Monday, February 23, 2015

Lifting Rocks?

Nowadays you can’t take two steps without coming across someone trying to sell you the next big thing in fitness. The truth is, a lot of what these people are selling is actually good for you…. and a lot is total crap. For the average person it can be hard to tell the difference. The human body is a complex system of moving parts and don’t get me started on how difficult it can be sometimes to understand proper nutrition. However, you have to think logically about what your doing. A personal trainer friend of mine uses this analogy whenever someone comes in and asks if they should do P90x, CrossFit, or whatever the new fad is. He tells them “Look, if you took rocks and carried them from one side of your back yard to the other for an hour a day, would you get stronger?” They say “Yes” and he replies “Should your workout consist of you lifting rocks in your backyard?” They say “No.” Of course not!!! Why would you lift stones when you can lift in a gym or at home with weights? The fact is, there is a hierarchy to everything in life. You have to prioritize how you workout.

Would doing P90x get you ripped and in great shape? Yes, Potentially, but shouldn’t you prioritize stability, core strength, and form before you start doing box jumps and Olympic lifts? I cant tell you how many people come to my gym complaining of knee or back pain after trying one of these workouts.

So what should you do? My first piece of advice would be to go to a
gym and find the most experienced and credentialed trainer you can find. Have them perform an evaluation on you. (A lot of trainers will do this for free in an attempt to get a sale) Make sure your evaluation applies to your everyday life. Most gyms will take body fat percentage and test your strength which is fine just make sure its applicable to everyday scenarios. Fro example, seeing how much you can bench is pretty much meaningless to the average person. Instead make sure they do what is known as a functional evaluation.

What is a Functional Evaluation?

A functional evaluation is a series of tests that will test your body for muscle tightness, muscle weakness, imbalance, stability, core strength, postural distortions and poor motor patterns. This test will give you a breakdown of how well your body is moving. From this test you can determine and individualized program that will allow you to hit your goals but also reduce pain related to daily activities. At the end of the day it is important to be able to move pain free. Would it be cool to have six pack abs that you could flash to friends and family? Yes, but isn’t it cooler to not have lower back pain all day?

Chris Petraglia BA, NFPT MT




Saturday, February 21, 2015

Training The Core


Training the Core - Charles DeFrancesco


The core is where the most of the body's power is derived. It provides the foundation for all movements of the arms and legs. It must be strong, have dynamic flexibility and function synergistically in its movements in order to achieve maximum performance. Motion of the human body is not isolated to one muscle or tissue moving in one specific direction. Rather, it is a complex event involving agonists and antagonist structures that work together to create changes in position and/or location, and to stabilize the body in all planes of motion. Regardless of what sport one plays, it is essential to have core strength and trunk stability to maximize performance and prevent injury.

What Makes Up the Core

The foundation of the core is much more than the abdominal muscles. It includes muscles deep within the torso, from the pelvis up to the neck and shoulders as well as the following structures:


Multifidus - deep spinal muscles that run segmentally from the neck (C2) to the sacrum. They produce extension, and to a lesser degree, rotation and lateral flexion forces that provide stability to joints at individual levels of the spine.


Interspinales, Intertransversarii, Rotatores - deep structures that directly attach to the spinal column. These are very important for rotatory motion and lateral stability.


External Obliques - abdominal muscles that attach at the lower ribs, pelvis, and abdominal fascia.


Internal Obliques - abdominal muscles that attach at the lower ribs, rectus sheath, pelvis and thoracolumbar fascia.


Transversus Abdominis - abdominal muscles that attach at the lower ribs, pelvis, thoracolumbar fascia, and rectus sheath.


These abdominal muscles work together to transmit a compressive force, and act to increase intra -abdominal pressure to stabilize the lumbar spine. They also work individually to perform trunk rotation, while the internal and external obliques on the same side can work together, or synergistically, to laterally flex the spine.


Rectus abdominis - abdominal muscle that attaches at the fifth through seventh ribs, the lower sternum and the front of the pubic bone. This muscle flexes the spine, compresses the internal organs of the abdomen, and transmits forces laterally from the obliques. It is a common fallacy that the upper and lower rectus' are isolated differently. One exercise can train the rectus.


Erector Spinae - helps to counterbalance all the forces involved in spinal flexion. They begin as the sacrospinalis tendon that attaches at the sacrum and ilium. This tendon then gives rise to different muscles that run up the spine and obliquely attach at lateral parts of the vertebrae and the ribs. In the cervical region, these muscles attach at the base of the skull.


