CategoriesCorrective Exercise Rehab/Prehab

The Truth About a Healthy Spine – Part II

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

Enjoy the weekend!

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

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

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

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

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

So here’s my take:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So what should you do to prevent back issues?

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

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

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

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

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

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

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

What should you do to treat back issues?

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

Consider the 3 points below:

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

And see one quickly.

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

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

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

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

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

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

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

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

Author’s Bio

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

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

CategoriesCorrective Exercise Rehab/Prehab

The Truth About a Healthy Spine – Part I

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

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

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

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

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

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

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

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

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

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

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

The bracing vs drawing in debate

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

So let’s get to the original message:

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

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

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

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

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

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

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

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

I think the best insights gleaned from this are that:

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

Lumbopelvic Proprioception – lost in the shuffle?

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

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

The Very Limited Role of Imaging in treating Low Back Pain

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Author’s Bio

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

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

CategoriesCorrective Exercise Rehab/Prehab

Recovery Revisited: The March Madness Edition

Today’s guest post comes from certified personal trainer and massage therapist, Geoff Pritchard. Geoff actually wrote a fantastic guest post for me last year around this time (link below), and when he extended the offer to write a follow-up I accepted without any hesitation.

I know for some, the topic of recovery is about as exciting as watching NASCAR or an episode of Downton Abbey.

Ironically, it’s a topic that most people could benefit from reading more on, as it’s generally the one thing that people tend to gloss over on day-to-day basis.

That said, READ IT!!!!!!

A year ago I posted on Tony’s blog about some ideas and people who were shaping the fitness industry in terms of recovery and regeneration. I wrote that article to inspire you to spend more time working on tight muscle tissue. But I realized in my massage business that my athletes were still coming in broken from lack of focused recovery work. So, what advice did I give them? Let’s take a step back in time, revisit what I said before and continue the dialogue with some new action steps to save your soft tissue from harm!

My objectives (as stated in my previous post):

  • Review the foundational items you should do to achieve better performance
  • Evaluate the research and evidence based practice of fitness and bodywork professionals, and
  • Incorporate simple changes into your schedule

These objectives are the key components of what I tell my clients to do for maximum results.

The foundational items are still nutrition and sleep.  The body can only recover from the daily demands of stress from appropriate nutrient intake and adequate amounts of rest. If this foundation isn’t solid, then no matter how hard you try, your recovery steps will be severely compromised … and crumble quicker than the #1 ranked teams in men’s college basketball!

Research and Evidence Based Strategies

Last year I mentioned the names of Nick Grantham and Sue Hitzmann for their recovery strategies and products. Nick is continuing to mentor athletes and fitness professionals in England, while in recent weeks, Sue has published her book, The MELT Method (currently #3 on the New York Times bestseller list) and appeared on Dr Oz to describe the structure of fascia and how it relates to mobility and optimal movement.

Sue was even able to convince NBC to show Gil Hedley’s video of dissection on national TV. If you want a true “inside look” at our muscle and fascia – and have a few hours to be amazed – Gil has made these videos absolutely FREE on his YouTube channel. In my opinion, you need to check it out – it’s pretty freakin’ remarkable!

My 2013 Recommendations

So, which experts are making a huge impact on resolving soft tissue dysfunction and therefore helping to eliminate the long-term consequences of poor movement – chronic pain and muscle damage? My list comes from two sources:

Kelly Starrett

Ok, so this won’t be a new name to most people, but his recent two-day seminar hosted by creativeLive was probably the best all-encompassing workshop I’ve attended.

He spoke for over 12 hours on the mobility paradigm and methods he uses with all clients – and how it all relates to athletes and the general population.  In addition, he enlisted the help of his friends … Carl Paoli (GymnasticsWOD), Brian Mackenzie (CrossFit Endurance), Jim Kean (WellnessFX) and Jill Miller (Yoga TuneUp). This workshop should go right alongside your collection of Assess and Correct, Muscle Imbalances Revealed – Upper and Lower Body, and Training = Rehab, Rehab = Training.

While full access to the videos at creativeLive will cost you $99, most of the content can be filtered out through his blog and videos at MobilityWOD (which contains over 400 posts). Just search and go!

My Peers –Bringin’ It in Baltimore.

Fifteen months ago I moved away from one of the major hubs of fitness – Boston, MA – and home of Mike Boyle Strength and Conditioning, Cressey Performance, and the kids of Harvard (where the Ancestral Health Symposium was held) to be living near family in Baltimore. It was a big transition for my family and my uprooted business – as well as my physical health – would be dependent on meeting great trainers and great bodyworkers.

