CategoriesMotivational Rehab/Prehab

Don’t Let That Injury Derail You

Today’s guest post comes from a former distance coaching of mine, Australian strength coach Shannan Maciejewski. Shannan started working with me when he was coming of a pretty serious ankle injury, and he hired me to help him sift through the program design process as he worked his way back to playing competitive rugby.

As a funny aside, speaking of contact sports, I had a very brief history playing football back in the day.  I tried out for the football team in 7th grade and lasted a week.

After getting crushed for five straight days I handed in my helmet and pads and decided I’d rather collect baseball cards and play wiffleball in my backyard.

Nonetheless, Shannan offered to write a guest post and thought the theme he came up with was spot on to a lot of what I write about on this site.  Which is:  yeah, you’re hurt.  But that doesn’t mean you still can’t train.  Learn to make lemonade out of lemons!

Enjoy!

It’s 3.45pm and you receive a call.

Client

“I am just calling to let you know that I got crunched at training last night and am only just able to walk. I am going to have to cancel todays session at 4”

A few things go through your head…

-Is this just a cop out?

-Hmmmm, it is lower body day? I’ll go to hell if he doesn’t deadlift.

Your response

“That’s ok mate, come on in I will tweak the session for you”.

Being able to adjust on the fly or even plan in and around injuries is an extremely important aspect of a coach’s job. Tony has brought it up before on here, and I am going to shed some further light into creating a positive training response while recovering or dealing with the mud that life throws at you.

As with the above example, to have the session off and do nothing would rarely be the best option.

Life is going to get in your way.

I don’t have much energy today, My car broke down, My knee hurts, My nose is snuffly, I am still sore from Monday, My Doctor said to rest, my mum said I’m special, I think I’m coming down with something, I finished work at 5.10 instead of 5, I think I slept on my arm weird, my neck hurts……………And it goes on..

I think we all can relate to something above, I know I can. Mainly the special one!

Each and every individual is unique in what they present, and that is how programming should be approached.

Now just so you know upfront, I am not a physical therapist or a physio and therefore do not treat pain. I work with other professionals to get the best outcome for everyone we have contact with. It is always best to understand what the actual injury is, or what the limitation is before you start tinkering with exercises. So if in doubt seek professional advice initially and build from there.

What I can do is shed some light on is how to incorporate smart training and programming while you feel all busted up and helpless or just in need of some immediate action points that you can incorporate to keep progressing and moving forward.

Quick Story of a client of mine.

-Debilitating and season ending low back injury from over arching and sharp movement of throwing a football.

(Not quite the same throw in, but amusing anyway)

There wasn’t much initially that didn’t hurt. Bending, leaning, twisting, running all aggravated and stopped him from playing.

12 months later he is 10kg heavier, broad jump and vertical jump has increased, deadlifting and squatting is completely pain free and now a dominant figure sitting smack bam in the mid field. Cutting, turning, jumping, sprinting is all fair game.

Below I will outline some tips for you not just in how I approached the above client, but how you can do so with yourself and your injury/mishap.

Because, as Tony always says, you can ALWAYS train around an injury.  Always

Whatever you do it must be pain free

I think this goes without saying, but it does warrant a mention. I have heard it time and time again, and I will also say it.

IF IT HURTS, DON’T DO IT…

It does not matter if it is the number 1 exercise that your specialist or favourite guru said you should be doing. If it causes you pain or discomfort, stop it….Now!

There is always an alternative.

It won’t put you right off track if you need to sub in some Barbell hip bridges instead of your beloved deadlifts. If it means pain free, and creates a positive effect, well I am all for it.

For example do lunges hurt your knee? First off: try doing them properly. That’s a novel idea, right?

A lot of the time this alleviates some issues. I won’t go into correct form in this post, but it’s safe to say that there is a ton of info on this site that you can go back through.

Note from TG:  In fact, you can always perfect your RDL….(hint, hint).

If that’s still no good, go through a pain free range. Or as an example try these Low Co-Contraction Lunges with Anterior Pull. These allow you to feel more controlled and keep more of a vertical tibia therefore performing the exercise more effectively.

Start Point: With your right hand on Vastus Medialis (teardrop shaped muscle) and left hand on your glute and your right butt cheek squeezed hard, lift yourself off the ground a few cm.

Mid Point-End Point: Raise up stopping shy of lock out. This will keep tension throughout and reduce the range. Be prepared for the burns, and an intense stretch through your trail leg. This is fantastic to engrain 90/90 position and give instant feedback on what muscles should be working.

The point is even if it’s a magic exercise, it’s not magic for you if it hurts or aggravates an issue.

Focus on what can do, rather then what you can’t

This piggy backs on the above, but it definitely is worth mentioning.

Accept that you may not be able to perform your heavy squatting pattern for the time being, and focus on what movement you can do to create a training effect.

This is exactly the process that I went through when I broke my fibula and dislocated my ankle being tackled. Write down a list of movements that can be done pain free, and focus on these.

Can’t squat/deadlift/lunge due to injured/stiff/recovering ankle: Maybe it’s a time to hammer on your glutes and hamstrings through various supine based exercises. Lean on the cautious side and build up.

I recently just had a client who outstretched to catch a ball and his ankle blew up to balloon status. We had sumo deadlifts programmed, but ended up starting out with plenty of upper body as well as quadruped glute work, glute bridges, single leg glute work, strap leg curls and went up from there.

After a few weeks we worked up to barbell glute bridges, and now as ankle mobility has nearly been regained I am confident, as he is to slowly incorporate some standing work.

Here he is with some warm up sets on the BB glute bridge.

Try incorporating some DB pressing variations and a lot of pushup progressions, while hammering and bringing up your back strength. There is hyuuuggeee variety to use.

For example we have successfully regressed back to single arm fat grip floor presses with a neutral grip (mouthful I know) pain free. This still lends itself to some heavy lifting, while respecting the body.

Pushup variations allowing the scapula to freely move are an integral part of a complete program as well. You won’t die if some extra pushups are programmed. You may actually feel better.

It never hurts to incorporate more back/upper back work into the mix all year round too. A 2:1, sometimes a 3:1 ratio of pulling to pushing can help regain some normality in your posture and any strength deficits you may have.

Some pressing variations that tend to give the shoulders a bit more room to breathe and be a bit more joint friendly are DB floor pressing variations, Tucked neutral grip pressing exercises, ½ kneeling cable/band presses, standing split stance cable/band presses, ½ or tall kneeling corner presses. There’s more this just gets you to think outside the norm.

This variation is great as the resistance is low on the shoulder, and it is an angled press. So therefore we get a fatter grip, neutral hand position and varying resistance all while the glute is on and we get a bit of anti-extension throughout. Perfecto!

Don’t forget the other limb

There are times when being couch or bed ridden is unavoidable. Although when you are able to be up and moving around, there is then also the chance to begin to start the process in moving forward.

When we injure ourselves, or something doesn’t go quite as planned we can feel quite defeated and mentally drained.

With my ankle injury I wasn’t going to let both my legs turn to jelly and lose everything I had gained. Having 3 surgerys over a 12 month period I needed some avenues to keep me mentally and physically on top of things.

The results of the carry over were positive. Training the other limb has a slight carry over in strength and muscle control.

Choose exercises you can do, and do so with a slowly progressing volume. Most exercises can be done single side loaded or off set loaded.

On a note on stretching here is a hip flexor stretch I had to use when I couldn’t put pressure on my left foot. It worked a treat, and I used it frequently.

(All the pressure is taken off the front foot).

 

Hit the other half of your body hard

If you are someone who trains 4-6 times per week and can’t bare the thought of missing scheduled training sessions, then don’t.

