CategoriesCorrective Exercise Exercise Technique

Fix Your Knees, Get Bigger & Stronger

It’s kind of hard to achieve the holy grail of brohood – i.e., bigger, faster, and stronger (and tanned) – if you’re constantly banged up and/or hurt.

Our knees take a beating as it is, but if you’re a meathead this statement is exponentially true.

But even if someone says “my knees hurt!”……what does that even mean? Knee pain, or how smarty pants people refer to it – anterior knee or patellofemoral pain – is a very subjective term and doesn’t help explain the mechanism or cause of the pain in the first place. Hell, many scientist can’t even explain or agree what the term pain means or where it manifests from!

I guess to be more precise I should allude to the actual diagnoses of patellofermoral pain. There are many and it’s hard to pinpoint one major culprit over the other. We have patellar compression syndrome, patellar instability, general biomechanical syndrome, direct patellar trauma, soft tissue lesions, and overuse syndromes to name a few.

Too, we can’t deny that many people just move like complete shit. And while squatting is often poo-pooed or pointed to as Public Enemy #1 with regards to eating up someone’s knees, quite frankly (and more often than not) their squat pattern is atrocious. Sometimes all it takes a one minor tweak to their technique which can make all the difference in the world.

And then there’s other stuff like how to coach someone to perform a more “knee friendly” lunge, addressing weak hips, addressing alignment, mobility deficits, and engraining in people that you can always, ALWAYS train around an injury.

In my latest article on T-Nation.com I discuss all of the above and then some.

Continue Reading……

CategoriesCorrective Exercise Exercise Technique

A Simple Way to Pattern the Hip Hinge

Sometimes I think to myself how much of a moron I am.

And I don’t say that lightly. I’m 100% serious. I’m a moron. Or, to use a more “Tony’esque” term…..an asshat.


Lets rule out the obvious offenses like that time, as a freshman in my first college start, I threw a 3-2 hanging curveball to the clean-up hitter. I still think that ball has yet to land.

Or that other time I thought it would be hiiiiiilarious to sneak up behind my girlfriend in college – whom I knew hated to be scared – and scare her.

Her immediate reaction was to punch me in the mouth and give me a fat lip. Needless to say I learned that night where she stood on the whole fight or flight spectrum.

But at least I’m not as moronic as the guy on a recent episode of Forensic Files I watched who killed a woman and, upon using her credit card at a convenience store, signed his own name on the receipt.

Or this girl who did this……

https://www.youtube.com/watch?v=y50POlvKRyw

 

I’ve had my moments, as I’m sure everyone reading can commiserate with, where I demonstrated less than exemplary common sense.

But when I say I’m a moron/asshat/pick chosen adjective here, I’m also referring to my profound inability to think of stuff that many of my esteemed colleagues seem to do with as much ease as breathing.

At least once or twice a week I read something or watch something that makes me have a Homer Simpson moment where I slap myself in the forehead, yell “DOH,” and wonder why it never dawned on me to come up with the same idea or concept.

Ben Bruno gets the most recent tip of the hat.

A Simple Way to Pattern the Hip Hinge

I’ve written on the importance of the hip hinge and some basic drills I like to use to help groove it HERE. The Cliff Notes version goes something like this:

“It’s important because I said so.”

 [Drops mic, exits stage left]

Okay, in all seriousness the sooner someone hones their hip hinge the sooner they’ll be putting the leverages and torques they’re placing on the body in a more advantageous or “user friendly” setting. I.e., learning to move through the hips (and greasing hip extension without compensating with lumbar hyperextension) in addition to less stress on the knees and lower back when performing exercises like squats and deadlifts.

Likewise, once the hip hinge is cleaned up it makes the learning curve when introducing new exercises down the road much more expedited.

While out in LA teaching a workshop Ben Bruno stopped by to say hello and was nice enough to take the attendees through a quick 30-minutes session on cool ways to use the landmine. He showed this ingenious way to use it to groove the hip hinge:

The placement and counterbalance of the bar lends itself so that the trainee has no where to go BUT to hip hinge in order to lower the bar. If they don’t they’re going to hit themselves in the boy or girl down there parts.

It’s more or less the most intuitive way I’ve come across to help someone “feel” the hip hinge yet!

Understandably, some people may cry afoul about the hands/arms moving towards the floor, but remember all I’m trying to accomplish is helping someone feel the hip hinge happen in the first place! Once they have that, then I can work on upperback and lat tension when deadlift and squatting.

As an FYI: you don’t necessarily need the landmine apparatus in order to perform this drill. You could just as easily place a barbell up against a wall or kitty corner between two walls and accomplish the same objective.

Give it a try yourself or with your clients struggling to master the hip hinge and let me know how it goes.

CategoriesCorrective Exercise

Everything You Know About Corrective Exercise Is Wrong

Raise your hand if the mere sight of the term “corrective exercise” makes the hair on the back of your neck stand up or results in having to resist the urge to jump through a pane glassed window.

[Raises hand]

Corrective exercise can mean different things to different fitness professionals. For some, like physical therapists, it can mean any number of things including implementing unstable surface training with an injured client coming off a nasty ankle sprain. For others, like personal trainers, it can mean pretty much the same thing, having a healthy client perform all sorts of unstable surface training in the name of optimal core engagement! (whatever that means), and because it helps to separate themselves from the masses and it looks super neato.

WEEEEeeeeeeeeeeeeeeeeeeee.

Yes, I’m being a bit sensationalistic here. And yes, I’m going out of my way to use extreme examples. Hey, you’re still reading right?

Corrective exercise IS a thing, it DOES have a time and place, and MANY (not all) trainers and coaches need a slight slap upside the head (just a tap!) to help remind them what it is and what it isn’t.

In my latest article on BodyBuilding.com I give some insight on what corrective exercise means to me. Try not too take it too seriously though…I had some fun with it. 1

Everything You Know About Corrective Exercise Is Wrong

CategoriesCorrective Exercise Exercise Technique Rehab/Prehab

Stretching Isn’t Always the Answer: 3 Common Mistakes

I’m an avid reader. At any given time I’m reading 3-4 books at once. I’m always working my way through something related to my field. These are what I like to call the “hafta reads.”

Meaning, I hafta read “x book” in order to stay sharp and on top of things related to my profession (HERE are some of my favs).

Not coincidentally these are also the books which (sometimes) take me F.O.R.E.V.E.R to get through, which shouldn’t come as a surprise. Topics like humeral anterior glide syndrome or the Patheokinesiologic model of movement doesn’t make for light reading.

In addition I like to read a fair amount of non-fiction, particularly self-improvement books or books on behavioral economics. As you can surmise, I’m always the life of the party!

I have a 40 minute commute to and from work each day, so I’ll also be working my way through a book from Audible.com, assuming I’m not listening to ESPN or EW Radio.

And like any true nerd I’m always game for a good piece of fiction, particularly science-fiction.

I started reading The Martian by Andy Weir two days ago, and I cannot put it down. Without giving away too many details it’s about astronaut Mark Watney (who’s sense of humor given his circumstances is impressive) and how his crew was forced to evacuate the planet while thinking him dead.

Only he’s not!

Mark is stranded on Mars’s surface with no way to signal Earth that he’s alive. OMG I’m biting my fingers nails as I type this!

It’s sooooo good. And not for nothing, is currently being made into a movie starring Matt Damon and Jessica Chastain and directed by Ridley Scott.2

As is the case every time I read something, I try to find parallels between what’s being written and how I can apply a certain theme or idea to what I do as a coach.

If you can believe it, I found something.

The Martian is about a guy who’s stranded and alone on a desolate planet. I, along with many of my colleagues, often feel stranded and alone when it comes to going against the grain on some common fitness myths and fallacies.

