CategoriesAssessment coaching Exercise Technique Rehab/Prehab

The Post Where I Tell You It’s Okay to Move Your Spine

Back pain can be tricky. First off, anyone who’s ever dealt with it (pretty much everyone) knows it’s no fun. Second, there’s no overwhelming agreement as to what actually causes it. One person says weak glutes, another says tight hip flexors or hamstrings, and yet another may point to a bad hair day (NOTE: read this footnote, it’s a doozy —>).1

Third, if the stock photo I chose below is any indication, back pain can also put a real damper on what can only be described as an Old Spice or Abercrombie & Fitch ad shoot.

Copyright: olegdudko / 123RF Stock Photo

 

In my career as a personal trainer and strength coach I’ve worked with dozens and dozens of athletes and clients battling low back pain. It comes with a territory as a fitness professional. I’ve tried my best to arm myself with the best skill-sets possible (within my scope of practice) to help my clients work through their low back shenanigans. I can assess – not diagnose – and try to come up with the best game plan possible to address things.

And, to be honest, addressing one’s lower back issues can be mind-numbingly simple.

In short:

“Find what movements hurt or exacerbate symptoms, don’t do those movements, and then find movements that allow for a degree of success or pain free training.”

I’d be remiss not to mention Dr. Stuart McGill’s work here. Not only is he one of the world’s Godfathers of spine research, but he’s also one of the world’s best mustache havers.

He’s co-authored hundreds of studies and written several books on the topic of low-back pain – with Ultimate Back Fitness & Performance (now in it’s 6th Edition) and Low Back Disorders being his flagship pieces of work.

Speaking of Ultimate Back Fitness & Performance, look who makes a cameo appearance on pg. 289 in the latest edition:

BOOM

For the Record: TG Life Bucket List

  1. Get to a point in my career where Dr. Stuart McGill not only knows who I am, but emails me out of the blue and asks permission to use a picture of me in his latest book update.
  2. Appear in a Star Wars movie.
  3. Become BFFs with Matt Damon
  4. Own a cat.

I’d have to say, however, that his most “user friendly” book is Back Mechanic. In it, he breaks down his entire method for “fixing” low back pain covering everything from spinal hygiene, assessment, corrective exercise, and strength training.

I’m not going to belabor anything, you can purchase the book and peel back the onion on his protocols (seriously, the assessment portion is gold).

I’ve noticed a trend in recent years, though. Dr. McGill has done so much for the industry and his work is so ingrained in our thoughts as fitness professionals that I feel the whole idea of “avoiding spinal flexion (sometimes at all costs)” has bitten us in the ass.

Yes, avoiding spinal flexion is a thing, especially if someone is symptomatic and flexion intolerant.2. It’s that point, though, “avoiding spinal flexion” that has gotten the best of us for the past decade or so.

We’ve done such an immaculate job at coaching people to know what “spinal neutral is” via prone planks, side planks, and birddogs, and then used strength training to engrain that motor pattern, that (some, not all) people transitioned into more extension-based back pain because they lost their ability to move their spine into (pain free) flexion.

Dr. Ryan DeBell discussed this phenomenon recently where he discussed his own back pain history. He started as flexion intolerant, trained himself into “spinal neutral,” (which is what you should do), started to avoid all flexion like the plague, and after awhile, extension-based movements & positions started to hurt…because he was locked into extension.

As a corollary, I see this quite often myself: someone comes in to see me and both flexion and extension based movements hurt. It’s so frustrating for the person and I can understand why.

My job, then, as the coach is to garner confidence and self-efficacy with my client/athlete and work with him/her on what I know tends to work….find movements that do not hurt and work from there.

Dr. McGill has his own version of the “Big 3,” or his go to exercises when first starting with a low-back person:

  • The Curl-Up (I.e., not a sit-up)
  • Side Bridge or Plank
  • Birddog

Even when we master those movements, which are often very challenging for people when performed right, I’ll stick with them for a couple of months and just up the ante with appropriate progressions. Lets take the birddog for example.

Birddog w/ RNT

 

The band adds an additional kinesthetic component where increased stiffness or engagement occurs in the anterior core and glutes. Truthfully, it’s not uncommon for me to START with this variation so the person can feel what their limbs are doing in space.

Birddog – Off Bench

 

I “stole” this one from Dr. Joel Seedman and feel it’s an ingenious progression. Doing the birddog off the bench takes away a component of stability (feet off the floor) and forces people to slow the eff down and learn to control the movement. If they don’t, they fall of the bench. And I laugh.

