Athletic Performance Podcast
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Athletic Performance Podcast
From Rehab to Performance: Fixing the Biggest Gap in Training w/ Alex Effer Ep 56
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In this episode, Coach Ryan Patrick sits down with performance consultant Alex Effer to break down the missing link between rehabilitation and performance training — and why many coaches struggle with exercise selection despite having more information than ever.
They explore how assessment, movement constraints, and exercise progressions can work together to simplify programming while improving outcomes for athletes.
Topics include:
- The “gray zone” between rehab and performance
- How exercises can function as assessments
- Center of mass and smarter progressions
- Why more mobility isn’t always better
- Rethinking foam rolling and tissue work
- Simplifying complex coaching concepts
About Alex Effer
Performance consultant and educator helping coaches bridge movement, rehab, and strength training through practical systems.
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again, if you, if I say, okay, you got zero ir, I'm gonna give you 30. It's like, I'm gonna keep on the ground longer. And that may actually hurt you because you staying on the ground longer means that your tissues have to absorb more force for a longer period of time.
Hello and welcome back to the Athletic Performance Podcast. It has been about four months. Life has been fast, and I don't want to rant about this. I want to get right into the content today. So if you are a strength coach or personal trainer who's ever gone down a biomechanics rabbit hole, you know exactly how this goes. You learn something that works. Athletes make a little bit of improvement, and then you decide to dive deeper. The concepts, they get more detailed, more nuanced, and before long you're chasing perfect movement instead of actually training people and creating results. I've been there. Many coaches I know have, and the truth is understanding the complexity is important, but coaching requires you to be able to make simple decisions in real time to provide a solution for your athletes. Today's guest is someone who has lived on both sides of the spectrum and come out with a system that simplifies exercise selection without dumbing it down. Alex Effer joins me today on the show to break down how he coaches. To help bridge the gap between rehab and performance, how he simplifies program decisions, and how he's built a repeatable model that works for everyone from chronic pain to elite athletes. So if you want a sharper coaching eye and a clear framework for choosing the right exercises at the right time, this episode is for you. Let's dive in.
Ryan PatrickAnyway, shifting to you man. Thank you for carving time to, to be on the pod today. Like super good to catch up.
Alex EfferMan, thank you so much for having me. I know, uh, it's been a while. I think it's been about four years or something like that since we talked last. And
Ryan Patrickyeah,
Alex EfferI was supposed to come up to, Cincinnati to do an in-person. We'll still get that organized. I was, or Kentucky I should say. We'll get that organized. But COVID hit unfortunately, so it caused a lot of restrictions, especially, especially here. Like we were very locked down. So we'll get that in the books. But yeah, man, so great to, so great to catch up. We were on the podcast for 45 minutes before we got started, so it's good.
Ryan PatrickYeah. Some about seminars in, in Cincinnati. I think it's like how I was talking about the pro guys, it's like not a lot of people wanna be here. And I, I don't even think most people realize actually the Cincinnati airport's in Kentucky. Yeah. First of all. But anyway, man. For those who don't know you, I can't imagine anybody listening to this doesn't, but give us a quick overview and I'd really love to hear just kind of your, your career path that ultimately led to where you are. Like, I don't know a whole lot of the, the origin story of, of Alex Effer.
Alex EfferYeah, so I'll keep it, keep it brief. So I started, when I was in university, I wanted to actually go into physical therapy. So I wanted to go into physiotherapy. Um, but you know what, I did a bunch of internship rotations in physical therapy on, on my own, not even through school, just going every summer, even during the year, trying to just learn as much as I possibly could. And I wasn't a huge fan of the traditional physical therapy model. Like, look, if I understood what I knew now, I would still probably go that route'cause I understand how to use it. But. At the same time, I, I grew up playing hockey and a bunch of other sports. I really wanted to work in professional sports because I couldn't get there myself. So the failed athlete dilemma, right. So then fast tracked, I did postgrad postgrad into something called exercise physiology, where I became a clinical physiologist, which allowed me to work in the rehab, but also in the performance setting. So I wanted both ends of the spectrum. I didn't wanna just do people on the table. I wanted to be able to work with people dynamically through the entire process. How can I get somebody from an injury or an injured standpoint, two moving better? Or if I understood somebody from a rehab perspective or injured where they're in their worst position, I'd understand what to do with them when they're at their best, and in fact, maybe alter some of the exercises mm-hmm. To accommodate movement. And so. When I first came in this industry, it was very much the physical therapist understood movement and then the trainers understood how to load and um, you know, increased strength, hypertrophy, speed. But, you know, to me it didn't make a lot of sense why the trainer didn't understand the movement aspect and then the physical therapist didn't understand the loading of it.'cause then you're gonna get lost along that transition, that handoff in between. Right. Where the physical therapist is not preparing them for movement, but then the strength coach is not actually loading proper movement. Mm-hmm. And so it's just like, let's just lift as much as we can. Hopefully nothing breaks. Right. And so I worked in the collegiate setting. Basically where they created a position for me to actually be that in-between person. So I was consulting with every single sport, football, hockey, soccer swimming, all those different sports. And then I worked in a couple rehab clinics, and then I went on my own and kind of here where I am today. I mean, it's been a, I started posting during COVID. I was, I, I shared a lot or I personally did not enjoy social media. I never posted, but I was connecting with people. I was still on the app just watching people and, you know, really liking what they were putting forward. And the real kind of kick in the ass to get onto social media was. Really like Katie St. Clair started this book club. Mm-hmm. And we were all sharing ideas and she was hosting a mentorship course and she asked me to speak on her mentorship. Mm-hmm. And then people wanted to buy that presentation and then it just started from there. And then there was encouragement from my wife, from other people to say, Hey, why don't you start your own course mentorship that kind of talks about the things that you use with your clients. And this was the stuff that I presented on, was an amalgamation of the previous 10 years working in clinics with osteopaths, which honestly is what I learned the most from.'cause the osteopath is essentially what we, we know today, the breathing, the gait. Mm-hmm. The assessment models. And that has evolved. It was four weeks, which you were in one of the earlier ones, and it was a bit of a bit of a mess'cause I was just throwing everything down and on the piece of paper. And then now it's more of a flushed out nine week mentorship. But currently what I do is I do a lot of consulting with trainers and therapists with their clients. I work with some professional athletes in the summer, and then I do a lot of education through helping trainers and therapists just having a better model to, to work.
