I had the honor and pleasure to write the foreword for this excellent book, which Bill has so graciously let me reprint.
You can read it below, and if it doesn’t inspire you to grab Bill’s new book, what will?
He had that shit-eating grin on his face. The type of smile you see when your parents found out something you didn’t want them to know. That smile you saw right before your untimely demise.
I knew damn well what that smile meant.
Back then I was Bill’s student. A quiet, shy, and uncertain kid. After doing a deal with the Mafia to find his email, offering up my future first born to learn from him, and signing a blood oath, I somehow convinced Bill to accept me as his physical therapy intern.
This was like meeting a rock star! Bill was all over Men’s Health magazine, T-Nation—the type of stuff young bucks like me were reading to get ahead of the curve. The last thing I wanted to do was let the guy down.
Then I overslept.
Stressed, frantic, and brushing only my front teeth, I made it to the clinic 30 minutes late. Only to be absolutely destroyed by that smile—a look that will forever be burned into my brain.
I apologized, he mildly scolded me, and we moved on.
Working with Bill was an amazing opportunity for me. Day-in and day-out I’d see him help individuals who were in pain—we are talking years of pain—become pain-free in a matter of moments. He was changing lives and helping people both return to both work and high level performance.
Whenever we had a lull, Bill would either grab his Lacrosse ball or do some type of mobility exercise. The guy was in pain, and was doing whatever he could to provide some relief.
After barely passing his clinical, I would periodically come back to visit Bill and see what he was up to. Each time I returned he had re-invented himself. Fine-tuned his process. Mastered his craft. Found better ways to reduce his client’s pain so they could get their lives back on track.
Yet he still hurt.
I’ll never forget that day I met Bill up at a continuing education course. It had been a little while since I last saw Bill, and I barely recognized the guy. He was lean. Like, really lean. I’m talking 6-pack abs, veins on veins, absolutely shredded lean. At 50-years old no doubt.
The coolest thing? He was in a lot less pain.
He rebuilt his body, reclaimed his health, and most importantly, restored control. Control for a time I’m sure he felt lost.
As incredible as Bill’s transformation was, I’ve continued to see him do this over and over and over again with clients who have been in pain.
Bill is simply one of the smartest and hardest-working individuals I know, and to see this continual evolution and drive to help people is inspiring. It is this drive that instilled greater confidence in my life, pushed me to write, fueled my discipline at continual self-improvement, and landed me an opportunity to work with the high performers in the NBA.
The fact that the man who I look up to more than anyone, the man who adopted me as his son, is asking me of all people to write a foreword for his book, is surreal. It feels like that moment in Star Wars where Obi Wan gave Luke his first lightsaber. Ready to carry the torch of the Jedi for the future.
Though let’s be real, I’d totally be turning to the Dark Side. Black is a much more slimming color.
Unlike Obi Wan, this Jedi master still has a lot of life left in him, and I am beyond excited for you to be learning how he helps people in pain stop surviving, and start thriving.
And there is no better time.
Chronic pain is a widespread epidemic. In the United States alone, 25.3 million adults suffer from daily pain, with 23.4 million reporting that pain as severe¹. This is a problem that costs the United States economy $635 billion dollars per year².
The things people do to become pain-free are numerous. Many times, these treatments are passive—massage, injections, icy hot, ultrasound, magnets—intending to provide some semblance of relief.
Too bad this stuff doesn’t work.
When comparing passive treatments to active approaches, such as exercise, there is no contest. Exercise wins, time after time³. Both aerobic exercise and weight training have been shown to help increase pain tolerance and brain function4,5. In fact, a lack of exercise may be the primary cause of most chronic diseases, as well as the cure6.
But how can I start exercising when I’m in agony just sitting here? How can I reap the benefits when my back hurts just looking at weights? You want me to walk for how long?!?
There exists no one better to answer these questions other than Bill Hartman.
If movement is the solution, then All Gain, No Pain is the guide.