What we can forget is that although we are injured, and recovery is number one at times, we still have 80-90% of our body to train. That’s a big chunk to me. Don’t let 10-20%  get you right off track with everything.

Get your meathead on and add in a varying upper body session. Alter the rep ranges, and go for it. Maybe even add some arms in there. I won’t judge.

If it’s your upper body, add in a lower body conditioning session, or some extra lower bodyweight exercises.

If your ankle/knee is playing up and you can’t join in team training sessions, try incorporating some battle rope conditioning sessions to jack the heart rate, and minimise joint stress.

Try these battle rope variations to keep it interesting and challenging. Not all will be able to used if you can’t walk forward or backwards but you get the idea.

Check List to kick A#*when injured and recovering

I wanted to provide you with a list to go over and sift through, and take note of what you are doing/can do/and will do to make the transition from where you currently are, to where you want to be.

– When in doubt, seek professional advice and determine your injury/restriction

– Focus on what you can do, what you can’t is not important and irrelevant

-List movements you can do pain free. Think in terms of horizontal push/pull, vertical push/pull, squat, hinge, isolation.

-What would you like to achieve in the next 2,4,8,24,52 weeks that you may be recovering etc

-Do you have any weaknesses/imbalances that you can work on and bring up?

-How many days per week do you want to train/ or can train?

-Do you have some opposite limb exercises to perform to carry over to the injured side?

-Omit the days of your current program that you can’t do, or tweak the exercises so you can do them

-Add in some pain free conditioning/metabolic methods to utilise if this is what is needed

-Surround yourself with positive people, and a powerful network that can help you when necessary

-Remain positive and know that this is short term and you can get back to your normal regime when it’s time.

Being injured and recovering takes a new skill set and different approach to training and lifestyle. Some small tweaks to your current plan, and you can remain on track, keep some normality and sanity and in general feel good that you are doing something to benefit not hinder the process.

If you have any questions, pop them below.

About the Author

Shannan Maciejewski is a strength coach from Australia and the founder of Raw Fitness and Sports Training located in Ballina NSW.

He has a strong passion for developing on and off field performance for football(soccer)players, and his no-nonsense approach and methods  produce long lasting results for many regular joes, individuals, athletes, and teams he works alongside.

He does not share the same passion for Star Wars as Tony though. Sorry!

Be sure to follow him on:

Website www.shannanmaciejewski.com

Facebook www.facebook.com/shannanmaciejewski

Football Specific Page www.facebook.com/footballperformancesystem

 

 

CategoriesMiscellaneous Miscellany

Miscellaneous Miscellany Monday: “GentilSet” or “SomerCore” Workshop?

1. I’ve got some exciting news to report.  No, Matt Damon isn’t reprising his role as Jason Bourne. No, a group of Victoria Secret models haven’t moved into the vacant apartment upstairs.  And no, unfortunately, Justin Bieber hasn’t fallen into a live volcano.

While all of those things would be pretty awesome, what I have to share today could very well tear a hole into the space-time continuum and alter all of human existence.

Slight exaggerations aside, Dean Somerset and I are tentatively planning an East coast/kinda Northwesternish (like way up north, like where it’s only warm like twelve days out of the year north) coast two-day workshop later this summer and fall.

We’re shooting for a two-day workshop here in Boston later this summer (and again, up in Edmonton, Alberta in the fall) where we’ll target personal trainers, coaches, and fitness enthusiasts and open up Pandora’s Box to discussing everything from assessment to corrective exercise to program design. But more importantly our goal is to make this a very hands-on (non-creepy) workshop where we have minimal lecture and place more of a premium on coaching!

In Dean’s words:  “We want people who attend to leave knowing about what we discussed, not just intellectually, but how to put it into action immediately when they return, and with enough competence to not have to refer back to notes while doing so.”

Like I said, we’re still in the initial planning stages but we’re excited as shit.  Read:  pretty excited.  I mean, Dean can’t contain himself!

That said, I’d still love for people to sound 0ff on this and let us know if there’s enough interest?

Due to space we’re going to keep this pretty exclusive and limit it to like 30-35 people.  Some candles, a little Sade playing in the background, some Femoral Acetabular Impingement talk.  Who knows where it will go…..;o)

Seriously though, who’s in?

More details to follow soon.

2.  Some other cool news.  For only the second time since its release, Eric Cressey is placing his flagship program, Show and Go: High Performance Training to Look, Feel, and Move Better on sale all this week until THIS Saturday (May 20th) at midnight.

Not that I need to sing its praises or anything, but the program is the bees knees.

I’ve seen with my own eyes countless people transform their bodies and make progress in the gym they never thought possible.  So if you’re still one of the few who have balked at trying it out for yourself, at 48% off the normal price you really have no excuse not give it a whirl.

3. As someone who routinely trumpets the message that women should can the Zumba classes and lift heav(ier) things, I’m always trying to relay top-notch, informative, POSITIVE material to the masses to help convey that same tone.

HERE is a fantastic blog post by Dave Hedges on why there’s really no such thing as a “women specific program.”

Fantastic job Dave!

4. And since I recognize that a fair share of women visit this site on a regular basis, here’s a litte Ryan Gosling for you.

I don’t know about you, but that video cracked me up!

5. And finally, keep your eyes peeled for a future TG original piece on BodyBuilding.com. The higher ups reached out to me last week asking if I’d be interested in contributing some content on a monthly basis, and I jumped at the opportunity.

Of course, my one prerequisite was that I’d be able to discuss the importance of getting stronger and that I wasn’t going to write about pec blasting, bicep pulverizing, or any other broscience shenanigans.

To that end, I just submitted my first article to them last night titled Top 3 Squat Mistakes.

Mistake #1:  What You Think is Proper Depth, Ain’t Even Close…….;o)

CategoriesRehab/Prehab Strength Training

Deadlift Cueing and Fixes

A few weeks ago I received an email from a DPT student in central Florida detailing a research project that he’s doing alongside a fellow student (as well as with one of the faculty at his school) looking at ways to use the deadlift pattern to treat patients with low back pain in a therapy setting.

He asked if I’d be willing to provide some common cues I use given certain “issues” people have when trying to deadlift which would aid in correcting their technique.

[Places finger over said student’s mouth]

Shhhhhhhh, you had me at deadlift.

What follows below is a candid/informal list I sent back highlighting my thoughts on more of the cueing side of things rather than the actual “correctives” (Ie: mobility drills, soft tissue restriction, chewing with your mouth closed, etc).

At the very least I figured it was something that could potentially help out others who may be looking to clean up their own technique.

And if it doesn’t, my bad.  I tried.

Lumbar Kyphosis

Depending on one’s kinesthetic awareness, this one can be tricky.  For those completely unaware of what their body is doing in space I’ll most likely take a more “hands-on,” non-Creepy McCreepypants approach – akin to what I call Play-Doh coaching.

Lets just say I’ve seen some trainers and coaches get a little too hands-on, if you’re catching my drift.

More often than one would think, you’re going to tell someone to “arch their back,” and then they’re going to look back at

you as if you’re speaking Klingon or have an extra nipple or something.  Not that you’d be showing off your nipples or anything, hence the whole creepy comment above, but I’m just trying to make a point.

They’ll literally have no idea or differentiation between lumbar flexion and what it means to arch their back.

One trick I like to use is to place them on the floor in the quadruped position and have them perform the cat-camel.  I’ll have them round their back as much as possible and tell them that’s what I DO NOT want.

Sometimes, depending on the severity, I’ll place my hands on my head, scream as loud as I can “no no no no no no NO!” and then jump through a pane glass window.

You know, for a little more effect. That’ll get their attention…..;o)

Back in reality, though, I’ll then have them bring their spine back to neutral and tell them that’s what I’m looking for.  I’ll have them perform a few rounds of this just so that they’ll get a feel for what I want and who I’ll want them to set up to deadlift.

