HMG: a primer

     Much has been and will continue to be said about hCG, or human chorionic gonadotropin. This pregnancy hormone produced in the placenta has been used in fertility treatments, anti-aging medicine, testosterone replacement regimens, doping, and weight loss scams. Its many off-label uses have lead to perfusion into a wide array of areas, and if you are involved in a strength or physique sport, or any elite sport you've likely at least heard of it being used to prevent testicular disruption from anabolic androgenic steroids. But you probably aren't as familiar with hMG, which is a similar hormone (actually a set of hormones) that, for the purpose of fertility and testicular health, has some interesting aspects that many consider superior to hCG.

     Human Menopausal Gonadotropin, or hMG, is a mixture of gonadotropins secreted by menopausal and post-menopausal women. This life stage tends to include hypergonadism and thus lends itself to the creation of a virtual biological gonadotropin factory. The primary gonadotropins in vertebrates are luteinizing hormone (LH) and Follicle Stimulating Hormone (FSH) and both are present in large amounts in HMG. HCG may be in the mixture as well in some cases.

     At this point, if you are familiar with male enocrinology, you'll understand why hMG is so valuable for men with secondary hypogonadism (testes can function but brain isn't sending the signal)or who use endocrine-suppressing steroid drugs. LH stimulates the production of androgens in the testes and FSH stimulates sperm production. While hCG mimics LH and doesn't directly stimulate sperm production, hMG is the real thing. It exerts a direct impact on both androgen production and sperm production, making it an effective fertility drug in most cases and providing an excellent tool for men wanting to maintain not only testicular function but fertility while using steroid drugs.

     As with hCG, though, there are concerns for sensitivity with administration in large regular doses.  Too much for too long will have a deleterious effect, desensitizing target tissues to the gonadotropins and reinforcing the negative feedback loop creating the suppression in the first place. Men seeking to use this as a fertility aid or as a replacement for hCG need to consider the other classic hCG issue with hMG as well: aromatase. Aromatase production will spike in response to the pulses of gonadotropins, adding elevated aromatase levels to the mixture of potential problems.

     In summary, what is hMG? It's a stronger gonadal stimulant than hCG, enhancing both testosterone and sperm production. It has the same uses and carries the same potential risks. Please take it upon yourself if you choose to use illicit PEDs to educate yourself so that risk can be minimized and health optimized. It's not just your performance at stake. You have to live with your health forever, so treat it accordingly.

An Example of Meet Week Prep

       I've been asked quite a bit what my final week before a meet looks like. So as the opening competition of my 2014 season approaches, I want to take the opportunity to put up a basic outline of the things I do during the final week of prep, at the end of training or even after training is over. This is my final prep timeline for this year's WABDL North American Championships, where I'm cutting weight to hit the 125 kilogram class. There will be a 24 hour weigh-in.

1. Monday: hit BP opener for a single, squat (light) to keep the lower body from tightening up into an unusable coiled mass, and do a little barbell rowing; water consumption increased by 50%.

2. Tuesday: PNF and soft tissue work on biceps, triceps, shoulder girdle, and T-spine.
   
     *Proprioceptive Neuromuscular Facilitation

3. Wednesday: depletion training to begin my weight cut

4. Thursday: depletion day 2; cals at maintenance, carbs at 150 g. Recovery walk in PM.

5. Thursday at dinner, reduce fluid intake to sipping on water; afterward suck on ice chips and sip herbal tea.

6.  Sleep if possible. Probably not though because I'll be essentially camping in the bathroom epitomizing the concept of the over-active bladder.

7. Weigh at 5 AM, 6 hours out from checking in at the meet. Hit the steam room and take a walk if needed. Monitor weight every half hour until target is hit, sucking on ice chips to keep from over-dehydrating. Continue to monitor until I check in.

8. Check in at 11 AM after vacating the bladder and bowels.

9. As close to 11 AM as possible, start drinking gatorade and eat an easy to digest breakfast; over the course of the day I'll have a gallon of gatorade, a gallon of water, and as much food as I can eat for the rest of the day.

10. See chiropractor and neuromuscular therapist. Adjustment, soft tissue work, and mechanical analysis.

11. Bed early.

The Cardio Boogeyman Exposed

       At this point everyone seriously involved in lifting weights has probably heard the refrain, "cardio limits gains and causes fibers to switch." It's well known that excessive endurance training can impact strength training negatively, and it's well-established in the literature that the two types of training don't always jive well. Additionally, it's been demonstrated that strength training and endurance training don't carry over well to performance in the respective alternate field.