The Rehab → Performance Gap
Ryan PatrickYeah. Man, you spent years sharpening the saw on this and, and it's so cohesive now. And I, I do want to shift over to this resilient roadmap in just a second, but I have a question that I. Might be maybe the difference between the states and Canada. So, we kind of have this gray area where maybe insurance runs out in America or they kind of graduate from physical therapy. And I'm kind of thinking of athletes that I work with now, right? They're not really qualified for physical therapy anymore, but they're nowhere near able to do sports performance. Is there that gap? You know, in us, I feel like it's in the US I feel like it's driven primarily by insurance being like, Hmm, we're done paying. Mm-hmm. Is it, is it different for you?
Alex EfferIt's, it is very similar. But the, the thing is, is, so one of the first clinics I ever worked at was insurance based.
Ryan PatrickHmm.
Alex EfferAnd I got out of that real fast because the people who were there had to be there. Mm-hmm. For purposes. Right. And once that ran out, then they're like, okay. Or you have the people who have the insurance and the temporary insurance who wanna just go in for just a few sessions and say, see you later. Whereas the people that I wanted to work with were more of, they, they understood the process and they were hurt. But you know, that, that gray area for me is kind of where I live. Where, you know, I think you are gonna have people who are gonna come in, use insurance and they're like, alright, I'm done. Insurance is done. I'm gonna move on. Then you have the people who are like, my insurance is done, but. I understand where I wanna go. Yeah. And what I wanna do, and I understand that I have to do these things in order to do it. And what I really try to do is make the rehab process look so similar to the training process. The difference is that there's just a lot more constraints that I'll use. So for example, like I was working with a guy today just before we got on, and he was having back pain and he was told not to hinge, and this is virtual. And I was teaching him how to hinge, elevating his heel, putting a phone roller on the front part of his knee, getting him to hug a med ball, doing all these positions. Even having, he was using his left leg, his right leg out to the side looking like a lateral lunge. So it was a lateral lunge position with a hinge and to teach him how to get into positions to feel these things. So when I think of rehab. I think of we are really constraining the body so much that we're trying to create a different movement pattern. Not saying that the training aspect of things isn't doing that. Mm-hmm. It's just a different scale, different intensity, but it's a lot more internal, a lot more feeling things and positioning. But if I can do that and then say, Hey, guess what? That is going to be your deadlift variation for the next two weeks. Now I can start to create a program so they also understand how this progression starts versus if I get them on the ground. And to be clear, like that is an effective thing to do is get on the ground, create some context, but you won't be rolling around for 45 minutes as we know. Right. So what we wanna be able to, to do is teach them. How this progression looks. And so now that gray zone doesn't become so gray anymore, it's just that next step of the process. And so I think maybe it's communication. Mm-hmm. For some, maybe it is, we think of rehab and so we think of rehab exercises or corrective exercises. Right? We get stuck into the terminology of things. Whereas I try to make it as clear as possible what the journey is going to look like, and always matching it towards their goals. And if their insurance runs out, it's like, Hey, look, we can modify things so you're not seeing me as often, but I still think we should continue and make sure that we're, we're moving them in the right direction.'cause the last thing I wanna see is you wasted your time because we're not, we're now not seeing each other. And now everything's derailed. So. We have the same similar issues. Mm-hmm. I've just worked into that. I, I've been working in that gray zone for the last 10 years, so I kind of understand a little bit how to smooth the path a bit more. Yeah. Um, but you're gonna have people, it doesn't matter. And those aren't the people that I'm really concerned about to
Why the Resilient Roadmap Was Created
Ryan Patrickwant. Yeah. That's a really great way of simplifying it as, you know, this is a spectrum. You're moving along rather than, you know, here's therapy, here's performance. Never the two shall meet.
Alex EfferYes.
Ryan PatrickAnd so I, I want to bring this kind of full circle to the recent product release, the resilient roadmap to exercise selection. It's great stuff. And these days my mentality is I appreciate people who have complex thinking, but program and Right. In a really pragmatic and simple way. And so. With that in mind, kind of what was the, what was the impetus, what was the motivation behind creating this specific product?
Exercises as Ongoing Assessments
Alex EfferSo I had somebody who went through, has gone through all my courses, my foundations, my evolve, and even taken some of my programs. And one of the things that they had mentioned was, I understand the assessment that you're presenting. I understand some of the movement. Where I really get stuck on is the practicality of it. How can I take the assessment and then how can I structure exercises or programs that match that assessment? So for the way that I wrote this was very much like, this is what is actually happening underneath the hood of all these exercises. So what is the real difference between front foot elevated and rear foot elevated split squat And it's not the. Subjective, this is harder than that one. I'm gonna give Bulgarian split squats to everyone because it's, it's harder that I wanna crush them. Mm-hmm. Versus we have to understand what those movements are actually doing. Mm-hmm. So that we're able to program it for the right person. Right. So everybody comes in different shapes and sizes when it comes ribcage, shape, pelvis shape their ability to have certain ranges of motion. And what I wanted to do was put forth this new progression regression model of common exercises, squatting, hinging, split squats, rowing, pressing right, that you would commonly see in normal strength programs. But just dive in a bit deeper to understand like what kind of compensations would happen, would this improve more external versus more internal? And how could I. Move forward and back along the line. So regress or progress these exercises that we're able to make it like a roadmap where it's like, it's so easy for me to pick the right exercise because I know this person is missing this and looking at my spectrum of exercises, I know that this particular one is a one that solves that issue so I can get this person to train still while picking better exercises. So it was very much like, how could I, like the feedback I was getting was I need to understand what exercise to pick and when and why, and how should I set it up and then how do I progress them? And so my whole progression model is not subjective. It's based on something objective, which is center of mass. Is my center mass backwards or is it going forwards? And the more it goes forwards, I use the, um, what the, the, the speedometer. Mm-hmm. At the gauge. Or you could think of it like, I'm pushing on the gas, so my foot is pushing down, which is I'm accelerating forward, or I'm taking my foot off the gas, so I am shifting my weight back towards my heels and playing along that speedometer as a guide as to what exercise is going to be where. And so it was just a way to simplify things for a lot of people, and not even people who've taken evolve or foundations. Just even for like the newcomer trainer who was like, okay, like I know I had to write lists of exercises, like when I was working at the university level. They're like, we want you to write a progression list of shoulder pressing exercises. Back then, I'm like, okay, this one's easy, then this one's harder. And I would do it exactly like we were taught, but I wanted to present a different and more transferable model on how to pick. Mm-hmm. So it really came from the feedback, which honestly is, is the best I, I asked for constant feedback to make sure that people aren't being lost and understanding where the missing links are in the industry.
