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.2
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 swing3 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.4
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 diarrhea5 – 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.6
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.
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.”7
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.8
✅ 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.
Today’s guest post comes courtesy of Dr. Michael Mash.
I have a legit man-crush on him ever since I’ve started diving into his online resource Barbell Rehab. As the name implies: Its mission is to help barbell athletes (and aficionados) overcome pain and improve performance WITHOUT being forced into “corrective exercise” purgatory.
In a sense, it’s designed to use barbells (and lifting stuff) to help fix shit. What’s more Tony G than that? Okay, maybe Jason Bourne fight scenes.
Or dragons.
Or an endless cheese plate.
Regardless, Barbell Rehab speaks to my strength coach love language, and as it happens Michael is offering his course to all my readers at $50 off the regular price for this week only.
All you have to do is click THIS link and enter the coupon code TONYG50 to receive your $50 credit.
And even if you’re not keen to saving money (weirdo) you should still give his blog post below a read because it’s riddled with common sense and practical applications you can use TODAY to improve your squat screen or assessment.
When it comes to effectively screening the squat, many personal trainers and strength coaches have different approaches. From not utilizing a screen at all, to performing dozens of assessments prior to implementing a bodyweight squat, what is the best way to screen the squat?
Before we answer this question, let’s first talk about the function of a “screen” in general.
What is a Screen and Should We Use it?
According to John Hopkins…
“…a screening test is done to detect potential health disorders or diseases in people who do not have any symptoms of disease.”
If we apply this definition to the squat, one could say that a squat “screen” is a test performed to detect potential joint, muscle, or movement impairments in those who don’t have any pain.
In order for a screen to be effective, a “failed” test must be highly predictive of future injury or pain. If it’s not, this could create a lot of false positives results (a.k.a telling someone they’re doomed for injury if they really aren’t). So on one side, you want to make sure your client is “safe” to squat before loading them up, but you also don’t want to prevent them from squatting if they don’t really need to.
Oh the dilemma!
It’s Tough to Really “Predict” Pain and Injury
As mentioned, in order to analyze the efficacy of a screen, we need to know if it can indeed accurately predict injury. As it turns out, the research isn’t so sure about this.
In fact, it has been shown that one of the most common movement screens, the FMS, is only slightly better than a 50/50 coin flip at predicting injuries. This doesn’t mean, however, that you need to throw the baby out with the bathwater. While both myself and the authors of this paper note that the FMS can be used to see HOW a person moves, it shouldn’t be used as a way to predict injury.
If the FMS can’t reliably predict injury or pain….what can?
Because pain is a multidimensional experience driven by biological, psychological, and sociological factors, it is really a reductionist mindset to blame pain solely on “tight hamstrings” or “poor form” in general.
In fact, factors such as stress, anxiety, depression, lack of social support, job dissatisfaction, and poor sleep and nutrition can ALL affect a person’s pain experience. This is why we need to zone OUT when it comes to “predicting” injury and really take a comprehensive approach. The WAY someone moves is certainly important, but it’s just one tiny piece of a much larger puzzle.
What is an Effective Movement Screen?
So how should you effectively screen the squat? In order for a screen to be effective, it needs to be SPECIFIC, and there’s no better way to be specific than to actually perform the movement itself. Yep, that’s right. The best way to “screen” the squat, is to actually have the client perform a squat.
This process will give you ALL of the information you need in order to make a decision on whether or not they are “safe” to proceed forward with loading the squat.
And guess what?
It doesn’t involve any kind of joint-by-joint assessment, specific muscle flexibility testing, or any other long drawn out processes either.
While the aforementioned approaches can be beneficial to “dig deeper” if someone already has pain, they’re rather unnecessary as part of a screening process in asymptomatic individuals.
For those without pain, here’s a simple process I recommend in order to determine if they are safe to squat.
Step 1: Show Me Your Squat
The first step of our world’s simplest squat screen is to simply ask the client to “show me a squat.” I like to do this for a few reasons. First, it will give you an idea of what they “think” a squat is and how they move in general. Two, it will also give you an idea of how hesitant they are to move.
Some will just drop it low into a perfect squat and others will hesitate to start and move really slowly. You may see the latter example if someone has a history of pain or has fear with movement in general.
This is all useful data to collect on this important first step. If the squat looks good, congratulations!
Your job is easy today, and it’s time to load them up!
If it needs some work, it’s on to the next step.
Step 2: Coach the Squat
After asking the client to show you their squat, it’s time to coach it. While everyone is going to squat with a different stance width, degree of toe out, and torso angle, it helps to at least have a frame of reference to start from.
I recommend cueing them into a heels shoulder-width stance with a moderate 20-30° toe out, and then asking them to squat as far down as they comfortably can. While this foot placement won’t work for everyone, it’ll work for the majority of people. In this initial bodyweight squat coaching phase, some people may have discomfort or won’t be able to quite get to parallel…and that’s ok.
