But I PROMISE I am going to 1) be brief, and more importantly 2) showcase why it’s important and why it will help you feel better, move better, perform better, and likely turn you into a Jedi Master Spartan Sex God of Minas Tirith.1
The reason I ask is because, ideally, you want to see a 360 or 3D expansion of your ribcage when you take a breath in.
In other words you want to see a little of everything move – chest, belly, back, sides, not eyeballs.
Unfortunately, for the bulk of people out there, this isn’t the case. Many tend to be just be
“chest breathers” or just “belly breathers,” and what ends up happening is a poor Zone of Apposition.
A Zone of Appo Come Again Now?
Zone of Apposition can simply be referred to as alignment. Or, more specifically, it can be described as the act of bringing together or into proximity.
Photo Credit: Postural Restoration Institute (<– AKA smart mofo’s)
If you take a gander at the Optimal ZOA picture (middle) you’ll see a diaphragm that’s domed out as well as aligned (stacked) above the pelvic floor; the ribcage is connected to the pelvis.
Conversely, in the Sub-Optimal ZOA picture (right), the diaphragm is flattened out and the ribs are in a more flared position; they might as well be located in Mordor in relation to the pelvis.
In non-nerd speak: Shit’s all out of whack.
At this point you may be thinking to yourself, “fuck outta here Tony. Who cares? Zone of Apposition sounds more like a term accountants use than anything I need to be worried about. Squats.”
Well, after listening to my colleague, Dr. Sarah Duvall, speak on the matter, here’s why it matters.
A Loss of Zone of Apposition Means:
Decreased core stability, control, respiratory efficiency, and exercise tolerance under fatigue…in addition to postural ramifications.
Increased accessory breathing muscle activity (scalenes, traps, levator), paraspinal activity, lumbo-pelvic instability, low back pain, SI joint pain, and even headaches.
A Quickie Breathing Assessment
Sit down in a chair and place your hands so that your fingers sit underneath and go around the sides of your ribcage.
Inhale.
What happens?
If an alien explodes out of your chest, that sucks.
You should feel LATERAL (into your fingers) expansion of the ribcage with a some motion in your chest and belly too. To steal another train of thought from Sarah, you should think of your breath as the handle at the side of a bucket.
As you take a breath in the handle should move out – LATERALLY – away from the bucket. This is a brilliant analogy for your ribs expanding.
Too, another overlooked aspect of the breath is what’s referred to as the High Hinge Point. This is the area that’s just underneath the bra line.
Can you (or your clients) expand air into this area.
Normal ZOA. Uncanny Jackedness.
Sub-Optimal ZOA (High Hinge Point). Still Uncanny Jackedness
Breathing into the back is an arduous and foreign task for many people, but it’s a key element to improving the ZOA.
Here’s a nice drill to help with that which I’ve used many times with my postpartum clients (as well as those attempting to resolve nagging low back or shoulder issues; encouraging the ribcage to move/expand works wonders for many people).
And That’s That
I suck at writing conclusions. To summarize:
1. Work on LATERAL rib motion.
2. Consider a high-hinge point in people and work to promote back-body expansion as well.
3. My wife and I bought the yellow chair on Wayfair in case anyone’s wondering…;o)
The topic of low back pain (LBP) – how to assess it, diagnose it, and how to treat it – can be a controversial one. I italicized the word “can” because I don’t feel it’s all that controversial.
Cauliflower as an option for pizza crust or Zach being chosen as the bachelor on the current season of The Bachelor (when it’s 100% clear that a ham sandwich has more charisma) = controversial.
Simple stuff to consider to help with one’s LBP = not so much.
The topic of low back pain and how to address it is controversial because there’s no one clear approach or answer to solve it.
(And if the last 3+ years of this pandemic dumpster fire has taught us anything it’s that we looooooove to argue over what’s best and what works).
SPOILER ALERT: Everything and nothing causes LBP.
Have ten different doctors or physical therapists work with the same patient and it’s likely you’ll get ten different opinions as to what the root cause is and what tactics need to be implemented to resolve it.
One person says it’s due to delayed firing of the Transverse Abdominus (TA), while someone else states it’s due to someone’s less than great posture or tight hamstrings.
For the record, all are weak excuses at best.
The culprit can rarely be attributed to any ONE thing.
But it’s amazing how often “tight hamstrings” is the fall guy.
Low back pain? Tight hamstrings.
Knee hurts? Tight hamstrings.
Have Type II Diabetes? Tight hamstrings.
Brown patches on your front lawn? Hamstrings.
It’s uncanny.
I mean, I could just as easily sit here and say in worse case scenarios LBP results from drinking too much coffee. I have zero evidence to back that up, but whatever.
…neither do most of the other “culprits” people tend to use as scapegoats.
So, why not coffee?
Or Care Bears for that matter, those sadistic fucks.
What works for one person, may exacerbate symptoms for someone else. And as my good friend, Dr. John Rusin notes:
“Fact of the matter is: there is NO one right way. it’s a big mistake to lump all LBP into the same category and even a bigger mistake to assume all of it presents the same or should be treated the same.”
There’s no way for me to write a thorough blog post on such a loaded topic; especially one that will make everyone happy.
It’s impossible.
I have better odds at surviving a cage match with an Uruk-hai.
Part of me feels like the proper response to the question “what causes low back pain and what’s the best way to address it?” is this:
Most people reading aren’t clinicians or physical therapists. There’s very little (if any) diagnosing going on in the hands of a personal trainer or strength coach. And, truth be told, if you are a personal trainer or strength coach and you are diagnosing, YOU……NEED…….TO…….STOP.
Just stop.
It’s imperative to defer to your network of more qualified (and vetted) fitness/health professionals whom you trust to do that.
However, it’s important to also consider we (as in personal trainers and strength coaches) are often the “first line of entry” into the medical model. We’re the first to recognize faulty movement patterns, weakness, imbalances, and bear the brunt of questioning from our clients and athletes when they come to us with low back pain.
There’s quite a bit we can do to help people.
What follows is a brief look into my mind and what has worked for me in the past with regards to LBP; a Cliff Notes “big rock” brain dump if you will.
Sorry if I offended anyone who likes Care Bears.
1) Rest Is Lame
My #1 pet peeve (and many agree with me) is that “rest” is the worst piece of advice ever.