It’s pretty effective, and will work for most trainees.

Another one I’ll use is to tell them to emulate what a basketball player does on the court when he’s tired (bends over and places his hands on his knees). Almost always, they’ll drop right into a neutral spine position and then I’ll be like, “there!”  Now, keep that same spinal position and grab the bar.

Another thing to consider is just using a deadlift variation which allows them to be successful. I’ve long championed that what makes the deadlift so awesome is that it can be so easily catered to the lifter, and not vice versa.

This is a huge reason why I love the trap (hex) bar so much, as it lends itself to be a bit more user friendly compared to other deadlift variations.  This is especially true for those who lack ample ankle, hip, and t-spine mobility to get into proper position in the first place.

With the elevated handles (and the fact that their center of gravity is inside the bar), the trap lends itself very appropriately to beginners or those with postural limitations.

Anterior Weight Shift

The main culprit here is people wearing those cement blocks that they call shoes.  Many have a significant heel lift which shifts the body anteriorly and makes it much harder to engage the posterior chain (glutes and hamstrings).

In addition, wearing shoes also increases the distance the bar has to travel, so it bodes in one’s favor to just ditch them altogether.

If for some reason they train at a gym that sucks and won’t let them deadift barefoot, I’d highly recommend things like Chuck Taylor’s or the New Balance Minimus (which, as the name implies, is more of a “minimalist shoe).

Outside of that, much of the resolution here is engaging a proper hip hinge pattern.

Having the ability to break with the hips and engage a hip hinge pattern – without losing spinal position – is HUGE in this context.

My go-to drill is hinging with the dowel rod.  We’re looking for three points of contact – back of the head, in between the shoulder blades, and the sacrum.

If at any point the dowel rod loses contact with the body, you’re doing it wrong.

I may have them perform a set of 8-10 reps with the dowel rod, and then immediately have them walk over to the bar and try to emulate that same motion. We need to CEMENT the pattern with strength training.

Along those same lines, another drill I use sporadically is where I tell them to pretend I have a rope tied around their waist and that I’m standing behind them and when they start their descent to imagine that I’m pulling their hips back with the rope.

It sounds weird and far too simple – but it works.

Limited Dorsifexion

This is an often overlooked limitation, as you need roughly 15-20 degrees of ankle dorsiflexion in order to perform a squat, lunge, and deadlift pattern without any major compensation up the kinetic chain.

Your garden variety ankle mobility drills are going to work wonders here.

Knee Break Ankle Mobs:

Wall Ankle Mobs:

Band Hip IR/ER with Ankle Mob (kill two birds with one stone here):


Some other things to consider, however:

1.  We live in PLANTAR flexion. Think about all the women who wear high-heels day in and day out, not to mention the aforementioned “cement shoes” that a lot guys opt to wear.  I love high-heels as much as the next guy (looking at them, not wearing them.  Just wanted to clarify).

Oh……my……..god…..I love them so much…

…..but I can’t even begin to describe how much of a train wreck they are in terms of the compensation patterns they elicit. Everything from chronic low back pain to plantar fasciitis to bone spurs.

It’s pretty telling how much they mess women up, and I’m often advocating for most, when they can, to ditch the high heels in light of wearing a flatter shoe.

Likewise, for dudes, purchasing a more minimalist shoe will work wonders in the long run.

2.  Dedicated stretches for the gastrocs and soleus muscles are going to be imperative here as well.  Standing around in plantar flexion all day is going to light these muscles up, so taking some time to do some simple stretches would be advantageous.

3. On that same note, I’m willing to bet that most even sleep in plantar flexion!  It sounds excessive, but even something like utilizing a Strassburg Sock – which encourages more DORSIflexion while you sleep – pays huge dividends in the grand scheme of things.

As an aside, I’d also gravitate more towards trap bar and sumo variations for those with limited ankle dorsiflexion and those will be less problematic postions to get into.

Limited Glute Activation/Weakness

This one is pretty easy. I’ll often defer to my good friend, the glute-master himself, Bret Contreras and place a premium on glute activation drills prior to training whether it’s supine bridge variations, single-leg variations, etc.

In my mind, glute activation drills is something that most people can’t get enough of so I have no qualms telling people to do them every day, several times throughout the day.

The key, of course, is to ensure that they’re doing them correctly.  Again, proper coaching comes into play here.

Moreover, in the context of deadlift technique, you have to be cognizant of a few things as you’ll inevitably come across two common errors.

1.  Incomplete or no hip extension what-so-ever.

Note:  for some reason I didn’t have a video available for the DL, but Eric does a good job of showing incomplete hip extension with this squat variation.

2. Excessive HYPERextension (essentially using lumbar hyperextension for hip extension)

In both cases proper cueing is going to be paramount.

For the former I’ll typically tell them to “finish with glutes” or “hump the bar,” which usually gets the job done.  Also, depending my rapport with the client, I’ll literally place my hands around their pelvis and try to encourage more posterior pelvic tilt.  Too, I may gently tap their glutes to help them fire.

In the case of the latter it’s a bit trickier, but I like to tell them to “finish tall,” and again, depending on the rapport, I’ll place my hands around their pelvis to help them but on the brakes (and prevent them from going into too much hyperextension).

Thoracic Kyphosis (keep in mind we’re just using the movement to influence lumbosacral movement, not trying to lift maximal weight)

Honestly, the dowel rod drill from above is going to be great here.  As well, I’ll cue guys to make sure they stick their chest out upon the initial set-up which will encourage a bit more t-spine extension

I pretty much shot from the hip on all of these, but hopefully they all made some sense and help a few people out.

Seriously though, I love high heels.

CategoriesNutrition

5 Reasons to Join a CSA

I don’t go out of my way to write a lot about nutrition on this site for a few reasons.  For starters it’s a highly debated topic with so many varying opinions and foods for thought (Ha!  Pun intended), that I just assume avoid any confrontation with the Paleo Bullies for having the gall to tell someone that it’s okay to have a scoop of ice-cream every now and then.

And for the record:  while I definitely lean more towards a “Paleo(ish)” style of eating, I also recognize that Gronk and his kin weren’t crushing broccoli and asparagus back in the day.

So back off Paleo peeps!

Secondly, I have a lot of very smart friends in this industry that I can defer people to if needed. As soon as someone reaches out to me and starts busting out verbiage like Glut-4 receptors, gluconeogenesis, or any number of similar big words, I point them in the direction of people like Brian St. Pierre, Dr. Cassandra Forsythe, Dr. Mike Roussell, Dr. John Berardi, Alan Aragon, and Gandalf.

Because, you know, Gandalf knows everything.

But really I just like to keep things as simple as possible.  At the end of the day it generally comes down to a handful of things:

1. Helping people make better food choices.

2. Helping them get over some behavioral humps which block success.

I mean, it’s not rocket science that crushing a bag of chocolate covered pretzels right before bed isn’t the best choice and that it probably won’t help in one’s fat-loss endeavors. But people do it anyway despite knowing better.

Much of the time it’s about helping people set themselves up for success and come up with specific behavioral strategies that will keep then on task.

For example:  how about not having the bag of chocolate covered pretzels in the house in the first place?

Nonetheless, I don’t want to get too off-track because I actually do have something I want to bring to light today.

Lisa and I joined a CSA!!!!

This is something we’ve both discussed doing together for at least two years now (since we moved in together), but for some reason have been putting it off for whatever reasons.

Whether it was cost, too long of a waiting list, busy schedules, some Star Wars convention that got in the way, what have you, we made excuses.

Which is weird because we’re both very health conscious, and go out of our way to buy a metric shit-ton (ie:  a lot) of greens, organic this, gluten-free that every week when we do our grocery shopping.