Take for instance……..stretching.

Ever notice how everyone has tight hamstrings or tight hip flexors? Also ever notice how having “tight hamstrings” (and stretching them) is the answer for everything?

Low back pain? Tight hamstrings.

Your butt “winks” at the bottom of a squat? Tight hamstrings.

Chronic hamstring strains? Tight hamstrings!

Bad hair day? It’s tight hamstrings, yo!

Facetiousness aside, this isn’t to imply that there aren’t people out there who have short or stiff hamstrings (or short and stiff anything). They do! Likewise, by all means, there are millions of people who could benefit from stretching those sons-of-bitches, and could benefit from some additional stretching in general.

There’s no denying the many advantages that static stretching provides. I’m not hatin. Although, I’d be remiss if I didn’t state that how most people stretch (and for what length of time they stretch) really does nothing other than increase the tolerance to the stretch.

I.e., you’re not “lengthening” anything.

In order to increase the length of a muscle you need to either 1) lengthen bone (um, ouch!) or 2) in the case of someone who truly presents as short or stiff, increase the total number of sarcomeres in series (which takes a metric shit-ton of stretching).

Ask physical therapist Bill Hartman how long someone really needs to stretch in order to have a significant affect and/or to add sarcomeres, and he’ll tell you the starting point is 2-3, 10 minute holds per day. Working up to 20 minute holds.

That cute 30-second “stretch” you’re doing isn’t really doing anything.

However getting back to my original point, I do find the default suggestion of telling someone to “just go stretch” is a bit overused. While a great piece of advice for some people, it could be a nightmare for others and the exact reason some people remain in pain and never see much improvement(s).

And it’s with that I’d like to highlight some common stretching mistakes and misconceptions.

1. Are You “Tight” or Just Out of Whack?

You’d be surprised how often it’s the latter. Simply put: most people aren’t so much tight as they are misaligned.

It goes back to something physical therapist and strength coach, Mike Reinold, brought up in casual conversation not too long ago.

Which is more important to hammer first: stability or mobility?

Those trainers and coaches who swing on the stability side of the pendulum tend to be the overly cautious type who have their clients stand on BOSU balls.

Those on the mobility side snuggle with their copy of Supple Leopard every night.

Neither approach is inherently wrong so much as they’re flawed (if haphazardly assumed as “correct” for every person, in every situation).

If you strengthen (stabilize) in misalignment you develop imbalances. If you stretch (mobilize) in misalignment you develop instability.

Take someone who presents with excessive anterior pelvic tilt. It’s not uncommon for said person to complain about constant “tight” hamstrings, and no matter how often they stretch them, they stay tight.

You would think that after weeks, months, or sometimes even years of non-stop “stretching” they’d see some improvement, right?

Wrong.

The reason why they feel tight all the time has nothing to do with their hamstrings, but rather pelvic positioning. Unless you address the position of the pelvis – in this case, excessive anterior pelvic tilt – you can stretch the hamstrings until Taylor Swift writes a song about not being broken up with (<– not gonna happen), and you’ll never see improvement.

Think about it this way: in this scenario the reason why the hamstrings feel tight is because they’re lengthened and firing on all cylinders. By stretching them you’re just feeding into the problem in the first place!

We could easily chalk this up to the classic Lower Cross Syndrome as popularized by Dr. Vladomir Janda and stretch what’s tight (hip flexors, erectors), and that would be a step in the right direction. Cool.

But I feel for most people that’s not going to solve the problem and raises another issue altogether (which I’ll discuss below).

For most people the bulk of their efforts should revolve around including more things which encourages posterior pelvic tilt. Things like…..

Posterior Pelvic Tilt Hip Thrust

Cueing PPT When Squatting and Deadlifting

Reverse Crunches

Deep Squat Belly Breathing w/ Lat Stretch

** Oftentimes the lats are stiff/short and pull people into more of an extension posture. This breathing drill helps to turn off the lats while also cueing PPT.

https://www.youtube.com/watch?v=SndY5ctyU8U

2. You’re Doing It Wrong

You know how I said above that performing hip flexor stretches (stretching what’s tight) may be beneficial but that it brings up another issue altogether.  No? Oh, you skipped that part? Well, FML!

Let me repeat:

We could easily chalk this up to the classic Lower Cross Syndrome as popularized by Dr. Vladomir Janda and stretch what’s tight (hip flexors, erectors), and that would be a step in the right direction. Cool.

But I feel for most people that’s not going to solve the problem and raises another issue altogether (which I’ll discuss below).

Stretching the hip flexors is fine and dandy, and a good idea…..assuming you’re doing it correctly.

Here’s how most people stretch their hip flexor, though:

Most aren’t cognizant of pelvic positioning and just go into MORE anterior pelvic tilt and end up hanging on the ligaments of their lumbar spine. This is NOT a hip flexor stretch, and I’d argue is doing more harm than good.

Instead, I coach people to do what I like to call “doing shit right.”

Here’s how you perform a proper hip flexor stretch:

– In the half kneeling position, think chest up.

– Dig the toes of your trailing leg into the ground (toes point into the floor).

– On that same side, squeeze the glute of the trailing leg…..HARD!!! This will posteriorly tilt the pelvis. This cue alone will DRASTICALLY increase the effectiveness of the stretch.

– From there, without cranking through the lower back, gently shift your weight forward a few ticks. It won’t take much. The idea here is to move into a “deeper” stretch through the hip joint itself and not the lumbar spine. SQUEEZE THAT GLUTE!!!!

If you’d like to up the ante, because the rectus femoris crosses two joints – the hip and knee – you can place one hand on the wall for support and reach back and grab the ankle of the trailing leg with the other hand and perform the stretch in that fashion. Honestly, though, most will feel plenty enough of a stretch without doing that.

3. Are You “Tight” or Just Unstable?

I posted this Tweet the other day:

This sorta mirrors my comments above – when discussing alignment – but deserves a bit more love here.

I can’t tell you how many athletes (particularly baseball players) and even general fitness clients I’ve assessed who adamantly tell me how “tight” they are (and have been told how tight they are from physical therapists) only to pass every range of motion test with flying colors and test a 5/5 (technically 9/9) on the Beighton Laxity Score.

In geek speak it’s called protective tension.

Yet, there they are……stretching, stretching, and doing more stretching.

STOP IT!!!!

These people have so much ROM and are so unstable that the body perceives it as a threat and as a results ends up putting on the emergency breaks (your body doesn’t want you to hurt yourself!).

Muscle will hold tension in the presence of implied instability of associated joints. Muscles will relax when the implied instability of the associated joint(s) is improved.

Stretching a tight muscle without improving stability will result in a muscle that remains tight.

As classic example is the person who has a poor squat pattern due to “tight hips.” They lean forward too much, their knees cave in, and they present with all sorts of compensation patterns because they’re so tight.

Of course, they’ve been doing nothing but stretching and implementing a litany of hip mobility drills to address the problem. To no avail.

Try this: have that same person hold a 5-10 lb plate with their arms extended out in front of their body and see what happens.  PRESTO……..more often than not you’ll see a profound difference on not only how the squat looks, but how deep they can go.

Holding the weight out front serves as a counterbalance (easier to hip hinge back) and forces the anterior core to engage. Hence provides more stability.

And this phenomenon can be applied to other things as well. As Dean Somerset has noted on several occasions, “muscles do not have origins or insertions, merely anchors to bone.” The body is essentially one muscle connected by fascia. Anyone who disagrees can read Thomas Myers’ Anatomy Trains and get back to me on that.

Or you can watch this video by Dean and see how he’s able to increase one’s hip ROM by having them perform a few repetitions of planks (done correctly).