“Go stick your finger in that electrical socket over there” would be better.
This isn’t to say there aren’t extenuating circumstances where taking a chill pill is absolutely the right choice; sometimes we do need to back off and allow the body a window of time to heal or reduce pain/swelling/symptoms.
That said, I think it’s lame when a medical professional tells someone to “rest,” or worse, informs them that they’ll need to learn to “live with low back pain.”
It’s a defeatist attitude and will spell game over for many people. Before you know it they’re living on a foam roller and thinking about a “neutral spine” while washing their hands.
(NOTE: I am not anti-teaching neutral spine to people. It’s a lovely starting point for most people, but at some stage people need to learn to move in (and out) of precarious positions…because that’s life).
A common theme reverberated in the S&C community is to say “strength is corrective.” I wholeheartedly agree with this sentiment. In fact, why the hell has this not been made into a t-shirt yet?
However, I think a slightly better moniker may be to say:
“Movement is corrective.“
We can use movement (and yes, strength) to help people get out of pain. Rest has its time and place, but I find stagnation to be more of a problem.
The body is meant to move and is wonderfully adaptive. And that’s the thing: adaptation and forcing the body to react to (appropriate levels of) change and stress is paramount to long-term success with LBP.
Sitting on a couch watching Divorce Court in the middle of the day isn’t going to help.
2) Move, But Move Well
I was watching Optimizing Movement with Mike Reinold recently and he noted there are three key elements to movement and why someone may not do it well:
Structural Issues
Coaching/Technique
Programming
It’s important to understand that, in this case, everyone is a unique snowflake.
Structure: Anatomically speaking there is huge variance amongst the population. Hip structure, for example, can have a large effect on someone’s ability to squat to a certain depth or get into certain positions. Likewise, who’s to say the hips are always the culprit? Even upper extremity considerations – like one’s ability to bring their arms overhead (lack of shoulder flexion) – can have dire consequences on back health.
The body likes to use the path of least resistance (also the most efficient) to accomplish any task. However in this case, “most efficient” doesn’t mean best. As Reinold notes:
“Efficient in this case refers to energy, not movement.”
Lack of shoulder flexion will often lead to compensation via more extension through the lumbar spine. It’s efficient movement, but it’s not better movement.
Coaching/Technique: I’m a firm believer that everyone should deadlift (it’s a hip hinge, learning to dissociate hip movement from lumbar movement, doesn’t mean we have to load it), but I don’t feel everyone should do it from the floor or with a straight bar.
Cater the exercise to the lifter, not the lifter to the exercise.
More on this below.
Programming: If someone lacks hip flexion why have them conventional deadlift? If someone lacks shoulder flexion why have them perform overhead pressing or kipping pull-ups? Some of the onus is on YOU, dear fitness professional.
Find what actions hurt or exacerbate symptoms, and stop doing it.
I know I just blew your mind right there.
For example:
1. Client says “x” hurts, and then places their body into some pretzel like contortionist position that would make a Cirque du Soliel performer give them a high-five.
Me: “Um, stop doing that.”
2. But that could also mean addressing how they walk or how they sit in a chair. Someone with flexion-based back pain, will like to be in flexion, a lot.
Maybe taking them through a slump test will offer some pertinent info.
Have them start in a “good” position:
Then, have them purposely “slump” into excessive flexion:
Someone who is flexion intolerant – despite preferring to be in that position – will often say this causes pain.
Ding, ding, ding.
So, the “fix” is to coach them up and try to keep them out of excessive spinal flexion. Cueing them how to sit in their chair and to get up (wider base of support, brace abs, chest up), building spinal endurance (and strength) via planks, and having them hang out in more extension may be the right path to take.
3. On the opposite side of the spectrum is extension, which is often a problem in more athletic populations and in those occupations requiring more standing (ahem: personal trainers/coaches).
Here you might put them into extension and see what happens.
Much like people who are flexion intolerant “liking” flexion, those in excessive extension will like to live in extension.
This will likely hurt.
Finding their spinal neutral is key too.
Hammering spinal endurance/strength via planks (done well) still hits the nail on the head, as does nudging them towards exercises that emphasize posterior pelvic tilt (much of time cuing people NOT to excessively arch during their set up on squats and deadlifts), and even drills that promote spinal flexion…albeit unloaded.
Spinal flexion doesn’t always have to be avoided. In fact, it’s sometimes needed.
Either way, meticulous attention to detail on finding spinal neutral – or pain from ROM – is huge. Once that is addressed, and symptoms has subsided, we can then encourage them to marinate in more amplitude of movement, taking them OUT of spine neutral (cause, it’s gonna happen in everyday life) and use the weight-room to help strengthen those new ROMs.
But I digress.
4) Don’t Treat People Like a Patient
I know this will rub some people the wrong way, but I still use the deadlift for the bulk of people I work with you have LBP.
Nothing sounds so absurd to me than when I hear someone say how the deadlift is ruining everyone’s spines.
To recap:
Deadlift = hip hinge.
Hip Hinge = learning to dissociate hip movement from lumbar movement.
Mic drop.
Resiliency is key in my book. And not many movements make the body more resilient than the deadlift or any properly progressed hip hinge exercise catered to the individual’s goals, injury history, and ability level:
Assuming I have coached someone up enough to understand spinal neutral and they’re able to maintain it, why not poke the bear and challenge them?
A deadlift doesn’t always mean using a straight bar and pulling heavy from the floor until someone shit’s their spleen.
I can use a kettlebell and band to groove the movement:
I can also use a trap bar, which is a more user-friendly way of deadlifting as it allows those with mobility restrictions to get into a better position compared to a straight bar.
https://www.youtube.com/watch?v=p-sA3PG1kGY
Too, I have found great success with various other exercises:
Farmer and Suitcase carries
Shovel Holds
“Offset” loaded exercises like 1-arm DB presses or 1-arm rows, lunges or RDLs (where you hold ONE DB to the side and perform the exercise). It’s a great way to increase the challenge to the core musculature.
Or even outside-the-box exercises like Slideboard Miyagi’s
So long as we’re staying out of precarious positions or those positions which feed into the issue(s) at hand, we’re good.
Find a training effect with your clients/athletes.
Help them find their TRAINABLE MENU.