Ryan PatrickYeah. I remember doing some of these lists back in the day, and it seemed like there were a couple. Things that influenced our thinking. Then one was, you know, external points of reference. Yes. So, you know, moving from least to most, which probably closely mimics some of the DNS stuff.
Alex EfferSure.
Ryan PatrickAnd then looking at, you know, kind of center of mass height, right. So starting from the ground working out. And so you had, you know, half kneeling press, then tall kneeling, then, you know, split, then stagger and, you know, single leg and, you know, next thing you were doing it on, you know, a boat suit bar or something, something silly. So, hypothetically speaking, and, and I like that you brought this up because I, I was almost reminded of when I started training, like there were these list of exercises. This was how we did, did things. And so I had this almost playbook to work with initially. Then later on in my coaching, you know, we kind of got into assessments and everyone was very cautious of, well, you know, if you're not assessing, you're just guessing. The reality is there's a lot of new coaches coming in who just need something to deploy, like plug and play. So hypothetically is this, do you feel,'cause you do a great job explaining these exercises. Do you feel like people, there's still things that they can look for to almost use some of their exercise selection in this model as, as an assessment unto itself?
Alex EfferA hundred percent. I tried to create this in a way that. And that's, that's where my big struggle was, was when I first came into this industry was there were so many different assessment ways to do things and what to look for. And I ended up by spending an entire session on assessing people, give them like 70 different measurements because I didn't know what was good and what wasn't. So I was just like, you know what, maybe I should just use all of them. And they weren't training and they never, and then, then they never came back because they're like, well, I didn't do anything that entire session. Like, I understand I need an assessment, but like, you know, maybe like for 10 minutes, 15 minutes and I wanna do something. And so I wanted to write this as a way to say, Hey look, if you're not assessing yet, that's okay. You understand what these exercises are doing. And then because you understand what these exercises are doing, you can use these exercises as an assessment process and. I'm gonna be honest with you. Like, so again, I said the split squat, like you could take the front foot elevated split squat, and I go into, well, here are some of the compensations you would see in the split squat, that knee going out, or the knee caving in, or the back arching and whatnot. And that's where you can put constraints. So instead of saying, mm-hmm this exercise isn't appropriate for this person, it may, they, there is a skill acquisition of course. Right? Especially for, for like undertrained people. Mm-hmm. The other thing too is we could say, well, I get them to hold onto a cable instead getting to hold onto A TRX or elevate their heel or elevate their toes. So I can still use this movement because the idea is you understand what this movement does, you just need, but they can't. Create that movement themselves. So for example, if I'm trying to, trying to improve external rotation of the hip and I say, okay, I'm gonna give you a front foot elevated split squat. Mm-hmm. But their knees caving in, they're doing all these things. That front foot elevated split squat is not enough to create the external rotation. So I now have to use other implements, like I said, like the the wedge or holding a cable position or holding a dumbbell position a certain way that then forces that hip to externally rotates. Right. And so you're absolutely spot on to say that this is helping people who don't have an assessment process as well, use it as an assessment because I think you can, I. And what I, what I see in a lot of my courses is, I think the assessment process is, is very, I think a lot of people are starting to understand the assessment process. Mm-hmm. But then like, where do I go from there? But if you actually take the exercise and make that a part of your ongoing assessment versus saying, okay, I've got 10 assessment measurements, it'll take me five minutes to do. There's one scenario we could say, I'm gonna go after, I'm gonna do that every session, which is just not logistical. You can't do that. The other way of doing it, like I like to do it, is just picking two of their shittiest movements. Mm-hmm. Looking at those. But in between those, it is very much, what does that movement look like? How can I constrain them in a way that makes it easier for them to do it? And then what movements are they trying to acquire based on. That exercise I'm giving them, so,
Ryan Patrickyeah,
Alex Efferabsolutely.
Center of Mass & Force Vectors Explained
Ryan PatrickOkay. So, you know, we've talked about the center of mass that has become kind of the foundation for, you know, tier one of how these exercises are categorized. Yes. You've alluded to some of the constraints based approach of modifying these exercises. So I guess, you know, for, I'll use an athlete, they want to improve speed, power, strength. What are some of the secondary factors beyond center of mass that kind of carry weight when you are evaluating these exercises?
Alex EfferSo. I take into account a force vector in which, so center mass and force vector are gonna kind of go to together.
Ryan PatrickYeah.
Alex EfferLike I said, the, um, pushing on the gas analogy. Mm-hmm. So if I push on, it's more of this forward horizontal force vector where I'm starting to take my foot off the gas, it's, it's gonna be a little more vertical. Mm-hmm. I really take my foot off the gas's. Now, this negative horizontal, so think of that as like deceleration or mm-hmm going backwards, like the sled for example. The cable would do that as well. Create that negative. Yeah. Um, so I'm appreciating the force vectors at play and then I am modifying the tempo in which somebody does things. So whether that is a speed, I'm increasing velocity of that forward force vector. So again, let's say at the end of the spectrum, we've got our rear foot elevated split squad. Right. I think I put Jefferson as the, as the last one. Mm-hmm. But let's say, or Bulgarian, because that's what a lot of people know. So with the, with that Bulgarian split squat, I get that. I, I look at that as that's a force producing movement that is a hip extension movement. You know, and people will say, this is gonna be loading the glutes more. And that's because you have to lean more forward. You got more weight on that side. So I can do a few things First. I can, if I wanna increase speed, well I can do the rear elevated gl squat, jump that, you know, do the quick jump, like very low to the ground, like tapping, almost like a pogo hop.
Yep.