NOTE: this is the type of voodoo stuff Dean and I go over in our workshops. We’ll be in LA in two weeks.

So, are you tight or just unstable?

Is stretching always the answer?

Are you even stretching the right way? Hmmmmmmmm.

CategoriesCorrective Exercise Program Design

Critical Eye for Program Design

Every Wednesday we hold a staff in-service at Cressey Sports Performance where the coaching staff along with the interns get together and talk about “stuff.”

One week Eric may break down thoracic outlet syndrome and how to go about programming around it.  Another week Greg may discuss some new sprinting drills and how we can better cue our athletes with their movement training.

Chris may take a week and touch on some elbow or shoulder anatomy.  I’ll take the reigns one week and speak to the differences between external vs. internal cueing (or just reenact a full blown assessment using nothing but shadow puppets).

And Andrew will jump in on some weeks and discuss youth training or how it is he’s able to maintain salon-quality hair at all times.

It’s fascinating.

As you can see, we hit on any number of topics and nothing is ever off the table. We even had one of our current interns discuss the merits of blood-restriction training recently and how if may have some merit with regards to training injured athletes.  The idea being that the increased hypoxia will help engage or stimulate type II muscle fibers in the absence of appreciable load.

I’m a bit skeptical, but he made some interesting points!

Nevertheless the idea behind the in-services is to promote an open platform for learning and for open dialogue and discourse.

Yesterday happened to be what we like to call the Intern Programming Challenge. The idea is simple:  We give the interns several specific scenarios with regards to injury history and musculoskeletal dysfunction of an athlete/client, and they’re expected to write a 2-day/week program for each one.

An example might be:

1. Severely sprained right ankle with secondary external impingement in left shoulder.

OR

2. Extension based back pain.

OR

3.  Grade II hamstring strain with no left eye due to a pirating accident and an explosive case of diarrhea.

We all gather together and dissect each person’s program(s). Admittedly it can be an intimidating environment because no one ever likes seeing their work held under a microscope for public scrutiny. But as Eric noted yesterday, sometimes the best way to get better is to have your stuff ripped apart.

Not that we’re purposely ripping programs apart to make our interns feel bad. Rather, we’re using this as an opportunity to refine their programming skills and to think more objectively and “outside the box.”

Take secondary external impingement for example.  The word impingement is a garbage term as it is, because it speaks nothing to what’s actually causing the impingement (or pain) in the first place.

In watered down terms all “secondary impingement” means is that we know it’s not caused from a bony growth or deformation like a bone spur (this would be referred to as primary impingement, where the boney growth affects the acromion space and makes it narrower).

Instead we can chalk secondary impingement towards things like poor t-spine mobility, anteriorly tilted scapulae (poor scapular stability), poor tissue quality in the pec, pec minor, and/or lats, downwardly rotated scapulae or “depressed” shoulders, so on and so forth.

Conventional wisdom may dictate that the prone plank is an innocuous enough of an exercise where it would be a nice fit for most people, even in this example.

Mmmmm, maybe.  Maybe not. It depends.

The plank position will cause a lot more approximation in the shoulder joint (jamming the humeral head into the shoulder socket itself) which may be problematic for someone with external impingement.

It’s this kind of critical thinking – and the type of feedback we give back to our interns – which helps them become better and programming.

Lets dive into another common scenario……

Extension Based Back Pain

While flexion tends to get all the attention and love, extension-based back pain is something that’s grown in prevalence in recent years – especially in more athletic populations which involve a lot of extension and rotation.  Think:  baseball, golf, etc.

Too, extension-based back pain is very common in the more “meatheaded” population in addition to the personal training and coaching fields (where we tend to stand on our feet all day).

I’m not going to re-invent the wheel and elaborate on the specifics since I already wrote on this topic extensively HERE.

Needless to say, since we’re on the topic of programming I wanted to highlight some ways and ideas we could work around the issue when working with a client or athlete who exhibits this condition.

 

Seriously, read my post HERE if you’re curious how to assess for extension-based back pain as well as some thoughts on how to address it (rib cage position, how to cue certain lifts differently, and how to address proper breathing mechanics).

Do it!!!!!!

The most severe cases will typically manifest as Spondylolysis.  “Spondy” refers to a fracture of the pars interarticularis portion of a vertebra (95% of the time, it’s L5). The pars essentially connects the vertebral body in front with the vertebral joints behind.

Presence of spondylolysis runs the gauntlet in terms of who it effects, but its highest prevalence is among weightlifters. That said we’ve seen a huge influx amongst young athletes as well, especially those who participate (and specialize too early) in sports that require excessive extension and rotation (ie:  baseball).

I wrote a post on Spondy HERE if you’re interested.

1.  First and foremost the name of the game when dealing with ANY injury is to ensure you’re eliciting a training effect.

No one wants to feel like a patient when they’re training.  I mean, what fun is it to head to the gym only to perform a litany of ankle mobility and breathing drills?

Booooooorrrrrrrrriiiiiiinnnnnnggggggg.

This isn’t to say that those things won’t need to be addressed, but it’s important to understand that your job as a trainer or coach is to garner a training effect for your clients.

2. Whenever we have an client or athlete with a legit case of Spondy start at the facility our general rule of thumb is no back squatting for TWO YEARS – and that’s even if they’ve gone through an entire “treatment” with a back brace.

Placing a bar on the back means you’re moving it further away from the axis of rotation which increases shear forces on the spine ten-fold.

In this case things like Goblet Squats may be a better fit.  But even then, you may need to hold off for a few months before you implement them into a program.

3.  Single-leg work will almost always enter the equation, but you need to be very cognizant of back positioning.

If someone lives in extension and has extension-based back pain, they’re going to want to go into extension.  I  know, it’s confusing.

It’s important to engrain proper rib positioning, core bracing, and pelvic positioning when doing any single leg work.

4.  To that end, variations like slideboard reverse lunges are an awesome fit because they inherently make people use less weight, which in turn will result in less axial loading on the spine.

But even if we’re not dealing with a severe case like Spondy, it’s crucial to stress “neutral spine” throughout.

Start with dumbbells and progress to barbell variations.

5.  Glute bridging is fantastic provided the back stays in a posteriorly tilted (flatter) position throughout the entire set.

6.  Anything which promotes posterior pelvic tilt with someone with extension-based back pain is going to be money.

To that end, ensuring they’re squeezing their glutes during things like chops and lifts will be paramount.

I’ve often incorporated Posterior Pelvic Tilt Hip Thrusts (via Bret Contreras) into the mix:

I’ll be your BFF for life if you do these in a public park or something. I dare you to perform them in the waiting area at your doctor’s office!!!!

That’s just some food for thought. It’s important to embrace a more critical mindset when writing programs – especially when writing them for people with specific issues or dysfunction(s).

Hope that helps.

Now excuse me as I go practice my shadow puppets…..;o)

CategoriesCorrective Exercise

Massage: Misunderstood and Misused

I have an excellent guest post for you today, but before I hand it over to you for your reading pleasure I wanted to quickly remind people of my Premium Workout Group on WeightTraining.com.

After a 4-month block of a strength emphasis (and people breaking personal records left and right), we’re currently in the midst of a fat-loss block that’s, well, kicking everyone’s ass.  And people are still breaking PRs.

I say “fat loss” with a grain of salt because honestly, I hate that term.  I think most people see the phrase “fat loss” and automatically cringe and assume endless repetitions of burpees, supersets, Prowler pushes, puke buckets and carrot sticks.

Wait! Maybe carrot sticks aren’t Paleo enough?  Celery sticks then?  Crap, now I’m just confused.  Maybe James Fell can help shed some light on that topic?

Anyhoo, while making things more metabolically challenging does enter the equation and helps to expedite the process, a major mistake many people make with their fat loss programming is going  bat-shit crazy with training volume.