Quadratus Lumborum - attaches at the 12th rib and the upper four lumbar vertebrae and the pelvis. It stabilizes the lumbar spine in all planes of motion, the 12th rib, and the attachment of the diaphragm during respiration. It also laterally flexes the trunk.


Latissimus Dorsi - this is the largest spinal stabilizer. It attaches via the thoracolumbar fascia to the lumbar vertebrae, sacrum and pelvis, and runs upward to the humerus. It assists in lumbar extension and stabilization, and also performs pulling motions through the arms.


Thoracolumbar Fascia - connects the latissimus dorsi, gluteal muscles, internal obliques and transverse abdominis, supplies tensile support to the lumbar spine, and is used for load transfer throughout the lumbar and thoracic regions.


Abdominal Fascia - connects to the obliques and rectus abdominis, and to the pectoralis major. Fascial connections, that cross the midline, transmit forces to the muscles of the opposite side of the body.
Training the Core

The common myth is that training the core simply involves sit ups, leg raises and low back hyperextensions. Research has proven that most of the old school core exercises are not only harmful but in most cases don't even work the core muscles you are targeting. In fact many of these old school exercises place a tremendous amount of shearing force on the spine which will lead to soft tissue injury over time.

An efficient core routine consists of multiplanar movements - training in all planes of motion while maintaining a neutral spine. As the body moves, the center of gravity changes, and forces exerted by, and on, the body's tissues are constantly changing. Dynamic stabilization must be included to increase proprioception and stability in the trunk, as well as in the rest of the body. This allows the parts of the body to react efficiently to external forces and stresses, such as gravity, changes in terrain, and carrying loads, as well as the internal forces exerted by other muscles. Doing a series of floor exercises is inefficient and for the most part have no carry over because most of life's activities are multidimensional and don't relate to single plane exercises on the floor.

Dynamic stability is best achieved through training in functionally
practical positions that mimic activities, or movements in one's particular sport, or in life as a whole. With this in mind, one can conclude that most core training that is done while sitting or lying down, and limiting pelvic movement has little functional value.

Medicine balls, balance boards and stability balls are great tools for core training and should be integrated into every program. Core exercises should include strengthening, as well as challenges, such as standing one-legged and/or two-legged on stable and unstable surfaces, reacting to external forces, such as a partner's light push, the catching and throwing of a medicine ball, and moving the joints of the body through all planes of motion. The goal of functional core training is to develop a system of efficient automatic responses to work as a stable base from which to generate optimal force and motion.
Postural Distortion and Biomechanical Dysfunction

Consider how the chronic shortening of just one muscle, which happens to be a core muscle, can impede performance and cause imbalances that lead to injuries. The rectus abdominis is a good example of an overworked muscle. As this muscle is overworked, the other core muscles are often ignored. Crunches, leg raises and exercises using abdominal machines all work in the sagital plane only, therefore limiting "benefit" to muscles that produce hip and trunk flexion. (Note that repetitive trunk flexion places increased injury - causing stress on the intervertebral discs of the lumbar spine). It is imperative to train the core in a multi-planar fashion, especially the transverse plane, in order to create stabilization in the trunk, and in effect, more optimal posture, strength and motion in the entire body. The following is a common example of the result of overworking the rectus abdominis.

A flexion force in the trunk is caused by a tight rectus abdominis, when it creates tension, or pull on its upper and lower attachments, including the anterior pelvis, anterior ribs and inferior sternum. This has consequences beyond the immediate structures affected.

These consequences include a chain of effects that begins with shortening and tightening of the pectoral muscles. These muscles will exert an inferior tension on the clavicle, superior ribs, and the anterior scapula, and will assist in internally rotating the humerus. The force of gravity also contributes to the internal rotation of the glenohumeral, or shoulder joint, as the trunk flexes forward. Internal rotation of the humerus tensions and lengthens the external rotators of the shoulder. This, in combination with the tension exerted on the anterior scapula by the pectorals will bring the scapula into protraction, lengthening and weakening the middle and lower trapezius, and rhomboid muscles. (Note that a tight latissimus dorsi can also be a primary contributor to internal rotation of the humerus.) The internally rotated humerus and protracted scapula will place the rotator cuff muscles at a biomechanical disadvantage by dynamically stabilizing the glenohumeral joint. The cuff will not function effectively, increasing the risk of injury.