       But be that as it may, the reality for many athletes is that the health benefits or performance improvements from endurance training can help them in their endeavors, and training in both areas is needed for a competitor to excel in many sports. Mechanisms for training adaptations are understood to be specific to context, so we know that performance increases of the type that would be significant to the athlete's game require training that matches the demands. A rugby player certainly needs to be strong, but he also needs to be able to run a 5k during a game while hitting other players, jumping, throwing, falling, and getting crushed by a pile of similarly stressed individuals. A trail runner needs to be in fantastic condition, but if he's got weak legs he'll get crushed by a dude who does his squats regularly when an 800 meter hill comes up. For lifters and bodybuilders, while cardio may present some hindrances, you also don't need to be a sloppy fat-ass with no work capacity and horrible circulation, so you may find yourself in a situation where a little cardio will make you healthier, and thereby better able to train and perform adequately.

       So, having established that there are times where you'd conceivably want to address both endurance and strength, we need to establish the extent of the potential hindrances to performance with concurrent training. Once we understand these and understand the context of the adaptations, we can plan these different training stresses and adaptations to be minimally incompatible or compatible completely in the best case. Let's look at some literature first.

http://www.jappl.org/content/56/4/831.short

http://www.portalsaudebrasil.com/artigospsb/ativfis150.pdf

http://jap.physiology.org/content/59/6/1716.short

       Endurance training induces changes to skeletal muscle. This includes metabolic as well as fiber-type adaptations. Duh. But since some of the cardio extremists insist on harping about how endurance training is too low-threshold to affect muscular development, we'll put these links up there. You'll adapt to endurance training just as you'll adapt to any training. We get better at what we practice. If you are still with me after the remedial assertion that the training you do has a physiological effect, good. You are now ready for freshman health class. If not, I don't know how you found this blog but it's beyond your current level of understanding. Please stick around, but do some major studying too.

http://sriechman.tamu.edu/629/2012/Nader%202006.pdf

       Another concept that should be simple to grasp but still eludes some is that too much endurance training can hinder both hypertrophy and strength development. This is not a problem confined to endurance training. Too much of any training that doesn't carry over to your sport directly will carry risk of hindering progress, for various reasons.

       There should be no debate about whether excessive endurance training can hinder strength and muscular growth. Many of the adaptations caused by endurance training run counter to many       
caused by strength training and bodybuilding. Many have said cardio has no or limited benefit in populations seeking strength and size.

       But looking at the issue in a black-and-white fashion completely ignores how things work in the real world: Energy systems do not function in isolation. All systems are working to keep you alive and functioning. Low aerobic capacity will affect your health and performance in major ways. Adaptation is a way to cope with a changing environment; much of it is transient. And lastly, the biggest thing the no-cardio-ever crowd forgets: a little bit of cardio isn't going to cause the same adaptations as intensive endurance training.

       Clearly, there is a time and a place where endurance work is appropriate. Considering that, it behooves us to look more deeply into how the resulting adaptations occur, especially when combined with strength training. Luckily, the good folks in the military-industrial complex have already figured it out:

http://allasamsonova.ru/wp-content/uploads/downloads/2013/12/1995_Kraemer-W.J.-at-all.pdf

       This study examines in depth the interaction of endurance and strength training, noting that the two seem to be incompatible. But what is more interesting to us at this moment is the hypotheses about why this is the case and how we might manage it. "Thus, incompatibility of training may be attributed to a large extent to the extreme stress of adrenal activation due to the total amount of high intensity exercise. Whether successful adaptations can occur remains dependent on the ability of various anabolic compensatory mechanisms (e.g. testosterone, IGF-1, and GH) to eventually override a catabolic environment." Later, the author states, "...such data and previous studies have indicated that total work stress may be a potentially significant factor in the development of incompatibility of exercise training. This concept is now supported from an endocrine perspective."

       While attenuation of adaptations was occurring in this study, it's important to note that strength, size, and endurance all increased significantly in groups training concurrently. It's hypothesized that, as discussed above, the limiting factor for the compatibility of the two training types could be determined more by the ability of the athlete to recover from training stresses than by an inherent attenuation. The author goes on to say that rest, periodization, and control of outside stressors contributed to continued improvements even with the attenuation, and suggests controlling these factors may decrease incompatibility of the two training types.