And That’s That
People have low back pain for a variety of reasons: They’re too tight, too loose, too weak, have poor kinesthetic awareness, or they’re left handed.
The umbrella theme to remember is that there is never ONE root cause or ONE definitive approach to address it across the board. However, that doesn’t mean there aren’t some “big rock” things to consider that will vastly improve your’s and their chances of success.
NOTE: There’s only a few more days to get my latest continuing education resource – Strategic Strength – at $50 off the regular price. Today’s post discusses one of the main topics covered in the course: Assessment.
Assessment.
People don’t like the feeling of being judged – especially by complete strangers.
However, when it comes to working with a coach or personal trainer for the first time, an “assessment” is pretty much standard procedure; a means to an end with regards to collecting data to better ascertain someone’s starting point.
In Short: An assessment guides the coach to help figure out the safest and most efficient path for a client to reach his or her’s goal(s).4
That being said…I feel many of us are approaching assessment the wrong way.
I am not writing this as an attack against assessment
Likewise I am also not here to say one way or the other how you should assess your clients.
You know your clients/athletes better than I do.
I don’t care if your assessment of choice is the Functional Movement Screen, the Selective Functional Movement Assessment, PRI (Postural Restoration Institute), DNS (Dynamic Neuromuscular Stabilization), FRC (Functional Range Conditioning), whatever institutions like NASM or ACE prefer, or, I don’t know, duck-duck-goose.
Everything has it’s strengths and weaknesses.
More to the point, I would think that as people progress through their careers they’d take it upon themselves to actively change their minds the more they learn and gain experience.
They’ll experiment more and eventually “cherry pick” from several modalities to best fit their philosophy and approach to training.
Ideally “assessment” should be a smorgasbord of reaches, rolls, carries, squats, hinges, toe touches, twists, presses, and bicep curls (<— only half kidding on that last one), among other things.
Here is Gray Cook’s definition of assessment (a good one, mind you):
“In the assessment you take your education background, your professional wisdom, the particular situation, the time constraints, other historical information like a medical history or previous problems…and put all that together. That’s an assessment.”
Pretty hard to disagree with that, right?
Here’s my lame attempt:
“Can the person sitting/standing in front of you do stuff?”
I’m not tossing darts at everyone, but I do find that the bulk of fitness professionals out there use the initial assessment as an opportunity to search every crevasse (not that crevasse, get your mind out of the gutter), nook & cranny, and area of the body for “dysfunction.”
Many use the assessment as an opportunity to demonstrate to someone how much of a walking ball of fail they are.
“Okay Mr. Jones here’s what we got: your hip flexors are tight, you have forward head posture, you lack frontal plane stability, you lack ample scapular upward rotation, your left big toe has zero dorsiflexion, you have weak glutes, you’re quad dominant, your shoulders are slightly internally rotated, you’re probably gluten intolerant, your wife is cheating on you, and I’m about 37% convinced you have cancer.
If you purchase a 24 pack you’ll save $13 per session. Whataya say?”
Some of the above may be relevant and stuff you should focus on as a trainer. I mean, I’m not going to sit here and belabor a coach for wanting to improve a client’s thoracic spine mobility.
However, if I were the person listening to some laundry list of things I suck at or need to improve on, I’d be like………
………..”fuck off.”
Be Careful of Being Told to “Fuck Off”
There’s much I can wax poetic on when it comes to the topic of assessment. My biggest pet-peeve, though, is when coaches/trainers place waaaaaaaaaay too much emphasis on someone’s resting/static posture.
Lets revisit the picture from above.
Many high-end gyms implement this advanced form of “postural assessment” as an up-sell to seduce more people into purchase training.
Said individual stands in front of a giant gridded screen and is then hooked up with a bunch of probes and what not that are placed at strategic locations around the body that bloop and bleep.
It’s reminiscent of one the most terrifying movies I have ever seen, Fire in the Sky.
Remember that one?
You know, that alien abduction movie from the early 90’s where the main character is relentlessly poked and prodded by a bunch of aliens on their spaceship?
It’s terrifying.
Anyway, I can’t help but be reminded of that movie whenever I see someone being told to stand in front of a grid so some trainer can scrutinize every inch of their posture in the hopes they’ll be hired to “fix” it.
Who says it needs to be fixed in the first place?
I’m reminded of a photograph shared by Fort Worth, TX based physical therapist, Dr. Jarod Hall a few years back which hammers home my point.
Here’s what he said/posted:
“I want everybody to look closely at this picture and tell me what you see…”
“I see 20 of the world’s top athletes that have tremendous range of motion, strength, body control, and physical capacity… Yet all have significant variances in their static posture as determined by the holy grail plumb-line.
Static posture is near worthless to measure for injury or pain prediction.”
Placing all your eggs into one basket – in this case static posture, which a lot of fitness professionals do – is unfortunate.
Posture is a Position, It’s Not a Death Sentence
To steal from another really smart physical therapist, Dr. Quinn Henoch, “posture will always be relative to two things:
the task at hand
and the load
If you’re not taking into consideration those two things during an assessment – in addition to movement, repetition, speed, etc – and you’re only assessing people based off static posture, well, you’re not smart.
The question, then, is….”what should an assessment look like or consist of?”
This is not an attempt at me saying dysfunction is a myth.
There are certainly any number of people walking into a gym on any given day with any number of “issues” that require a bit more, shall we say, TLC.
Lack of scapular upward rotation.
History of disc herniations.
Poor t-spine extension.
Gonorrhea.
You know, stuff like that.
That being said, I’m tired of coaches and personal trainers defaulting to verbiage that assumes everyone is broken because they can’t squat to a certain depth or lack 4.2 degrees of big toe dorsiflexion and then in order to fix said “things” they have to complete a laundry list of corrective exercises or go through an eleven week seance in order to begin actual exercise.
Sometimes, actually a lot of the time, we just need to kinda-sorta remind people that they can do stuff.
Take overhead mobility (shoulder flexion) for example.
I’m a firm believer people need to earn the right to overhead press, and putting someone though a simple overhead mobility screen is a simple way to ascertain that information.
My good friend and London based trainer, Luke Worthington, has a really nice way of stating things:
“Can you do it? Can you really do it
Observing a task as simple as an overhead reach, we should be asking ourselves where that motion came from…
…was it true motion from the shoulder (scapulae)? Or was some of that motion ‘borrowed’ from other segments?”
