Optimizing Movement and FAI
Often times strength coaches, personal trainers, and the like fall into the habit of thinking every client should be able to perform the perfect squat, the perfect deadlift, the perfect overhead press, etc. The issue with this is that not everyone’s structural anatomy is created equal. It’s our job as Strength & Conditioning professionals to determine whether poor quality of movement in a client is a structural issue, which we then have to work around, or if it is a functional issue, which we can use all of our tools to try and fix.
In many cases, there are functional issues that stem off of compensation patterns due to structural issues. For example, not everyone is going to be able to squat “ass to grass” due to their hip structure. If I tried to get a client to squat to a 90 degree depth or lower but their anatomy doesn’t allow their body to do so, bad things will happen. A lot of times in cases like these we’ll see people go into excessive pelvic posterior tilt, which then causes the lumbar spine to rotate into flexion. This occurrence is commonly referred to as “butt wink.” This is a big no no and a disaster waiting to happen. You should never feel lower back pain when you squat.
If poor movement is an anatomical issue, we teach our clients to squat to a depth that they’re capable of. And when we realize it’s an anatomical issue, we definitely don’t throw them right back under the bar and just tell them not to squat as deep. Back off in your training for a session and peel off the layers of the issue. Maybe we change a back squat to a front squat and see if that changes anything. Maybe we test how much you can dorsiflex your foot, and if that’s the issue, we work on that for awhile before we get you back to testing out your squat. These things are like peeling back an onion, once we get past the first layer of an issue, we keep on peeling until we get to the true root of the issue. Never force somebody into a movement they’re not capable of, otherwise you’re not helping your client’s athletic development, you’re actually hurting it in a big way.
In working with many hockey players, an issue I see a lot is femoroacetabular impingement, or FAI. This is an issue that has recently been popping up more and more. Because of the anatomical positioning hockey players are in while they skate, over time their hips become susceptible to FAI. This is one of the primary causes of hip pain in hockey players. Femoroacetabular impingement occurs when the femoral head and the acetabulum rub abnormally, resulting in damage to the articular cartilage and/or the labrum. FAI can also cause limited range of motion in the hip. In other words, these abnormal developments around the hip joint that cause pain are due to less cartilage and more bone on bone movement, or growths that hinder range of motion of the hip. There are three types of FAI, shown below:(2)
Cam Impingement – there is an abnormal contour of the femoral head-neck junction, resulting in impingement against the acetabulum, particularly with flexion, internal rotation, or a combination of flexion and internal rotation of the hip.(3)
Pincer Impingement – caused by an acetabular abnormality, usually anterior, which results in over covering the femoral head. The range of motion is limited as the femoral head impacts the extended acetabulum which can also lead to labral tears and chondral lesions.(3)
Mixed Impingement – this is a combination of both the Cam and Pincer Impingements.
While surgery is an option for this type of hip issue, many athletes don’t have the time to go through with the surgery and fully recover without missing significant training time, or more importantly, playing time. What we often do in these cases so that this issue does not worsen and force the athlete into surgery, is switch over to loaded single leg exercises instead of doing double leg exercises. For example, in a lot of cases I have my athletes switch over to Rear-foot Elevated Split Squats (Bulgarian Squats), because single leg exercises allows the hips a greater degree of freedom and can still elicit the same training effects.
Think about it, if you have a client weighing 200 lbs front squatting 250 lbs for ten reps, but they can’t get full range of motion without a compensation pattern which leads to pain, why would you have them continue to do so? This will only lead to further injury to the hips or another area of the body entirely. Work in the weight room should help prevent injuries, not cause them.
So, we take that same athlete with FAI and give him Rear-foot Elevated Split Squats, and they give me ten reps on each leg at 165. We’ve eliminated any pain the Front Squat may have caused, allowed for more range of motion, which gives us a greater training effect, and still managed to load the athlete’s body even more due to the bilateral deficit. Each leg is still getting 10 repetitions of work, but there’s a big difference in the load each leg is receiving.
At a 200 pound body weight and a Front Squat of 250 lbs, the entire load is 450 lbs, which broken down equals 225 lbs per leg. Now that same person at 200 lbs doing a Rear-foot Elevated Split Squat has their 200 lbs of body weight plus the 165 lbs on the bar, for a total load of 365 lbs per leg. Big difference, right?
Now, going back to the butt wink that we talked about while squatting with poor hip anatomy and weak levers; the main difference between athletes with FAI and those without, is that with FAI you reach your hip flexion end range sooner, causing lumbar extension and pain in your lower back to go along with further damage to your hip structure. If it’s a unilateral issue, you’ll notice that maybe the bar is dipping a little bit lower on one side as the athlete gets further into hip flexion, and then it straightens out again at the top. This typically means that one hip is dropping below the other. So this single leg work we’ve talked about becomes not only more effective from a training standpoint, but is also more safe in general for the athlete.
In conclusion, it’s our job as Strength Coaches to find out what works for our athletes on an individual basis. Evaluate, plan, implement, and then re-evaluate. There is no effective cookie-cutter workout for athletes and we shouldn’t treat these individuals by trying to place them in one. If you want to see your athletes succeed and go the distance, you need to give them the tools to do so. We can fix functional issues, but we have to find a way to train around structural issues on an individual basis. Find out what works best for them, and watch their growth and success unfold faster than ever.
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Eric Fish, B.S., CSCS, is a Strength & Conditioning Coach at The Way HPI located in Cranston, RI. He specializes in Hockey Performance and runs the Sports Performance program, working with athletes of all ages and ability levels.
(1) Winnegge, Trevor. “Femoroacetabular Impingement – Etiology, Diagnosis, and Treatment of FAI – Mike Reinold.”
(3) Leunig M, et al. The Concept of Femoroacetabular Impingement: Current Status and Future Perspectives. Clin Orthop Relat Res. 2009 March; 46793): 616-622.