       We also need to note that fiber type conversions took 12 weeks to become apparent, and that other markers of endurance adaptations took a while as well.

       If you want a sound-bite answer to the question of whether cardio is okay here it is: it's not cardio
that kills gains. It's excessive cardio. Controlling training volumes and intensities and making sure the bulk of your work is specific to your goals continues to be the best way to train. Adding some cardio is not going to immediately impact your strength training in any negative way unless you go whole-hog into intensive and specialized endurance work. Appropriate modes of endurance training in appropriate volumes will aid you rather than hindering you.

       The question now is only, "what is appropriate?" If you've learned anything from me so far then you already know the answer. It depends.

The way I do it.

       Since some programs I've used to train for competition were well received upon my recent posting of them on some facebook groups, I've been in several conversations that set off huge waves of requests for my current training methodology. I've discussed alot of training programs and methods I use with clients in detail in various outlets, but it's been pointed out that I haven't really explained the way I train myself. The following is the basic template I set my training up on, and is the result of my experiences as a lifter and my education/study. It took me a long time to work up to this so don't expect it to treat you nicely if you decide to jump in without prior experience with this type of training.

Off-season



 

       I train relatively infrequently in the off-season, which for me is typically 3 months. It's very simple during this time, with low volume. The focus is on full recovery, abbreviated training, and hypertrophy. This template is pretty standard in the HIT crowd, and was heavily influenced by the work of Ellington Darden.

 

       Every 3rd day: 6-8 exercises encompassing the major muscle groups. One set to failure of 6-15 reps after adequate warm-up. Sometimes I break these up into A and B sessions, with squats or DLs in the beginning of session A for a heavy set of 1-5 and bench presses in the beginning of session B. The two are then alternated, so that each main lift is hit roughly every 9 days for a single heavy set.

 

 

In-season

 

       During the season, I swing all the way in the other direction. Training is high volume, high intensity, and high frequency. Training load and volume are purely autoregulated. Targets for average load, total volume, and fatigue level are decided on weekly but are subject to change. The goal is to increase average weekly workload, average weekly volume, and total tonnage throughout the season, with minimal accumulated fatigue and absolutely no over-reaching. I only ever take weights I know I can hit and I err on the side of too light or too few lifts instead of letting fatigue and injury limit me. The daily and even the weekly performance doesn't matter. Daily capacities change. What matters is the trend should always be toward heavier loads and more work. After all, the strongest man is the one who lifts the most weight the most often. This one is less a template and more a set of guidelines.

 

1. Every lift every day.

2. 4-6 times a week.

3. Do singles with a load exceeding 70% in every session.

4. 80/20: 80 percent of my work is squatting, benching, and pulling; the remainder is essential support work.

 

       At present, this takes the shape of:

 

Monday: 

     SQ and BP: heavy triple, then repeated down-sets until fatigue reaches goal

     Sumo DL:single, then a single down-set for 3+ reps

     Row: one top set to failure and a second set either at less weight or using rest-pause reps

 

Tuesday:

     SQ and BP variation (pause squat, close grip, etc): heavy single

     Hip hinge movement (RDL, GM, etc; occasionally GHR, despite it not being a hinge): 6RM

     Upper arm accessories: one set for bis, one for tris, both to failure

 

Wednesday:

     SQ and BP: 80% of Monday's top weight, either for 3 triples or a single set of reps

     Olympic lift variation: work up to a daily max and follow with down-sets of 3

     Upper back/ rear delt: varied depending on the movement chosen

 

Thursday:

     SQ and BP variation: heavy single

     DL from varying positions: heavy single

          *mid shin, knee, and 1-2 inch deficit are the ones that carry over for me

     Upper arm accessories

Friday:
    SQ and BP volume work: see Monday
    Conventional DL: heavy single, then a down-set
    Chins: 2 working sets, typically with negatives on the second, or a reduction in load

Saturday:
     Active recovery: during the warm parts of the year, I hike at least an hour on this day; other times I do LISS cardio, a circuit, yoga, or whatever I want that isn't powerlifting.

     There you have it. I think I'll call it "Boring and Hard."

Just work hard damnit!

       It's humorous how often people warn me that the way I train (very basic without much accessory work) will lead me to sub-par performance on the platform and a huge set of injuries. It's impossible, they tell me, to adequately train and prepare the muscular system for athletic exertion without a massive list of special exercises and corrective drills, and without isolating motor patterns around joints, I'll be hurting myself regularly.