The reaction of the cervical spine is two-fold. The lower segments of the cervical spine follow the forward and downward movement of the trunk, and they themselves flex, causing lengthening and weakening of the deep cervical flexor muscles. (This can also stress the outer layer of the intervertebral discs, which over time, may lead to injury.)

Naturally, if the lower cervical spine flexes forward, the head will follow, and if this force is not countered, gravity will cause the head to fall forward. In order to prevent this from happening, tension will develop in the cervical extensors, including the upper trapezius, splenius, semispinalis, spinalis and sub-occipital groups, which attach to the base of the skull. The upper cervical segments, including the base of the skull, are extended, shortening the sub-occiptal muscles. This extension will allow the skull to remain somewhat level as it rests on the atlas, or the uppermost cervical vertebra.

The overworking of the upper trapezius muscle, and lengthening and weakening of the middle and lower trapezius and the rhomboids will also contribute to early elevation of the scapula with shoulder motion. This will worsen the position of the glenohumeral joint and further stress the rotator cuff.

This example has been limited to the rectus abdomiis. It is important to understand that single muscles are rarely isolated culprits in postural distortions and biomechanical dysfunction. (An exception would be an acute specific muscle injury that has not healed correctly and has caused compensatory overloading in other areas.) Because muscles act synergistically and as agonists and antagonists, there is usually more than one contributor. There are also connections between muscles through tough fascial connective tissue, which help to transmit forces between tissues. These cases of dysfunction can be rooted in other parts of the body, as the musculoskeletal system functions as a whole.

These faulty positions and compensatory biomechanics will not only cause an athlete to move inefficiently. Overtime, they may lead to degenerative processes in the soft tissues and joints, leading to further injury and impairment.

The neurological system also adapts to these changes, applying muscle memory as it controls the musculature. Training this system is essential in developing healthy neurological pathways and muscle firing patterns. This is achieved through methods already mentioned: medicine balls, balance boards and stability balls, and challenging the neuromuscular system.

Any of the aforementioned muscles may be the source of dysfunctional patterns, but it will most likely be a combination of them that will be the cause. It is important to follow the entire kinetic chain when assessing and treating these conditions.
Cycling

Most cyclists focus on their hamstrings, quadriceps and gluteal muscles, and forget about the importance of core stability.

Consider how many hours the cyclist spends bent over in a flexed position on the aero bars, with no rotational or side bending motions. A strong core is needed to counter-balance these forces. With a focus on the core, a cyclist can generate more power and sustain a higher level of intensity for longer periods. A stronger core also means less stress on the primary muscle movers and a delay in the build up of lactic acid.

Even minor changes such as brake position can affect core stability.


If the brake handle position is too low, the cyclist is forced to reach too far forward with their forearms.


This reaching position forces the cyclist to raise their head, forcing the pelvic girdle posterior. This position can cause a restriction in several key muscles in the core, thus reducing performance.


The ideal position is to have the elbows bent and the forearms flattened out. Here, the cyclist's head drops into a more comfortable, aerodynamic position, and the pelvis tilts forward; the cyclist is able to use all the core muscles with improved efficiency.
Running

Now consider how a shortened rectus abdominis affects a tri-athlete's performance during running. Although opinions about the "ideal running form" vary greatly, most authorities will agree that the less energy that is expended, the more effective and efficient the running style will be. Table 1 explains common running recommendations, as well as how having a shortened rectus abdominal can affect your running.
How a shortened rectus abdominis affects your running

A shortened rectus abdominis will pull the runners posture forward. This causes a braking action that reduces running economy. As the rectus is shortened, it pulls the chest forward, allowing gravity to pull the head down. In order to look straight ahead as instructed, the athlete wastes a considerable amount of force in trying to overcome the contracted rectus abdominis. As the shoulders move forward, a shortened rectus abdominis causes the arms to rotate internally. This makes keeping your arms relaxed at the recommended 90-degree angle much more difficult, reducing running economy.
Common running recommendations, together with how having a shortened rectus abdominis can affect your running.


Run upright. Your back should be straight, roughly at a 90-degree angle to the ground.


Look straight ahead. Your eyes should be focused straight down the road on a point moving about 10m in front of you. This helps to keep you in a straight line.