The role of a WELL-STRUCTURED fat-loss program should be to MAINTAIN or PRESERVE as much muscle mass as possible.

Most fat-loss programs do nothing but make people a smaller, weaker version of their original selves.  In other words, skinny-fat.

To that end, with my approach to fat-loss, people still lift heavy things, and the overall training volume isn’t egregious.  Ie….assuming you’re not eating like an a-hole, and calories out trumps calories in, training doesn’t have to be too dissimilar compared to regular ol’ strength training.

For more information just click HERE and you’ll see what I mean.

And with that, I now introduce to you Justin Sorbo.  Justin’s a local personal trainer and competitive powerlifter here in the Boston area who’s currently finishing up massage therapy school.

He’s been gracious enough to offer some free clinical hours to both myself and Lisa and I have to say, he’s good.  Like, REALLY good.  He offered to write a post on the massage industry and how it’s often misunderstood and misrepresented.

I hope you enjoy it!

Massage: Misunderstood and Misused

“ Sweet, bro. You’re gonna be a masseuse?  Can I sign up for a rub-n-tug?”

“Oh, that sounds like a nice idea for  some work on the side.  Which spa are you working at?”

“…What do you plan on doing with that?”

As a massage therapy student with a background in Kinesiology, I cringe every time I hear a friend or family member interject with one of the above statements.

Among other specialties like lymphatic drainage, clinically trained LMTs can prescribe and perform movement assessment, soft tissue work, stretching, active movement, joint mobilizations, and corrective breathing drills.  Combined with an exercise background (exercise science, CSCS, etc), we can be capable clinicians with a wide scope of practice.

In the United States, popular culture continues to regard the profession as strictly a form of pampering for the rich and famous, or; a thinly guised romp with a prostitute.

Note from TG: BOM CHICKA BOM BOM (sorry Justin, I couldn’t resist).

In reality, massage can be a powerful facilitator in the healing process and the management of pain.  The cloud of ambiguity surrounding the true nature of bodywork rests largely on the massage community itself.  In no particular order, here are a few of the forces driving massage culture in America today:

-Low Barrier of Entry with Minimum Prerequisites:  In most states, one can acquire a license to practice with a GED and a couple thousand dollars.  Massachusetts requires 650 hours of education, while some states require less.

This is a double edged sword: higher rates of entry mean lower quality students, but the relatively small financial and time commitment allows for a potentially better investment than a typical non-profit university.

-A History of Sex Work: Many of us have witnessed or heard of a local business being raided for prostitution.  The massage setting can be an easy target for shady people and moral-less money makers.  Privacy, intimacy, and trust are easily abused.

-Lack of a Definition of Massage: In reality, massage encompasses many modalities of manual therapy, yet usually seems to be imaged as a picture of a woman lying face down on a table.

-Pseudoscience: To me, this is the most damning of the bunch.  The world of massage therapy abounds with poor logic, uninformed or apathetic educators, and a lack of good research.

Historically, massage theory and technique has been derived largely from anecdote. Mechanisms for its effects have been proposed throughout the years, but very few have stood the tests of research and time.  The embrace of half-truths and lies surrounding soft tissue science further distance the profession from its rightful place as a part of mainstream medicine.

While certainly not a “cure-all”, manual therapy can be a formidable weapon for the treatment of a variety of conditions; some of which are better supported with research than others.

Specifically, massage shows promise as an effective treatment for low back pain in both acute and chronic sufferers.  Massage is an excellent treatment for the relief of anxiety and depression, conditions which are highly correlated with painful physical manifestations.

Mobilizations are effective at improving rehab outcomes, and breathing work can facilitate range of motion changes.

In order to be recognized as a form of healthcare, we need to focus on movement rather than just static palpation on a table.  We need to be testing and retesting our techniques, and documenting the outcomes.  We need to be able to communicate through anatomical language, and recognize our lack of understanding of biological mechanisms.

Most of all, we have to be morally and intellectually honest.

Addition from TG: Much like any profession, the process of learning and continuing to improve one’s skills doesn’t end once you stop paying for a course.  In addition, those therapist who succeed are generally the one’s who understand that not every person fits into one mold where one form of massage or manual therapy works 100% of the time.

While it’s great to have a niche or speciality to help separate yourself from the masses, in my experience those therapists who thrive are the ones who DO NOT pigeon hole themselves into being  SOLELY a deep tissue guy (or girl) or a fascial manipulation guy or a Swedish guy or a Graston guy or a Active Release guy or however many other forms of manual therapies are out there.

Opening up your skill set and adopting other modalities as you learn and gain experience is paramount.  What’s more, just to toss it out there, developing a network and referral system is hhhyyyyyyooooogggge.  This is something a lot of fitness professionals neglect to do, and I can tell you right now that in the future I’ll be referring clients to Justin because 1) he was proactive and reached out and 2) I KNOW he’s good.

It also doesn’t hurt that I know he’s open minded and he actually lifts weights.

For those looking on more insight on how to develop solid referral systems, Dean Somerset wrote a nice post on that topic HERE.

About the Author

Justin Sorbo is a Boston based personal trainer working out of One-to-One BodyScapes located in Newton, MA.  He’s also a competitive powerlifter.

You can find out more information via his Facebook page HERE.

CategoriesAssessment Corrective Exercise

How Deep Down the Rabbit Hole Do We Really Need to Go?

Today’s topic has been something that’s been festering in my brain for a while now, and it’s only been within the last few weeks where I felt the need to put something down on paper.

Or in this case, down on keypad.

To save face, you can relax….it has nothing to do with Tracy Anderson (I’m kind of over bitching about her).  Or Paleo Nazis. Or the fact that I was never able to beat Mike Tyson in Mike Tyson’s Punch-Out back in the day.  There’s always been a void in my childhood for that fail.

Nope, it has nothing to do with any of those things.

I guess you could say the impetus or tipping point came a few weeks ago at The Fitness Summit when Harold Gibbons and Kyle Langworthy – both brilliant coaches at Mark Fisher Fitness in NYC – asked me the following question:

“Hey Tony, do you think the long-head of the tricep can act as a spinal rotator?”

[Cue crickets chirping]

Uhhhhhhhhhhhh.  Yes? No?  I mean yes. No wait, no!  What was the question again?

What made the interaction more hilarious was the fact they asked it in such a nonchalant, casual manner, as if asking me “Hey Tony, do you like food?”

To their credit, both Harold and Kyle have been immersed in the rabbit hole that is PRI (Postural Restoration Institute), and not surprisingly have been having their minds blown.

It’s very much akin to Alice’s Adventures in Wonderland, where Alice ends up following the White Rabbit down his rabbit hole.

Except in this case, instead of a mescaline induced world of hookah smoking caterpillars, Cheshire cats, and Mad Hatters, we have things like predicted (normal) asymmetries in the human body, terms like Left AIC (anterior interior chain) and PEC (posterior extension chain), and aberrant breathing patterns (we’re really good at inhaling, but poor at exhaling).

Both Harold and Kyle admitted that they’ve been exploring the rabbit hole and that they’ve been traveling deeper and deeper.

To which I say:  how deep do we as coaches and trainers need to go?

Don’t get me wrong, I think it’s fantastic that more and more trainers are educating themselves, experimenting, and digging deeper.  I wish more would follow suit and do more of it!

This phenomena is something both Harold and I discussed in our little chat last week (so for those assuming I’m tossing Harold and Kyle under the bus, think again.  I’m not).

Besides, I’d be remiss not to express my own accolades and biases towards the PRI mentality.

We’ve been using aspects of PRI at Cressey Performance for coming up on two years now. We recognize that it’s POWERFUL stuff, that it works, and it helps people feel better.