Your Spine, Move It!

Going back to the assessment for a quick second, it’s not uncommon for me to assess someone and to find that their spine doesn’t move. Whether it’s because of a faulty pattern or they were coached to avoid flexion at all costs (even when asymptomatic) it’s as if their spine is Han Solo frozen in carbonite.

One screen I like to use is a the toe touch drill. When someone bends over to touch their toes there should be a consistent curvature/roundness of the spine. Often, what I’ll see is more of a “V” pattern where they’ll bend over, but instead of seeing a nice curve I’ll see their lower back stay flat throughout the movement; as in zero movement.

This can be just as detrimental as anything else. It may or may not be a root cause of their low-back pain, but I know it’s a red flag I’d like to address.

Segmental Cat-Cow

Below is a drill I’ve been using more and more with my low-back clients. We’re all familiar with the Cat-Cow exercise, where you round and arch your spine moving through a full-ROM.

Cool, great. The human body is great a compensating, and unless you have a keen eye for detail it’s easy to assume that if someone can round and arch their back they’re good to go. But

But are they? Often, if you SLOW PEOPLE DOWN it’ll become abundantly clear that they may move well in certain areas of their spine (thoracic), but not in others (often lumbar).

Coaching them through the movement – point by point, segmentally – is a fantastic way to hammer this point home and to help nudge them to move their spine in a slow and controlled fashion.

 

Give this one a try with some of your clients. COACH THEM. This drill doesn’t require more than two passes (up and down) per set, for a total of 3-4 sets. Helping them understand that they are allowed to move their spine – assuming it’s pain free – is a sure fire way to set them up for long-term healthy spine success.

CategoriesAssessment Corrective Exercise Program Design Rehab/Prehab

The Forgotten, Often Overlooked Cause of Low Back Pain

There are many root causes of low back pain and discomfort, and there are many people who’s day to day lives are affected by it.

In my neck of the woods – Strength & Conditioning – the culprit(s) can often be displayed on the weight room floor. Lifters who routinely default into movement patterns that place them in (end-range) LOADED spinal flexion or extension are often playing with fire when it comes to their low back health and performance.

NOTE: this isn’t to say that repeated flexion/extension is always the root cause.

1) There’s a stark contrast between flexion/extension and LOADED flexion/extension. Many people have been programmed to think that all flexion/extension of the spine is bad. It’s not. The spine is meant to move, albeit under the assumption that one can do so without significant compensation patterns (relative stiffness), limitations in mobility, and with appropriate use of both passive (ligaments, labrums, and tendons, oh my) and active (muscles) restraints.

It’s when people start placing the spine under load in ranges of motion they can’t control – often in the name of social media glory – that bad things end up happening. 

2) However, there are plenty of examples of lifters (mostly elite level, which is an important point) who have been utilizing techniques many fitness pros would deem incendiary with regards to the increased likelihood of spines all over the world resembling a game of Jenga.

A great example is a piece Greg Nuckols wrote HERE, explaining the benefits – biomechanically speaking – of a rounded back deadlift.

But back pain – specifically low back pain – can strike at any moment. I’ve heard stories of people hurting their back during training of course. But I have also, and I think many of you reading will nod your head in agreement, have heard stories of people messing up their back while bending over to pick up a pencil or to tie their shoes.

Or while fighting a pack of ninjas (hey, it can happen).

In pretty much all cases it comes down to one of two scenarios going down:

1. Ninjas attack.A one-time blunt trauma. Think: spine buckling under load, car accident, falling off a ladder.

2. A repetitive aberrant motor pattern. Think: tissue creep into sustained spinal flexion for hours on end at work.

Dr. Stuart McGill and his extensive research on spinal biomechanics has been the “go to” resource for many people – including myself – to help guide the assessment process and to attempt to figure out the root cause of most people’s low back pain.

A term he uses often is “Spinal Hygiene.”

It behooves us as health and fitness professionals to use the assessment as a window or opportunity to “audit” our client’s and athlete’s movement and to see what exacerbates their low back pain.

From McGill’s book Back Mechanic:

“Our approach in identifying the cause of pain during an assessment is to intentionally provoke it. Provocative pain testing is essential and irreplaceable when it comes to determining which postures, motions, and loads trigger and amplify pain and which ones offer pain-free movement alternatives.”

People who have more pain and discomfort in flexion (slouching, sitting, bending over to tie shoes) are often deemed as flexion intolerant. Moreover, people who have more pain and discomfort in extension (standing for long periods of time, bending backwards, excessive “arching” in training), are often deemed as extension intolerant.