Swing your arms naturally. The angle at the elbow between your upper and lower arms should be about 90 degrees. Your hands should be loosely cupped, about belly level.





When performing a biomechanical analysis, it is very common to see numerous imbalances of which the athlete is completely unaware. By videoing them during their activity,the practitioner can show and explain what is happening, and then it can be corrected.

When analyzing a runner, some of the most common biomechanical faults looked for are:


Over-pronation (rolling in as the arches collapse) in the feet - this can cause a series of to the cervical spine.


biomechanical imbalances from the foot up


Excessive hip adduction - this is due to tight hip adductors and can cause increased load in the lateral tissues, such as the iliotibial band, tensor fascia lata and gluteus medius.


Lack of trunk rotation - due to restrictions in trunk rotators or shoulder extensors. This can cause overload in the hip musculature, spinal joints, and other trunk rotators.


Lack of hip extension - caused by tight hip flexors restricting extension, and weak gluteal muscles. This causes the extensors and rotators of the lumbar spine to become overloaded in order to compensate for the lack of hip extension.


Lack of shoulder extension - caused by restrictions in anterior shoulder muscles or poor trunk rotation.

Educating yourself on how the core works will help to avoid injury, improve your athletic performance and increase training efficiency. Far too often people read the most popular book or take advice from someone who they think knows more than they do.



This cookie cutter approach does not take into account the person's specific needs and goals. In my opinion, anyone who participates in any sport or activity should have a professional evaluate them for any weaknesses or poor movement patterns. I can't tell you how many patients have told me "It just started hurting. I never did anything to it." A simple evaluation can save you from repetitive stress injuries.

Visit NEXT LEVEL SPEED for more help and custo tailored training programs.








Thursday, February 12, 2015

CrossFit Editorial



CrossFit–a nationwide ‘chain’ of affiliated gyms advertising ‘elite fitness’–has gained popularity including several locations here in Westchester. But before you drink the CrossFit cool-aid, you might want to check out what NL Speed Master Trainer Chris Wade said in response to a recent Wall Street Journal article about the CrossFit craze:

Dear Editors:

The Wall Street Journal would never report on a new financial product by simply quoting the high returns of a single neophyte investor while suppressing reports of high losses and controversy. Yet, in a half-page, picture laden article of more than a thousand words that is what the Journal did for a new and controversial fitness product. Not a single expert was quoted in Jen Murphy’s January 4th “Special-Ops: Getting in Shape the Military Way.” (D3). Instead, readers were offered glowing descriptions of where to train, bold faced “Fitness Tips” and “Quick Fixes.” All this praise and advice came from a single unqualified source: a woman who has trained at a local CrossFit for one month.

CrossFit boasts that its program is “perfect” for “any committed individual regardless of experience,” from “elderly individuals with heart disease” to “cage fighters.” Ms. Murphy’s article essentially endorses this view by describing “instant results” and “defined abs” without ever discussing the risks associated with these intense, boot camp style classes. As a former Marine infantry officer and an NSCA Certified Strength and Conditioning Coach, I’ve often been asked to lead ‘boot-camp’ classes and have been happy to do so for clients who were apprised of the risks and screened for the level of fitness and skills that I consider pre-requisites for such demanding work. But no-one told Ms. Murphy’s readers that boot-camps had higher risks of injury than traditional exercise regimens, or that these risks are raised still higher by the particularly intense style and culture of CrossFit. She failed to tell readers that CrossFit’s high risk training culture has made it an outlier in the world of fitness. In fact, the risks are so pronounced that CrossFit has been unable to buy insurance (CrossFit Inc. and its affiliates have been forced to self-insure by creating their own Risk Retention Group). Nor did Ms. Murphy see fit to mention that CrossFit training is the subject of an ongoing investigation by the U.S. military after a rash of CrossFit related injuries.

Rather than giving over the entire article unqualified praise of a recent CrossFit convert, your reporter should have found room to explain that the CrossFit location described in the article is part of a much larger CrossFit movement and that that fitness professionals have started to raise concerns about its grassroots driven model. To be clear, CrossFit is a rapidly growing international business that markets its vision of “elite fitness” through a variety of licensed affiliates, media outlets, and proprietary certification courses. These businesses exist within a larger “virtual community” of locations and individuals who use an ‘open source’ communication style. All members of the community are encouraged to post their fitness results online and to develop and share new CrossFit training ideas and workouts that idiosyncratically borrow and take out of context just about every conceivable form human exercise. These borrowed exercises are then applied to what CrossFit founder Greg Glassman describes as the proto-typical CrossFit model: “mixing heavy fundamental movements with high intensity ‘cardio’ efforts.”