That’s why we have Step 3.
Step 3: Modify Stance and Depth if Needed
If you coach the client into a shoulder-width slightly toed out stance, and they have pain with this, or they can’t squat very deep, all is not lost yet. Two of the most common pains you’ll see with a bodyweight squat are hip and knee pain. And just because they have pain, doesn’t mean they are injured or need to be referred out to a rehab professional. It may simply just be the way they are built.
For example, if you take someone with highly retroverted hips, and have them try to squat with a narrow stance with minimal toe out, they may get a “pinch” in the front of their hips at the bottom. This can usually be remedied by widening the stance a bit and turning the toes out more. This doesn’t mean anything is wrong with them…it’s simply the way they are built!
Tying it all together, if someone has pain when you coach them into a bodyweight squat, see if it’s relieved with a simple stance adjustment. This is 100% within your scope to do as a personal trainer or strength coach, as you’re not diagnosing, assessing, or putting your hands on the client at all.
Step 4: Change the Exercise and/or Refer Out
Sometimes the squat pattern itself is so sensitized, that a stance or form adjustment isn’t enough to eradicate pain. If this is the case, I’d recommend NOT proceeding forward with having the client squat, and instead, finding a similar exercise like a rear foot elevated split squat or a lunge variation that they can tolerate.
If the client’s goal is to squat, it would also be best at this point to refer out to a qualified rehab professional as well. This is why interdisciplinary care is so important in the health and fitness world. At this point, as the personal trainer or strength coach, you can continue to train your client with what they can tolerate (full upper body workouts and modified lower body exercises) while the rehab professional addresses the pain itself.
A Quick Note on Squat Depth
Sometimes no matter how much you modify stance, degree of toe out, or hip position, your client won’t be able to squat to “depth.” Depth is defined as when the greater trochanter of the hip goes below the top of the patella from a side view.
In this case, you need to find out if it’s simply because they feel “tight” or if it’s limited by pain.
If it’s limited by pain (even after stance adjustments) then you may want to refer out. If they just feel “tight,” then you can proceed forward with loading them up to tolerance….even if it’s not quite to depth. That’s right. There is no evidence to suggest that squatting above parallel is inherently dangerous.
Rather than spending six months working solely on mobility to increase squat depth, you can work on BOTH simultaneously. Train the squat to the depth the client is comfortable with and tease in mobility drills at the same time.
This one-two punch of increasing mobility and loading through it, will help your clients squat deeper (if that’s their goal) much quicker than not squatting at all.
Tying it All Together
The squat is one of the most beneficial lower body movement patterns to coach your clients through. While everyone will squat with a different stance, degree of toe out, and variation, there’s no need to take clients through an extensive “screening” process prior to loading them up.
Instead:
1️⃣ Ask them to “show me a squat” to get an idea of how they move to begin with
2️⃣ Coach the squat. Cue them into a moderate stance with slight toe out and ask them to squat as deep as they can
3️⃣ If they have pain, see if you can find a stance width, degree of toe out, and depth that is tolerable for them. If so…it’s time to load them up!
4️⃣ If they still have pain after a stance adjustment, it’s probably best to hold on squatting for now and to refer out to a rehab professional for further assessment.
About the Author
Dr. Michael Mash is the owner and founder of Barbell Rehab, a continuing education company dedicated to helping fitness and rehab professionals improve the management of barbell athletes. Check out his CEU approved online course, The Barbell Rehab Workshop at this link and use coupon code TONYG50 for $50 off.
The third and final installment of my “30 Days of Shoulders” series went live today over at T-Nation.com. All three parts cover everything from shoulder assessment and tips on shoulder friendly pressing t0 how to improve shoulder health and performance.
Collectively it’ll make all your hopes and dreams come true.
I’m writing this from my most favorite place in the world…
…a room full of cute and cuddly kittens.
Just kidding, I’m in London.
I’m here because I have a few speaking engagements lined up – a half-day Shoulder workshop for a crew of Equinox trainers in Kensington on Saturday, my Coaching Competency Workshop in Dublin on Sunday, and then mine and Luke Worthington’s Strategic Strength Workshop back here in London next week.
Spots are still available for both the Dublin and London events (wink, wink, nudge, nudge).10
I just checked into my hotel after an overnight flight from Boston and I feel like a zombie.
Needless to say I am not in the writing mood, but I do\ have a little sumthin, sumthin to share today.
This is Part II of my latest series over at T-Nation.com dealing with anything and everything shoulders: How to make them bigger, how to make them feel less like a bag of dicks, you know, the usual.
You can check it out —> HERE (also includes link to Part I in case you missed it).
Enjoy and keep your eyes peeled for Part III coming next week!
I’m willing to bet that if you’re reading this if you have two shoulders.11
I’m also willing to bet that, given the two shoulder scenario, and given this is a blog dedicated towards strength & conditioning, you’re interested in:
Keeping your shoulders healthy.