Ironically, in both scenarios, people will find relief in the same postures that are “feeding” the dysfunction and their symptoms.

What’s the Fix?

Funnily enough, pretty much everything works. There are any number of methodologies and protocols in the physical therapy world that have worked and have helped get people out of low back pain.

It’s almost as if the appropriate response to “how do you fix low back pain?” is “the shit if I know? Everything has been shown to work at some point or another.”

Active Release Therapy, Graston, positional breathing, stretching, mobility work, rest, sticking needles in whereeverthefuck….it’s all been shown to work.

I’ve had numerous conversations with manual therapists on the topic and the ones who tend to “get it” and elicit the best results are the ones who take a more diverse or eclectic approach.

They’ll use a variety of modalities to best fit the needs of the individual.

That said, I’m a fan of directing people towards therapists who take a more “active” approach as opposed to a “passive” approach.

Both can work and both have a time and place. However one approach is less apt to make me want to toss my face into an ax.

Passive Approach = Ultra sound, electric stimulation, etc. This approach treats the symptoms, focuses on instant relief, and not necessarily addresses the root cause(s).

Active Approach = Is more hands on and more “stuff” is happening. Practitioners who fall on this side of the fence tend to focus more on the root cause – poor movement quality, positioning, muscle weakness, mobility restrictions – and work in concert with the patient/athlete to educate them on how to prevent future setbacks.

Above all, an active approach is about finding and engraining a neutral spinal position, and finding pain-free movement.

I think by now you know my preference.

 

Tony, Shut-Up, What’s the “Forgotten” Cause of Low Back Pain?

Well, to say it’s “forgotten” is a bit sensationalistic. My bad.

We tend to solely focus on either flexion or extension intolerance…and granted those are the two biggies.

However, have you ever had someone come in and pass those “screens” with flying colors only to complain of back pain or discomfort when he or she rolls over in bed, rotates, or maybe experiences an ouchie when they sneeze?

What’s up with that? And bless you.

Spinal Instability – That’s What’s Up.

Instability can rear it’s ugly head with flexion/extension based issues too, but it becomes more prevalent when rotation is added to the mix.

The body doesn’t operate in one plane of motion, and it’s when people meander out of the sagittal plane and venture into frontal and/or transverse plane movements, when they begin to get into trouble.3

The muscles that provide intersegmental stability to the spine may be under-active and may need some extra TLC.

I’ve worked with people who could crush a set of barbell squats (they handle compression and shear loading well), but would complain of l0w-back pain whenever they did anything that required rotation.

 

The fix is still going to be helping them find and maintain spinal neutral – I don’t feel this is ever not going to be a thing. Kind of like too much money in politics or LOLcats.

In addition, gaining motion from the right areas – hips, t-spine, for example – will also bode well.

However, I’d like to offer some insight on what exercises might be part of the repertoire in terms of “pain free movement” when spine instability is a factor.4

The Stuff Most People Will Skip (It’s Okay, I Won’t Judge You)

One word: planks.

Dr. McGill has stressed time and time again that improving spinal endurance (and hence, stability) is paramount when dealing with back pain. They key, though, is performing them in ideal positions.

I chuckle whenever someone brags about holding a 5-minute plank. When in fact all they’re really doing is hanging onto their spine….literally.

This does no one any favors.5

RKC Plank.

1. It’s a bonafide way to help people gain a better understanding and appreciation for creating full-body tension.

2. I like cueing people to start in a little more (unloaded) flexion, so that by the end they’re residing  in a neutral position anyways.

3. When performed as described in the video below, 10s will make you hate life.

To up the ante you can also incorporate 3-Point Planks (where you take away a base of support, either an arm or a leg, and hold for time) or Prone Plank Arm Marches:

 

NOTE TO SELF: do more of these.6

You can also incorporate Wall (Plank) Transitions where the objective is to cue people to keep the torso locked in place. Motion shouldn’t come from the lumbar spine then mid-back. Everything should move simultaneously, as follows:

Deadbugs

I’m a huge fan of deadbugs. When performed RIGHT, they’re an amazing exercise that will undoubtedly help build core and spine strength/stability.

A key component to the effectiveness of a deadbug is the FULL-EXHALE (check out link above). However, one variation I’ve been using lately is the Wall Press Deadbug (for higher reps).

https://www.youtube.com/watch?v=gmtsGHk34C0

 

Here the objective is to engage anterior core (pressing into the wall), to breath normally, and then to perform a high(er) rep set (10-15/leg) making sure motion comes from the hips and NOT the lower back.