This open source model for developing intense forms of exercise is at the root of at least four issues that should concern your readers. First, there is an incredible problem of quality control. Though CrossFit licenses its affiliates, there are few coherent standards for what this affiliation implies or describes and the $3000 licensing cost is fairly low barrier for entry. Rather than building a defined curriculum, CrossFit describes its affiliates as unencumbered members of “an Internet-based grassroots movement” that encourages experimentation with “varied, intense, functional exercise.” Thus no one really knows what is going on at the 2,500 affiliates or the ever-growing legion of unauthorized locations that have stolen the CrossFit name. The anti-establishmentarian, grassroots ethos causes another serious issue that worries professionals like me: the use of exercises and volumes of exercise that may be counterproductive or unsafe. Consider, for example, the barbell snatch. The snatch is an extremely technical exercise in which a barbell is lifted from the floor to a position directly over the athlete’s head in single, swift and precise movement. Developing a good technique for the snatch takes years of training. As a USAW certified coach who teaches as well as performs the snatch in competition, I use the lift only after complete rest and in sets that never exceed six repetitions. These are standard protocols practiced throughout the sport of weightlifting and the professional strength and conditioning community where it is believed that exercises like snatch demand such rigorous, focused attention to form that it is unproductive and unsafe to perform them without rest or in high volume sets. But without regard to the wisdom of the athletes and professionals who specialize in this type of training, CrossFit workouts routinely include the barbell snatch in high repetition sets and as part of aerobically taxing circuits of multiple exercises performed consecutively without rest. The main CrossFit web site even offers ‘how to’ videos for those who hope to ‘teach’ the snatch and other complex exercises to themselves. Another egregious example of questionable CrossFit exercise advice comes directly from Ms. Murphy’s article where she reports on her subject’s abdominal training routine and all but suggests that readers perform the same high repetition sets of jack-knife crunches. As any professional active in the field today knows, these types of extreme, end-range hip flexion exercises put a tremendous stress on the soft tissues of the lower back and have little applicability to functional movements of life or even most sports. Indeed, Stuart McGill, the world’s foremost authority on the causes of back injury has described crunches as ‘back herniators’ and worked hard to have them removed from the lexicon of fitness because they so contribute to the growing epidemic of low back disorders. We can only hope that your uncontextualized, blind-leading-the-blind advice didn’t cause injury to one of your readers. But finally and most disturbing of all, is the manner in which CrossFit’s grass roots community celebrates excessive risk. Vomiting due to over-strenuous workouts—which most fitness professionals view as a sure sign of an excessive and counterproductive exercise load that puts the athlete’s health at risk—is considered a badge of honor in the CrossFit world. They even have a cartoon mascot of a vomiting clown named ‘Pukie.’ But Pukie isn’t nearly as bad as his mascot brother, a bleeding clown named ‘Uncle Rhabdo.’ He represents exertional rhabdomyolysis. A once obscure exercise injury, rhabdomyolysis is a potentially fatal condition in which the detritus of dead muscle cells enter the blood stream at a rate that damages and ultimately causes kidney failure. While CrossFit induced cases are hard to quantify they are not uncommon and, in at least one case, resulted in a large settlement being paid to a victim of a CrossFit induced rhabdomyolysis. Nor is this the work of a few bad apples: the web site for the Manhattan location that was so heavily praised in Ms. Murphy’s article, CrossFit NYC: The Black Box, has the co-owners and coaches of the facility joking about heart attacks and describing bouts of exertional rhabdomyolysis as the cathartic experience that sold them on CrossFit.

I don’t mean to denigrate or demonize everything about CrossFit. There are certainly many people who have enjoyed, even beniftted from participation in CrossFit. But if you are going to print praise for a radically different fitness facility whose owners make light of life threatening injuries that their practices can induce, I think you owe your readers a bit of that context. So, since you didn’t do it, I will conclude by advising your readers to seek the advice of both their physician and an experienced fitness professional to help them find an exercise regimen that is specific to their individual goals, commitment, physical readiness and tolerance for risk.