I like PRI. I use PRI. But man, I really wish some trainers and coaches would tone it down a notch and just get people strong.

The PRI 10-Second Elevator Pitch

Before we continue, I should first apologize to those reading who have no idea what the hell I’m talking about.

I’m sure some of you are sitting their scratching your head and thinking to yourself “Postural Restor……WTF are you talking about?”

Let me explain.

While trying to squeeze PRI’s philosophy into one sentence or paragraph would be doing it a huge disservice, if I had to give a quick ten second “elevator pitch” on what their schtick is and what they’re all about, I’d say:  it’s about breathing!  Or, to be more precise, it’s about how most of us suck at it.

I’m more of an analogy guy, so using one that most people can (hopefully) appreciate:  if our breathing patterns are like the worst karaoke singer we’ve ever heard, we’d sound like a whale passing a kidney stone.

Yeah, not pretty.

More to the point it’s about understanding that symmetry – as much as we try to attain it, and think that it exists – probably ain’t gonna happen.

It’s recognizing that we’re inherently designed in such a way where asymmetry is inevitable – we have a heart on one side, a liver on the other, more prominent diaphragmatic attachments on one side compared to the other – and that how we breath plays a major role in that.

PRI tries to teach people how to breath more efficiently, which in turn, in conjunction with their corrective modalities, will help attempt to bring them back to neutral.

In short, the diaphragm is kind of a big deal, and because many of us are locked into a scissor pattern in conjunction with a left rib flare – what PRI refers to as a Zone of Apposition – we have a hard time breathing correctly.

Ideally the diaphragm will act as a superior and inferior “canister,” compressing when we inhale and elongating when we exhale….which in turn provides optimal stability up and down the kinetic chain.

Unfortunately, due to the aforementioned scissor posture (to the far right in the pic above), we tend to see more anterior translation of the diaphragm locking us into more extension, which in turn doesn’t allow it to perform optimally.

For the more visual learners out there, here’s how the diaphragm should work:

So that was a little more than 10 seconds, but you get the idea. I think.

This stuff IS important, and it definitely has its place in the grand scheme of things – ESPECIALLY if someone is in pain.

But I can’t help but feel that sometimes this knowledge is crippling some trainers and that they’re missing the forest for the trees.

It’s kind of like they’re constantly operating with their emergency brakes on.  They can apply the gas, and yes, the car will move, albeit it will be at a snail’s pace.

What’s starting to become more common is that trainers and coaches are forgetting that they’re trainers and coaches and they’re not training their athletes and clients.

Where I find this becomes more dangerous/annoying is that new, more inexperienced trainers are falling into this trap.  It’s one thing for someone with years of experience to start playing around with this stuff – as is the case with myself, Harold, and Kyle (and many, many, many others).

But it’s a whole nother ball of wax when you have inexperienced trainers trying to implement this new information when they haven’t yet learned to integrate it appropriately.

Stealing a line from Michael Mullin (who’s a PRI instructor himself)…..”just like any new skill, there’s a learning curve involved.”

How can one justify using more advanced techniques like positional breathing tactics when they can’t even coach someone how to squat correctly?

More importantly:  how much are we (as coaches and trainers) allowed to teeter with our scope of practice?

There’s no doubt an overlap between the physical therapy world and the strength and conditioning world.  Where do we draw the line though?

I’m always asked my opinion on “corrective exercise,” and to be brutally honest I feel that CORRECT MOVEMENT is corrective.

Coach people to squat, hinge, lunge, push, pull, and carry correctly, and it’s amazing what can happen.

The kicker is that PRI has been around for a few decades.  It’s only been in the past 2-3 years that it’s blown up to the point where everyone – physical therapists, chiros, strength coaches, personal trainers, and your local weather man – are using it.

As my boy, Mark Fisher himself, notes:

It frankly reminds me of the FMS mania a few years back where every trainer thought they were “diagnosing dysfunction” and “correcting” shit for hours on end (which is hilariously something that drives Gray fucking NUTS)

I’m sure it will all blow over soon (these things always do) and we’ll be left with the good big rocks of knowledge that can be implemented in a fitness setting, but good loooord people.

I’m 100% on the same page as Mark, with the exception of one thing.

I don’t feel PRI is just some random thing that will blow over – I mean, come on, One Direction is a thing.

I find a lot of value in PRI, and I know it works because I’ve seen it with my own eyes.

I think it’s great that more trainers and coaches are exploring the rabbit hole. But it’s important not to get too carried away. PRI is a tool in the toolbox.  Nothing more.

Just remember that.

CategoriesAssessment Corrective Exercise Product Review

Functional Stability Training for the Upper Body

Eric Cressey and Mike Reinold (otherwise known as Erik Cressnold) released their latest module in their Functional Stability Training series, Functional Stability Training for the Upper Body, yesterday and I’m excited for a few reasons.

1. I’m not going to sit here, blow rainbows up your ass, wax poetic, and say that this product is going to make the industry better…..except that that is exactly what I’m going to do.

This product is going to make the industry better.

I think it goes without saying – especially considering the two who are involved  – that FST for the Upper Body is a baller product that delivers on its promise to offer people a deeper look into the upper extremity and how to effectively assess dysfunction and address it through corrective exercise progressions and strength training.

It’s also gluten-free.  So there’s that.

2.  I have a unique perspective in that I see this stuff every….single…day. What you’ll watch in these videos are the exact assessment protocols and strategies we use at Cressey Performance on a daily basis with our overhead athletes and general population clientele.  It’s an inside-look, if you will.

3.  And, not to be understated, as I’m sure both Eric and Mike strategized this move to help increase their sales, you get to see me with no shirt on for 15 minutes.

I think I just broke the internet……;o)

Functional Stability Training for the Upper Body is on sale now at a low introductory price from today until this Sunday (5/18).  Click the link below for more details and to order.

—-> FST for the Upper Body <—-

CategoriesAssessment Corrective Exercise Exercise Technique Motivational personal training Rehab/Prehab Strength Training

A Response to Anyone Who Feels Deadlifts Are Destroying Everyone’s Spine

A HUGE thank-you to Bret Contreras for his contribution to this post. You’re my boy blue!

A little backstory.  A long time ago, in a galaxy far, far away A few years ago – back in 2010 – I wrote a blog post in response to someone claiming that deadlifts were “one of the worst things you could do for your spine.”

The comment was made by a TA (Teacher’s Assistant, not to be mistaken for Total Asshat) in a University setting, and the student who overheard the comment reached out to me and asked for some commentary.

I happily obliged.

You can read the original post HERE.

Even though I wrote that blog coming up on four years now, it’s still one that gets a lot of “love” and frequent comments.

Today I want to share the latest comment (another deadlift detractor) that was posted up two days ago by a physical therapist (and I assume a pilates enthusiast based off some of her wordplay), as well as mine, and subsequently, Bret Contreras’s, response.

I understand that some people will think to themselves, “What’s the point? If someone who’s clearly educated and is a practicing therapist feels deadlifts are the worst thing since Hilter (my words, not the therapist’s), do you really feel writing a response will change their mind?”

It’s a valid question, but my response is simple.

These types of posts are important for other fitness professionals since they’ll undoubtedly hear these types of arguments over time and they need to know how to respond.

So to begin lets take a gander at the therapist’s comments. Again, it may help to read the original post HERE.

I’ll preface this by saying that, giving credit where credit’s due, she kept things “civil” and refrained from using ad hominem attacks, which was refreshing to say the least.

In addition, she used her REAL name in the comments section (Meggen Lowry.  I wasn’t going to include the name here, but since people can see it in the comments section anyways, why not?), which was a nice change of pace and sure beats hearing from the likes of PowderPuffPrincess or JackedGunz84.