In this book, you will find strategies to restructure your life in such a manner that reduces pain, improves fitness and health, and builds you to better withstand life’s stressors. Simply stated, you’ll be able to live the life you thought was once gone.
Bill has spent countless hours researching and experimenting with various methods; figuring out what methods work, and which one’s do not. He’s eliminated the unnecessary and ineffective strategies that many people try and fail with, while providing you strictly the essentials. The stuff that works.
His No Pain Principles will aid your quest in pain freedom, and his All Gain Principles will build the fitness necessary to keep persistent pain at bay. As for those movements that bother you in the gym? Bill has designed wonderful workarounds that can still drastically improve your fitness.
What makes this book different than the rest is that it comes from an author who has dealt with chronic pain himself. Bill understands the trials and tribulations you have and will go through. There simply is no better guide out there for your journey to rediscovering you.
And I must say, the strategies outlined in All Gain, No Pain flat-out work. As I was reading and editing this book, I adapted many of the principles myself. Over the course of three months, I dropped 25 pounds and was below 10% body fat for the first time in my life. Moreover, I’ve established rituals and habits that have increased my work output, energy levels, and overall satisfaction with life. You may have come to this book because you are in pain, but I promise you will leave with so much more.
If you stick with the principles, you’ll get results. You’ll look better, feel better, and move better. Most importantly, you’ll be you again. Not the old you. Not the you in pain.
But the best version of you.
Again, this book is an excellent read, regardless if you are in pain, wanting to perform at the highest level, or wish to understand stress.
Just when I thought I was out, the clinic pulls me back in.
Though I’m glad to be back. There’s just a different vibe, different pace, and ever-constant variety of challenges that being in the clinic simply provides. This has been especially true working in a rural area. You see a much wider variety, which challenges you to broaden your skillset.
Previously, I was all about getting people in and out of the door as quickly as possible; and with very few visits. I would cut them down to once a week or every other week damn-near immediately, and try to hit that three to five visit sweet spot.
This strategy no doubt worked, and people got better, but I had noticed I’d get repeat customers. Maybe it wasn’t the area that was initially hurting them, but they still were having trouble creep up. Or maybe it was the same pain, just taking much more activity to elicit the sensation.
It became clear that I was skipping steps to try and get my visit number low, when in reality I was doing a disservice to my patients. This was the equivalent of fast food PT—give them the protein, carbohydrates, and fats, forget about the vitamins and minerals.
Was getting someone out the door in 3 visits for me or for them? The younger, big ass ego me, wanted to known as the guy who got people better faster than everyone else. Yet the pursuit became detrimental to the patient’s best interest. There were so many other ways I could impact a patient’s overall health that I simply sacrificed in place of speed.
I only got them to survive without pushing them to thrive.
I see a lot of individuals proudly proclaim how many visits it takes for them to get someone out of pain, but pain relief is only part of the equation. There are so many more qualities we can address before we consider a rehab program a success.
This stark realization has reconceptualized how I structure a weekly rehab program. I now emphasize all qualities necessary to return to whatever task the patient desires, and attempt to inspire them beyond those initial goals.
You want to know what my visit average is right now?
I stopped counting, and started treating.
Let’s look designing the rehab week to take your clients to the next level.
I did all the right stuff returning guys back to sport.
I’m talking getting guys more neutral than Ron Hruska on a tropical island, FMS scores that Gray Cook would be ‘mirin’, hop tests that Kevin Wilk would foam at the mouth over, and high intensity continuous training sessions that would make Joel Jamieson say “really?”
Yet as soon as they got onto the court, they’d be smoked.
I’d hear that cursed phrase over and over again.
What was I doing wrong? I thought we address all of their performance needs, yet we would continually run into the same problem.
I recently attended the FMS Level 2 course after rocking the home study. In my quest to take every con ed course known to man, I got into the functional movement people because the idea of improving movement over isolation exercise interests me. I find the way they build up to the patterns very logical, namely because they liberally use PNF and developmental principles; and they do so quite eloquently.
But really, I wanted to go to this class so I could meet and learn from Gray Cook. And his segments did not disappoint. While I may not agree with everything he says, he is a very brilliant man and knows movement.