If you want to build stability (and endurance) this is a doozy.

Stuff People Are More Likely To Do (Because It Involves Lifting Things)

1. Offset Loaded Lifts

This is an untapped, often overlooked component to back health and performance. Offset or asymmetrical loaded exercises are a fantastic way to train spinal stability and challenge the core musculature.

By holding a dumbbell on one side, for example, you have work that much harder to maintain an upright posture and resist rotary force:

 

Likewise, with offset presses, the core must fire to prevent you from falling off the bench. Unless you fall off because you’re drunk. If that’s the case, go home.

 

And we don’t have to limit ourselves to dumbbells, either. We can use barbells too.

2. Shovel Deadlift

3. Farmer Carries

Farmer carries – especially 1-arm variations – can be seen in the same light. The offset nature is a wonderful way to challenge the body to resist rotation (rotary force) and to help build more spinal stability.

 

4. 1-Legged Anti-Rotation Scoop Toss

Another option is to perform anti-rotation drills such as the 1-Legged Anti-Rotation Scoop Toss. As you can see from my un-edited video below….it’s tougher than it sounds.

 

5. Anti-Rotation Press

 

A bit higher on the advanced exercise ladder, the Anti-Rotation Press is another great drill to help hone in on increased core strength and spinal stability. To make it easier, use a longer stride stance; to make it harder go narrower.

This Is Not an End-All-Be-All List

But a good conversation stimulator for many people dealing with low-back pain nonetheless. Have you got own ideas or approaches to share? Please chime in below or on Facebook!

CategoriesCorrective Exercise personal training Rehab/Prehab Strength Training

Bridging the Gap Between Physical Therapy and Strength and Conditioning. How Much of a Gap Is There?

Today’s guest post comes courtesy of Andrew Millett – a good friend of mine and brilliant physical therapist outside of Boston.

The term “bridging the gap” is always brought up when the discussion of physical therapy and strength and conditioning comes up. There’s no doubt a melding of the two when discussing the most successful outcomes for patients and athletes. However, in a day and age where more and more personal trainers are taking it upon themselves to play the role of “therapist” (and vice versa), it’s important to note that, while it behooves us to dip our toes in both ponds, there IS a distinction between the two.

And we need to respect that.

Enjoy.

Bridging the Gap Between Physical Therapy and Strength and Conditioning

In the fields of strength and conditioning, human performance, physical therapy, etc., we interact with people on a daily basis.  We learn about their family, their job, their goals, and what they want to get out of their training or rehab.  The majority of the people in this field did not get into their respective field for the money.

I am not saying that any of these fields can’t be lucrative.  The majority of us share a common bond:  the desire to help people.

Whether you are a physical therapist trying to help someone get rid of their pain and get back to doing what they want to be doing or a personal trainer trying to help someone lose some weight, most of us want to help people.

When we see a client who is in pain or has some type of movement dysfunction, most of us want to help them get out of pain, whether or not we are a healthcare practitioner.  Personal trainers, strength and conditioning coaches, etc. are well-qualified to assess and correct movement.

There are many schools of thought such as the Functional Movement Screen (FMS), Selective Functional Movement Assessment (SFMA), and Functional Range Conditioning (FRC) – to name a few – that teach trainers and coaches how to assess movement so that they can make their programming more effective based off of how their client presents on their assessment.

 

More often than not, a strength coach or trainer will see a movement fault they would like to fix in order to optimize their client’s training in order for their client’s to succeed.  There is nothing wrong with wanting more for your client and for your client to achieve their goals.  When assessing a client, if some type of movement limitation is present (I.e., decreased joint mobility and range of motion), then by all means, use the tools in your toolbox to attempt to correct it.

Tools such as a foam roller, lacrosse ball, or other self-myofascial release device, can be beneficial in attempting to increase soft tissue flexibility that could be limiting a client’s movement pattern.

 

Self-myofascial release can be very effective for improving movement quality and at reducing pain.  By doing something such as this, you are doing your due diligence in trying to help your client to the best of your abilities.

If you use an implement suggested above and someone moves or feels better, GREAT!

If someone doesn’t move or feel any better after something like that, then as Charlie Weingroff has said,

“4th and 10, you have to punt.”

As he described in his DVD, Training = Rehab, if you have a client who has some type of mobility limitation and they aren’t improving, “punt” them, not literally, to another provider…I.e., physical therapist, sports chiropractor, or a massage therapist.