Alex EfferIf I to start to create faster impulse, but the other thing I could do is actually slow down the concentric aspect of the movement. So they go down one second, they hold so that we break momentum. We restart inertia, basically. Mm-hmm. And then they gotta slowly come up four seconds in order to keep them in their hip as they're producing force. It's pretty nasty. But what it does is it forces them, because when we think about what force production is, which is hip extension and ir, well IR is the longest phase on the ground. So the longer I can keep somebody on the ground, this would be your acceleration people. The slower concentric the more I can basically produce force, like, I think of like a, and I don't know why I always think of this analogy, and I sound super dorky when I say this, but you're, see, you remember Dragon Ball Z. Yeah. Powering up. Like that's what I see as the slow concentric. Like they are producing a shit ton of force. Mm-hmm. But they require more time to basically load that spring. Right. And so from an acceleration standpoint, I'm thinking, how can I load the spring longer? How can I really power up that movement? And then from a speed standpoint, that's where you're looking at, you are doing the quick drops or you're doing the slow down and then you're springing yourself back up from where your top speed things. So there are a couple like performance things that I'll look at, like mm-hmm. You know, if you got access to force plates. Very helpful. Vertical jump tests. I actually really like looking at. Lateral heightens as a performance measurement, right? Just how fast can they go in at a cup? What does that look like?
Ryan PatrickYep.
Alex EfferBut from the soap of this progression regression, it's still gonna fall underneath the same, same progression. You're just doing another layer where I talk about, there's the force acceptance. There's the force production aspect of things where front foot elevator is more force acceptance, deceleration. Bulgarian is more of the production. And so I can just play with the tempo of doing things, playing with the resistance. Am I using the chain links? Am I. Having overcoming bands am I are artificially creating an overcoming movement like the co, the slow concentrics, right? It still falls within that same spectrum, and so when you actually start to remove more layers of each exercise, you realize that that encompasses everything, right?
Programming Layers: Tempo, Constraints & Intent
Ryan PatrickWell, you don't realize today, Alex, is that we're starting to build out the, the 2.0 version of this product. So that's,
Alex Efferyeah, exactly.
Ryan PatrickUm, I'm gonna, I'm gonna add some more to this in a second, be, but I do wanna highlight this because right away it's okay, we have this progression left to right. These are, these are the exercises as the, the speedometer goes, you know, all the way to the gas from center of mass being the most back to the most forward. But within each, there's kind of this vertical of I can change speed and kind of the, you know, tempo what that does to the connective tissues as I, as I do it. But I, I'm doing it in a, within a kind of vertical column of this is where they can really manage and control that center of mass. And now I wanna play with some of these secondary variables.
Alex EfferExactly. And for me, I, so one part of the program I put like this onion looking thing where
Ryan Patrickmm-hmm. You.
Simplifying Programming for Groups
Alex EfferCenter mass range of motion, force specter the shape and position of the, of, of the joint, I should say. Yep. And then you going deeper and it goes into the tissue. And as you mentioned, I really like that, that what you said about the vertical aspect of things with each side of the gas pedal, right. Or each side of the spectrum. Every single exercise has that own vertical ness to it. Where, what happens at those, all those different things. And what I get people to do is take that, print out that piece of paper, or print out that slide mm-hmm. That onion slide and have it beside them when they're writing their programs. Every single exercise answers each one of those buckets. Okay. What's happening with center mask? What's happening from the force vector profile or from the. Is it force acceptance or production? Yep. Range of motion. And then what's happening at the tissue level. Okay. Well, if I'm trying to go force production, then I either want speed or I want to have an overcoming resistance. Right? And so now I can start to, to manipulate that vertical with whatever position I want. And look, this is not an exhaust list. These were just the most common exercises that you probably see on the gym mm-hmm. Are in specific programs. And so instead of there being randomness, there's, there's more to it. And I think that was the real point of the course, was to show that each exercise there is so much more to consider. And by considering those things they. It, it really makes it so much easier to program. So you could have a group of 10 people all doing front foot elevated split squats with a slight tweak to make them slightly different. This person is going slower on the eccentric because they don't really have hip flexion either. This person's gonna go slower on the concentric because maybe they've gotten a little bit of hip flexion, but they start to break down. When they start to push off out of the bottom, their knee starts to cave in, right? And then you got somebody holding onto a cable. You got someone holding onto a goblet position, right? Mm-hmm. The person got the cable is the person who really wants to flare through the rib cage, whereas the person who's the goblet, that's the person who wants to arch through the lower back, right? Mm-hmm. So you now have 10 people all doing the front foot with slight little tweaks, and that's how you can get like a large group to follow this progression. While adding a couple things. I mean, look, if if you get everybody on the front foot, you're probably gonna get some benefit across the board. But if you wanna be more sniper focused versus just, you know, spraying, like, you know, that's how we can start to change these things, right?
Ryan PatrickOne of the problems people run into, I think, is having too many options, right? You know, I, I can't tell you how many times I've cut exercises from our movement menu. I've just, you know, just chopped away because they're, they're things I never use. They're things that maybe just don't work as well. Like, they're kind of reducing the available options is gonna make decision making a lot easier. So I actually appreciate that. Everything is not in there because then you're kind of back to square one is like, well, you know, both of these bring the center of mass spec. So like, which one should I use? Like, I don't know, pick one. You like, pick one. That's easy. Like there are, so, there are so many things that live in my ecosystem of programming that are literally just the child of logistical constraints. Mm-hmm. The equipment we have available, how many athletes we run, what's easiest for, you know, an eighth grader who has a three second attention span to set up. Like those drive a lot of decisions for me.