In doing a quick Google search, Meggen’s a well educated professional who works with a very specific population (pre-natal/post-natal clients, as well as those in a rehabilitative setting), which is relevant and gives context into her point of view.

Anyways, lets get to the meat and potatoes!

Posted on TonyGentilcore.com 4/27/14:

1) Your attitude and arrogance makes for an unpleasant reading experience.

2) Pilates uses limb loading, and can create significant loads through your spine but tends to be done in better postures and positions that support the spine and reduce downwards strain on the pelvic floor. Try it. You might find it isn’t for wussies.

3) Osteogenesis (bone adaptation by means of increased bone laydown) in response to loading is not a phenomenon unknown to researchers and physical therapists.

4) The problem with ‘educators’ like yourself is that you use the collective terms “spine” and “back” when talking about individual components of those structures. Deadlifts do not strengthen your whole spine. They are not good for your back.

The erector spinae will be strengthened (and possibly injured) with a dead lift, nobody is denying that.

The vertebral bodies themselves will experience adaptation and increase in density also. The intervertebral discs, however, will suffer. Under such huge compressive forces the nucleus pulposis will be ‘squished’ backwards and the annular fibres of the posterior portion of the disc will tear under strain. Those discs are not replaceable….

5) Intra-abdominal pressure is far far greater with a deadlift than any other exercise you mentioned, and increases even more if the person holds their breath. Intra-abdominal pressures of that magnitude cause significant detrimental strain to the abdominal wall, predisposing it to herniation. Even worse, it causes even greater strain to the pelvic floor, stretching and weakening the pelvic floor muscles and predisposing them to urinary incontinence and prolapse.

Until you show me some research (preferably not 20-30 year old research) demonstrating intervertebral disc and pelvic floor adaptations to dead lifts, proving that the annular fibres of the discs are not broken under strain and the pelvic floor is not weakened and lowered, I’m still going to advise my clients against them.

WHEW! And there you have it.

I’ll admit it:  when I first read all of that the other day my first reaction was as follows:

LOL – Just kidding.  I’m not going to kill anyone.

I was a bit “miffed,” but I think that would be anyone’s reaction whenever someone questions your training philosophy and beliefs.  Strength coaches defend deadlifts; yoga instructors defend downward dog; pilates instructors defend reformers; bodybuilders defend fanny-packs and benching with their feet up. It’s just how the world revolves.

Even so, I was bit taken aback by some of Meggen’s comments.  Sure, she brought up some valid points (addressed below), but she also seemed, in my opinion, to have a very narrow-minded mentality – especially for someone who’s a physical therapist.

I mean, in checking the Mission Statement of the establishment where she’s employed you find the following text:

In addition to home visiting, we offer exercise classes carefully designed and delivered by physiotherapists for people whose bodies are vulnerable to pain and injury because we believe movement can be the best medicine if you perform exercise tailored to the shape you are in.

How can someone who’s company’s Mission Statement says “we believe movement is the best medicine if you perform exercise tailored to the shape your are in” completely disregard a basic, human movement pattern – the deadlift – and deem it and all its iterations “dangerous” or “risky” or gloss over them because of the potential for spinal stress?

That seems a bit harsh and shortsighted if you ask me.

Isn’t that the point of exercise – to stress the body, including the spine?

Any competent coach will assess his or her client/athlete, progress them accordingly – based off their training experience, injury history, etc – and provide the minimal essential strain to stress the body so that it will come back stronger.  It’s called adaptation!

In my experience, those who disregard certain exercises or movements and/or poo-poo them altogether typically (not always) are those who’ve never performed them themselves in the first place.

Calling a spade a spade, these are also the same people who have no idea how to coach said movement(s) well.  So, as a result, the exercise becomes too “risky” and everyone else who uses it is wrong.

Meanwhile if we were to take Meggen’s company’s Mission Statement and apply it to real life, we’d realize that the deadlift, like every exercise ever invented by human beings, can be regressed and tweaked to fit the abilities and needs of each individual.

Using a quick example: Look at me hinge from the hips, load my glutes, maintain tension in the upper back and lats, keep a “neutral” spine, and reduce “stress” on my spine below.

This is a deadlift, too.  Not all deadlifts have to be max effort, full-exertion, grind it out movements. And while it (should) go without saying:  a properly executed deadlift – done with a neutral spine – is a far cry from the eye sores you see a lot of trainees performing.

The two can’t and SHOULD NOT be lumped into the same category (which is what I feel many people, not just Meggen, are doing).

Okay, so lets break down Meggen’s comments. I’ll re-post her point-by-point breakdown below followed by my response (if I have one) and Bret’s.

1) Your attitude and arrogance makes for an unpleasant reading experience.

Tony:  You know what.  You’re right.  I re-read the post again and I can see how someone would come to that conclusion having never read any of my stuff before. I did come across as a bit of an a-hole, and I apologize for that.

Not that it’s a hard defense, but it was FOUR years ago that I wrote that post, and I’d like to think that I’ve grown as a person (and writer) since then.

Having said that, I “get” that my writing style isn’t for everyone. Touche.

Bret: As somebody who is very well-versed with industry leaders in strength & conditioning, I can say with confidence that Tony might be the most humble of the bunch. 

Tony’s Response to Bret’s Response:  Awwwwwwwwwwwwwwwwwww.

2) Pilates uses limb loading, and can create significant loads through your spine but tends to be done in better postures and positions that support the spine and reduce downwards strain on the pelvic floor. Try it. You might find it isn’t for wussies. 

Tony: And, Pilates should be held under the same microscope. Just like deadlifts, Pilates, too, can add undo strain or stress on the spine when done incorrectly.

Can you honestly sit there and tell me that performing hundreds of repetitions of any Pilates exercise – even if supported and done in alignment – won’t “stress” the spine?

I actually know quite a few Pilates instructors, most of which understand the importance to strength training, who recognize that it can hurt people when done incorrectly.

The key term you use is “better postures and positions,” which I assume means alignment.

YES!!!  Alignment is key.

This is something I discuss quite often. It makes no sense to debate over which comes first or should be prioritized – mobility or stability – if someone isn’t in (optimal) alignment.

Note:  it should be highlighted that there’s no such thing as true alignment or neutral or symmetry.  It doesn’t exist, because the human body – based off our anatomy – is designed to be asymmetrical.

I 100% agree with you on this point.  So, tell me again, if a deadlift is performed correctly, with a neutral spine, it places too much stress on the spine?

And, as far as your comment “Try it (Pilates). You may find it’s not for wussies.”  I did!  

You can read about it HERE.

Funny thing:  I like to try things that I write about.  In fairness, the Pilates post was written well after the post we’re all discussing here.  But still, I feel like I should get a gold star or something.

Which begs the question, Meggen:  what’s the parallel you’re trying to make between a modality which was originally designed to treat injured dancers and……deadlifts?

More specifically: deadlifts, when performed correctly and by healthy individuals with no contraindications?  Even more specifically:  deadlifts, which have been utilized by thousands of physical therapists (past and present) to help people get stronger and move more efficiently.

Also, when was the last time you performed or even coached a deadlift?  When was the last time you ever prepared an athlete for a long, competitive season?  When was the last time you coached ANYONE interested in performance?

I hate to break the news to you, but deadlifts are kind of important in this regard.

Context is important here.  I understand – and respect – the population you work with (pre and post natal women, and those in a rehabilitative setting), and deadlifts may not be a good fit for some of YOUR clients.  I doubt that’s the case entirely, but still…….you know your clients better than me.

There are ways to regress the deadlift and to teach someone how to groove a proper hip hinge pattern.  It takes coaching, it takes times, and it also takes not deeming an exercise too “risky” because you’re not familiar with it.