To that point, but to expound a bit further, it’s imperative to observe active vs. passive range of motion. I.e., comparing what they can do (active ROM) to what you, the coach, can help them do (passive ROM).
This is an important component of coaching.
As coaches we’ll see a limitation in active ROM and immediately think we have to start smashing, thrashing mobility, and/or putting someone through the gauntlet of corrective exercise purgatory in order to “fix” it.
Don’t forget passive ROM.
Because if you can nudge more ROM just by helping them a teeny, tiny bit…it’s not mobility issue. They have access to that ROM, but are unable to control it.
Here’s an Active vs. Passive screen in action:
To Summarize (for those who are too uppity to watch a less than three minute video):
Jonathan had limited active ROM with shoulder flexion.
Jonathan had access to more passive ROM when I helped him.
I then had him hold his end range to remind the brain that “oh, I’m okay, I got this.”
Jonathan improved his active ROM without me stretching him or showing him a litany of mobility drills.
My butt looks amazing.
Now, of course we’d have to perform a few simple drills to “cement” that new ROM before we started training, but the more cogent point I’m trying to make here is that…
JONATHAN…ISN’T…BROKEN.
I just had to provide a window where his brain had to figure shit out, which in turn resulted in him turning some shit on, which in turn allowed him to do some shit.
How’s that for simplifying things?
It’s not lost on me there’s much more to it than that. This is just me pausing the Rotisserie and cooking one part of the chicken.
If I want to cook the entire chicken – which I do, it’s delicious – I’d still want to address other stuff like tissue quality (pecs & lats), anterior core strength, not to mention upper trap, serratus activation, etc.
But, pretty cool nonetheless.
Want More Tidbits Like This That Will Melt Your Face?
Well, you’ll have to wait a few more weeks.
The DIGITAL Strategic Strength Workshop is coming soon!
Having the ability to extend the thoracic spine is a game changer for many people, especially for those who tend to be sequestered for hours on end in front of a computer on a day-to-day basis.
For lack of a better term, a lot of cool shit happens with extension:
The shoulder blades can retract and upwardly rotate.
It’s much easier to get the arms overhead.
It’s easier to keep the chest up during squats and deadlifts.
It makes for a “better” bench press. I.e., shoulder blades can retract and depress providing a more stable base of support.
The thoracic spine (thorax for the nerds in the room) is the “anchor” of the shoulder blades. Ideally we like to see congruency between the ribcage/thorax/t-spine/whatchamacalit and the shoulder blades.
When someone is a bit more kyphotic (rounded) in that area it makes it almost impossible for this to happen because the shoulder blades will often be more abducted and anteriorly tilted.
This can setoff a domino effect of other shenanigans such as a narrowing of the acromion space (for example), which in turn leads to rotator cuff issues, which then leads to not being able to bench press without pain, which, as we all know, means the Apocalypse is upon us.
Let’s avoid the Apocalypse.
To that end I’d like to take this time to share some of my “go to” T-Spine Extension drills I use with my own clients and athletes on a weekly basis.
1. T-Spine Extension Off a Foam Roller (Performed In a Way That Doesn’t Make Me Want to Swallow Live Bees)
Likely the most recognizable drill many gravitate towards – and for good reason (it’s a good one) – is T-Spine Extension off a foam roller.
However, many tend to go waaaaaaay too far with their total range of motion on this to where it becomes more of a lumbar spine movement.
Here’s how to do it correctly:
2. Prone T-Spine Extension
I reserve “fancy” for choosing a nice restaurant for a date night with my wife.7
I don’t feel the need to get fancy with my T-spine extension drills.
The Prone T-Spine Extension drill is a fantastic way to build mid-back endurance.
3. Child’s Pose Back Extension Off Med Ball
What’s great about this variation is that when we adopt the “child’s pose” (knees tucked underneath) we OMIT the lumbar spine.
So now the only area we can get movement is the t-spine.
4. Pigeon Stance w/ Reach Through & Extension
Taking the previous concept and upping the ante a little bit is this exercise I “stole” from Dean Somerset.
If we want to talk about a drill that provides a TON of benefit for our training buck this is it.
Here we get a stellar hip mobility/glute stretch, while at the same time taking the lumbar spine out of the equation (because that’s NOT where we want movement from).
Too, with the reach through (and then extension) we’re getting a double whammy effect of mid-back mobility goodness.
NOTE: I like to add in an inhale (through the nose) on the reach through and then a FULL exhale (out the mouth) as the individual extends back up.
NOTE #2: My tricep looks fucking amazing in this video.
5. Wall T-Spine Extension w/ Lift Off
This drill is a doozy as well.
Pushing the hips back and “settling” into your accessible t-spine extension ROM is money enough for most people. But when you add in the end-range “lift off” (lifting the hands off the wall) at the end, it adds that little “eff you” component not many people will like.
Be careful not to crank through your lower back on this one!
This one is more challenging than it looks, so way on the side of conservative when choosing the loads you use.
I’m using a 10 kg kettlebell in this video and am pretty sure I blacked out after shooting this video.
Want More Shoulder Magic?
Join me IN-PERSON for two upcoming Fall workshops I am putting on. I cover shoulder/hip assessment, programming strategies, the concept of the TRAINABLE MENU, favorite Decepticons, and much, much more.
It’s not lost on me that the title of this post will raise some eyebrows. The title shouldn’t be taken too literally, because I do feel there are ideal approaches, methodologies, and “rules” to consider when coaching any lift in the weight room.
That said, when it comes to exercise technique (or human movement in general) why are textbooks the metric at which we compare everything?
Textbooks provide context, information, and sometimes make for handy coffee table improvers.
However, we don’t live in textbooks. What a squat, sprint, overhead press (or hell, even a carrot cake) looks like in a textbook can (and usually is) a stark contrast from what is emulated in real life.
I do believe there are some universal tenets to coaching a deadlift or squat or bench press or kettlebell swing8 that will not only allow a client or athlete to marinate in its benefits, but to do so in a fashion that won’t increase their likelihood of injury (or their contributions to their physical therapist’s mortgage payments).
I’m interested in making people savages, but I’m also interested in the long-game. It wouldn’t bode well for business (or my reputation) if all of my client’s deadlifts looked like this:
To that end, with regards to universal tenets for deadlifting:
Loaded spinal flexion is a no-no.