Whenever we walk into Whole Foods and Lisa sees something she’s never seen before (OMG rutabaga is on sale Tony!!!!) her eyes immediately widen and she’s like Charlie in the Chocolate Factory, sans the creepy Oompa Loompas.

So a few weeks ago we decided to nip things in the bud and join our very first local CSA here in Massachusetts.

For those scratching their heads and wondering what the heck CSA stands for, it’s Community Supported Agriculture.

Essentially the nuts and bolts is this:  it’s a commitment between individuals or families and farmers, where people pay a lump sum into a farm as members at the start of the growing season, and in exchange receive a weekly “share” of the farm’s harvest.

What’s cool about the one Lisa and I joined is that it offers several different options like a vegetable share, egg share, flower share, and fruit share.

We opted for the vegetable share, but I wouldn’t be surprised if I try to snake some eggs and fruit into the mix on occasion.

Additionally, to sweeten the pot our CSA is one that delivers to area Whole Foods markets throughout Mass. and Boston. So all we have to do is show up between “x” hours on a specific day at our local Whole Foods parking lot (which is less than a mile away from our apartment) and pick up our basket of locally grown, fresh, organic, veggies.

So with that I figured I’d give what I feel are the top FIVE reasons to join a CSA.

1.  You Support Local Agriculture

More to the point, you KNOW where you’re food is coming from. While I understand people have great intentions when buying organic at their local supermarket, does it really make any difference if the food is being shipped from half-way across the world in order to make it to your dinner plate?

When you support local agriculture, you’re supporting your LOCAL economy and ensuring that your local farms will prosper and continue to produce delicious, nutrient-dense foods in the long-term.

And this doesn’t even take into consideration the substantial reduction in the carbon footprint when you purchase locally.

2. More Nutrient Dense

How “nutritious” is that head of kale or romaine by the time it’s shipped from 2,000 miles away to your market? This isn’t to say that you’re still not going to get a bevy of nutrients, but I’d garner a guess that buying more local produce is a heckuva lot more nutritious in the long run.

3. It Tastes Better

I think this one goes without saying. Once you’ve biten into a locally grown apple fresh off the tree, you’ll understand that those apples you’ve been eating from Whereeverthef*** taste like sandpaper dipped in lice poop.

4.  You’ll Eat More Seasonal Produce

We’ve grown accustomed to having the opportunity to eat what we want, when we want, all year round. While this is great – hey, I want my bananas year round too – it pigeon holes us into not venturing out and trying new things.

Joining a CSA forces you to try more seasonal foods, and opens up your “foodie” repertoire.

You’ll just die when you try your first roasted parsnip.

5.  It’s Cheaper!?

I know some may balk at the price-tag of some CSAs – and admittedly, some are pretty expensive.  But I’d venture a guess that most will end up saving money in the long run.

It’s not uncommon for Lisa and I to spend roughly $50 per week on produce alone between Whole Foods and Trader Joe’s. Take a peek into your grocery cart and you’d think we were feeding an army of rabbits.

The CSA we joined has 24 total distributions starting in early June running all the way through early December, which is going to significantly reduce our weekly grocery bill.

Holla!

Those are just a handful of course, and certainly don’t represent all the benefits of joining a CSA. I also heard through the grapevine that joining one increases t-levels by like 47%.  Give you take.*

Either way, I’d love to hear everyone else sound off. Do you have your own CSA story to share?  Did you like it?  Hate it? Felt it was a waste of time or the best thing since sliced bread?

Please, share your comments below.

* = For the record: I completely made that up.  It’s more like 49%

CategoriesRehab/Prehab Strength Training

Why Shoulder Injury Prevention Programs Are Failing

I recently had the opportunity to write an article for Stack Magazine, which is an online resource for high-school athletes and coaches.

When I was originally contacted and asked if I’d be interested I wasn’t really sure what I wanted to write about.  Then it hit me:  Um, dude – you work with a crap ton of baseball players, why not start there?

Seemed like a logical course to take, and that’s exactly what I did.

Now understandably, not everyone who reads this site is interested in throwing a baseball 90 MPH and could probably care less about “arm care.”

Besides chicks dig the long ball, right?

But I’d venture a guess that even though this article is geared towards baseball players, there are some universal nuggets dealing with shoulder health that has a lot of applicability towards the general population as well – especially with regards to the “true” function of the rotator cuff (and how to train it) and how the anterior core enters the equation.

That said, I want to demonstrate to Stack Magazine that the TonyGentilcore.com entourage can reach P-Diddy levels.

I’d really love for everyone to check out the article, give any feedback (positive or negative; hopefully mostly positive), and if you feel so inclined, “Like” it and share it on Facebook and Twitter.

Snuggles!

==== > CLICK ME <====

 

CategoriesStuff to Read While You're Pretending to Work

Stuff to Read While You’re Pretending to Work: Movie Reviews, Truths About Squatting, and More

Before I get into today’s meat and potatoes I wanted to take the opportunity to suggest some new movies I think some of you will like.

As most of you who read this blog consistently understand, I’m a huge movie nerd.  I’d venture a guess that if I wasn’t a strength coach I’d probably try to figure out some way to become Kate Beckinsale’s cabana boy watch movies for a living.

Sort of like a more jacked version of Robert Ebert – except instead of something mundane like a star system or something trademarked like a thumbs-up/thumbs-down review (ALA Siskel & Ebert), I’d rank movies using a ” loaded” barbell system.

A barbell with no plates = god awful (Pain and Gain,The Hangover II, anything with the word Twilight in it).

From there, the more plates added onto the barbell dictates its level of badassery.

Ahhh, a guy can dream right?

Anyways, two movies I’ve watched recently that I felt were fairly decent and worthy of 3-4 plates were:

Killing Them Softly and A Place Beyond the Pines.

The former stars Brad Pitt as a hitman for hire and has some of the best cinematography I’ve seen in any film this year. Coincidentally, there was a movie that Pitt did a few years back with the same director called The Assassination of Jesse James by the Coward Robert Ford which I felt was another highly UNDERrated film that didn’t get much fanfare despite being nominated for two Oscars (Best Supporting Actor – Casey Affleck, and Achievement in Cinematography).

A fair warning: It’s more of a dialogue based movie and doesn’t really have a lot of shoot em-up scenes despite the title.  All I’ll add to that point is that I LOVE good dialogue and Pitt’s closing monologue is epic!

The latter movie – A Place Beyond the Pines – is one that Lisa and I have been meaning to see for a few weeks now.  I mean, it’s Ryan Gosling – the man can do no wrong after Drive.

We finally had the chance to go see it yesterday. This film teams Gosling with director Derek Cianfrance, who also directed Gosling (and Michelle Williams) in a Blue Valentine (arguably one of the most depressing yet unflinchingly real films on the heartache of relationships), and while I wanted to really, really like this film, I had to give it a solid B- because it’s so freaking long.

The acting was superb – kudos to Bradley Cooper by the way – but there were a few plot points I felt didn’t jive, and while I appreciated the storyline (the first act focuses on Gosling’s character, the second on Cooper’s, and the third on their two sons, I don’t want to give away the “twist”), I felt it was a teeny tiny bit far reaching.

Nonetheless, if you’re looking for two non-Iron Man 3 movies to watch relatively soon, maybe these will be up your alley?

Talking Shop: Video Interview with Tony Gentilcore – Harold Gibbons

I had the pleasure of sitting down for a Skype video interview with my pal Harold Gibbons last week where we discussed everything from why Yoda would make such an amazing strength coach to the fitness writing process. And lots of other stuff in between.

If you’re looking for an hour to kill while you’re sitting there at your desk hating life and think listening to my sultry voice would help pass the time, then I’d highly recommend slapping on a pair of headphones and give it a listen.