[On a side note… it eases the transition when your Super Bowl success in New England (2002, 2004, 2005) follows you south and you watch the Ravens bring the trophy to Charm City … which I credit my son for doing, since only days before a Wild Card game with Indianapolis he got his first sports jersey J]

Fortunately for me, the local Baltimore community is outstanding. I have access to a wonderful network of people:

Not too shabby!! (And we even get to enjoy the local clothing scene from Under Armour, who just opened their first storefront)

So, how does this relate to recovery and restoration? What changes should you incorporate into your program? My suggestion is anything you HAVEN’T been doing. We get stuck in our ways pretty frequently – think Groundhog Day with Bill Murray – and forget to challenge our soft tissue in areas that need assistance.

One way to do this is to get an outside opinion. Here’s your A-ha moment … Contact someone from your network of local experts (who’s not your regular gym buddy) and ask them to assess and find your weak links! By fixing these areas of dysfunction and stagnant tissue, we restore better resting muscle length, alleviate unwanted fascial restrictions and improve our chances for optimum performance.

You can even utilize online coaching – it’s easy to access the best movement specialists around the world with an Internet connection and webcam. If you have the funds to pay for a couple sessions, then utilize those experts to get you moving, literally and figuratively, in the right direction.

After you know what to do (trigger point, soft-tissue work, and/or active stretching – AIS or PNF), then these restorative changes should be incorporated into your schedule for 15 minutes a day, every day until the change is permanent and integrated (this could mean between two and five trouble areas). And, don’t forget to move! If we don’t integrate the new patterns with movement, then we haven’t fully reset our neuromuscular motor control.

Be vigilant to complete those 15 minutes EVERY DAY! And be aggressive and focused – constantly remind yourself of the agonist / antagonist relationships and go deeper as long as you can control your breathing.

Need Any Help? Free Skype Consultation?

If you want suggestions on movements, leave a comment about what’s hampering your performance or recovery and I’ll reply with a couple ideas to get you started.  Whether it’s “gliding surfaces”, “hydration”, “breathing patterns”, “joint centration”, or “wow… how do Bikram Yoga teachers have such crazy mobility?”, search your favorite blogs and YouTube channels for ways to achieve better movement patterns.

I also want you to comment about local experts in YOUR city that are making a difference – and pushing the envelope against the barrage of magazine and TV mis-information – to educate and influence our understanding of recovery and regeneration.

BONUS… to show my love for Tony and his loyal audience – I’m offering a FREE Skype consultation to one person – chosen randomly – who posts a comment and/or question over the next two weeks.

Now, I’m off to practice my recovery and mobility routine: trunk rotation and extension using active isolated stretching and a couple internal hip rotation mobility exercises from Evan Osar.

Author’s Bio

 

Geoff Pritchard is an NSCA certified personal trainer and a licensed massage therapist. He has eight years of training experience at gyms, health clubs, and corporate wellness centers. He is passionate about using bodywork and exercise to help people move better. He recently relocated to Maryland and opened up Charm City Massage – Therapeutic Bodywork for Optimum Performance – in Lutherville-Timonium. If you want to contact him, please connect with Geoff on Facebook.

 

CategoriesCorrective Exercise Product Review Program Design Rehab/Prehab Strength Training

Introducing Spinal Health and Core Training

For those familiar, Muscle Imbalances Revealed has slowly engrained itself as one of the more sought after, consistent, and continuously revered fitness product series out there.

Seemingly, every year (give or take a few months) the man and mastermind behind the scenes, Rick Kaselj, is releasing a new version to the masses.

If I had to equate it to anything, it’s basically like the Fast and Furious franchise where we can expect a new(er) and more badass upgrade of some sorts every so often. Except in this case there’s no tricked up cars, high-speed chases, hot chicks (bummer), or cheesy Vin Diesel dialogue (even more of a bummer).

High-octane gear head talk aside, some of you may recall a little trip I took to Canada last summer where I went alllllllllllll the way up to Edmonton to “party” with my Muscle Imbalances Revealed Upper Body alumni Rick Kaselj, Dean Somerset, and Dr. Jeff Cubos.

And by “party” what I really mean is the four of us decided to combine our collective minds, go all Professor X on the world, and set up an epic 2-day seminar all dedicated to a multi-disciplinary approach to core training and keeping spines bullet proof.

