Red Flags

Wed Jun 19, 2013 by Gray Cook

The flags in golf, no one talks about. 

I want to open this talk by saying that we’re here to improve golf performance. 

The entire concept of golf fitness is to improve golf performance.  If it also improves other aspects of a golfer’s life, this is a tangible benefit and a parallel benefit.  However, everything that’s done at TPI and everything that’s done at the philosophies that run concurrent with TPI are done to enhance golf performance.

One way that we enhance performance in every sport or activity is to improve durability and improve adaptability.  Okay?  This means that we want the most plastic neurological system there is – a neurological system that can learn a new concept and new things.

In the first six weeks of any strength and conditioning program, there’s very little change in body tissues.  Most of the efficiency and most of the improvement in strength, power, agility, coordination and timing is a refinement of the neurological system.  Circuitry gets better, timing gets better and all of the things that come out of that get better as well but what I want to talk about today are the ‘red flags’. 

I’ve been a physical therapist, a strength-and-conditioning consultant and a sports medicine specialist for a long time.  I get a lot of credit for really helping people advance their performance or accelerate their rehabilitation. 

I’m going to give you the secret of what I do right now.  I basically go through the entire landscape of the person in front of me and I pull out all of the ‘red flags’ before I ever worry about optimization or performance enhancement. 

Now, it seems like I’m putting the program off, delaying exercises or something but that’s not the case at all.  Everybody who sees me is getting some type of program or exercise today.  They’re working on their golf skills as well as their golf performance and their golf mobility as well as whatever rehabilitation is on the table but I must know the ‘red flags’. 

When we have the Level 1 TPI screen, we’re looking for the ‘red flags’ in the way you move that correlate with swing faults but a lot of confusion comes up when we start talking about the Functional Movement Screen. 

The Functional Movement Screen is a general movement test.  If you score a ‘1’ anywhere on the Functional Movement Screen, we call that a dysfunction.  If you wanted to go into the gym and do exercises in that dysfunctional pattern, whether it’s squatting, lunging or balancing on one foot, we would basically warn you that you’re probably not going to get much benefit there. 

As a matter of fact, your risk of injury is actually present there because you don’t even have a minimum level of competency in that pattern but here’s the amazing thing.  Whether it’s a week away or 10 minutes away, as soon as you clear up that pattern, get on it.  Get with it. 

TPI and the whole functional movement model are not designed to dispense corrective exercises.  They’re designed to leverage the best possible movement platform for a golf-specific skill.  One of the ways to do that is to take those ‘red flags’ off the table.  ‘Red flags’ that are movement issues which correlate with swing faults will be found in the Level 1 TPI screen.

However, if you’re already working with a golfer who likes the gym, likes moving weight, likes to do some plyometrics, likes to run, likes to do some higher-end cardio and intervals, then you’re going to need a little bit of extra information.  That’s because one of those things that golfer is doing in the gym or doing to promote their performance could actually be the detriment.

When we work in other sports and do movement screening, the Functional Movement Screen tells us what patterns need correction but it also tells us what patterns not to load.  In many cases, when I go into a professional sports team whether it’s hockey, baseball, football or basketball, we see an athlete and actually have to delete an exercise.  Simply deleting that thing helps movement because what we’re doing is sort of compounding a problem.

Now, that may be a new concept in fitness but it’s not a new concept in nutrition.  A good nutrition consultant will basically give you just as many ‘don’ts’ as they will ‘do’s’.  I use the analogy all the time. 

A little extra flaxseed on your cereal in the morning will help but if you quit smoking and drinking to excess, it will probably help a little bit more.  You become healthier by what you quit doing than what you start doing so remember this about the movement screen. 

The Functional Movement Screen is going to give us almost an appraisal of how things are going to go at the gym when we’re loading in sort of functional patterns.  Remember, we’re doing these functional exercises because they’re supposed to have carryover into golf.  A lot of exercises get called functional sometimes because of the equipment used or the way the exercise looks but that’s not our definition of functional exercise.

Our definition of functional exercise is exercise that produces function.  What I mean is that a specific drill makes you better at that one specific activity whereas a functional drill has carryover and improves many other things, or at least makes you more adaptable and able to learn and accelerate through many other fitness problems, issues, dilemmas or whatever.

We also have a few more tests that we do to find ‘red flags’.  If the Functional Movement Screen or the TPI screen shows us balance deficits in the lower body, we have the Y Balance Test. 

Greg Rose and the other authors with me on the “Movement” book made an appendix in the “Movement” book about how to use a Y Balance Test.  It catches some things that those other two tests will not catch.  It dials it in and gives you an exact number as to how bad the balance may be on one side. 