This was easily of the funnest interviews I’ve ever done.

And look!  There’s a dragon in the background. Sweet!……;o)

Too Jacked to Olympic Lift: OLY Lifting Mobility – Wil Fleming

I’m about as adept at olympic lifting as I am at playing poker.  Which is to say, I’m god awful.  Speaking truthfully I don’t have a lot of experience with the OLY lifts which is why I generally steer clear of them and point people in the direction of guys like Wil whenever someone is interested in dabbling a little bit.

Even if OLY lifting isn’t your bag this was a fantastic post which digs into some common mobility restrictions.  Check out the t-spine drill!

On an aside, for those who are interesting in OLY lifting, I’d highly recommend Wil’s Complete Olympic Lifting DVD.

6 Truths About Squats – Lee Boyce

My internet high-five of the week goes to Lee for writing this excellent piece on some of the common misconceptions when it comes to squatting.

CategoriesCorrective Exercise Rehab/Prehab

The Truth About a Healthy Spine – Part II

Here is Part Two of Dr. Michael Stare’s guest post on spinal health from yesterday.

Enjoy the weekend!

In part one I focused on discussing the debate about bracing or hollowing the spine for optimal stability, and revealed evidence suggesting that focusing on just on muscle is a flawed method of improving stability and treating low back pain.Rather, I suggested that the focus should be geared towards improving position sense, or lumbopelvic proprioception.

Then I discussed why imagining has a very limited and potentially negative role in helping diagnose and treat low back pain.

In part 2 I’ll offer insights about whether spinal flexion and rotation is really bad for the back, then provide suggestions for preventing and treating low back pain.

Are spinal flexion and rotation bad or not – What gives?

This issue seems to confuse many, mostly because like most things it can’t be discussed in absolutes. Plenty have offered their opinions, but few of those opinions are from those who treat back conditions for a living.

So here’s my take:

Flexion and rotation of the spine is just fine. But when you do it repetitiously without breaks, with high speeds, and heavy loads or light loads held away from your body, or sustain these positions for long durations you are asking for trouble. Still, under these circumstances, healthy spines won’t have many problems.

Now this is the key point that I believe gets lost on most: very few people have healthy spines!!

The fact is, many of us have abused the bajeesus out of our spines. In this context, rotation and flexion become even more risky, especially under the conditions described above. Then, let’s consider the state that many people are in – acute pain. Under these circumstances, rotation and flexion are like chewing on a steak with an abscessed tooth.

Now there are some back issues (extension sensitive spondylolisthesis and stenosis) where flexion might be just fine, but for most with disc issues, the above statement applies.

Like most things, the appropriateness of flexion and rotation applies to context.

So the follow-up to this, then, is what about athletes or fitness folks with little to no low back pain that want to keep it that way? Should they avoid exercise that involves flexion and rotation?

The best way to answer that is: what are the benefits of these movements compared to the risks?

A simple way to look at this is to view the programming of those who treat high level athletes. Several have taken a cue from McGill and greatly reduced the amount of flexion and rotation based exercises in favor of anti-flexion and anti-rotation exercise, or emphasizing full body rotation (emphasizing the hip and thoracic spine versus lumbar spine). This approach has a strong biomechanical rational, considering the high failure rate lumbar tissues experience during flexion and rotational based motions, as well as data suggesting that many sports motions involve limited segmental rotation or flexion of the spine. It’s hard to argue the success with such an approach.

Just ask Tony and Eric about the mph they add on pitchers doing mostly heavy compound lifts.

Here’s some more interesting biomechanical data about the lumbar intervertebral disc as it relates to rotation. Studies show that the lumbar annular fibers can lengthen to about 4% of their resting length, after which point annular fibers tear. After these fibers fail, the next constraint to rotation is the facet joints.

And yes, as you can imagine, repeatedly smacking facets together can lead to joint damage and fracture, giving rise for spondylolysis and spondylolisthesis.  This maximal lengthening tolerance of the annular fibers occurs at about 3 degrees of segmental spinal rotation. Given 5 segments of the lumbar spine, we are looking at 15 degrees rotation total. That’s not much.

Accordingly, it seems to behoove us to focus on getting more motion from other areas best suited for rotation. Yes, that means hips and thoracic spine.

So, considering that most of us beat up our spine enough by sitting at computers and doing stupid things throughout our twenties rendering these tissues less capable of withstanding abuse, I’m going with the approach that minimizes flexion and rotation during training. Many herniated L5-S1 disc and other happy backs I treat agree.

Note from TG:  Granted the guy in the video isn’t in his 20s, but this is the kind of batshit craziness the good Doc is referring to (I think.  Well, I’m pretty sure it is.  Wait, what are we talking about again?):

So what should you do to prevent back issues?

Prevent is the buzz word, but I think what we really mean is reduce likelihood of back problems while being very active and doing what we want. If you really wanted to “prevent” back issues, don’t use a computer, play golf, row a boat, or have kids. With that out of the way, try the following:

1. Don’t sit without changing positions longer than 15 minutes. Don’t sit longer than 30 minutes without getting up. Don’t sit longer that 7 hrs total a day, including driving.

2. When lifting heavy things, focus on keeping the object close to you. Good spine position is important, but not helpful if the object is at a great perpendicular distance from your spine.

3. Don’t be in any position without moving every few minutes, especially if it is away from neutral spine.

4. Learn to distinguish the warning signs of back issues. Forget distinguishing muscle from joint issues. Few can do it. Nothing good happens after the back fatigues, so that counts. Don’t freak out, keep moving, but reduce intensity and frequency, and start thinking about what might have caused it. Find it and change it.

5. Learn to improve proprioception of your spine. You should be able to easily anteriorly and posteriorly tilt your spine from any position to find neutral spine. Start by practicing in easy positions, like hooklying, and palpate your spine to verify. Challenge it with arm and leg movement. Progress to quadruped and standing. People usually skip this part, especially those who are very strong but have chronic pain. It requires a skilled coach to help you develop and recognize better motor patterns. Here’s a video of me teaching a basic means of using pressure biofeedback to teach proprioception.

6. Have a qualified strength coach develop a conditioning program for you – there’s too much to give it justice in this article. Key points would be trunk endurance, producing power with the hips, learning how to pull with your scapula versus arms, avoiding stupid high risk stuff, etc.

What should you do to treat back issues?

I’m sure you appreciate that no good clinician will tell you in an article exactly what you need to do to fix your back. The process involves too much human interaction to articulate a comprehensive solution for your specific scenario. However, there are a few generalities that should help clinicians, coaches, athletes, and patients move towards an effective treatment solution.

Consider the 3 points below:

1. Of course the best option is to see someone who evaluates and treats backs for a living. As a PT I have to say that. I really do believe it, as it will save you a boat load of time and frustration.

And see one quickly.

I unfortunately get disaster cases that come far and wide after two or more failed episodes of “care”. Studies clearly show that the quicker you see a PT, the quicker you get better and the less health care dollars we spend (by the way, I’m sure good chiros would see the same – just reporting on what the research said).

The main reason you want to see a spine specialist for your back issue is to rule out red flag issues that require immediate non-conservative care (requiring a referral to a surgeon or PCP to address non-musculo skeletal causes of LBP).

This scenario is rare, but can prevent a serious problem from getting worse. The other major reason you want to see someone is so they can educate you about self management strategies before you inadvertently make things worse.

2. Spend a lot of time investigating why the pain is there. I tell patients and colleagues this all time during my seminars: the patient always has the answer.