The only disappointment I have to say about this course was that I did not get enough Gray and Lee. I would say I probably saw them teach 30% of the time, with another FMS instructor just running us through their algorithms. I am sorry, but if you are going to advertise Gray Cook and Lee Burton as the instructors, then I want Gray and Lee instructing me!
A lot of these exercises were review for me, but there were definitely some tweaks that I liked a great deal. I think if you are new to more motor control-based exercises, this course is great for you. Just make sure you are taking it from Gray and/or Lee.
The FMS is predominately used to manage risk and prioritize exercise selection. They look at fundamental movement patterns to rule in/out asymmetries and dysfunctions, which ultimately allow someone to safely train in the weight room. If you are unfamiliar with the FMS, check out this previous post from my review of the Movement Book
Lee Burton mentioned that his goal is to look for 0’s and 1’s; once we get to 2’s we’re good to go. This number ensures we have movement compentency as opposed to excellence, which is a requisite to loading these movements.
One thing I will say positively about this group is that they are all for doing and testing whatever you want, as long as you are consistent. But if you plan on doing the FMS, the research is done in the same manner taught in the home study course and the Movement Book.
Within the FMS model, we choose corrective exercise based on a particular hierarchy. Mobility impairments are attacked first via the active straight leg raise (ASLR) and shoulder mobility (SM) tests. From those two screens, ASLR is first corrected. We go after this part first because developmentally we have leg control before we do arm control. Moreover, ASLR is purely sagittal plane, versus the triplanar shoulder screen.
Once we get good mobility, we then work on developing improved motor control via rotary stability (RS) and trunk stability pushup (TSP); done in that order.
Once these areas are squared away, we go after functional patterns. We first hit the inline lunge (ILL), then the hurdle step (HS), then the deep squat (DS).
The FMS actually started incorporating more movements to look at once you get into level 2, which eerily look like the SFMA. Likely because it is the SFMA 🙂 Here is where to screen next once you get past the basics.
ASLR –> Toe Touch –> crocodile breathing
SM –> Cervical ROM–> Impingement testing –> AC impingement testing –> Seated T-spine rotation –> Grip screen –> Crocodile breathing
RS –> Spinal flexion clearing –> Crocodile breathing –> Upper body rolling –> Lower body rolling
ILL –> Ankle mobility (goal is 40 degrees in half-kneeling)
HS –> Ankle mobility
DS –> Ankle mobility –> Toe Touch
The corrections for each movement progress from mobility, to static motor control, to dynamic motor control, and finally strength. Here were some of my favorite correctives for each screen (Many videos courtesy of the IFAST folks).
Mobility work goes after the hip flexors and performing leg-lowering patterns.
Static motor control involves working in half-kneeling, and dynamic involves patterning from double leg to single leg deadlifts. One of my favorite correctives was utilizing RNT to facilitate the lats during deadlifts.
I also liked the way he patterned the deadlift by using a squat to get into the position
Once you get the deadlifts down, load-up for strength
Mobility predominately went after the t-spine via various rib-rolls and such:
Motor control involved deadlifts again, as well as various drills that involve shoulder packing:
We can progress these drill dynamically to armbars, get-ups, pushups, working toward a press in the horizontal and vertical planes. And of course, don’t forget the beastly real row:
The correctives usually build on from previous one’s the further you go in the screen. Mobility involves rib rolls and ASLR derivatives. Eventually you work toward quadruped and bird-dog activities.
We can then progress to single leg deadlifts, presses, and pulls.
Mobility work involves hip flexors and half-kneeling. We go after motor control via planks, mountain climbers, and quadrupedal activities. From here, we just go into pushup progressions; culminating into various presses.
The big mobility work goes after hip flexors and calves. With the famous brettzel stretches being incorporated here:
Motor control exercises go from half-kneeling building up to lunge variations. Eventually, we will load these patterns.