Alex EfferAnd, and that's, that's why I try to keep it as simple as possible without equipment. I mean, the reality is, is I started getting very creative when I was in, in my post-grad because the gym had nothing. They had a couple cables, they had a couple dumbbells and they had a wall. And I'm like, all right, well, and they had, they had one bench and so it was very small and that instead of like. Before I was in big box gyms, so I had all this equipment, I had all the space, I could do whatever I wanted. So it really forced me to, you know, have to have like, how can I work with limited equipment? Mm-hmm. And basically I don't have all the options. And so what this is more, this is more of like a, a skeleton, the what I've, what I've listed out as exercises. Mm-hmm. And you can have a million different variations. So many people, Ryan asked me for an exercise database and I'm like, look, I've got like a million different variations of each exercise that I modify for the person in front of me. I can't possibly record every single one, but just like the brain, you know, we don't have to teach it. For a split squat, every single angle that you would have to go into in sport. But if you teach the brain, if I do this split squat, I can have this, it's called invariant representation. I can have this different, all these different types of, like, I know that this is a split squat, this position that I'm familiar with. Mm-hmm. And I, subtle micro adjustments based on what the sport entails. And so again, you want to go into a deeper layer. You're like, well, these are just like your traditional movements that you can then train all the different angles you want to, or different load profiles or different equipment uses. Like, it could be safety bar front uh, front squat front squat, front rack. Like all these different variations, but the point of it is that you understand what each of these do. Mm-hmm. And depending on where you put the load is either going to push the center mat forward or push it back. Right. And so the other, the other reason why this came about was I was training professional hockey player in the summer last, last summer. And he was doing all these traditional strength training, bigger, faster, stronger programs. And he was getting buried. Like he's, he was getting slower, he was getting hurt. He had hip impingement just from the sport itself. And you know, he didn't know how to do a normal split squat. He actually didn't know how to do one, which was crazy. And so I tested this theory out on him of like, okay, can I give him this front foot elevated split squat. Let's see what happens when I get to hold cables. That's what happens when I give them to front foot front squat position, and a safety bar. And so within that spectrum it was, you can have this like little arrow in between each movement of like, okay, you can add this here, you can add that there. But it was more of like, here is an database, or here is something, use variation at the same time. Like,
Where Single-Leg Exercises Actually Fit
Ryan Patrickno, that's, that's pretty brilliant. I like that.'cause then he, he can refer back to that. Right? I do wanna ask about a couple exercises. So. Not to get an exhaustive list and go against everything you just said, but one, it would be like your true single leg exercises. So I'm thinking step ups pistols, unless they're just a cool party trick. Your skaters, your single leg, r dls what do those kind of fit in?'cause they're kind of unto themselves.
Alex EfferYes. So speaking of roadmap 2.0, those are in there and, uh, I just gotta be able to do a single leg pistol myself before I can record it. So, okay, so single leg, when you inherently go on one leg. So let's just talk about like single leg deadlifts. Um mm-hmm. Just thoughts first before we get into step ups. Sure. So your single leg deadlifts and your pistols, those are, you're inherently on one leg. And so what actually happens at the hip is. You start to lose your femurs ability to move properly, it now becomes the pelvis moving over the top of the femur, right? Because you've got so much weight on that leg that you basically lock yourself into whatever position you have available at the hip. So for example, if I don't have the ability to internally rotate my femur, which is being able to go over top of one leg, mm-hmm. And then I lift up my leg doing a single leg deadlift, that's when you see the people, they open up their hips or their knees bow out or cave in, right? So again, it's locking me in that external rotation position and further creating that. So now my pelvis is moving over top of this externally rotated femur. Conversely, if I actually do have that ability to internally rotate, then I can get there and that's when it looks pretty smooth. I'm able to go up and down. I'm able to bend forward. So for me, those single leg deadlifts, those pistols, they're more at the end of the spectrum. Yep. Right where they are. You're force producing because you're inherently on one leg and whether you slow it down, the deceleration ability is, is still not going to have as much effect. Like you're not gonna get that much yielding out of those movements yielding being like the muscles ability to. You have eccentric of the muscles, but you don't have like the absorption that the muscles would create.
Ryan PatrickYep.
Alex EfferThat makes sense.
Ryan PatrickYeah.
Alex EfferRight. Okay. And then your step ups, even your step downs. Well, I would say your step up is more in the middle of the line. Mm-hmm. That's like your, so if you've got like three different angles, that's more of your vertical displacement, that's more your mid stance thing. Because as much as you wanna slow down that step up on the way down, it's still gonna be more of this concentric based movement. Right. It's more of the push off. But why I like that, and I'll actually get people to start with that who don't have hip extension, is because instead of a split squat, you know when you see a split squat, they have their back leg back, they arch to their back. Well, these people don't have. The ability to bring their leg back that far. So I bring it underneath them instead, and I put their foot on top of a box, which brings them in more hip flexion, and I can train that extension hip flex. Right. What you say your step ups gonna be the middle of the road because it's still gonna drive the hip extension. You're just gonna put the foot in front of you to do it.
Ryan PatrickYep.
Alex EfferSo it goes from in front of you to underneath you. And then the other part of the extension would be from underneath you to behind you. Right. Um, at the beginning of the spectrum. Then it would be more of what I consider like transitionary. The leg deadlift. So think of like doing a curtsy step back or doing a reverse split squat. Do you know what I mean? Like where it's, the leg is off the ground for a little bit, but it gets contact with the ground pretty fast. And then at the. Even before that would probably be like you are doing a single leg hinge, but you're allowing the foot to drag along the ground.
Ryan PatrickMm-hmm.
Alex EfferLike with a, like a, they call valve slides or, yep. Yeah. The
Ryan Patrickslide board.
Alex EfferSlide board, right. Like that would be probably the first one. And then, then there would be your transitionary movements. Then it would be your step ups and step downs, the vertical based movements, and then there would be your single leg dead lifts where your leg is totally off the ground. But again, that should be for people who have internal rotation at their hip. So think of like you're laying on your back, bring your leg to hip flexion, and you turn your leg in. They should have. The, you know, arbitrary people are gonna be like, well, why 20 degrees? Why is that like scientifically appropriate? Like for me it's like 20 degrees, which is like half of the available motion in the hip. Like to me, that's kind of like, if you don't have that. I'm not gonna give you a single like deadlift because it's just gonna be a disaster. You're not, you're not actually going to get what you want out of it or load what you're supposed to, you know what I mean?
Ryan PatrickSo somebody with a negative 20 on the overs like me is underqualified.
Alex EfferYeah. Yes. You'd be at the other end. You'd be slid along the ground.