It’s up to the clinician to help them reveal it. There are many parts of the history that are used to reveal the answer, but the following questions are vital for tricky cases when the pain gradually comes on overtime with no clear event. If you are seeking treatment, make sure you have answers to the following:

  • What makes your pain worse? Or put another way, if you were to receive $500 to bring on your pain, what would you do? When you get your answer, avoid this activity, think about other activities that involve similar motions and avoid those as well. As soon as symptoms calm down, then work to modify those activities. In cases when those activities can’t be avoided, immediately work on strategies to modify them.
  • What activities make your symptoms better? Again, this tells you a lot about what to do to treat your back. For example, if someone feels better laying on their back with their knees bent and feet resting on an ottoman, then I’m fairly certain deloading activities will help them. Check out my T-nation article from several years ago for some pics of some deloading exercises.
  • How has your life changed in the weeks prior to the onset of symptoms? Many times, changes in jobs, moving, weather (ie lots of shoveling, raking, or gardening) or less often changes in your workout, may serve as a catalyst for the onset of low back pain. This is vital to know, because it tells you that your treatment must eventually involve modifying these catalysts so the issue doesn’t resurface. Failing to do this is the reason why LBP so frequently reoccurs.

Remain as active as possible. Movement can help the diagnostic process, facilitate healing, prevent fear avoidance behaviors, keep you sane ( a big issue for fitness freaks like me and probably you as well who need to exercise), and has profound effects on the neurophysiology of pain. This can seem overwhelming or impossible, so yet again a great reason to have a good clinician/coach to help.

I hope you found this to expand your view of low back pain. I believe understanding the above issues with allow you to better prevent and treat low back problems while continuing to seek optimal performance. Feel free to let me know if you have any questions – I would love to help!

Author’s Bio

Dr. Stare is the Director and Co-owner of Spectrum Fitness Consulting, LLC, in Beverly, MA, where he trains clients of various fitness levels seeking weight loss, improved health, and performance enhancement. Mike received his BS in Kinesiology from the University of Illinois at Urbana-Champaign, his MS in Physical Therapy from Boston University, and his Doctorate of Physical Therapy from the Massachusetts General Hospital IHP. Mike is a Fellow of the American Academy of Orthopedic Manual Physical Therapists and also practices with Orthopaedics Plus in Beverly, MA as a Physical Therapist.

In addition to his clinical practice, Dr. Stare lectures nationally to fellow clinicians regarding the proper treatment and prevention of lumbar spine disorders and  fitness. He also provides seminars locally on weight loss, performance enhancement, and rehabilitation for young athletes to seniors. Dr. Stare has obtained the Certified Strength and Conditioning Specialist (CSCS) distinction, which is regarded as the gold standard certification in the fitness industry. Mike is also a Board Certified Nutritionist by the American College of Nutrition, and has been training clients for over 15 years. Mike resides in Windham, NH with his wife and three girls. To learn more about Spectrum Fitness Consulting, go to www.spectrumfit.net.

CategoriesCorrective Exercise Rehab/Prehab

The Truth About a Healthy Spine – Part I

Today’s guest post comes from physical therapist and strength coach Dr. Michael Stare.  Mike is wicked smart, wicked fit, and wicked good looking.  I hate him because I’m not him….;o)

I’ve known Mike since I moved here to the Boston area in 2006 and have corresponded with him intermittently in that same time frame.

I’m not going to lie:  This post may rub some people the wrong way, as Mike delves into the whole bracing vs. drawing in debate as well as burns some sacred cows with regards to the efficacy behind MRIs.

HINT:  they’re not as “helpful” as you would think.

Nonetheless, I think you’ll all enjoy this one for sure.

I love sharing and gathering information about health and fitness, so when a recent exchange with Tony lead to him suggesting I guest post about lumbar spine issues, I was thrilled to jump at the chance. And when given the license to get all nerdy and drop some geeky science because he says his readers are super smart (no surprise given who Tony is), well how the hell could I not get excited?

I’ve been very fortunate to obtain some great perspectives into treating and managing lumbar spine pathology from formal education, clinical experience, and personal experience as a patient. From that vantage point, I wanted to share some insights addressing some of the most controversial issues regarding spine health, and provide some suggestions about prevention and treatment. This should be should be very important information to you because:

1. As fitness fanatics you want to push the envelope of human performance, which often means walking a fine line between adaptation and injury,

2. 80% of the population will experience low back pain in their life, and 90% of first time episodes will reoccur. Translation: in all likelihood – you will experience a back injury so you best learn how to reduce your chances and manage it properly when it happens. And finally,

3. based on the above, in all likelihood someone you know and care about, or even advise, is dealing with back pain.

I’m not going to bore you with the oft regurgitated platitudes like “we need to stabilize more” or “this exercise is the root of all evil and will make your spine disintegrate” nor will I tell you that sitting up straight will cure every condition. Instead, I want to get at some hot button topics and provide some practical solutions rooted in evidence and real world results. Part 1 will deal with the debate on drawing in vs bracing and the usefulness of imaging for determining the cause and treatment of low back pain.

The bracing vs drawing in debate

Ever since the smarty pants Aussies in the late 90’s (Hodges, Richardson Spine 1996) released some great studies about motor control dysfunctions being common in those with spinal disorders, it seems like there has been more confusion about how we should train the torso to affect back issues. I think it’s like that game “telephone” you played when you were a kid. Each time the message gets passed on, it gets distorted so that by the end of the line, it rarely resembles what the original message was.

So let’s get to the original message:

These researchers had a hunch that motor control errors were occurring in those with low back pain. In particular, they believed those with LBP would not recruit their stabilizers properly in anticipation of a routine destabilizing event, like moving the limbs. So they tested this on subjects with and without low back pain. Subjects alternately lifted an arm and testers recorded patterns of truck muscle activation.

There was a subtle, yet consistent difference between those with LBP and those without. In the LBP folks, there was a delay in recruiting one muscle group by a milliseconds compared to those without LBP. This muscle group was the now famous transverse abdominus.

The conclusion: there appears to be a subtle delay in recruitment of the transverse abdominus in a subset of those with LBP versus those without LBP. Yet, as the message penetrated the ranks of PTs’ Chiros, Trainers, butts and cuts class leaders, yoga instructors and pilates folks, the message sounded a little more like this:

“The Transversus abdominus is the most important stabilizer, the transversus must be selectively activated to stabilize and improve motor control, and the best way to recruit the transversus and thus stabilize the spine is to perform a hallowing out maneuver.”

Sound familiar? Well, this isn’t really what the original research concluded. And research since hasn’t supported that the above is actually true.

For example, it has been determined that the drawing in or hallowing maneuver actually reduces spinal stability. This makes a lot of sense. Imagine the abdominal muscles are like a bunch of friends lifting a couch. Then you ask 3 of them to take a rest, leaving just one to do most of the work. As a result, you’d probably have a hurt friend or broken couch. Clearly, it’s best to have all the muscles recruited to stabilize in anticipation of movement or loading, which is what a bracing maneuver facilitates.

Remember, the research did not say that those with LBP are not recruiting the TA. Instead, it was just recruited slightly later – in a small subgroup of those with low back pain. Many studies since have shown that delayed activation of other key muscles, like the spinal erectors, the QL, and the latissimus have also been found in subjects with back pain. Training to brace in anticipation of instability in various positions would satisfy the anticipatory recruitment while also ensuring all muscles were involved.

So the preoccupation with the drawing in maneuver or transverse abdominus is not supported by the research and is missing the point in finding a solution for low back pain. Both Mc Gill and Hodges agree that the days of looking for one dysfunctional muscle for the low back solution is ill advised.

I think the best insights gleaned from this are that:

  1. LBP may be caused by, or the result of (chicken or the egg thing) anticipatory motor control impairments. This means the brain must learn to recruit stabilizers before movement.
  2. All stabilizers are important, and it might not be practical or possible to selectively activate or train them separately anyways.