If someone has pain, punt!  Per the Functional Movement Screen (FMS), if someone presents with pain, the test is over and they should be referred to a healthcare practitioner.

Now, if you referred all of your clients who are in pain to another healthcare practitioner, you would probably have a lot of free time on your hands.

Most clients have some type of ache or pain they are dealing with.

By “punting” them, this does not mean you have to get rid of them.  You can use a multi-disciplinary approach and continue to train them without worsening their pain or dysfunction while they are treated for whatever ails them.

Don’t try to be a jack of all trades and a master of none.  Don’t try to be the strength coach or personal trainer who trains their clients, but also attempts to treat their pain or soft tissue dysfunction by performing some form of manual therapy.

This is where you need to know what you are good at and what someone else may be able to do better.  If a patient or client presents to me and I know another practitioner that is better at it than me, they are definitely going to continue their care with that better clinician.

Keep the manual therapy to the physical therapists, sports chiropractors, etc.  These clinicians have hours upon hours of training on various manual therapy techniques to assist in improving movement, pain, and dysfunction.

By meeting with local PTs and chiropractors in your area and developing a network of providers you can refer to, you should have no problem sending a client to a colleague who can help improve their current state.  Your client will think the world of you for having the humility to refer them out to someone who can help them properly.

Even if the physical therapist helps decrease their pain, that client will always remember that you had their best interests at heart and you were thinking of them first.

Think of your client’s needs first, not your ego!

Now, just because I am a physical therapist, doesn’t mean I am not going to “bash” on personal trainers and strength coaches.  I have a background in physical therapy and strength and conditioning.  I consider myself a hybrid physical therapist, bridging the gap between rehab and strength training.

I know that I am not the smartest trainer or coach out there.  I have the confidence in my skill-set to start the programming process and teach and help clients squat, deadlift, lunge, carry, push/pull, etc.

There eventually comes a time where I can have a personal trainer or strength coach take over and continue the process.  My goal for my clients when they leave me is that they have some type of basic foundation of the various movements just mentioned so they can effectively and safely progress towards their health and fitness goals.

If you are a physical therapist, sports chiropractor, etc. and you either do not have the confidence in how to teach basic movements and program them OR you have not educated yourself on how to program and teach basic movements, then leave that to the strength and conditioning or personal training professionals.

The message goes both ways: as much as we encourage personal trainers not to be too “bridge gappy,” the same goes for physical therapists.

The major point of this post is not to bash either side of the health and performance spectrum.  The point is that we need to coexist and develop connections with various healthcare and performance disciplines so that we are in the position to help the most important person in this process:  the client or patient.

About the Author

 

Andrew Millett is a Metro-West (Boston) based physical therapist

Facebook: From The Ground Up

Twitter: @andrewmillettpt

Instagram: andrewmillettpt
CategoriesExercise Technique Exercises You Should Be Doing Rehab/Prehab

Exercises You Should Be Doing: Stationary Bear Crawl

Hope everyone enjoyed the game last night.

Congrats to Peyton Manning and the Denver Broncos on the win.

But screw the game. Did everyone see that new Jason Bourne teaser trailer?????

 

It took all the will power I could muster not to start dry humping the television screen. I knew a Bourne movie has been in the works for a while now – because I’m a nerd and read Entertainment Weekly and hang out on IMDB – and had been anticipating something epic in the coming months now that both (Matt) Damon and (Paul) Greengrass are back on board with the franchise.

But I was NOT expecting to see a sneak peak teaser last night. I caught me completely off-guard.

The only thing more manly would have been if it showed Bourne bare knuckle fighting a grizzly bear.

On an aside – and serving as the worst segue in history – I recently recorded a video “chat” with Ryan Ketchum for the Elite Training Mentorship titled Behind the Scenes: Tony Gentilcore on Program Design Made Simple.

As a whole, the Elite Training Mentorship gives you access to monthly “inner circle” content from the likes of Eric Cressey (and the entire coaching staff of Cressey Sports Performance), Mike Robertson (and the entire coaching staff of IFAST), in addition to Tyler English, Dave “the Band Man” Schmitz, and Steve Long and Jared Woolever of Smart Group Training.

For a very fair price ($29.95/month, $299.95/year) you gain access – past and current content – to the entire library.

HOWEVER, because this is my first solo addition to the service, you go HERE you can take advantage of a special trail rate of $4.95 for the first 30 days.