Making your shoulders stronger.
Building shoulders that resemble boulders.
Argon. You know just because it’s a cool element.12
It’s more like an amuse bouche or bite-sized commentary on a pet peeve of mine: Fitness professionals who place waaaaay too much emphasis on it (often times to the detriment of the client/athlete).
As well as a scenario where we might pay a little closer attention to it.
A more downwardly rotated scapular position (depression).
An “interesting” shade of blue on the walls.
Now, to be clear: I am NOT someone who places a ton of credence on one’s static posture. While we’re getting better of late, I think the industry as a whole has gotten into a bad habit of placing all if its eggs into the posture basket…
…labeling people as dysfunctional the second we see forward head posture or a hair that’s out of place.
I’ve witnessed some coaches reaching for their “corrective exercise” bag of tricks before they’ve even seen the person they’re assessing do anything:
“Okay Mr. Smith, I notice you exhibit a slight kyphosis in your upper back, your right shoulder is a bit internally rotated, and it looks as if your left eyeball is lower than the right.
Weird.
But here’s the deal: You should purchase a 424 pack of training, and maybe, just maybe, after 62 weeks of dedicated corrective training where we dive deep into some transverse fascial line reactive neuromuscular breathing techniques we’ll be able to progress towards looking at a barbell.
This is not to short-change the importance of someone’s static posture and the information you can glean from it. Of course, if someone walks in with a lengthy injury history and it hurts to blink, then, yeah, it’ll have a bit more weight.
However, we can’t assume that just because a particular person presents with “y” – posturally speaking – that that automatically means “x.” I’ve seen some individuals walk in for their initial assessment with questionable (textbook) posture only to reveal the cleanest health history you’ve ever seen.
Zero injuries. Zero discomfort. Zero fucks to give.
Static posture is nothing more than information.
No one is a walking ball of fail because he or she presents a certain way.
Besides, we also need to respect that “good” or “bad” posture is relative to the load in addition to the task at hand. The latter point is especially cogent to the conversation because as my good friend Alex Kraszewski notes in presentation for The Trainers’ Toolbox:
“Posture/position will govern where motion is available from, as well as who much and where load is distributed. The task will dictate the appropriate range of posture available.”
How I want someone to “look” when attempting a challenging set of deadlifts is quite different compared to someone who’s just sitting there in front of me, sitting.
What’s more,
Anyway, back to the original picture above.
You forgot didn’t you?
Here, this one:
This is a very common theme or resting “presentation” amongst athletes – especially overhead athletes – as well as fitness professionals who 1) stand a lot during the day and 2) lift heavy things for a living.
Again, nothing is cemented as an absolute here, but if an individual walks in complaining of shoulder pain, and you ask him/her to take off their shirt (don’t be creepy about it) and their shoulder blades rest in a more retracted and downwardly rotated position, we can deduce that said individual (may, not always) need to work on more protraction to nudge them back to a more neutral position.
Neutral Scapular Position = Superior/inferior border of the scapulae rests between 2nd-7th thoracic vertebral levels, medial border is ~1-3″ from midline.
Photo Credit: MikeReinold.com
Someone “locked” in a more downwardly rotated position will almost always have a hard time achieving ample scapular UPWARD rotation (protraction is part of this equation), which is kind of a big deal for overall shoulder health & performance.
But don’t assume, you should check.
This is why it’s crucial to include both load AND movement in the initial assessment; sometimes scapular position will clean up on its own with minimal intervention.13
But let’s assume it doesn’t, and the person has been complaining of shoulder ouchies.
What then?
Here are a few drills I like to use and I offer for your consideration:
NOTE: I will say the bigger umbrella theme here is addressing ribcage/thorax position. The position of the shoulder blades are at the mercy of the T-spine.
1. Deadbug w/ Reach
I have a crush on deadbugs and their infinitesimal variations.
They’re a bonafide rockstar when it comes to improving anterior core strength and lumbo-pelvic control (which comes in mighty handedly when you’re working with someone who’s stuck in a more extended position).
Simply “reach” towards the ceiling as you extend your legs towards the floor and perform a FULL exhale with each repetition.
2. Deadbug w/ Loaded Reach
Same as the above, but now we add a smidge of load in the form of a med ball, kettlebell, dumbbell, a basket of He-Man figures, anything.
Sometimes adding a very slight load here can help clients/athletes “feel” the protraction more.
3. Quadruped Band Protraction – off Foam Roller
This is a drill I stole from my good friend and business partner, Dean Somerset.
He’s Canadian.
4. Forearm Wall Slides – off Foam Roller
1. You can blame my buddy Justin Kompf for the verticalness of this video.
Amateur hour.
2. This was/is a staple exercise from my days at Cressey Sports Performance. Start with a foam roller against the wall with your forearms against the foam roller. Protract (push away) from the foam roller and then slide up the wall making sure not to crank into your lower back and flair your rib cage.