Regards,



Chris Wade,CSCS

Tuesday, February 3, 2015

Choosing A Personal Trainer



When seeking a personal trainer, it is necessary for the public to educate themselves on how to interview the right person for the job. While there are many certified personal trainers out there, only a select few of them are truly competent. You should always ask and verify where their certification is from and what their credentials are. There are different types and levels of training certifications, only a handful of them are good. Most tests are multiple choice questions that are moderately difficult and some others require some essay or program design but are usually easy. What you need to look for is the continuing education courses the trainers have taken. It is the seminars and practical workshops that make a trainer better.

It is difficult for the public to decipher a good trainer from a bad one. In many cases, even the worst trainer knows more about physical fitness than the average person. Below are some fundamental questions that should be asked before making your choice. They are designed to save you from choosing a bad apple.

Questions you should ask:
  • What credentials do they hold?
  • Do they attend workshops and seminars? Which ones?
  • How long have they been a trainer?
  • How thorough was your evaluation? Did they do a medical history and test flexibility, balance, core strength, proprioception, muscle strength and endurance?
  • Are they familiar with functional training (training according to daily activities or a specific goal)?
  • Have they explained the importance of flexibility?
  • Do they stress how important it is to properly brace the core and preserve the lumbar spine?
  • Do they know what P.N.F(Proprioceptive Neuromuscular Facilitation) stretching is?
  • Have they explained that function is more important than vanity?
  • Can they explain what they are going to do in the routine and how it benefits you?
  • Did they explain that cardio alone is an inefficient workout?
  • Do they have a basic understanding of nutrition?
If you already have a trainer you can evaluate them:
  • Does your trainer understand that a core routine is not a series of floor exercises?
  • Do they understand current research that proves traditional sit ups, leg raises and many of the common exercises that flex the spine can actually be harmful even for healthy people?
  • Are you doing more free weights and medicine balls than machines?
  • Do they ever take notes?
  • Are you being properly warmed up at the beginning and being stretched at the end?
  • Does your trainer change the routine periodically?
  • Does you trainer incorporate balance boards, swiss balls, single leg exercises and other challenged environments?
  • When training the core (midsection) does your trainer explain how important it is to do dynamic multiplantar movements as well as isometric exercises and the importance of low back exercises?
  • Does your trainer target weak areas?
  • If you feel pain in places that you should not like your knees, low back and neck does your trainer change or modify the exercise to a pain free range?
  • Do you truly understand what you are doing while you train
  • Are you really getting results?
  • Do you do more back exercises than chest and abs?
  • Are you setting goals?
  • Are you talking about you and your needs?
  • Are you getting undivided attention?

If you answered no to any of these questions, then your trainer may be lacking key knowledge that is necessary for you to reach your fitness goals. More importantly, your trainer may be doing you more harm than good. It is simple for a trainer to deceive an unsuspecting client into believing they are knowledgeable. This is due to the general public not being educated about the fitness industry and trusting a gym will provide them with a competent trainer. In most cases, gyms are not always concerned with the quality of the people they are hiring. If a gym thinks a trainer possesses strong sales skills, they will hire them as long as they have some type of certification. A qualified fitness professional will understand at the very least everything listed above. Remember when hiring a trainer to make sure they are a full time professional. Part time does not cut it when it comes to your health. Would you go to a part time Medical Doctor?

Be aware of trainers that are charging low rates

The going rate for a high level trainer in a gym like Equinox or New York Sports Club is around $85-$90/hr even their entry level trainers are $65-$70/hr in addition to membership. There are other gyms that charge way more than the rates just mentioned. In homes for a high level professional trainer are around $125 and can be more. You may be able to get a really good trainer for $90-$100 depending on travel time, trainers charging much less are either just starting out, not that good or a close friend. You get what you pay for. It is important you research the trainers’ certification and check to make sure they are currently certified by multiple accredited agencies. Presently there is an agency named Ethics Safety Compliance Standards http://www.ESCS.info. It insures all registered trainers are acting appropriately. Find out if your trainer is registered.



It is important to understand that certifications and degrees certainly help but do not mean everything. You want to know about their clinical experience and the workshops they attend. Ask who they work with and get at least three references to call from current clients. See if they work with any local doctors, all the good trainers work with at least one doctor. A bad trainer can hurt you - do your research and make sure they are good.

Check us out at Next Level Speed for the most qualified trainers and support staff.