Lumbopelvic Proprioception – lost in the shuffle?

I believe it is at least as important, if not more important, that people focus on lumbopelvic proprioception versus muscle activation.

To illustrate this, think about this scenario: You are about to throw a punch with your wrist cocked. How well would that workout for you when you make impact? Clearly, not well, and you’d probably end up with a broken wrist. Now, imagine doing the same thing, except your forearm muscles are jacked and maximally recruited, with your wrist still bent. What’s the result? Yup – the same thing – a badly damaged wrist. So the point here is that muscle activation is critical, but not unless your joint is positioned such that it can optimally distribute forces imposed upon it.

The Very Limited Role of Imaging in treating Low Back Pain

For all the wonderful things technology and imaging has done for our healthcare system, I think MRI is responsible for our health care system taking a major step backwards in dealing with the low back pain epidemic, not to mention the hefty financial burden.

The facts are that MRI is very poor tool to help determine the cause, the source, and the best treatment for back pain. These facts are well established in the literature.

For example, one study revealed that 90% of people without back pain were found to have disc herniations on MRI (Boden SD, et al J Bone Joint Surg Am. 1990;72:403-408). Another study looked at a large population also without low back pain, and took baseline imaging (Carragee E. et al Spine J. 2006;6:624-635. http://dx.doi.org/10.1016/j.spinee.2006.03.005).

They were followed for 5 years and inevitably, a percentage of those people went on to develop LBP. These people were then reimaged, and their findings while suffering from LBP were compared to their baseline findings before they had pain. The conclusion? In 84% of them, their “in pain” images were either unchanged or actually better than their pain-free baseline images!

Clearly, the correlation between pain and imaging is poor. What the research suggests is that these pathologies may be painless aberrancies and conversely that pain can be present in spite of the absence of significant structural damage, as suggested by Deyo et al (NEJM, 2001) who found no pathology in 85% of people with LBP symptoms.

OK, so now we are clear that MRI doesn’t tell us the source of pain or exactly how to treat low back pain. So when should MRI be used? Whether you are gym rat or clinician, this is important to know:

1. If there are red flag signs suggestive of systemic pathology (like tumors, cancer, etc) like fever, vomiting, night pain, unexplained weight loss, etc or a past history of cancer. All clinicians are well trained to recognize these signs.

2. If there is saddle anesthesia (suggestive of cauda equina) or progressive neuro compromise (continued loss of motor, sensory, or reflexes). Again, these are easily discernible by clinical exam (however, I must say I am shocked by the number of PTs, PCPs, and surgeons who don’t know how to do a proper neuro exam. I can tell you, that if you know anyone who went through the IOMT residency or fellowship in nearby Woburn you can guarantee they do a proper neuro exam)

Otherwise, MRI or other imaging won’t be helpful.

In fact it might actually cause harm for a few reasons.

For example, increased radiation exposure, exposure to contrast materials (CT), and increased risk of surgery are significant concerns. A less appreciated risk is what happens when people are labeled with a pathology (again, one that as discussed above may actually have little to do with their pain and dysfunction). Many people respond to that with a logical question: “But won’t it just make people feel better knowing they got it completely checked out, and extensive pathology was ruled out?”

Based on the research, no it won’t. First, it doesn’t do a better job of doing these things as using the above criteria is enough, and second studies reveal that it did not improve patient satisfaction or ease anxiety (Chou R,et al. Lancet. 2009;373:463-472.). Evidence indicates that those who are labeled with pathologies from imaging may actually have worse outcomes (Fisher ES, JAMA. 1999;281:446-453).

I see this all of the time. People will be in a holding pattern, waiting to address the obvious causes of their back issues until the smoking gun can be revealed by the MRI. We all have a need to be validated, believing such suffering can only be explained by the most elaborate technology, and anything less trivializes the severity of our condition. People sometimes feel offended when simple explanations are offered to explain their problem, even if addressing these issues leads to less pain! What people really want is someone to listen, then patiently and persistently seek the cause and explain the solution. In absence of this, they will stray, looking towards some elaborate technical gizmo which ultimately disappoints.

I wish everyone could see the face of my patients when they come in with their radiology reports. They read the scary terms with fear and uncertainty, giving rise to the paralysis by analysis syndrome at best, and at worst, fear avoidance behaviors. I am often the first to explain to them terms like “degenerative disc disease”, “decreased disc height”, “facet arthropathy”, or “mild to moderate bulging of L5” as common findings found on the majority of MRIs of people without any symptoms. Unfortunately, this might be after all the negative effects of paralysis by analysis have already set it, so I’ll have my work cut out for me.

Hopefully the take away here is that we cannot use machines to reduce our responsibility for problem solving. This requires us to ask focused questions to match patient tendencies with the natural history of LBP based on the available evidence, and observe and correct impairments associated with many types of back pain – possibly in addition to the imaging findings. We can all play a role in this by empowering patients to be a part of the problem solving process and fixing their back.

Stay tuned to Part 2, dealing with the issue of whether spinal flexion and rotation in training is bad, as well as suggestions to prevent and treat spine issues.

Author’s Bio

Dr. Stare is the Director and Co-owner of Spectrum Fitness Consulting, LLC, in Beverly, MA, where he trains clients of various fitness levels seeking weight loss, improved health, and performance enhancement. Mike received his BS in Kinesiology from the University of Illinois at Urbana-Champaign, his MS in Physical Therapy from Boston University, and his Doctorate of Physical Therapy from the Massachusetts General Hospital IHP. Mike is a Fellow of the American Academy of Orthopedic Manual Physical Therapists and also practices with Orthopaedics Plus in Beverly, MA as a Physical Therapist.

In addition to his clinical practice, Dr. Stare lectures nationally to fellow clinicians regarding the proper treatment and prevention of lumbar spine disorders and  fitness. He also provides seminars locally on weight loss, performance enhancement, and rehabilitation for young athletes to seniors. Dr. Stare has obtained the Certified Strength and Conditioning Specialist (CSCS) distinction, which is regarded as the gold standard certification in the fitness industry. Mike is also a Board Certified Nutritionist by the American College of Nutrition, and has been training clients for over 15 years. Mike resides in Windham, NH with his wife and three girls. To learn more about Spectrum Fitness Consulting, go to www.spectrumfit.net.

CategoriesCorrective Exercise Program Design

The Sway Back Equation

I know what you’re thinking:  This is either the title of an archived Robert Ludlum novel or the name of an old-school hip-hop album.

Both are wrong – but wouldn’t it be awesome if either of the two were true?

As someone who’s read every Ludlum novel, I’d kill to have access to another one of his masterpieces. While there are a few authors today who write really good espionage fiction, in my opinion Ludlum is the Godfather and everyone else is just Fredo Corleone.

And as far as hip-hop is concerned, lets be honest: today’s hip-hop pales in comparison to what I grew up with in the late 80s through the 90s.  I distinctly remember the first time I listened to Wu-Tang Clan’s Enter the 36 Chambers and thinking to myself, “Holy fuck balls. This is amazing.”

Likewise, I can’t even begin to tell you how many times – much to my mom’s chagrin – I listened to A Tribe Called Quest’s The Low End Theory.  Since that was a more PG-rated album, I literally played it everywhere.

I blared it in my bedroom, outside while playing wiffleball, and even, sometimes, when she allowed it, in the family caravan.

Momma Gentilcore used to head bop to a little Scenario back in the day!

Here we go, yo!  Here we go, yo!  So what so what so what’s the scenario.

I literally wore that tape out playing it so much.

But alas, like I said, neither of the above is the topic at hand in today’s post.  Instead what I want to dive into is a little discussion on posture.

More specifically swayback posture.