Foam Rolling Reconsidered
Ryan PatrickYeah, I'm in, I'm in kindergarten. Uh, that brings, I think that brings up a really good point'cause we're talking about getting some of this requisite motion and you know, a common listener might think, okay, so I need to stretch more or I need to do some, you know, quote, mobility work. So my question, you know, I wanna talk implement specific. Do you feel like foam rolling and soft tissue work is a thing of the past? Or are you using these tools in with kind of a different mindset to maybe increase the available range of motion that someone has?
Alex EfferYeah, it's such a great question. I would say that I. Extremely value it. Now, I went on the rollercoaster of foam rollers are amazing and they suck. Now I'm back on their, they're really good. But I, I have a different perspective on it and there's, there's really two different perspectives that I think I have on it. So the first is, I think of the foam roller as something that will change the shape of the joint that I'm using. So the easiest thing to think about is the rib cage.'cause it's the most visible. Mm-hmm. So if you think about somebody who, when you take a big breath in, everything just opens up. Or you think of the person who's this really big barrel chest, right? Mm-hmm. Well, they've got these ribs that are, that are going out towards the side. So what people would traditionally say is that person's LA are, lemme go foam roll the la. Like, okay, well maybe there's some validity and maybe you're going to get that right. But the other way of thinking of it, of it is, I'm gonna get that person to lay on top of the foam roller on their lower part of their rib cage, almost to bash their ribcage back in or smosh their ribcage in. I can then create a better position for a muscle like the external obliques that's supposed to close that ribcage to actually be able to work properly. Right? So, mm-hmm. The foam color is used to help mobilize joints, or the other way of the other good example is the tibia or the shin bone. When you bend your knee, you want the shin bone to turn inwards.
Ryan PatrickYes.
Alex EfferNot like a pigeon toe. That's different. But like if you bend, if you have your foot off the ground and you turn your knee in, like, or turn your shin in, like that's kind of what you want. So I could use the foam roller and go right where the pointy part of my bone is, go on the outside of it, get into what looks like a pigeon stretch position and just rock side to side. So every time I rock on the outside, the foam roller pushes that bone inwards, turns it in. So I get that mobilization of the shin, right? And then so I, so that's the first thing is they use it as a joint shaper, right? Mm-hmm. And then the second variation is, well, I think about if I do all these things, I do the foam rolling to manipulate the joint shape. If for some reason I'm not able to unlock that. Tension, the tissue that, okay, so let's say you've got somebody who's got flared rib foam, the left page. Mm-hmm. You have to either lay on and to forth, not up and down, but roll back and forth, explicit it, and then you try to, I don't know, do some kind of movement, right? Like, uh, cross body. Okay. The people who don't have that ability are the people who just turn their whole body like a refrigerator, right? So I switch that into place. I'm able to press, it looks pretty clean. I, as I press across. I got it. If I don't, there could be. And I look from the backside, I see that they're arching through their lower ribcage still.
Ryan PatrickYep.
Alex EfferI'm like, okay, well part of this swooshing is also the backings to open up. So I'm gonna now go after that lower rib cage and foam, pull it up and down, turning my body towards that side as I do it because the rib cage in and down, I do that and the back will open. I will use that as like, this is the joint position. Let me try to get the joint and do a better position and shape. Mm-hmm. What tissues would be preventing me from getting into that position. So it very surgical in. Let's just bar gun everything or let's just foam roll the whole body and like doing, that's totally fine. But like if you're like, Hey, like for some people I will put two foam rolling movements in the program. And how I know they work is I take one of my assessment measurements and test and retest doesn't improve. Resting your time. Right? So,
Ryan Patrickyep.
Alex EfferYeah, I think those are extremely valuable tools if you,
Ryan Patrickyeah. So I wanna ask kind of a pointed question about this, because obviously we talk about this stuff. Gaining range of motion is good. Or at least we assume to a point.
Alex EfferYes.
How Much Mobility Is Too Much?
Ryan PatrickRight. And we can look at, you know, a baseball pitcher, you know, you want total, total shoulder arc to be consistent, but they may not have all the internal rotation. They might have a little bit more external rotation. Right. So we're biasing this. There's one, I think that's maybe an easier example is, um. You know, I'm looking at a sprinter. Okay. Sprinters need really great hip extension to get an effective push. However, I also know many of them present with some degree of anterior orientation of the pelvis, which is going to reduce some of that backside leg action. And so when you're evaluating the athletes you're working with, how do you restore or give back some of these ranges? Rather than just like indiscriminately saying, oh, we need to get you all of this back.
Alex EfferYeah. Part of it has to do with a sport. So like your sprinter example. So if I give somebody more internal rotation with the hip. Mm-hmm.
Ryan PatrickSo
Alex Efferthere, there's your hip flexion internal rotation, then there's your hip extension. So think of like side, like an overs as
Ryan PatrickYep.
Alex EfferYour hip extension and then your supine ir. So if I improve the supine ir. I'm keeping you on the ground longer. Right. Which for a 40 meters printer is not very advantageous. Right? Right. But if they've got zero, there's probably a problem. Like we probably should have zero. You're so far on your toes and your hip extension and your forced production is happening because you're just throwing your pelvis and ribcage forward. So then, you know, you obviously wanna look at how they sprint, how they perform their movement. And then you also want to look at, you know, if you have forced plates, that's also very effective. If you don't, you know, you wanna look at their take, you wanna look at how they're running. That's kind of like a, a major assessment process. Then you wanna take a look at what their hips and rib cage are doing. So then when I'm, I'm reverse engineering this, I'm like, well, you need hip extension. Obviously to propel, you need front side mechanics to a degree. Right. The lower, I would say the, sorry, the, the distance matters in terms of how much front side mechanics matters. Mm-hmm. So longer distances, front side mechanics matter more compared to short distances. So then I'm like, okay, are you 60 meters sprint or you're 40 meter sprinter? If, or, or, uh, sorry, a hundred meter sprinter. If you're a 40 meter sprinter, like we need still some ir, we need probably, like, I usually say like 10 in my experience. 10 is again, like why 10? Like, I don't know. 10 ten's enough. Right. 10,
Ryan Patrick10 times more than I got.
