials. This conversation would never be necessary if we assumed that all military engagements are efforts to defend freedom or a way of life we deem to be virtuous. Indiscriminately associating military service with defense of freedom eliminates the need for the scrutiny that sustains healthy democracies.
In Kaepernick’s case, the real issue is whether generating more awareness about racism, oppression, and strained relations between law enforcement and certain communities will produce meaningful change. The assumption here is that if more people were aware of these issues, there would be less disconnect between the values the nation alleges to espouse and the reality for particular racial and ethnic groups. In the age of social media, camera phones, and instantaneous news, it is doubtful that lack of information is really the problem. As a society we are so oversaturated with information that we are often paralyzed to make a decision without acquiring even more of it. People who think racism doesn’t exist are a lost cause. They won’t be swayed with more information. People who think white police officers wake up in the morning with the intention of shooting unarmed black men are also a lost cause. Today’s racism and prejudicial behavior are more insidious than the overt hatred and bigotry that plagued the nation in the past. Consequently, leveling the remainder of the playing field will require the most difficult conversations we’ve ever had. As human beings, we are hard-wired to make stereotypes and simplify complex phenomenon to expedite decision-making, recognize patterns, and increase survivability. Some degree of prejudicial behavior is innately human even if ascribing biological, intellectual, or moral superiority to particular groups of people is not.
The country needs less soundbites and hashtags and instead needs to ask more relevant questions. Do the policies that cause law enforcement officials to spend a disproportionate amount of time in certain neighborhoods maximize reward and minimize risk to the public? In other words, are they working? If not, why do we continue to invest so much human and financial capital into enforcing them? Are most law enforcement officers sufficiently trained in the use of non-lethal force and de-escalation techniques that they can reflexively employ them under extreme physical and emotional duress? Camera phone videos incite us to demand emotionally satisfying, reductionist solutions to complex problems. While these recordings do promote transparency and accountability, they can dupe us into asking the wrong questions and providing us a false sense of context.
For various reasons, military members are careful not to highlight themselves as individuals in a group dynamic. Members of a team often have to suppress their individuality to increase the potential for collective success. Some commentators have compared Kaepernick to Muhammad Ali. Muhammad Ali, however, did not have to worry about being a distraction to a team. Kaepernick has stated that he will continue to sit during the national anthem until social equality is achieved. When one considers the pace at which social change usually occurs, it is unlikely that Kapernick will be rising from his seat any time soon. Eventually the novelty of Kaepernick’s protest during the national anthem will wear off. Until that time arrives, Kaepernick’s seat on the sideline will be a bigger story than the game on the field. While the issues Kaepernick is bringing to light are certainly more important in the grand scheme of things than football, his actions are not without consequences for the 49ers. Kaepernick is likely very aware of those consequences and should be given the benefit of the doubt regarding his motives for inevitably drawing so much attention to himself and away from his team.
Ultimately, celebrities like Kaepernick, despite their best intentions, are incapable of enacting meaningful social change regardless of the awareness and buzz they generate. Lack of awareness is not the problem. That the opinions of entertainers and athletes garner so much interest speaks to the lack of accountability we demand from elected officials and ourselves; we hold the former to a higher standard than the latter. A celebrity exercising his/her constitutional rights is only newsworthy because portraying someone like Kaepernick as polarizing comforts us by sidetracking us from the details that really warrant our attention. Passion and conviction do not generate solutions. Solutions demand restraint, humility, open-mindedness, skepticism, and candidness from participants in the political process, none of which can be achieved with a hashtag or symbolic gesture.