Like I said above, not all deadlifts have to be loaded with 400 lbs on the bar. You can’t equate all deadlifts as being equal. What I’d do for someone who’s in pain, de-conditioned, has little to no training experience has chronic back issues, and moves like the Tin Man is COMPLETELY different compared to someone who’s healthy and otherwise “good to go.”

Take THIS post I wrote not too long ago on how to groove the hip hinge.

Lets try not to toss the baby out with the bathwater.

Bret: Most strength coaches borrow from Yoga and Pilates and incorporate various drills into their warm-ups and corrective exercise regimes. We’ll use anything that’s effective, as S&C is all-encompassing.

The same cannot be said of trendy modalities that pick and choose what’s included and what’s excluded and fail to tailor programming to the goals and needs of the individual.

Pilates can definitely be progressive in nature and isn’t always “wussy,” but if maximum power, strength, or conditioning is the goal, then you’re going to have to jump, sprint, lift heavy, and move around more. 

3) Osteogenesis (bone adaptation by means of increased bone laydown) in response to loading is not a phenomenon unknown to researchers and physical therapists. 

Tony:  Cool, we’re on same page. 

Bret: Agree! Perhaps you’d be interested to know that the highest bone densities ever recorded are in powerlifters (see HERE and HERE), and that high load exercise is more effective than low load exercise in increasing bone density (see HERE). 

4) The problem with ‘educators’ like yourself is that you use the collective terms “spine” and “back” when talking about individual components of those structures. Deadlifts do not strengthen your whole spine. They are not good for your back.

The erector spinae will be strengthened (and possibly injured) with a dead lift, nobody is denying that. 

The vertebral bodies themselves will experience adaptation and increase in density also. The intervertebral discs, however, will suffer. Under such huge compressive forces the nucleus pulposis will be ‘squished’ backwards and the annular fibres of the posterior portion of the disc will tear under strain. Those discs are not replaceable….

Tony:  Again, I think you’re equating deadlifts done incorrectly (which if that is the case, I’ll agree with you 100%) with deadlifts that are progressed appropriately and with progressive overload in mind.  They are not the same.

And, not for nothing, a 1994 study in the New England Journal of Medicine found that in a study of MRIs of 98 asymptomatic individuals, 82% of those MRIs came back as positive for a disc bulge, protrusion, or extrusion at one level.  And, 38% actually had these issues at more than one level.  You can read the free full text HERE.

I bring this up because, as this study shows, there’s a fair number of people walking around out there with disc bulges who are asymptomatic and show no signs of stress or pain.

What prevents (most) of them from reaching threshold is appropriate strength training, attention to tissue quality and movement impairments, and, yes, things like positional breathing and pelvic alignment (but that’s obvious, right?).

It’s not a death sentence, and we shouldn’t go out of our way to demonize certain exercises and to toss them aside because of personal ignorance.  

As fitness and health professionals we can’t place people in these “no stress” bubbles, cower in the corner every time we ask them to do anything challenging, and expect them to get better.

As noted earlier, any competent coach will assess their client, progress them accordingly, and provide a minimal essential strain to STRESS the body so that it comes back stronger. 

Using a population you (Meggen) may be more familiar with, HERE is an article I wrote about training women through their pregnancy.  These were HEALTHY women, with no major injuries and dysfunctions, and both of which had been training with me for a few years.

I’m not sure if you’ll read the post (don’t worry, I won’t be offended), but hopefully you won’t cringe at the thought that both women deadlifted throughout their entire pregnancies.

Here’s Whitney at 32 weeks:

Here’s Cara at 33 weeks:

NONE of these lifts were even close to what either woman could do when not pregnant. The objective was to maintain a movement pattern and training effect, do what felt comfortable, and prepare them for something a helluva lot more strenuous…..giving birth!!

In addition, because I had been training both women for two years, progressing them accordingly, I had full confidence that they would be able to deadlift up until “game time.”

And, as it happens, both had seamless births (coming from a guy, that seems a bit wonky as I recognize that giving birth is anything but “seamless”) with no complications or ramifications afterwards.  

It’s BECAUSE they strength trained (and yes, we did diaphragmatic breathing and tons of core work, too) that they were able to bounce back so quickly.  I believe both were back in the gym within a week after giving birth. 

Bret: Do you have any research to support your claim that deadlifting with a neutral posture leads to disc herniation?

I’m very well-versed in spine research, and I’m unaware of any such research.

I believe that with proper deadlifting, the erector spinae will be strengthened, the vertebrae will be strengthened, and the discs will be strengthened too, in concordance with Wolff’s law of bone and Davis’s law of soft tissue. 

Nevertheless, the spine is very good at handling compressive loads when in neutral postures, and shear loading is limited in neutral spine deadlifting as well. If you round your spine close to full flexion when deadlifting with heavy loading, then lumbar intervertebral discs can indeed herniate and ligaments can be damaged.

However, now we’re talking about a different exercise (roundback deadlifting, not neutral deadlifting). An exercise is judged based on how it’s supposed to be performed, not how jackasses screw it up.

We could also speculate about the effects of performing Pilates maneuvers with improper form, but this wouldn’t imply that the exercises should not be performed with proper form.

5) Intra-abdominal pressure is far far greater with a deadlift than any other exercise you mentioned, and increases even more if the person holds their breath. Intra-abdominal pressures of that magnitude cause significant detrimental strain to the abdominal wall, predisposing it to herniation.

Even worse, it causes even greater strain to the pelvic floor, stretching and weakening the pelvic floor muscles and predisposing them to urinary incontinence and prolapse.

Until you show me some research (preferably not 20-30 year old research) demonstrating intervertebral disc and pelvic floor adaptations to dead lifts, proving that the annular fibres of the discs are not broken under strain and the pelvic floor is not weakened and lowered, I’m still going to advise my clients against them.

Tony:  So 20-3o year old research, even if it’s applicable and still very much referenced by many other fitness professionals, isn’t relevant to the topic at hand?  Why not?  

Besides, good luck finding ANY research which states exercise doesn’t stress the spine. Walking stresses the spine.

Unless you tell someone to lie down their entire life, it’s impossible not to put the spine under some strain.

Research is more Bret’s wheelhouse, and I’m sure he’ll satiate your appetite for something more “up-to-date,” but it’s my hope that this conversation will help shed some light from our (mine and Bret’s) point of view.  Neither of us are therapists, nor claim to be. We don’t diagnose anything and we don’t “treat” our clients and athletes. That sort of stuff is reserved for the likes of you.

We do, however, both recognize the importance of bridging the gap between the strength and conditioning world and the physical therapy world.

Going out of your way to state deadlifts aren’t beneficial because of the “perceived stress” they cause not only widens that gap, but flies in the face of pretty much every physical therapist I’ve ever dealt with.

I don’t expect this to alter your mindset, and I am in no way stating that I’m completely correct and without my own biases, but I hope it challenges you to think a little more outside the box.

Bret: If you’re going to deadlift, you better hold your breath until you pass the sticking region.

Failing to do so would reduce IAP and therefore reduce spinal stability, which could compromise spinal posture and lead to injury.

I agree that IAP will be extremely high during deadlifting. However, strength coaches first introduce deadlifting to clients with light loads, ensuring proper mechanics.

Each week, loads are increased so that the body has the ability to build up in strength. This is the essence of progressive resistance training. We also program multiple exercises that will further strengthen the abdominals, the erectors, and the glutes, which will further help prevent injury. 

I’m aware of no research showing that deadlifts lead to increased incidents of hernias.

You can speculate that deadlifters might be at greater risk for experiencing hernias, but the role of exercise and occupational lifting on hernia risk has been debated, with both sides providing great arguments (see HERE for references).  In my experience as a personal trainer for well over 15 years, I would say that proper deadlifting does not significantly increase hernia injury risk. 

