04 May 20 Weeks to Rebuild Guedo
By Paul Oneid
If you have followed our training logs, you will see that Dean Guedo has had a recent string of injuries. Essentially, since he competed last May, he hasn’t been able to stay healthy. After years of playing football at a high level, multiple surgeries, and some bad luck, he has had to regress his training and focus on rehabilitation. He has now gotten himself to a point where he can begin to load his lower body. He reached out to me, so that I can hold him accountable, help him break some bad habits and to ensure that he does things in a way that won’t decay all that hard work he did to get himself back to this point. My hope is that through this 3-part series, we can give you some insight into what goes into writing a program for someone like Dean. Someone who wants to be able to push their body to the limit, but also needs to manage some chronic movement deficiencies.
[wa-wps]
History
Previous Injuries
- Torn right MCL Grade 2+
- Non-surgical
- Torn left shoulder labrum
- Non-surgical
- Torn right Triceps
- Non-surgical
- Torn left pec
- Non-surgical
- Left knee meniscus tear
- Surgical, arthroscopy
- Tumor from football hit on patella
- MRI Pending, possible injection pending
- Left hip acetabular remodeling (pincer)
- Surgical intervention
- Head of femur reshaping
- Labrum resection, 50%
- Surgical intervention
Current Issues
- Left knee pain due to tumor
- Compensatory movement patterns due to left hip
o Low back involvement
Athletic History
- 2 years of Junior Football
- 5 years as a Starter for the University of Alberta
- Ranked in the top 50 prospects in the CFL Draft
Powerlifting History
- 539/358/639/1536 @198
- 580/390/650/1620 @198
- Arnold Classic Elite Day – 600/380/ ***/ Bomb @198
- May 2016 – 600/413/705/1718 @220
So, as you can see, our boy Dean is a train wreck. He’s been beat up, cut open and haphazardly put back together a couple times. That is the beauty of the human body, my friends. Regardless of the circumstances, it will move. The issue Dean is dealing with is that the movement he wants, is coming from places it doesn’t belong. Now that we know the history and the big picture, how do we go about trouble shooting?
The Big Picture
For the sake of this article, I am going to be quite detailed in the process. I don’t have any secrets and those who know me as a coach know that I am a “meat and potatoes” guy. That means I do not make things overly complicated. Usually, the simplest way to fix a problem is the best way.
Tell me about your pain?
First, we need to figure out where? when? and doing what? hurts Dean. As I listed above, the only current issues he is dealing with are the knee and hip. This means that from a programming perspective, no considerations need to be made for the upper body. As for the knee and hip… they are related issues.
- The Hip
- Dean has no direct pain in his hip, thankfully. However, the hip does not move properly. This chronic movement deficiency has caused Dean to develop some compensatory patterns and has placed added sheer and torque on his lower back – the all too familiar hip shift.
- This hip shift affects Dean in hip flexion. Every time he hinges at the hip without proper bracing, he loads one leg more than the other. This increases rotational demand on the lumbar spine.
- Dean can avoid this shift to a certain degree. He does this by focusing on his bracing and squat mechanics. The problem is that his midsection musculature fatigues quickly and his technique decays after 2 reps. Over time, our goal will be to increase his midsection strength and endurance under load, but this will need to be accommodated for in the short term.
- The Knee
- This is an issue that may, or may not require medical intervention. We won’t know until mid-summer. That is the bad news. The good news is that sometimes, it DOES NOT HURT! When you ask? It doesn’t hurt when Dean braces properly and focuses on his hip position. Guess what that means? If we can control the hip and strengthen his midsection, we can avoid accommodating the knee to a large degree!
- When the pain does affect Dean, it happens in deep knee flexion. In the squat, deep knee flexion is accompanied by deep hip flexion. In this deep hip flexion position, the shift in the hips is the greatest, placing a larger load on one leg. The load translates the femur forward, increasing flexion demand on the knee.
- We know that Dean can avoid the pain in the knee by focusing on the hip. To accommodate the knee issues, we must address the hip.
The big picture with Dean’s pain is that it is all rooted in his hip mechanics. Lucky for me, his rehabilitation focused primarily on his hip. It is moving better than before. Unfortunately, something Dr. McGill has taught us is – when you cut something open, it is never the same again. Dean will never have optimal hip mechanics. He will not be able to train like someone who does. While the primary goal here is to get Dean ready for a meet, the secondary goal will be for me to educate him on the accommodations needed for him to be able to train as hard as he wants/needs to, while avoiding another regression like he had after his meet in May. Part-2 will go over how we can accommodate the hip deficiency, while accomplishing our goals this off-season and meet prep. Also, be sure to follow along with his training log, so you can see what the program looks like on a day to day basis.
Want to learn more on how to manage back pain? Check out Dr. Stewart McGill’s books: Back Mechanic and Ultimate Back Fitness and Performance
Paul Oneid
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