Mobility work builds further onto previous exercises; leg lowering, ASLR, dorsiflexion. We also go into stride stretches, which are basically mobilizations in a hurdle-step position.
Motor control goes from half-kneeling to single-leg chops and lifts, all the way to single leg deadlifts. The ultimate strength exercise for this pattern is step-ups
Mobility work goes after ankle dorsiflexion, hip flexors, and any SM corrections.
Motor control involves working in tall-kneeling (foam roller behind to cue upright posture) and progressing from deadlifts to squats
Eventually we work toward performing an overhead squat.
Other random exercises
I also liked how Gray added some nice tweaks to the Turkish get-up which you will see below:
“Gray”te Quotes…Get it? It’s funny because I combined Gray Cook with the word great…just read on
“Tightness and fatigue feel the same way.”
“If I could pick four exercises to do, they would be chops, lifts, deadlifts, and Turkish Get-ups.”
“Your people with total hips and total knees should get up from the floor.”
“Stabilizers have to be fast, not strong.”
“Everyone develops differently.” (Haha DNS)
“3 degrees of extra mobility leads to 300 degrees of increased proprioception.”
“The best entertainment you can get is results.”
“There’s a difference between good and bad and good and can’t.”
“We’re not laying down new motor programs, we’re getting old ones back.” (This was from Lee)
“First step in correctives is to remove the negatives.” (Also from Lee)
This is a chapter 10 summary of the book “Movement” by Gray Cook.
Mistakes, I’ve Made a Few
When we are talking corrective exercise design, people often make 4 mistakes:
1) Protocol approach: Exercise based on category.
Problem – 1 size fits all.
2) Basic kinesiology: Target prime movers and some stabilizers.
Problem – fails on timing, motor control, stability, and movement.
3) Appearance of functional approach – Use bands and resistance during functional training.
Problem – If the pattern is poor, adding challenges to it can increase compensation. There is also no pre-post testing.
4) Prehabilitation approach – Prepackaged rehab exercises into conditioning programs as preventative measures to reduce injury risk.
Problem – Design is based on injuries common to particular activities as opposed to movement risk factors.
There are also certain mistakes that are often made when utilizing the FMS and SFMA:
1) Converting movement dysfunction into singular anatomical problems.
2) Obsessing over perfection in each test instead of identifying the most significant limitation/asymmetry.
3) Linking corrective solutions to movement problems prematurely.
The overarching rule is to address these movement deficiencies first, as we do not want to put strength or fitness on top of dysfunctional movement.
The Performance Pyramid
When designing an exercise program, we look for three areas to improve performance: Movement, performance, and skill.
It is important that program design is based on the individual’s needs and has these qualities in a hierarchal fashion. For example, if one performs excellent on functional performance capabilities but has poor foundational movement, injury risk may increase.
When implementing corrective exercise, it is important to provide the correct stimulus amount. We want the individual challenged, but not struggling for dear life.
Too easy – >30 reps with good quality.
Challenging, but possible – 8-15 reps with good quality and no stress breathing. There is a decline in quality secondary to fatigue towards the end of rep ranges.
Too difficult – Sloppy from the beginning and only worsens.
Rarely does increasing difficulty equate to increasing resistance. Oftentimes you may advance the exercise position, decrease the base of support, or add more movement complexity.
You may have to remove some activities that feed into dysfunction from one’s current programming, lest you wish to not change the movement pattern. Often how quickly one changes his or her ability to move depends on how diligent one is with corrective exercise.
Realize that corrective exercise should only be supplemental and temporary to what one is doing. It is supposed to be corrective in nature, not preventative. Moreover, movement scores can decrease with hard training, so continual reassessment is important.
The corrective exercise pathway should proceed as follows:
1) Exercise selection is driven by screen and assessment.
2) A thought out framework gives you the best possible choices.
3) Retest, note positive or negative changes, and then use results to modify next session.
4) Reassess once an obvious change is noted to see what the next priority is.
Purpose: Full-body coordinated mobility and stability; linking the hips and the shoulders.
Here is how it is done.
Purpose: Evaluate stepping and stride mechanics.