When you deadlift, the muscles of the TVA, multifidus, diaphragm, and pelvic floor (sometimes referred to as “inner core unit” muscles) contract to produce IAP. Essentially, a pressurized cylinder is formulated via contraction of each of these muscles (a few more assist, but this is beyond the scope of this article).

The pelvic floor muscles draw upward and inward, which increases the IAP and stabilization. As you can see, the pelvic floor muscles will be strengthened and not stretched out.

Women tend to notice improvements in incontinence after learning proper resistance training, including deadlifts.

If their pelvic floor muscles draw outwards, then they are exhibiting a dysfunctional pattern and need to be taught proper pelvic floor biomechanics.

Research shows that 78% of women who exhibit flawed pelvic floor mechanics can properly contract the pelvic floor muscles after basic instruction (click HERE for an article on this topic).

Women who properly contract their pelvic floor musculature will properly stabilize during deadlifts, Pilates, and other exercise. Women who don’t will improperly stabilize during deadlifts, Pilates, and other exercise. The IAP doesn’t blow the pelvic floor outwards during the deadlift like you propose, nor does it force the diaphragm upwards. Rather, it’s the proper mechanics of the core muscles that creates the high IAP. 

 

In summary, you have failed to issue an evidence-based response, and I believe that your unfamiliarity with the deadlift exercise is biasing your beliefs.

Just as you recommended that Tony give Pilates a try (Note from Tony:  I did! See above), I recommend that you start learning about deadlifts and experimenting with them in the gym.

From the various hip hinging drills, to single leg RDLs, to partial deadlifts such as rack pulls and block pulls, to full range deadlifts such as conventional, sumo, and trap bar deadlifts, to various variations such as Romanian deadlifts, stiff leg deadlifts, and snatch grip deadlifts. 

Since you’re making the claims that proper deadlifts damage discs, abdominal walls, and pelvic floors, the burden of proof is on you.

You can speculate all you want, but bear in mind that if this were true, all powerlifters would have wrecked spines, hernias, and incontinence. This isn’t the case at all; quite the opposite. But they’re loading the spine to the maximal limit.

Research shows that there’s a u-shaped curve with regards to low back pain and exercise. Sedentary folks and individuals who perform strenuous exercise have increased pathology and low back pain, whereas those in the middle are more healthy and comfortable (see HERE and HERE).

Therefore, a few days of strength training per week utilizing basic strength training exercises such as squats, deadlifts, hip thrusts, planks, push-ups, and rows will generally improve back health and structural integrity. 

CategoriesAssessment Corrective Exercise

Tendinitis vs. Tendinosis: Yes, There’s a Difference

Yesterday I had the pleasure of attending the filming of Eric Cressey and  Mike Reinold’s next phase in their Functional Stability Training series, Functional Stability Training – Upper Body.

As an FYI:  the first two modalities, Functional Stability Training – Core, and Functional Stability Training – Lower Body, can be accessed HERE.

Think of the whole shebang as on par with The Dark Knight trilogy.  All stand alone pieces are equally badass in their own right, but as a whole……can be considered mindblowing.

Yesterday entailed the filming of the “hands-on” or lab portion, and Cressnold (as I like to call them) took volunteers from the audience and placed them through a few shoulder screens/assessments to demonstrate that not all shoulders are created equal.

More importantly, they took it as an opportunity to demonstrate to everyone that how “we” approach treating and addressing certain dysfunctions can drastically change from one shoulder to the next.

And, as it happened, I ended up being one of their guinea pigs, as seen below in a “behind the scenes” shot.

Basically, it went down like this:

Mike:  would anyone be willing to take their shirt off?

[dead sprint from my seat]

Me:  Can The Rock smell what’s cookin?  Does a bear shit in the woods?  Does Dolly Parton sleep on her back?  YOU WANT MY PANTS OFF TOO????

I suspect that my 20 minute shirtless cameo will be a huge selling point for Eric and Mike when they finally release this module.

Learn the secrets behind an effective shoulder screen/assessment.  

Find out how both Mike and Eric choose what treatment and corrective exercise progressions come into play based off a thorough shoulder assessment.

Watch Tony squeeze his pecs and turn a piece of coal into a diamond!

Okay, all facetiousness aside, it was a FANTASTIC event and it should come as no surprise that Mike and Eric helped make a lot of people a heckuva lot smarter.

One key point that I want to discuss today which Mike hit on briefly during one of his talks, is the notion of tendinitis and tendinosis.

Many people think the two are one in the same and that both should be lumped together (like Star Wars and Star Trek.  You know, cause both take place in space) with regards to how we go about assessing and addressing each.

This is wrong, and here’s why.

– itis = is the Greek suffix for inflammation.

– osis = is the Greek suffix which denotes actions, conditions, or states. In the context of this conversation it refers to degeneration.

Someone with acute elbow pain or discomfort for example has tendinITIS.  You can palpate the area, the person will say “ow,” tell them to apply ice, take some ibuprofen for a few days, lay low on things that exacerbate symptoms, and they should be fine within a few weeks, if not days.

Conversely, someone with a more chronic, insidious condition has tendinOSIS.  You can palpate the area, the person will probably want to punch you in the face (but it could just as easily be more acute discomfort like the example above), but in this case, despite icing, popping NSAIDS, and rest, the condition, even after six months hasn’t gotten any better.

The problem here is actual degeneration of the joint, and it’s in this scenario we need to look more outside the box.

In keeping with the elbow example, someone with tendinitis will typically – not always – respond well with dedicated manual therapy on the problem area itself alongside your standard ice/rest protocol.

If the issue doesn’t resolve and it continues for months on end (tendinosis), and as Mike pointed out, sometimes you need to look elsewhere along the kinetic chain to see what’s the TRUE culprit.

It’s something he’s routinely referred to as The Kinetic Chain Ripple Effect.

When dealing with a more chronic issue, you still need to look at the affected area (in this case the elbow), but you also need to look at other factors elsewhere.

You can treat the elbow all you want with manual therapy and corrective exercise, but if someone has atrocious T-spine mobility, is overly kyphotic, and has forward head posture, wouldn’t it make sense to address those “red flags?”

Interestingly, Mike worked with someone yesterday during his presentation who had elbow pain, and one of the first things he did was test her grip strength bilaterally.  It should come as no surprise that she was weaker on the side which hurt to squeeze.

After coaching her on her posture – getting the shoulders back and posteriorly tilted, learning to brace the abs and posteriorly tilt the pelvis, and to tuck the chin – he retested her grip and she immediately saw a 16% increase (and it was less painful!).

And all he did was place her into better alignment!

There’s no doubt that she would still need soft tissue work to address her elbow, but many of her symptoms were corrected by taking a closer look at her shoulder and head position!

All of this to say:  if you’re a personal trainer or strength coach and have a client with a nagging injury that hasn’t gotten better with traditional ice, rest, and NSAIDS, it’s a safe bet that it’s not just a simple case of tendinitis, and you’re dealing with something more chronic like a tendinosis (or, actual degeneration of a joint).

Step one would be to refer out to your network and have him or her work with a manual therapist.

Step two, and something which you can take more of the reigns on, would be to keep an eye out for other factors such as posture or any movement dysfunctions who may notice.

More often than we think an “elbow issue” isn’t just something that’s wrong with the elbow. Likewise, a “knee issue” could be something fishy going on elsewhere. We can’t assume it’s solely the knee.

I like to put all the blame on CrossFit….;o)  Just kidding.  Kinda.

What are you thoughts?  Agree?  Disagree?  Tomato? Tomahto?  I’d like to hear everyone else’s thoughts on the matter.