Alex Effer10 times more. Exactly. Exactly. You got zero. There's a problem like running on, running on red. But no, like. For me, it's like the, again, if you, if I say, okay, you got zero ir, I'm gonna give you 30. It's like, I'm gonna keep on the ground longer. And that may actually hurt you because you staying on the ground longer means that your tissues have to absorb more force for a longer period of time. Mm-hmm. You also become slower. Yes, you maybe producing more force, but you become slower because you're staying on the ground. You're gluing yourself on the ground. And that's where the mistake a lot of people do, or that is the big mistake that people will do is, is they'll say exactly what you said, I gotta give this person so much range of motion, I'm gonna blank slate. Everybody needs 40 degrees of IR at the hip. And they start getting hurt and you wonder why it's'cause they're staying on the ground too long. They're sparked, and their compensations that they've adopted are to get them off the ground faster. So I'm looking at it as saying, well, how much hip extension do you have? How much hip extension. How much hip ir and er on both sides to determine if there's any kind of rotational element at play. And then I'm looking at, well, if I give you five degrees, what happens? I give you 10 degrees. What happens? I tend not to go above 20 degrees with these people because then I start staying on the ground too long.
Ryan PatrickYep.
Alex EfferUm, but that's kind of how I, I do it. I just always refer back to what they look like when they sprint, what it looks like when their foot hits the ground. So by mechanically speaking if they've got pain, it's so much easier. Marker.'cause you're like, all right, well it's starting to get better because you're starting to get more motion. Yeah. Right. But how are they striking the ground with their newfound motion? Is it better? Is it more underneath them? Do they feel like they're leaning less forward as they're running? Are they able to get the top speed a little faster? Because if they don't have ir, they will also stay on the ground longer in the acceleration because their leg is going to be going into ER and whipping around. It looks like they're, when they're walking, they're doing like a circle or semi-circle with their leg. Or they don't get down low enough. Yep. Right. Or they, as they come up outta the blocks, they're just like really extending through their ribcage. So I guess to, to answer this in a simplistic manner, I always retest, give them a little bit retest. But the big thing with these people is more of a opening up their rib cage than it is actually their pelvis. Their rib cage is usually in front of their pelvis. Hmm. If you look at a side profile. Vis looks like it is sticking back more and they're leaning forward. Yes, exactly right. So if I could slow down their ribcage a little bit, I could probably open up some space so that when they land, foot, shoulder, hip, foot are all stacked up versus they're ahead of their toes as they come off really quickly as though they're just doing half raises. Right. Do I want the heel to hit? Probably not. I don't. I want more of a forefoot. Yeah. Running right. But I don't want them to go into forefoot running because the ribcage is leaving the charge. Right. So I find that in order to acquire that range of motion is probably you're gonna have a better time with the rib cages than you will with trying to mess around with the pelvis so much.
Old Coaching Wisdom Revisited
Ryan PatrickI love, this has almost come full circle in a lot of ways because we used to look at athletes as, and I think Mike Robertson used the term toned up rose, right? They're just standing like they're in the squat rack, you know? Yeah. Yolked up chest proud, imaginary lat syndrome. Um, and you just think of how much like gross extensor tone is on the backside of that body just literally shoving everything forward. And so before we had some of these assessments, before we were looking at ISAs, it was like, well, we just need to pull these guys back and reduce the tone a little bit. Maybe not a lot.
Alex EfferYeah.
Ryan PatrickBut something will help. And we were getting great results, you know, 10, 15 years ago before this. Some of this was even part of the, the, you know, dialect in strength and conditioning. So I just, I love that because it's, it's kind of bringing back what has worked in the past with maybe a slightly different explanation that's now. You can tell it's much more distilled in, its in its messaging. Right. It's not as confusing as maybe some people feel about the ISAs.
Alex EfferI think. Yeah, I think that, I mean, I personally have eliminated that out of my thought process. I mean, there's some, there's some things that I will consider when it comes to like the shape of the rib cage. Mm-hmm. Like their ability to turn and, you know, where their base support is gonna be with people who've got the smaller rib cages, they're gonna be a little bit more under underneath them.
Ryan PatrickYep.
The Industry’s Biggest Mistake
Alex EfferRight. Versus the people who are wider. Like those are, you know, linemen. Like those are like, those are the wide stance people. Again, those are your Dragon Ball Z they need to supercharge in order to produce forest. Right. Versus the springiness. It's like, there are some elements that I'll consider, but like, man, I think that we tend to overcomplicate things by understanding more. Mm-hmm. And it's more like, well, okay, you have somebody who's like really extended through their pelvis in their ribcage, what's compressed the backside of their ribcage in their pelvis, so how can we open that up more and what people would do? Unfortunately, as they'll say like, you got an anterior pelvic tilt, let's strengthen your hamstrings. It's not as, it's not as simple as that. That's very diluted. Mm-hmm. Right. It's more like, how can I get you in your heels and stay in your heels as you're moving, which will effectively get your hamstring, but it's not, let's go in the seated, like curl and strengthen your hamstrings in that same pelvic position. Right? Yep. But it's like, okay, I look at the whole body. Where are they compressed? Looking at things from a posture standpoint, a lot of people can kind of like, they're pretty good at looking posture and being like, well, they're flared, so the back's probably tight. They got the hip hike, that's probably tight. Mm-hmm. But then you go deeper layer and saying, well, this is what they're probably missing in their hip and their shoulders and their rib cage. And then you look at their performance and you're constantly reverse engineering. You're like, Hey, what does it look like? The performance, what does their movement look like? What are they presenting with now? Do they look a little more relaxed, right? Mm-hmm. And then how can we get them in a better position and train that? So it's like, let's put the dumbbell in front of us. And we've kind of known that for a while. Right now, I, I am simplifying things a lot.'cause you have some people who have like, longstanding issues. Mm-hmm. And they need a little bit more of the deeper dive into things. But like, like play around in the 80%, right? Because the 20% of people, those are the people that you have to get a little more specific with. But the 80% is, you know, what does their posture look like? What does their movement look like? What does their sport look like? What is their sport requirement? And then what are positions I can do in order to, don't worry about the sport don't worry about what they look like in the sport yet when you're doing an exercise, but retest that. See what it looks like. This is what you look like when you're sprinting. Is what your sport requires. You get off the ground really fast, or you're getting off too fast because your ribcage is way too forward. You're not efficient. Yep. And you think that increasing speed drills or doing more speed drills is gonna make you faster. It's, I promise you, you bring the ribcage back a little bit. You're gonna be faster because you're not gonna be constantly falling forward and catching yourself, right? Mm-hmm. So, as you said, I think what happens in our industry is we get too simple. And then we go way too complex and then we try to simplify too much. That complexity we just learned and then we go on that rollercoaster again. Whereas where we need to live is right in the middle of those two points. Here's too simple, here's too complex.