Here is how it is done.
Purpose: Test deceleration and left/right function utilizing contralateral upper extremity patterns and ipsilateral lower extremity patterns.
Here is how it is done.
Purpose: Evaluate scapulothoracic rhythm, thoracic spine and rib mobility.
Here is how it is done.
Purpose: Tests hip flexion, hip extension, and core function.
Here is how it is done.
Trunk Stability Pushup
Purpose: Tests reflexive core stability.
Here is how it is done.
Purpose: Check multi-planar pelvic, core, and shoulder girdle stability. Also looks at reflexive stability and transverse plane weight shifting.
Here is how it is done.
The FMS is designed to give a corrective pathway that may involve temporarily ceasing potential risk activities. Many things can perpetuate faulty movement, so it is best to control as many variables as possible. Here are some possible activities that may be compromised if one scores lower than a 2 on the screen.
ASLR: Heavy closed-chain loading activities, running, plyometrics.
Shoulder mobility: Heavy or overhead pushing/pulling movements.
Rotary stability: Conventional core training, high threshold training that requires core control.
Trunk stability pushup: Heavy upper/lower extremity loads; vigorous plyos.
In-line lunge: Exercises and loads involving the lunge pattern
Hurdle step: Exercises and loads involving the single leg stance pattern
Deep Squat: Exercises and loads involving the squat pattern.
The Basic FMS
Now I know what you are thinking. “Zac, there is no way that some of my clients can perform all these tasks.” Well, Gray has an answer for you. The FMS does not have to be performed in its entirety, and can be progressed in the following fashion:
BASIC FMS: ASLR, shoulder mobility, and pain-clearing tests.
Rotary stability along with flexion and extension clearing tests
Mistake Recovery – Training to recover from worst case scenarios.
Here were Lee’s recommendations for program design.
Skill acquisition – The ability to control desired movements. This portion can be trained by either skill components (3-4 exercises), skill itself (1-3 exercises), or linking skills (shuffle to sprint).
Force application – Performing the desired movement patterns with increased force or resistance.
Random reactive training – Challenge movements under a random setting, but make sure the above 2 components are rock solid first.
Here were Lee’s recommendations to progress to reactive training
Acceleration → deceleration → Change of direction →One direction reaction → Multi-direction reaction.
Some great cues that Lee used
Stay in the tunnel.
Arms long and strong.
Tear the paper – Get in the athletic position, load the big toes, and try to rip the floor apart.
Stop in front of a person.
Here were my favorite Lee quotes.
“The biggest component of developing multi-directional speed is being able to re-accelerate.”
“Do the most important things often.”
“We don’t teach pivoting. Open hips and retreat.”
Reactive Agility – Nick Winkelman
The first thing Nick did in his presentation is define agility, which he says is the ability to change direction and react; the ability to quickly make a decision. Both of these qualities therefore must be tested.
To test change of direction, many of your traditional tests such as 5-10-5, T test, L acceleration, can be utilized. The important thing to understand is that you only need to utilize one of these tests because they are all looking at the same thing. You want to pick one that best captures the movement you are looking for.
Before testing reactive agility, we must first discuss reaction time’s two phases. First is the latency phase, which is the time between receiving stimulus and the appearance of EMG in relevant muscles. The second key and trainable phase is response phase, which is the time from EMG appearance to motor action. The response phase is predominantly what we test, and the ability of one to respond to relevant cues is what separates the good from the great.
The big test that Nick used was the reactive agility test (RAT), which I will demonstrate in this video below.
What is nice about the RAT unlike your traditional agility tests is that we can look at asymmetries in both movement, decision-making, and accuracy. Moreover, he presented a lot of good research in support of the test.
With the RAT, you can also group athletes into how fast one moves and reacts based on ability to change direction and react. This bucketing allows you to train athletes based on necessary qualities. Here are the categories:
Fast Change of direction
Slow change of direction
Fast mover/thinker (elite)
Fast thinker/slow mover
Fast mover/slow thinker
Nick showed us several different drills utilizing the Fusion Sports Smartspeed light system to train these qualities. For most, this system is likely not in the cards to utilize. But as long as you apply the above principles, you can add a reactive component to most any activity.