That’s pretty sick if you ask me.

Exercises You Should Be Doing: Stationary Bear Crawl

 

Who Did I Steal It From: I got this bad boy from Dr. Mark Cheng when I watched his excellent DVD, Prehab=Rehab 101. In particular the exercise stems from when he covered the topic of ground based training, transitioning from primitive patterns – rolling, sphinx pose, etc – to crawling patterns.

What Does It Do: crawling (and bear crawls especially) have grown in popularity in recent years…mostly in group training environments such as boot camps and/or CrossFit classes.

However I don’t think most people understand what advantages or uses the exercise provides other than “making people tired” and provoking a cacophony of groans whenever they’re placed into a WOD.

The “making people tired” approach makes me cringe because, well, that’s when bad shit starts to happen.

The real reason(s) bear crawls carry weight in a program are as follows:

1) When performed correctly – hips level with shoulders (no excessive arching or rounding of the spine) – they’re an excellent way to train lumbo-pelvic stability/control. More importantly, they help the trainee dissociate hip movement from lumbar movement.

I like to tell people to pretend as if a glass of water or wine is lying their back upright and the objective is to not allow one drop to spill.

2) There’s extensive motor learning (or motor remembering) involved here. I’ll purposely go out of my way to not coach someone on these at the start.

I’ll demonstrate and then point to the floor and say, “your turn.” I feel like a big a-hole in saying it, but I’d be lying if I said there wasn’t a smidgeon of entertainment and comedic relief when watching some people try to perform a bear crawl.

It’s as if some are cemented to the floor. They don’t move.

But after awhile it’s just a matter of them figuring things out and reacquainting themselves with some simple motor patterning.

If you really want to be mean have people reverse the action, or go sideways.

2) Bear crawls are also an excellent anterior core exercise (due to the aforementioned focus on lumbo-pelvic control). I can’t tell you how many times I’ve had a client contact me the day after saying something to the effect of “WTF, Tony, my abs are on fire today.”

Weird how when you perform something right it becomes more challenging and “stuff” is engaged to a higher degree or turned on.

3) There’s also a fair amount of serratus activity involved, which is a great fit for those with excessively adducted and/or downwardly rotated scapulae. Another BIG mistake many people make with their bear crawls is “hanging” on their shoulder blades and allowing them to touch the entire time. This causes a lot of ramifications with glenohumeral issues. The scaps should more or less move around the rib cage.

4) And, too, I can’t deny the conditioning component to the exercise. There are innumerable ways to make people hate life here. Performing them for time, for distance, dragging a bulldozer behind, it’s endless.

All that being said, oftentimes people don’t have the luxury of having turf or open space to perform traditional bear crawls.

So why not do them in place?

Key Coaching Cues: Hands under shoulders, knees under hips. Depending on one’s ability and comfort level, how wide someone has to go – base of support – will vary.

Brace abs, chin tucked. From there I’ll say “lift opposite limbs a few inches off the ground, but prevent any teeter-tottering of the torso/hips.”

Of Note: the water/wine analogy from above works well here.

Another crucial cue is to make sure the trainee pushes him or herself AWAY from the floor. Basically, make sure those bad boys are moving AROUND the rib cage.

I’ll have someone perform these for “x” number of repetitions (usually 5-8/side) or for time (15-30s).

This is a great exercise for many populations. I’ve used it with clients/athletes with chronic low back issues, as well as with clients/athletes who need to be humbled….;O)

You can always regress the exercise and have someone focus on ONE limb at a time too. Also, I’ve had people perform this in clockwise/counter-clockwise fashion, lifting/lowering each limb in both directions.

Give it a try and let me know what you think.

CategoriesRehab/Prehab

6 Reasons Why You’re Always Hurt

Everyone has that one crazy uncle in their family. The one who burps in public, says inappropriate things at the most inopportune times, and who’s social filter is otherwise…always a little off.

By that same token many of us – the fitness minded ones, the gym rats – tend to have that one friend who’s always hurt

Whether it’s a bum knee, an old shoulder injury, or nagging lower back pain that never seems to go away, they’re never 100% and can’t seem to get out of their own way.

In my latest article on T-Nation I discuss a handful of not-so-common reasons why some people are always hurt.

I had a lot of fun writing this one.

Check it out HERE.

CategoriesCorrective Exercise Rehab/Prehab

Prioritize Your Mobility

Today I have an excellent guest post by Boston based strength coach, Matthew Ibrahim. I love pointing people in the direction of coaches in the industry who are on the up and up, and Matthew definitely falls into that camp.