Ryan PatrickYeah.
Alex EfferWe should understand both sides, both to a degree, but then live in the middle of it so that those peaks and valleys were just actually, it then becomes more of this linear line cross. Yes. Right. Yeah. So, yeah, and I think, you know, and I will say I was the person who was too complex. I presented things that were too complex, didn't explain them very well, because I probably didn't understand them as well. But now I can understand things and that's when you start to get back to the middle of the road between, here's way too diluted. Here is way too noisy. Mm-hmm. Let's go back to the center and there's a ton of noise in our industry because you gotta make it different if you lived in the, in the, uh, in between. It's not fancy man. Right?
Elegant Simplicity in Coaching
Ryan PatrickNo. I, I don't know who to give attribution to, but somebody described it one time as, um, you know, in the beginning it's, it's simple in a simplistic sense.
Alex EfferYes.
Ryan PatrickThen you, then you get to the confused complexity. And I think for you, you've kind of emerged to the other side where you've kind of unwound this ball of yarn. And now it's simple, but it's elegant, it's nuanced, but it, the approach and the delivery is just very straightforward.
Alex EfferLike, think of it like, uh. I think of it like a, a really nice present. Mm-hmm. Like the wrapping, like wrapping for presents at Christmas all look very much the same, but inside the box is very different. Mm. Right. So, as you said, like on the outside, okay, this is, this is your split squat. This is your front five split squat. I know that. But on the inside there's a lot of different nuances and we can go way down the rabbit hole. Mm-hmm. Or we can give you enough of the complexity that is also simple enough to say, okay, I understand why I'm doing this movement now versus I saw this cool exercise in the gym, or I saw this cool exercise online, I'm just gonna use it with all my clients. I actually have a structured approach. Mm-hmm. Where again, it looks from the outside, you walk in the gym, it's like, man, everybody's just doing the same thing. Like, wow, what you don't know. Is that we are slightly tweaking it because we understand what's inside the box. Right.
Ryan PatrickBrilliant. I love it, man, there are a lot of, a lot of gold nuggets here. I really appreciate your time again and I wanna be respectful. So I'm gonna give you a few like quick, quick fire questions before we sign off here, and then I wanna make sure you kind of give us the socials and where people can find you. So, we are in amidst the Winter Olympics. So as a Canadian, what is the must see Winter Olympic event?
Alex EfferMan, I mean, for me, I'm Canadian, so hockey has gotta be
Ryan Patrickhockey.
Alex EfferOkay. Bests of the best. I really enjoy watching hockey. I also really enjoy the, I can't remember the name of it, but it's the, the, the downhill skiing when they go side to side. Is that luge? Is it? No, it's not luge. You don't
Ryan Patricktalk like, like Alpine or
Alex EfferYeah. Alpine. Exactly. I really enjoy those two.
Ryan PatrickMm-hmm.
Alex EfferFor sure. I mean, team can is playing right now.
Ryan PatrickI mean, curling. I, I'm curling
Alex Efferactually curling too. You're right. I love curling.'cause the strategy, I mean,
Ryan Patrickicy shuffleboard is, but man, the focus.
Alex EfferYeah. And, and the movement and the mobility they gotta get into, I mean, that's, that's pretty impressive. But the, the strategy and, and all that. Yeah. I love that. It's like, it's like chess on ice.
Ryan PatrickMm-hmm.
Alex EfferIt's amazing. Yeah.
Ryan PatrickSo those people, I think there's actually a, a curling place somewhere in Cincinnati. You can go test it out. So maybe I'll have to give it a shot.
Alex EfferWonderful.
Ryan PatrickOkay. For people who do wanna dive deeper, what, what product of yours do you recommend they get started with?
Alex EfferOkay. I used to say my foundation biomechanics course. Mm-hmm. I now say my roadmap.
Ryan PatrickOkay.
Alex EfferSelection, because I think there is a tremendous amount of practicality. So you can get started right away. Mm-hmm. And then start to dive deeper from there in understanding things. So roadmap, then foundations that evolve.
Ryan PatrickAll right. Appreciate that. What projects are coming up or what are you excited
Alex Efferfor? Well, I'm going to, I'm actually going to England to present at a conference in two weeks. Yeah. And I'm also gonna host a workshop out there, so I'm really excited about that. I have a, I don't know if I wanna say what I'm working on, but something pretty big coming out in the fall that's going to be more education, just about everything when it comes to biomechanics, the rehab process, the training case studies behind the scenes. And it's going to be more. I wanna say like, the intention of it is to, is to reduce the noise of all the stuff that's out there and just make things so practical. So you'll see that coming out at the, in, in the fall. It's gonna be, I'm really, really excited about that. I've been working on that for the last year.
Ryan PatrickWow.
Alex EfferThat's gonna be pretty excited. Still not done, still have a lot more recording to do, but I think it's gonna be something that'll, that the industry doesn't really have and I think it's just gonna be a tremendous resource for, for people. So that's, it's gonna be like a monthly thing, so it's gonna be's gonna be
Ryan Patrickawesome. Can't wait to see that man. Okay. What are the social handles? Where can we get in contact with you?
Alex EfferYeah, so most of my activity is on Instagram, so it's at Alex Effer. I started YouTube about eight months ago, so that's at Brazilian rehab. I've also got my podcast at Brazilian Rehab, which is kind of just like small nuggets, like five, 10 minute.
Ryan PatrickCool.
Alex EfferAnd I think that's, that's it. I got, I think I gotta start on TikTok, but um, I dunno,
Ryan PatrickI don't know if I wanna see you dancing on there. No,
Alex EfferI don't. You don't wanna see my dance, that's for sure.
Ryan PatrickNo, I preach. Hey man, I appreciate your time. I'll make sure I get those links up and, uh, let's do this again soon, man. Take care of.