       The fact is, as I've transitioned over the years to a low-variety system based on specificity, many nagging injuries have cleared up. I've PR'ed in 2 weight classes in powerlifting and expanded the number of federations I hold titles and records in by over 100% with no new major injuries. I've attained my largest size yet at a leanness I haven't matched in years.

       My hiking performance has benefitted too. It's the other sport I participate in with serious interest. Times and recovery intervals have decreased while my capacity for long hikes and hard trail runs in a given time span has gone up. I'll add that I sustained no hiking-specific injuries last season either.

       My hamstrings haven't exploded because of a lack of knee flexion in my program. In fact, both hamstrings have old injuries that have improved since removing the fluff from my training to go harder on what works.My pec tendons haven't shortened into unmoveable cords because I don't do deep dumbbell presses and my bench lockout hasn't gone to hell over a lack of triceps extensions. My back requires me to let the seams out on my shirts, even though I haven't done anything for it besides chins and rows since I moved to Portland. Neither ankle has been devastated by the rampaging injuries supposedly common to those who don't train calves, and my calves push on the legs of my pants hard enough to rub all the hair off. And, oh yeah, doing absolutely zero cardio training hasn't affected my conditioning. At all. (Clearly hiking is endurance training and this specificity has been enough to prepare me for the rigors of the sport.) My training is a lifting template so boring you'd have to be in love with powerlifting just to do it and as many hikes in a week as I can fit when the season to hike approaches.

       You'd be surprised how much of an impact proper, basic strength training will have on every single aspect of your athleticism if you give it a chance. Clearly, there is more than one way to train. I'm all for individualizing programming to meet specific needs and I'm all for doing the corrective work and special training that carries over to your athletic endeavors. But I often ask people to look critically at their training and ask what the purpose and result of every lift they do is. If you can't identify a purpose, and the movement doesn't result in a measurable performance or rehabilitative improvement then why are you doing it? Isn't it a waste of time? Many times, athletes are shocked to learn that a large portion of their training falls into the category of lifts without clear purpose or effect. If this describes you, consider going back to basics. It's okay not to be fancy, especially if it allows you to finally train as hard as you always should have been.
     

Testosterone and Your Heart

       Testosterone receives much more than its fair share of bad press. A few seconds on a search engine reveals it will shrink your penis, make you permanently sterile, cause multiple forms of cancer, destroy your heart, weaken your connective tissues, and make you go insane. But what does the data say? If you've looked, you'll know that testosterone has classically been considered a major cardiac risk but that attitudes are changing as we learn more about the pathologies of various cardiac issues and diseases.

       Recently, the media is piling on accusations of extreme cardiac risk associated with testosterone following the publication of a recent study and article. It's too bad for these sensationalists that the study was one of the worst designed ever and was roundly dismissed by most authorities. I won't link it here, but you can find it easily if you want it. Instead, lets look at studies designed to look at the issue in more detail.
    
       Fair warning: This post, in its entirety, is going to be a thick read. Skip it or skim it if you have not yet delved into the murky world of PED research. It's essentially a collection of hard data that I've been working through for a research project for my work. I'm not going to go into heavy detail on most since the papers themselves are satisfactory to explain the data. For the more research-minded among you I strongly urge at least a cursory skimming of the provided literature to get up to date on the current understanding of risk. For those of you just looking for broad summaries and interpretation, stick to the synopsis sections.

http://cardiovascres.oxfordjournals.org/content/57/2/370.short

Not much more to say here: "We found no evidence for cardiac toxicity of T administration despite a 10-fold increase in T levels after testosterone undecanoate administration compared to placebo administration. Neither infarct size nor procedure-related mortality was influenced by T status. In contrast, there was a tendency to an improved hemodynamic outcome..."

http://www.ncbi.nlm.nih.gov/pubmed/12800107

Visceral Abdominal Fat is a major risk factor for myocardial infarction, linking and perhaps superceding other risk factors and "linking" them for a larger effect. Estradiol is emerging as a major risk factor for myocardial infarction in men as well. This study concluded: "(1) VAT in men may largely explain the correlations of sex hormones, insulin, and obesity with the risk factors for MI measured, (2) VAT may be the principal factor in men, independently of other measures of adiposity, that links risk factors for MI to form the constellation, and (3) estradiol may play a more important role in the sex hormone-insulin relationship in men than has generally been considered."