Remember, a right-handed golfer with a left single leg stance problem is an issue just waiting to happen.  Being able to dial in on that balance problem is a major ‘red flag’ and removing that ‘red flag’ is a huge performance boost.

Lastly, we use the SFMA – the Selective Functional Movement Assessment – in a medical situation where movement produces pain.  ‘Red flags’ again, but we don’t just find the painful patterns.  In the clinic starting off with an injured golfer, we also find the dysfunctional patterns.

Now, these ‘red flags’ can be found.  The ‘red flags’ that we find in the screens are somewhat predictive.  We’re finding problems before they really happen.  Isn’t that the way good health systems go?  They literally find signs before symptoms occur. 

Well unfortunately, sports medicine is one of the last medical professions to operate this way.  When we’re looking at your eyes, lungs, kidneys or your blood insulin levels, we’re very much more proactive.  We start doing testing early on to look for signs or problems long before you experience those problems. 

However in sports medicine, we just bang it out and eat some ibuprofen.  When we can’t tolerate it anymore and the ibuprofen isn’t working any longer, we usually seek the help of a website, a professional, a self-help book or the thing they’re advertising at 3 o’clock in the morning that will make all things in our life good.  We really don’t take responsible action with musculoskeletal problems these days but we can’t. 

The TPI model is a model that many other sports medicine systems are patterning after simply because they’re screens before assessments.  Performing an assessment before a screen tells you to do one is the biggest freshman mistake in medicine. 

Once I find out that you’re hypertensive, I start investigating those things that can cause hypertension.  However, if I were to investigate all those things on everybody else, I would find a lot of false-positives if I never established a problem with hypertension in the first place so we don’t bring out the big guns right away.

Now, many of the other individuals and myself on the TPI advisory board have been accused of being ‘Well, it’s just intuition for you’ but let me explain what intuition is.  If you don’t like my explanation, get the one from Malcolm Gladwell in the book “Blink” because when we step into a situation whether it’s the SFMA, the Titleist screen, the Functional Movement Screen or the Y Balance Test, intuition is not the skipping of data collection.  It’s the filtering of data collection.

There are many platforms out there that have ‘paralysis by analysis’.  They collect too much data, or, they collect the right data but don’t consider it in the right sequence.  They don’t prioritize the right thing. 

For any of you out there who understand this business model, if my business is an assembly line and that assembly line is about a mile long and I’m optimizing any station on that line other than the one where the bottleneck or the weakest link is, I’m not really going to change what comes out of the other end of my warehouse. 

That’s the way we’re trying to treat this thing so I’ve gotten a lot of credit as an expert clinician and an expert strength coach simply by doing the obvious – pull out the ‘red flags’ first. 

Now, here’s the one mistake that we see.  If you see a ‘red flag’ but can’t really connect it with the other issues or problems that somebody has, don’t debate whether you should pull out the ‘red flag’ or not.  If your balance is poor on the left leg and I also find a ‘red flag’ in thoracic spine mobility or you have pain in your neck, those are ‘red flags’ too.  I really don’t care if changing your thoracic spine or your neck pain will affect your single leg stance or not.  I just know that I can’t optimize you once I get your knee better if those other two things are on the table. 

Secondly, if they are connected, I have a small window of opportunity to see if they are.  I can easily take those off the table while we’re working on those things that make single leg stance better as well.  I can also start seeing the connection in this wonderful system that the human body presents us with – this wonderful neurological system, where if we just remove the ‘red flags’, it becomes plastic again.   

You use a lot of your neuroplasticity when you’re in dysfunction to create compensation, substitution or working around a problem that could easily be removed.  This doesn’t mean that we’ll remove all the ‘red flags’ either.  Some ‘red flags’ are permanent.  It’s a permanent disability.  It’s a joint that’s never going to move normally again. 

However, it’s never more important to pull out all the other ‘red flags’ than it is because we already know the bottleneck on this person, on this individual and on this golf game.  Why not pull out all of the other ‘red flags’ and keep a supportive eye on that bottleneck or that weak link at all costs?

We’re talking here about the ‘flags’ that nobody talks about in golf but remember.  If you’re working in performance and you don’t basically take that scan to remove the ‘red flags’ first, and you go straight to optimization or you go straight to some other thing, you might not even be on the bottleneck. 

That’s what the entire TPI system is designed to do.  Most of us are already doing this.  We see it, we live it and we breathe it but every now and then, we need to be reminded of the mission. 

If I mention the ‘red flag’ that you’re not capturing, if you’re not looking at how often your golfer sleeps or if you’re not looking at how often your golfer is eating good nutrition, check that out too.

This is Gray Cook. Thank you.

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