That’s pretty much it.
If you’re following that one golden rule, you’re doing a better job than most. It’s sad, but true.
However, golden rule(s) aside, there are many intricate, more nuanced things to consider person to person. One’s training experience comes to mind. We can’t hold someone holding a barbell in their hands for the first time to the same standard as someone who’s been a competitive powerlifter for 17 years.
Likewise, someone with a vast and delicate history of lower back issues is not going to take the same path as someone with a “clean” health history. And, of course, other factors come into play such as goal(s), movement quality, favorite color, and anatomical/structural differences between individuals.
Someone with hips like this…
…is going to move differently – and presumably be coached differently – than someone with hips like this:
There are many, manyfantastic resources out there that help to break down anatomy, assessment, biomechanics, joint positions, and what’s considered ideal exercise technique. I have my biases as to what I feel is correct – as does everyone – but it’s important to take every resource with a grain of salt, because…
“Textbook technique only exists in a textbook.”
When I heard Mike Reinold say this sentence years ago my immediate reaction was this:
My second reaction was to start doing handstands down the sidewalk outside my apartment, but I didn’t.
You know, cause that’s fucking weird.
And because I can’t do a handstand.
Either way, what Mike said was/is 100% correct.
Textbook technique, in the real world, is every bit as much of a myth as detox diets making you pee rainbows or me riding a Dire wolf to work today
What we read or deem as “ideal” on paper, while often a great starting point for many people, doesn’t always translate to real-life. As coaches it’s important to understand this. Anytime we corner ourselves into one-train of thought or that any one thing applies to everybody, we’re doing the industry – and our clients/athletes – a disservice.
A Real-Life Example
A few months ago I started working with a woman who had been battling some low-back issues, yet wanted to hire me to take over her programming and help clean up her technique.
Specifically she wanted to hone in on her deadlift.
She was frustrated because no matter what she did (or who she worked with), her back always bothered her.
I like to be a fly on the wall and just watch people do their thing during an initial consult. I want to see what their default movement schemes are. In this case I set up a barbell on the floor, loaded it up with a weight I knew she could handle safely, and then asked her to do her thing. Her “default” stance was a conventional stance, and while it wasn’t the worst one I had ever seen, I could clearly see why her back may have been bothering her.
We had established earlier in her assessment that she lacked t-spine extension and her hip mobility wasn’t great either.
More to the point, after doing a simple hip scourand Rockback test, I surmised she was able to attain more hip flexion ROM with more hip abduction. An important point, as you’ll soon see.
Note: the Rockback test is a great assessment to use to figure out one’s “usable” ROM in hip flexion. The idea is to see if or when the lumbar spine loses positioning.
Bad Rockback Test
Notice when spine loses position.
Dead Sexy Rockback Test
Notice the spine stays relatively “neutral” throughout. Also, notice those triceps.
We can then compare what we see here with what we see on the gym floor.9
Going back to my client, she read a lot of articles and books on deadlifting, most of which told her that deadlifting = conventional stance. Always. Moreover, other coaches/colleagues she had consulted with in the past told her to use the conventional stance.
No exceptions.
This is what I mean by falling into the “textbook technique” trap. On paper everything sounds (and looks) great. Everyone can and should be able to conventional deadlift.
In real-life, though…not so much.
Here’s a before and after picture I took of my client. The top picture shows her original set-up with a conventional stance. The bottom demonstrates me putting her into a modified sumo stance.
Immediate improvement in her lower & upper spine position. Having her adopt a wider stance better complimented her anatomy, which then resulted in an infinitely better starting position to pull (no lumbar flexion, improved t-spine extension).
What’s more, with that modification alone she noted there was zero pain.
She left that session feeling motivated and hopeful about training. A win-win if you ask me.
I posted the above picture on some social media accounts – explaining much of what I mentioned above. And wouldn’t you know it: I was called out by a handful of coaches.
One stated the problem wasn’t with her anatomy, but that the real issue was my poor coaching. A funny assertion given he wasn’t in the room with me. Another coach agreed stating something to the effect of:
“No client has walked into “x gym” and not have been able to perform a conventional deadlift after a little coaching on day #1.”
I guess all I could have done at the time was to just go fuck myself.
I demonstrated I was able to clean up someone’s deadlift and do so in a way that was pain-free, and yet, here I was being told by a crew of All-Star coaches I had failed because I didn’t have her conventional deadlift. My actions, apparently, were on par with drop kicking a baby seal in the mouth.
Pump the Brakes
I hope people can appreciate the narrow-mindedness of this type of thinking. To expect everyone to fit into the same scheme or way of doing things because that’s what YOU prefer to do (or because a textbook told you to do so) is about as narrow-minded as it comes.
No one has to conventional deadlift.
Likewise…
No one has to low-bar squat or squat with a symmetrical stance.
No one has to bench press or bench press with an aggressive lumbar arch.
And no one has to start watching Severence on Apple TV. Except, yes you do.
I’d argue a “good” coach understands and respects that everyone is different, and that he or she will be humble enough to put their own personal biases in their back pocket and appreciate there is no ONE way to perform any exercise.
Get your mind out of the gutter, I’m talking about muscles here…;o)
The Difference Between Good & Bad Stiffness
Having “tight” or “stiff” muscles is often viewed as a bad thing. Not losing a match of Squid Game bad, but bad nonetheless.
When someone presents with a (true) muscular length limitation there are increased risks of injury involved – strains, tears, explosive diarrhea10 – not to mention an increased likelihood of faulty movement patterns up and down the kinetic chain.
But injury isn’t always omnipresent.
Take any NBA basketball player through the FMS (Functional Movement Screen) – specifically the Active Straight Leg screen – and you’re bound to open up a can of epic fail.
NOTE:I personally don’t use the FMS currently when assessing/screening new clients. I took both modules several years ago and gained a lot of insight and knowledge. But in the years since I have gradually weened away from the FMS for myriad reasons. I know a lot of fitness professionals who still utilize it though and feel it’s a relevant talking point in the context of this post.
Many would be lucky to score a “2” (which is an average score), and many would showcase a right/left asymmetry, which, as we all know, means a baby seal dies.11
As a result, we’re quick to go into corrective exercise overdrive and implement every strategy under the sun that’ll increase hamstring length.