He’s someone who I feel provides a ton of great content and has a lot of great things to say. Today he discusses mobility, what it is (what it isn’t), and some new drills I think you’ll enjoy.

Craig: “Hey bro, I can’t wrap my right hand all the way around my back and grab my left arm.”

David: “Really? Everyone can do that. You definitely need some shoulder mobility to fix that.”

The word ‘need’ is quite subjective here.

Does Craig really need mobility in his right shoulder? Is that particular range of motion and pattern important enough to warrant this need? How much mobility is truly enough?

Think about these few questions. Let them marinade for a bit. We’ll jump back to them soon, but first let’s talk about the why, the where and the when.

WHY MOBILITY IS IMPORTANT

Everyone needs mobility, to a certain extent and in certain areas more than others.

It’s just a common thing to see in clients/athletes/patients: a lack of mobility in a joint.

Regardless of the reason, more often than not, that particular individual will benefit a great deal by incorporating more mobility drills in order to increase the overall range of motion for that joint to have access to. We see this both in the strength and conditioning world and in the physical therapy world.

Perfect example: if you can’t perform lunges properly due to hips that just don’t seem to function correctly, then a quick fix may be to perform a few hip mobility drills to open these areas up.

Most recently, I’ve had the opportunity to work with a big group of NFL Combine Prep college football players from Division I programs at Athletic Evolution in Woburn, MA.

One incredibly glaring thing I noticed right from the start: all of their hips were jacked up, so much so that each of their gait patterns were altered due to this imbalance, which was ultimately affecting their performance.

I knew this problem needed to be fixed, especially if they had high hopes of making some noise in the next couple months during their Pro Day.

Luckily, I was given the task of creating and implementing a mobility program, specifically designed with their needs in mind.

In this case, mobility in their hips has been most important since it has helped a great deal in restoring their gait pattern, improving their posture, and most notably, optimizing their overall performance in the weight room and on the field.

Mobility is crucial to certain joints in your body that are either limited or don’t have full access to certain ranges. It’s important for you to find the areas of most need and to constantly address them through daily maintenance.

Note From TG: it IS important to note (and I know Matthew would agree) that sometimes lack of mobility at a certain joint is due to a stability/alignment issue.  We shouldn’t set our default to always thinking it’s a mobility issue.

WHERE AND WHEN TO APPLY MOBILITY

I see too many individuals performing mobility drills without actually having a legitimate reason. They just feel that they need to do it. It’s almost as if they truly believe that their entire body “needs” mobility.

Stop. Please, STOP!

Before you go any further, put the foam roller, the lacrosse ball and the stretching strap down for two minutes.

I’ll use the shoulders as an example. Here’s what you need to know:

  • Should you perform an excessive amount of mobility drills if your shoulders already have plenty of range without any limitations? No.
  • Should you perform a couple short mobility drills for your shoulders if they’re especially tight/naggy due to a recent workout, but typically have very few limitations? Yes, go for it, but keep it light.
  • Should you perform a handful of mobility drills for your shoulders if they’re especially tight/naggy due to a recent workout, but are usually limited in several areas? Yes, definitely: address what needs to be addressed.

My point: have a legitimate reason for performing mobility drills with a thoughtful goal in mind. Don’t just do it to do it; have a purpose.

Case in point: apply mobility where it is needed most at the time of most need.

Simple enough? Yes, but that’s the point!

For example: it wouldn’t make much sense for me to focus the mobility program solely on shoulder/thoracic spine drills for the aforementioned college football players. They wouldn’t benefit much since they aren’t really lacking in those areas.

Always make sure there is a reason as to why you are doing what you are doing when it comes to mobility.

Referring back to the introduction

Is it truly that important for Craig to wrap his right hand all the way around his back and grab his left arm?

Think about what we just went over.

With those items in mind, I’m not so sure it is that important. Plus, we haven’t even discussed anything about his overhead shoulder range of motion or shoulder external rotation range of motion.

These are the angles you need to start viewing mobility from. Be conscious of how much is enough, and also how much is needed in order to perform the exercise task (i.e., overhead shoulder press) and the daily task (i.e., grabbing a snack from the top cabinet).

CHOOSE AREAS OF PRIORITY

You’re not always going to need mobility everywhere in your body.

Note From TG: Read THIS (<— it will melt your face)

It’s important to be able pinpoint what areas may need the most attention.

I’ve created three short mobility sequences below, where the body has been divided up into three separate compartments: lower, middle and upper. Select the compartment that you need to focus on the most.