Here were some other interesting tidbits from this presentation.
Human delay before you become aware of things is 300-500 ms.
Reaction time is subconscious
We react fastest to auditory cues, next to tactile, slowest to visual.
Post-injury strength returns in 6 months, whereas rate of force development takes up to 1 year.
The Science of Coaching: Applying Theory in Practice – Nick Winkelman
First, Nick talked about the classic Fitts and Posner three stages of motor learning, which are as follows:
Coginitive → associative → autonomy
Each stage requires different coaching styles. Generally, earlier stages require more feedback than later stages. You also want to transition toward having the athlete/patient describe what was done right in an activity.
It is also important to maximize context, as this helps facilitate better memory. The athlete retains and progresses more when they know rational why, how the activity felt, and what needs to be done next. Telling stories and using sticky phrases is also very helpful.
Nick also discussed attention regarding how it is the filter for all information. Understand that we all have similar attention span, it is just that some activities require more attention than others. This is most evident comparing a novice and expert performing the same activity. The activity is old hat for the expert, thus requiring less focus to perform. The novice, on the other hand, is just learning the activity and must pay greater attention when performing.
Transitioning these principles to coaching, Nick designed a framework for coaching that involved practice design at the foundation, followed by instruction and feedback.
First, let’s discuss practice design. The goal of practice design is to optimize learning and retention. The way this goal occurs is by both varying movements and context as well as interfering with the context. You want to have your athletes struggle and have bad days in practice. If this part does not occur, then we go into autopilot and learning is not facilitated.
Contextual interference also occurs by performing practice in either a blocked, serial, or random fashion. Many people tend to think that random is the way to go for motor learning, but it really depends on multiple factors:
Generally, the younger the age, the lower one’s skill, and the more complex the activity, the more block practice should be utilize. As these qualities hit the other end of the spectrum, random practice becomes more desirable.
The biggest takeaway from this portion was that most people over-coach. Generally 1-2 positive focus cues are needed at the most to build awareness. You also want to start and finish instructions with what you want versus don’t want.
When it comes to cueing, externals are key. By external cues, I mean that attention should be focused on the desired outcome as opposed to the internal process. Let’s take a pushup for example. An internal cue might be “pull your shoulder blades together, and then straighten your arms.” Whereas an external cue might be “rip the ground apart, then push the ground away from you.” When utilizing external cues, less attention span for the cue itself is required, therefore allowing for automatic motor processes to occur.
It is also beneficial to watch others perform activities. This change occurs due to mirror neurons which are present in the brain’s motor cortices. Benefits can be achieved by watching both experts and novices; experts by seeing the activity done correctly, novices for improving problem solving.
Nick listed two types of feedback.
Knowledge of results – Information about the outcome (quantitative) [E.g. You ran 4.5 in the 40.]
Knowledge of performance – Information about movement characteristics that led to the outcome (qualitative). [E.g. drive your knees more during the first 5 yds.]
In terms of feedback quantity, it can be detrimental to give too much feedback unless that feedback is external. The problems with too much feedback include coach dependence, less self-independnece, people becoming practice champions because there is no retainment, and paralysis by analysis. If we relate quantity to motor learning stages, less feedback should be given the further along they are. Research demonstrates that cognitive stages should get feedback 100% of the time, and associative stages 33% of the time. Research also states that athletes want feedback only 8-10% of the time and only if it was the right movement/activity.
My favorite lines from this presentation:
Art is when we don’t understand how something is.
Movement efficiency is the opposite of learning. It is okay to make errors.
Shoot for 60-70% success and 30-40% failure.
Visual memories last better.
“Movement needs a goal” [On external cues]
Don’t tell athletes things they already know.
Use noises to reinforce movements (BOOM, SNAP).
Overall, the course was excellent and one of my favorites for the year. Learn as much from these guys as possible.