But we’ll need to give a little anatomy lesson first

When looking at one’s posture, the first thing I typically look at is their pelvic positioning.  The pelvis will tell you a lot as far as what’s going on up and down the kinetic chain.  In a way, much of the postural imbalances, dysfunctions, and asymmetries that we see on a daily basis have their impetus at the pelvis.

Keeping things (very) watered down and simple, you generally have three presentations:

1.  Those who are in some semblance of (excessive) anterior pelvic tilt:  typically indicative of stiff/short hip flexors, weak anterior core musculature, short/stiff erector spinae, and weak/inhibited glutes and hamstrings.

You’ll see this present quite often in the athletic population:

2.  By contrast, another common presentation are those people who are in (excessive) posterior pelvic tilt, which is typically indicative of the polar opposite of the above:  hip flexors are lengthened, anterior core musculature is shortened (due to sitting in flexion too much), erector spinae are lengthened, and the hamstrings are short/stiff.

All told the lumbar spine tends to be flattened, which can lead to an increased incidence of disc herniations.

Not surprisingly this is most common those who sit in front of a computer for large portions of the day.

Again these are just gross generalizations and I understand that more can make it’s way onto the canvas when looking at compensation patterns (and their root causes).

With all this information in our back pocket, we can then set out to write an appropriate training program that will address the underlying issues.

Speaking in generalities it may look something like this:

For those in anterior pelvic tilt:  we want to emphasize protocols which will encourage a bit more posterior pelvic tilt and help get the pelvis back to a more neutral position.

1. Lots of glute activation drills and strengthening.  While your garden variety glute bridges are fantastic option, one variation I really like is the Posterior Pelvic Hip Thrust highlighted here by Bret Contreras:

 

2. Emphasizing more posterior chain work – deadlifts, pull-throughs, GHRs, squats, etc (but making sure to cue a brace rather than an excessive arch).

Cueing is key here. Tossing in deadlifts (RDLs) and squats and then cueing someone to arch (and thus falling into more APT) defeats the purpose and just feeds into the overriding problem.

It’s important to teach someone to brace – and maintain as much of a “neutral” spine as possible – rather than arch.  Mike Robertson does an awesome job of being Mike Robertson (dropping knowledge bombs left and right) and explaining the rationale HERE.

3.  Dedicated (long-duration) stretching for the hip flexors.  30s second stretches aren’t going to cut it here, as all that does is increase one’s tolerance to a stretch and does nothing to increase the number of sarcomeres (which is what’s needed to lengthen a muscle).

Maybe some dedicated stretching for the erectors – although I’m not a massive fan of this.

DO NOT stretch the hamstrings.

Think about why:  if someone is walking around in APT all day long, the hamstrings are already lengthened, and the only reason why they “feel tight” is because they’re firing like crazy.  Stretching them will only make matters worse.

Of course, this needs to be taken on a case-by-case basis as some will inevitably have “tight” hamstrings. But most of the time is a pelvic issue, not a hamstring issue.

4. Placing a premium on addressing tissue quality – especially in the hip flexors, external rotators, etc.

5.  Lots and lots and lots of anterior core work (but not crunches or sit-ups. At this point, I don’t feel I need to go out of my way to explain why).

 

For those in posterior pelvic tilt: we want to emphasize protocols which will encourage a bit more anterior pelvic tilt and help get the pelvis back to a more neutral position.

In short, those in PPT need to strengthen the hell out of APT.

1.  Honestly I’m still going to hammer posterior chain work here (glutes and hamstrings) because most people are woefully weak there anyways.

I want all of my male clients to be able to deadlift a mack truck (female clients too, for that matter), and I want all my female clients to actually have a pair of glutes that they can be proud of and rock their “sexy” jeans (and, if that’s your bag, you too fellas. I don’t judge).

Much of the difference is how I go about coaching and cueing everything, as I’ll need to make sure that they don’t compensate and excessively posterior tilt when deadlifting or squatting – especially when going into hip extension.

2. I won’t include much (if any) dedicated anterior core work here as the rectus abdominus (which aids in posterior tilt) is short and stiff already.

Instead, I’ll focus mainly on STABILITY based exercises and emphasize length (staying tall) on things like Pallof Presses, chops/lifts etc.

In addition we’ll also probably rock out with some planks.

Watch most people do a plank and they’ll inevitably curl up/round their back which just plays into the dysfunctional pattern.  Instead, try to coach/cue your spine to get as long as possible – without exhibiting a forward head posture and allowing the lumbar spine to “dip.”

Ideally it will look something like this:

Along those same lines we can consider the RKC Plank, which is a bastard in of itself.  Again, stealing from Bret, here’s the nuts and bolts:

 

3. As far as any dedicated stretching is concerned, I’ll hammer the hamstrings, but in all likelihood will defer to more multi-planar mobilizations, or what’s also referred to as 3D stretching.

That’s just the tip of the iceberg on both fronts, but hopefully helps people understand the big picture.

The red headed step-child of posture: the sway back

Sway back is rarely discussed in fitness circles probably because it’s seemingly so rare.  But it IS becoming more prominent and it’s something that was brought to light while watching Mike Robertson’s Bulletproof Back and Knee Seminar recently.

FYI:  It’s a fantastic resource, and I’d highly recommend it to any fitness professional reading.

As noted by Mike, sway back is simply a posterior pelvic tilt albeit with the hips pushed forward.

While a bit rarer in the general population, one demographic where it’s becoming more and more prevalent is….drum roll please……

Vikings?  No

Boy Bands?  Not quite.

Bomb sniffing dolphins?  Nice try, but no.

In actuality, it’s PERSONAL trainers and coaches.

As a coach and trainer myself I can commiserate.  I spend roughly 6-8 hours of my day standing – in extension – coaching people. And while I don’t rock a sway back posture I do possess some APT sumthin fierce.

To their credit many have recognized that APT is an issue, and have done a remarkable job at trying to alleviate it.

To that end, many have been placing a premium on cleaning up glute and hamstring issues by strengthening them, only to disregard and neglect the other crucial component of the equation…….

External obliques!

Tossing a little more anatomy into the fire, the external obliques have a few important functions:

1. Trunk flexion (bilateral).

2. Trunk rotation (unilateral, alongside opposite internal oblique).

3. Posterior pelvic tilt without a pull on the rib cage!  Meaning, unlike the rectus abdominus – with prominent attachment points on the rib cage – the external obliques also posteriorly tilt the pelvis sans all the postural ramifications.

So, for those in a sway back, placing more of an emphasis on the external obliques can be of great benefit.  You still have to be somewhat careful here, though, because you don’t want to promote too much PPT.

My first choice would be reverse crunches, but you may need to use these on a case-by-case basis depending on how much PPT someone is in:

Not far behind would be Offset Farmer Carries.

I love offset (1-Arm) farmer carries because they absolutely destroy the obliques as you have to fight to stay as upright as possible throughout the duration of the set.

The first progression would be your standard suitcase carry where you hold a DB or KB at your side:

 

There should be NO compensating in any form. No tilting, rotating, leaning, NOTHING.

From there, I’d progress to RACKED carries:

 

And then the grand daddy of them all would be overhead or WAITER carries:

 

I should also add that with all these variations the goal is to keep the rib cage locked down and to wear the coolest t-shirt ever (like the one in the videos).

Just sayin.

Tall kneeling Variations

I’ll also add tall kneeling variations onto this list too.  Whether we’re referring to chops, lifts, Pallof Presses, or the plethora of landmine exercises out there, these are all excellent ways to target the external obliques and to help alleviate the sway back posture.

And That’s That

WHEW my brain hurts – I said a lot there. Hopefully within all my rambling I made some sense and was able to shed some light on some simple (albeit not all encompassing) ways to fix/address the sway back posture.

If not, my bad…..;o)