Ironically, it’s “tight hamstrings” that allow many NBA players the ability to do what they do so well. Namely, jump through the roof.
In this case stiffness is a good thing. We don’t have to fix it.
Of Note:the ASLR screen isn’t necessarily a hamstring length screen to begin with. Sure, offhand, it can be a way to ascertain hamstring length…but what we’re really looking at is the ability to both flex and extend the hip.
Stiff hamstrings can affect the ability to do so. However, more importantly, the ASLR is about teaching people to get into better positions – improving stiffness in other areas – to “trick” the CNS into turning off the emergency breaks.
Get people into more optimal positions (nudge them into better alignment), and what presented as “tight” or stiff is no longer the case.
Core Engaged Active Straight Leg Raise
Here we engage the anterior core – increase stiffness – to promote more posterior pelvic tilt (decrease “bad” stiffness in lumbar spine) in order to improve ROM, in addition to getting movement from the right areas (in this case the hips).
Likewise we can throw the hip flexors underneath the bus. I think we all know someone who’s been stretching their “tight” hip flexors since 1997.
Newsflash: If you’re someone who’s been mindlessly stretching your hip flexors for that long, with no improvement, what the hell?
I’d garner a guess the reason they feel tight/stiff is due to protective tension (and not actual tightness).
The stretch you’re doing – what I like to call the BS Hip Flexor Stretch – is doing nothing more than increasing “bad” stiffness in the:
Lumbar spine.
Anterior hip capsule.
My eyes.
It exacerbates and feeds what’s causing the issues in the first place.
Instead, perform a REAL Hip Flexor Stretch by increasing (good) stiffness in the appropriate areas – the anterior core and glutes – and actually get at the crux of the issue.
Another prime example would be the lats.
Stiff lats can be a bad and a good thing.
When Shit Hits the Fan (I.e., Bad)
In mine and Dean Somerset’s Complete Shoulder & Hip Blueprint, we spend a large portion of time speaking about the lats and how, in the overhead athlete population (as well as in the general population), they’re often stiff/short and overactive.
As a result: Overactive/stiff lats will drive more shoulder depression, downward rotation, adduction, as well as lumbar extension in general.
Anyone familiar with PRI (Postural Restoration Institute) and their thought process and methodologies will recognize this “Scissor Posture,” where the pelvis is pointing in one direction (tilted forward in Anterior Pelvic Tilt) and the diaphragm pointing in another direction (due to an excessive rib flair and lumbar extension).
This is not only an unstable position to be in, but also keeps the nervous system “on” at all times, driving more sympathetic activity.
What’s more, with regards to shoulder health, overactive lats will make it much less likely someone will be able to elevate their arms overhead, as well as “accessing” their lower traps (which share a similar fiber orientation as the lats @ 135 degrees), which, in concert with the upper trap and serratus, aid scapular upward rotation, posterior tilt, and protraction.
Taking the time to coach someone to turn off (or down-regulate) their lats in order to flex, externally rotate, and abduct their shoulder works wonders.
Bench T-Spine Mobilization
Wall Lat Stretch w/ T-Spine Extension & Lift Off
When Lats Can Increase Your Overall Level of Badassery (I.e., Good Stiffness)
And now it’s time to turn those fuckers on!
Your lats are a MAJOR player when it comes to performance in the weight room and lifting heavy things.
It also behooves you to turn them on in order to improve your technique in the “big 3.”
With the deadlift in particular there are some significant advantages:
Another trick I like to use to help people learn to use their lats during a deadlift is to attach a band to the bar and a stationary object.
Trainees will learn very quickly what it means to “pull the bar towards you” and to keep the lats engaged throughout the duration of a set.
You can also peruse a few more options in this IG post from a few weeks ago:
…it’s not always end of days or something that requires going into DEFCON 1 corrective exercise purgatory mode. Whether or not stiffness/tightness is bad or good depends on the context.
One of the more flagrant “mic drops” I toss down whenever I speak to a group of fitness professionals (remember when we used to be able to do that in person?) is that forcing people to adopt a symmetrical stance while performing basic lifts such as deadlifts or squats is more likely hurting people rather than helping them.
In fact, I’ll go a step further and tell them symmetry in the human body doesn’t exist and then yell something like “UNICORNS ARE REAL!” and walk away.
You’re Not Broken If You’re Asymmetrical. You’re Normal
We need to stop thinking we’re broken if we display any degree of asymmetry.
It’s 100% normal, actually.
The human body is designed asymmetrically. If it were so deleterious I think natural selection would have fixed it by now don’t ya think?
Admittedly, I appreciate it’s a tough nugget to swallow…the whole “symmetry is a myth” thing.
I had a hard time tackling it myself. For years all I read was how we should strive for perfect balance and symmetry both statically (posture) and dynamically (think: maintaining a symmetrical stance during a set of squats).
However, the more I worked with people – with varying backgrounds, injury histories, and body-types – and the more I coached, the more I realized it was all B.S. Holding everyone to the same standard didn’t make sense.
The tipping point for me was my introduction to PRI (Postural Restoration Institute ®) a number of years back. Neil Rampe stopped by Cressey Sports Performance and did a 1-day workshop and opened my eyes to just how UN-symmetrical the body really is.
Not long after Michael Mullin stopped by CSP several times and took the entire staff through a number of in-services which further slapped me in the face with the whole Morpheus “blue pill/rep pill, we’re asymmetrical creatures, open your eyes” schtick.
More currently, guys like Dean Somerset, Dr. Ryan DeBell, Dr. John Rusin, Dr. Stuart McGill, and Papa Smurf agree: The human body is all sorts of effed up.
But in a good way.
In some facets of life symmetry is the goal.
A ballet dancer needs to elicit “symmetry” when performing, as does a figure athlete or competitive bodybuilder when strutting their stuff on stage. No one ever won Ms. Olympia or Mr. East Lansing Stud Muffin with a yoked up right quadricep and a teeny tiny left.
But those examples aren’t necessarily the same thing as what I’m referring to in this post. Aesthetically, symmetry is visually pleasing.
90’s Mariah = pleasing
Crazy Eyes from Mr. Deeds = not pleasing
However, for performance or function, symmetry shouldn’t necessarily be the default goal or expectation.
It’s a hefty statement to make, and whenever I say something so seemingly egregious it often invokes a little push-back.