MY GO-TO MOBILITY SEQUENCES

1.) Lower Compartment

If you’re someone who has a tough time loosening up the areas of the calves, ankle and feet, then give this mobility drill series a try for 2-3 rounds:

 

  • Lacrosse Ball Rolling
  • Lacrosse Ball Pin and Extend/Flex
  • Tibial External/Internal Rotation Shifting
  • 1-Leg Ankle Rocking

2.) Middle Compartment

Do you find it challenging to get limber in the hips, glutes and posterior chain areas? Try out this sequence for 2-3 rounds:

 

  • Quadruped Rocking
  • Inchworm
  • Hip Series: Spiderman, External Hip Rotators, Lateral Lunge w/Toes Up

3.) Upper Compartment

Tight shoulders? Naggy thoracic spine? Give this series of mobility drills a shot for 2-3 rounds:

 

  • Overhead Floor Slides
  • Scap Push-Up
  • Lateral Crawl
  • Linear Crawl
  • Quadruped Thoracic Spine: 4-Way Reach w/1-Leg Abducted

Always remember: address what needs to be addressed, and always keep it simple.

Now, go get limber!

About the Author

Matthew Ibrahim is a Strength and Conditioning Coach and Physical Therapy Rehabilitation Aide with an evidence-based approach to human movement, biomechanics and injury-prevention, and is knowledgeable on how each area impacts performance in sports and life. He delivers training methods that are aimed at bridging the gap between rehabilitation and performance through proper movement education and basic human maintenance. Feel free to read more at www.mobility101blog.com and follow ‘Mobility 101’ on Facebook and Twitter.

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.7

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.

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. 

CategoriesCorrective Exercise Rehab/Prehab

Add Some “Flow” to Your Warm-Up

I could easily pull a fast one and just tell everyone to start playing some Tribe Called Quest or Nas during their warm-ups and call it day.

Done, you just added some flow.

But I feel that would do nothing but yield a bunch of weird looks and not really give me much “cred” as far as training advice is concerned.

My musical taste would be on point though.

Can I kick it?

Yes You Can!

After perusing a few videos from the likes of Dean Somerset, Max Shank, and Louie Guarino – and there are a litany of others – lately I’ve been toying around with more “flow” based warm-ups prior to my training sessions.

So, rather than performing the standard A (glute bridge) t0 B (ankle mobility drill) to C (T-spine mobiity) to D (forearm wall slide) to E (lunge pattern) to F (smashing my face into a cinder block from boredom) warm-up, I’ve been “flowing.”

Like This

And yes people, that is ERIC freakin CRESSEY (and Tank) doing what they do best…..videobombing me walking around in the background. Kudos to Eric for the commentary in the background too…..haha.

We like to keep things professional at the facility….;o)

This is a drill that really opens up the hips and is A LOT harder to do than it looks.  Starting off, I’ll do 2-4 passes of rocking side to side working on hip internal-external rotation.

From there I’ll come up onto my knees working into terminal hip extension.  I’ll also perform 2-4 passes on each side here as well.

Of Note:  be careful not to hyperextend through the lower back here.  Those with limited hip extension will tend to compensate with lumbar extension.

Then I’ll transition up onto my feet and work in a squat pattern, performing 2-4 passes on each side again.

I really like the seamless transition and positioning of the body and feel there’s a lot more carryover to everyday movement.

Don’t get me wrong:  for most people performing a more traditional warm-up that targets problematic areas is ideal.  But for those looking to step up their game, following more “flow” based warm-ups might be a nice change of pace.

Give it a try and let me know what you think!

CategoriesProgram Design Rehab/Prehab

Steps You Can’t Afford to Skip: The Warm-Up

Yes, this is an article on warming up (both the pre-lift ritual as well as how to warm-up for your main lift of the day).

Yes, most people are going to read the title and subconsciously yawn.

Yes, these are the same people (athletes included) who tend to get hurt more easily, have more nagging injuries that never seem to resolve, and quite frankly – although not always – are shooting themselves in the foot from a performance standpoint for not taking the ten minutes (tops) it takes to warm-up.

Seriously, we’re talking ten minutes here!

Yes, this is something I feel is important and that most trainees haphazardly gloss over.

And yes, this article includes a Twilight burn. So at least there’s that.

Don’t you roll your eyes at me!  I’ll give you something to roll your eyes about!

Warm-Up Fundamentals (<— Seriously, Don’t Skip It!!!)