http://circ.ahajournals.org/content/102/16/1906.short


Again, pretty clear: "Low-dose supplemental testosterone treatment in men with chronic stable angina reduces exercise-induced myocardial ischemia."


http://www.pnas.org/content/74/4/1729.short


Glucose metabolism dysfunction and estrogen elevations continue to be seen as primary cardiac risk factors. "The hypothesis is presented (i) that in men who have had a myocardial infarction, an abnormality in glucose tolerance and insulin response and elevation in serum cholesterol and triglyceride concentrations are all part of the same defect (glucose-insulin-lipid defect), (ii) that this glucose-insulin-lipid defect when glucose intolerance is present is the "mild diabetes" commonly associated with myocardial infarction but is based on a mechanism different from that of classical diabetes, (iii) that this glucose-insulin-lipid defect is secondary to an elevation in E/T, and (iv) that an alteration in the sex hormone milieu is the major predisposing factor for myocardial infarction."


http://www.ncbi.nlm.nih.gov/pubmed/3573299


http://www.sciencedirect.com/science/article/pii/S0140673676929688


Both of the two links above show estrogen elevations, with the second of these two having this to say:


"These results suggest that the hyperœstrogenæmia preceded the myocardial infarction and that hyperœstrogenæmia may be an important risk factor for myocardial infarction in men."


http://archinte.jamanetwork.com/article.aspx?articleid=601660


More about estrogen as a risk factor.


http://circ.ahajournals.org/content/99/13/1666.short


Reduction in exercise-induced ischemia with supplemental testosterone.


http://circ.ahajournals.org/content/100/16/1690.short


Testosterone induces coronary dilation and is shown to improve bloodflow in men with coronary artery disease.


http://cardiovascres.oxfordjournals.org/content/57/2/370.short


Reduced stress on the cardiac wall with testosterone doses sufficient to cause anabolism in diseased populations.


http://atvb.ahajournals.org/content/14/5/701.short


Low T hypothesized to be a risk factor for coronary atherosclerosis.


http://biomedgerontology.oxfordjournals.org/content/60/11/1451.short


Notable for it's conclusion that T did not significantly affect likelihood of cardiac events.


http://journals.lww.com/co-endocrinology/Abstract/2010/06000/Testosterone_and_heart_failure.14.asp


"Anabolic deficiency is a major component of the CHF syndrome and testosterone replacement therapy has been subject to recent trials."


There can never be enough research. We need much more to assemble a proper understanding of testosterone and associated cardiac risk. But here is a summary of what we know about it:


1. Obesity and metabolic syndrome are considered over-arching risk factors.


2. Elevated estrogen levels are beginning to be seen as primary instigators of cardiac issues in men, despite physiologic doses exerting positive effects.


3.Testosterone is being studied for its potential therapeutic uses in cardiac patients.


        There is and should be concern for health if you use PED's. These drugs carry risk and that should not be ignored. But when we look at the data, it’s easy to see that much of the fear mongering about testosterone and cardiac risk is just that. While some studies do highlight risk, it’s important to note that methodology and design alters the appearance of the data in many cases. The pieces above, and many more, support the idea that testosterone is not as dangerous to cardiac tissues, in most cases, as is often claimed. In fact, lifestyle factors such as metabolic syndrome and other hormones, estrogen and insulin chief among them, carry much more risk and affect cardiac tissue much more negatively. Until a full picture is assembled, continue to focus e on staying healthy via exercise and diet to maintain cardiac health, and be aware of how estrogen levels might affect your heart. It appears at this point that cardiac risk from testosterone has been overstated. The American Heart Association says TRT improves quality of life and carries minimal cardiac risk. Enough said.

Basic Shoulder Rehabilitation

       The stabilizers of the shoulder are the mid-level executives of the strength training world. With reasonable oversight and training they do their job well, but they are utterly hopeless when the boss (the larger shoulder structures and ultimately, you) does something stupid that renders their efforts useless or, at the very least, diminished. Just as with the mid-level executives in the corporate world, when the boss wants someone to demean for failure, the shoulder stabilizers bear an inordinately large share of the blame. It is common to see an athlete assuming every single issue with the shoulders stems from the much-discussed  but little-understood rotator cuff, or some specific muscular imbalance which must be corrected painstakingly with some ghetto-ized version of a physical therapy modality they saw on YouTube. This is even more prevalent in the well-educated, who often overthink any ache or pain they experience and skip the simple interventions to go right to band distracted PNF with pressure-augmented reflex modulation, or some such tool that sounds equally fancy but likely isn't warranted.