“Well, what about cars?” someone may blurt out. “If we don’t maintain alignment (symmetry) the car will start veering to one side or the other, causing additional wear and tear on the tires, and run the risk of further damage.”
To this point, I agree. Cars are designed by engineers and manufactured by computers and machines with precise precision to be replicated over and over and over again to (hopefully) ensure a quality product and return business from consumers.
The human body is not a Volvo.
This isn’t to insinuate the human form is any less fantastical, beautiful, intricate, or complex of a design. But, you know, we’re not some Clone Army to be replicated en mass.
Dare I say: This is a rare moment where “we are, indeed, all special snowflakes.”
During our Complete Shoulder & Hip Blueprint (dates are in the works for a return in early 2022!), Dean Somerset and I try to reiterate to attendees that asymmetries are normal and that, often, we’re doing a disservice to our clients and athletes by forcing them all into a standard, one-size-fits-all way of doing things.
It’s important to recognize everyone has variances in bony structure.
Using the hips as an example we know:
Pelvic structures differ person to person.
Femoral angles vary person to person.
Hip socket depth can vary (Scottish hip)
People have two hips (surprise!) and either side can have retroverted or anteverted acetabulums, as well as retroverted or anteverted femoral heads. All of which affects someone’s ability to flex, extend, abduct, adduct, externally and internally rotate the joint.
To that end, when coaching someone up on the squat why not use those variances to better set up your clients and athletes for success?
Much like what an optometrist does when fitting someone for a new pair of glasses, sitting someone down in front of that thingamabobber (<— I believe that’s the technical term) and flipping back and forth between lenses to see which looks and feels better – is this better, or is this? – why is the parallel approach all of a sudden wrong when trying to figure out the best squat stance for someone?
Shouldn’t it be our goal to figure out what stance feels more stable, powerful, and balanced? I’d make the case we’re trying to fit square pegs into round holes much of the time when we force people to use a symmetrical stance.
Why?
Especially when we know there’s a multitude of structural anatomical variance from person to person.
If you’ve somehow developed a mutant power of X-ray vision:
1) That’ll help
2) Can we hang out?
Performing a thorough assessment – something both Dean and I cover in depth HERE (hint, hint) – will provide a ton of feedback and help peel back the onion of what will be the right approach for someone.
You could also watch Dr. McGill take someone through a hip scour here:
I can’t tell you how many times I’ve encouraged someone to use a staggered stance when squatting, or maybe to externally rotate one foot more than the other, and then they perform a few repetitions and they look up and say “holy shit-balls that feels so much better.”
And we hug.
Why would I disregard that?
We’re not causing irreparable harm by accepting asymmetry.
But if I would have titled it what I wanted to title it:
“That Time I “Fixed” Someone’s Squat In Five Minutes, BOO-YAH, God Damn I’m Good. And While I’m Here Bragging About Myself: Did I Ever Tell You About That Time I Almost Single Handedly Won the Sectional Championship For My High School Baseball Team Back in 1995? Oh, And I Made Out With a Girl Once.”
A Tale of Two Squat Patterns (But Seriously, Though: I Did Fix It In About Five Minutes
Last week I had a gentleman come to CORE for his initial assessment. After some initial back-and-forth and pleasantries we got into the topic of his training and injury history. He had noted that he had never really participated in strength training before and after digging a bit further he also noted that he’d had a history of chronic lower back pain (L3-L4).
Most people can commiserate.
A vast majority reading these words right now have likely experienced some form of low-back pain in their lifetime.
(raises hand)
It’s never fun and can leave most people in a seemingly never-ending state of frustration and despair. In dealing with many people in the same predicament throughout my career as a coach & personal trainer my goal during their initial session isn’t to spend it telling them how much of a walking ball of dysfunction they are.
Rather, my objective is to take them through a few rudimentary screens, watch them move, see if anything exacerbates their symptoms, and if so, modify things to see if we can reduce them.
Low back pain is very common and has myriad of root causes:
✅ Tight this
✅ Overactive that
✅ Inactivity
✅ Aberrant movement patterns
✅ Losing a street fight to Jason Bourne
✅ It’s Tuesday
Whatever.
It’s rarely ONE thing, which makes it altogether impossible to look someone in the eyes and say, definitively, “x is why your back hurts.”12
Which is why I prefer to get people moving during their assessment.
It’s easier for me to ascertain and glean a larger picture of things when I can watch someone show me their movement strategies through a variety of tasks.
Don’t get me wrong: I’ll perform several screens on an assessment table: Thomas Test, Craig’s Test, Slump Test, active vs. passive ROM, etc.
However, I also believe it’s important (if not crucial) to get them off the table and have them demonstrate to me how they choose to move.
It’s simply more information.
Without any prompting from me (I didn’t want to coach him on how to perform the “test”) here’s what my client’s squat pattern looked like:
Before
Notice how he immediately “falls” into an aggressive anterior pelvic tilt as a descends toward the floor? Likewise, notice the speed or lack of control as he lowers to the ground?
Furthermore, notice anything as he finishes at the top and “locks out” his hips?
He hyperextends his lower back.
I.e., he finishes with LUMBAR extension rather than HIP extension.
I had him watch the same video above and then broke down in more detail everything I explained here (and that my suspicions were that those may be the culprit of his low-back woes).
I then spent a few minutes breaking down some simple “squat technique tenets” I like to pass along when breaking down the movement with clients.
✅ We talked about foot pressure and corkscrewing his feet into the ground (to help ramp up torque in the hips).
✅ We also discussed the abdominal brace.
✅ I broke down the canister position and how that’s ideal (rib cage down and stacked over the hips)
✅ I reiterated that the squat is equal parts breaking with the hips & knees simultaneously so the net result is squatting DOWN, not BACK.13
✅ I wanted him to think about “pulling” himself down toward the floor rather than falling.
✅ Lastly, I encouraged him to “finish tall” at top; to squeeze his glutes (lightly) rather than ramming his hips forward.
Five minutes later this happened:
After
By no means was it a perfect squat (does that even exist?), but that wasn’t what I was after.
I was seeking PROGRESS.
And I think we achieved that.
Here’s a top (before)/down (after) comparison:
The bigger indicator, though, was that he had zero pain while squatting after these minor tweaks to his technique were made. And it didn’t take me giving him a laundry list of “corrective exercises” in order to “fix” it.
Sure, I could have told him to foam roll for 37 minutes and stretch his hip flexors, followed by an abyss of varying glute medius exercises…
…and he likely would have felt better as well.
However, we wouldn’t have really addressed anything.
In short: Help people find their trainable menu. COACH them. Show them what they CAN do, rather than barking at them what they can’t.
Do you exhibit a hip/weight shift (swaying to the left or right) when you perform a squat? It’s one of the more annoying things that can happen in the weight-room.
It ranks somewhere in between people who don’t re-rack their weights and kipping pull-ups.
Admittedly, it’s rather common and almost always a benign occurrence; most people never even notice it unless they’re routinely filming their squat sessions.
And when that is the case, I can understand someone’s “itch” to want to solve the conundrum. I mean, things could go awry down the road and manifest into pesky hip or knees issues.
A Case Study: How to Address a Hip Shift During the Squat
I received the following email earlier this week:
“I was looking to see if I might be able to send you some videos for a squat assessment. I have been having issues leaning to my right for some time and cannot for the life of me figure out what is causing the issue. I’ve followed you for years and trust your judgement!”
I responded back with a “sure, I can take a quick look,” and in swift fashion I got this in return:
“Some initial feedback would be great.
Some things to note before watching:
Though subtle, I find my left hip lower than my right on both the descent and ascent of the squat (as you can probably see).
My right hip flexor/quad tends to be tighter than my left usually.
My left glute has always been tighter than my right
History of SI joint hypermobility (in the past) but has not caused me issues for over a year. I used to have issues with my sacrum shifting around and causing misaligned hips which was quite painful.
I do not have any pain barbell squatting or semi sumo deadlifting but I do feel the unevenness when I squat especially.”
https://www.youtube.com/watch?v=-OGaW1JmADw
For Starters
That’s a pretty good lookin squat if you ask me.
After reading her “heads up” commentary before watching the video I was half expecting a dumpster fire when I pressed play.
Au contraire – all things considered, that’s a very passable squat.
However, given her past injury history, her own words of feeling the “unevenness,” not to mention you can see a subtle weight shift to the right with each repetition, I had some thoughts.
It’s funny, I perused my blog archives to see whether or not I had written on this topic in the past, and as it happens I did!
Back in 2015 I wrote THIS post where I discussed the idea “feeding the dysfunction,” a concept taken straight from renowned physical therapists (and creators of the Functional Movement Screen), Gray Cook and Lee Burton.
The gist goes like this:
You see a weight shift, say, to the right. In this scenario you grab a band and wrap it around the individual’s waist and as he or she squats, you pull the band in the direction of the shift, essentially “feeding the dysfunction.” The idea is that reactive neuromuscular training (RNT) trains the nervous system to recognize a faulty movement and to encourage body to correct course.
In the broader consciousness of health/fitness it’s an okay approach. It 100% works. In the years since writing that blog post, however, I’ve gone out of my way to reduce my use of the word “dysfunction” with clients. I don’t like the connotation the word breeds; that the individual is in some way broken or needs fixing.
Some people hear or see the word dysfunction and they’re ordering an exorcism.
Myself?
I hear or see dysfunction and I think “well, outside of extenuating circumstances (past/current injury history, whether or not there’s pain present), it’s fairly normal.”
Everyone is a bit different and moves in different ways. What’s more, there are, what, seven billion people on this planet currently? Is the expectation that everyone, everywhere, in the history of ever, is going to squat (or move) the same exact way?
Okay, Tony, We Get It, Personal Growth, Blah Blah, Blah…WTF Did You Tell Lisa To Do?
This, I said this:
“I totally see what you’re saying when you say your left side is lower than your right. I don’t think we need to get too far into the weeds as to whether or not that “needs” to be corrected (or even if it’s bad).
While slight, the hip shift IS there, and I think there are one of two things you can try”
1) Lean Into the Asymmetry
(NOTE: I actually wrote my thoughts on asymmetry HERE a few years ago).
I asked her to externally rotate (open up) her right foot more and to take note whether or not that improved her weight shift?
If so, there’s her answer.
People are built differently and what this would suggest is that her right hip socket is likely more retroverted compared to her left and that that side requires a bit more ER.
For many, using a “symmetrical” stance is akin to attempting to fit a square peg into a round hole. We don’t live in textbooks, so we shouldn’t train like it either.
She tried it and (no surprise to me) saw an improvement:
https://www.youtube.com/watch?v=CcKlqEkC8EI
But Tony, Won’t Having Her Squat With An Asymmetrical Stance Lead to More Issues Later? What’s Next: Telling Her to Club a Baby Seal? No, Wait, To Go Keto?
Relax.
I truly don’t feel having someone perform a handful of sets with an asymmetrical stance is going to cause irreparable harm. I mean, I’d make the case that forcing symmetry is leading to more issues. Besides, if a certain stance feels better, feels more secure, stable, and powerful…why wouldn’t we want to lean into that?
Furthermore, the human body is a bit more resilient than that. If it can survive plagues, saber-toothed tigers, and Michael Bay Transformer movies, it can withstand a few sets of asymmetrical squats.
Further furthermore, this is why we use things such as single leg work to help fill in the gaps. There’s a reason why we write well-rounded training PROGRAMS. You know, to address stuff.
So anyway, moving her foot out a bit seemed to have solved the issue. This strategy will work for most people, but what happens when it doesn’t?
2) Listen to Katie St. Claire
This scenario reminded me of something my colleague, Katie St. Claire, discussed last year. She showed a video of one of her clients who also had a hip shift to the right on her squat.
Katie recommended the woman perform 15 hip bridges (off the wall) on her LEFT side only.
Now, why the LEFT side only in order to fix a RIGHT sided issue?
“To allow more posterior rotation and nutation on the left side so she can load the right side correctly.”
In non-Elvish, as you squat down into deeper hip flexion (most often in Stage 2: 60-120 degrees of hip flexion), the inability for the LEFT side to internally rotate and compress essentially “pushes” you to the right.
I don’t know, maybe that still sounds confusing.
Try this: Whatever side you shift to, perform a boat-load of bridges on the OPPOSITE side. Chances are you will see an improvement.
Cool?
Cool.
Give both options a try and see if one of them solves the issue.