       In this post, I want to discuss simple interventions for misbehaving shoulders. If you are spending 30 minutes on rehab work and special warm-ups you are either too hurt to train or, more likely, you are just using the splatter approach - throwing everything you can think of at it in hopes something will work. But it need not be that complicated and with a little attention to detail you can prevent issues while fixing the ones you have.

       The first thing we need to get out of the way here is proper mechanics while lifting. If your form is atrocious you don't need rehab. You need to learn how to move. This must be the first step when dealing with shoulder problems: ensure you are moving correctly, with proper posture. Fixing your bullshit form will fix 90% (just a guesstimate to represent how staggering the number is) of the problems you face with the shoulder.

       Secondly, once proficiency is established, consideration needs to be made for muscular balance. All of your time spent pressing with no pulling will inevitably lead you to pain and problems. This again is not a rehab issue. You simply need to train correctly. Of the minority of issues not related to mechanics during movement, the majority are due to simple imbalances. Complicated variations of movements and dedicated rehab work is a waste of time here. Fix your structure by allocating training efforts.

       If neither of these is the issue, you are one out of a hundred, or maybe less.Once we have extablished a true stabilizing issue in the shoulder girdle we need to set out to find what the problem is. And here it gets tricky. Most likely, you cannot do this on your own, even if you are trained to do so. You need an outside view from a qualified diagnostician. The 18 year old PT at the gym is not one of these, and neither is the guy who slings test in the locker room or that really hot Zumba instructor. Seek out a physiologist or coach who specializes in rehab, an athletic trainer, a sports medicine physician, or a manual therapist of some sort (NMT, DPT, DC, ART). Once the problem is identified a specific rehabilitative approach will be recommended to address the specific issues you have.

       Many athletes of a more advanced sort, who have their training nailed down and their movements perfected, are looking for a basic set of movements to do as an adjunct to ensure weakness or movement restriction does not develop in the stabilizers. These include the rotator cuff (supraspinatus, infraspinatus, subscapularis, and teres minor) as well as other muscles acting on the shoulder girdle, depending on the movement in question. This article, while being a little on the academic side and thus boring as hell, provides a good synopsis of the basic movements we use to affect stability in the absence of special situations. These should be done when instability has been noted and the issue is not being solved by regular training, but may not be appropriate if you are injured.

       http://www.pitt.edu/~neurolab/publications/1992-1996/BorsaPA_1994_JSportRehab_Functional%20assessment%20and%20rehabilitation%20of%20shoulder%20proprioception%20for%20glenohumeral%20instability.pdf

       It's worth noting though, that in most cases, going as far as all that is simply time taken away from more important aspects of training. The following is the basic preventive toolbox I use to manage and prevent shoulder issues. It addresses joint position and mechanics, imbalances, and stability deficits while taking literally minutes.

       1. Muscle Snatches: These force stabilization of the shoulder girdle in myriad ways, in both dynamic and static positions; recruit the rotators, traps, and thoracic muscles involved in shoulder mechanics; and force activation of high threshold motor units that are often missed in traditional rehab movements.
     
       2. Face pulls. Superior to pull-aparts in my opinion, face pulls involve horizontal abduction of the shoulder, depression and rotation of the scapula, and external rotation of the humerus. EMG data even indicates it is a sufficient stimulus to cause a training effect in the medial deltoid.

       3. Pushups: These can be added as a warm-up drill or used as a stand-alone. The light load allows focus on shoulder position and mechanics and testing multiple positions can help identify issues. This link includes some more detail and offers examples of modifications. http://articles.elitefts.com/training-articles/what-you-don%E2%80%99t-know-about-the-push-up/

       That's it. I use these drills regularly, sometimes as a separate session and sometimes added into existing programming, as a basic way to ensure proper function, stability, and mechanics. If you are looking for a preventive strategy, this is simple and quick, and if you are looking to start rehabbing, this will allow you to make some corrections to the issues on your own. As always, evaluate the need, match the training stress to the need, and modify as needed based on result. Don't over-complicate, don't over-work, and don't look so intently at the details you forget the big picture. With proper training, you will not need real rehab in your training. Now that you aren't wasting time with a  bunch of irrelevant corrective work picked arbitrarily, you have more time to put weight over head, so do it.