We video’d the entire thing in all of our high-definition glory (I even shaved!) and have finally made it available for everyone.

===> Spinal Health and Core Training Seminar <===

Outside of being completely freaked out by the fact that it was still daylight at ten o’clock at night, it was an awesome two days where everyone involved – the presenters as well as the 15+ attendees – had the rare opportunity of learning from four high-quality, uber smart, and unwittingly handsome professionals with varying backgrounds and expertise.

Rick has extensive experience working with and dealing with a wide array of injured clientele, and is a straight up Jedi when it comes to assessment and understanding how to program around injury.

Dean, too, has a plethora of knowledge with regards to rehab, assessment, and working with the general public. He also broke a deadlifting PR that weekend with me just standing in his presence.  True story.

Dr. Jeff is a chiropractor and manual therapist with tons of experience working with elite athletes. His knowledge base with regards to corrective exercise, posture, and the newly minted “it topic” in the industry, breathing patterns, is second to none.

And then, you know, there’s me.

Because I don’t want to leave anyone hanging, I felt it only fair to give a sneak peak into each person’s presentation so that everyone on the fence would have a general idea of the material and topics covered:

Me Discussing Assessment

Dean Discussing Assessment as Well

Dr. Jeff Discussing the Importance of Self Mobilizations Drills

Note:  This is a clip from the actual finalized product!  HD baby!!!!

Rick Discussing Parameters Writing Programs Around Pain

And there you have it!  That should give everyone a sense of what to expect.  And remember, there’s roughly TWELVE hours worth of this stuff – including more “hands-on” lecture, some talk on breathing patterns and how that effects core function as well as posture, exercise technique, programming, and there may even be some shadow puppets thrown in the mix for good measure.

Okay, I’m kidding on that last one. Needless to say there was no stone left un-turned, and I really feel this is something that can (and will) help a lot of trainers and coaches out there stay on top of their game.

And the general public shouldn’t feel left out in the cold either.  This is a very “user friendly” product for all the general fitness enthusiasts who may be reading as well.

I’ll finish by saying that I’m often asked what I feel differentiates the “good” trainers and coaches from the bad ones, and what – if anything – I feel separates the masses.

While I could sit here and come up with some arbitrary rationale as to why bald trainers and coaches are far superior compared to those who are more “follicly” endowed (you know, cause I’m kinda bald), the real truth is that those who tend to be more successful and have a long shelf-life are those who don’t view continuing education as burden, or more to the point……as a “cost.”

I’ve always used the mantra that even if I only learn ONE thing from any DVD or book, and it leads to me picking up ONE client, it essentially paid for itself.

It was a goal of ours to make this product as easily “accessible” as possible (while still being profitable enough to satiate my impending beef jerky addiction).  To that end, Spinal Health and Core Training is on sale NOW (2/12) through this Friday (2/15) for $97 (. Which is a steal given the amount of information provided, and the fact that you’ll see videos of me from when I had hair.  I mean come on: That’s worth the price alone.

After this week the price climbs to it’s regular price of $197. So get it while the gettin is good….;o)

===> Spinal Health and Core Training <===

CategoriesCorrective Exercise Program Design Rehab/Prehab Strength Training

5 Reasons Your Shoulder Is Jacked Up and Not Jacked Part I

We work with a lot of overhead athletes at Cressey Performance – in particular baseball players – and it’s no coincidence that we deal with, address, work around, and (hopefully) fix a lot of shoulder issues ranging from the acute like AC joint issues and external/internal impingement to the more “oh shit factor” scenarios like shoulder separations and post surgery situations.

And using the word “acute” in this instance isn’t to downplay things like impingement (as anyone who’s had to deal with a chronic case will think otherwise), but rather it’s just to put things into perspective that some shoulder pathologies take a little more attention to detail and TLC compared to others.

As an example I can’t tell you how many times someone’s walked into the facility complaining of consistent shoulder pain preparing for the worst, only to demonstrate to them that their push-up technique is god-awful.

I didn’t need to resort to bells, whistles, and smoke machines or take a page out of Professor Dumbledore’s Magic Book of Bedazzling Hexes and Awesome Shoulder Remedies (on sale now through Amazon!) to show them how to perform a push-up correctly and to not piss their shoulder off further.

Unfortunately, it’s not always so cut and dry.  For many people out there – average Joe’s and meat heads in particular – living their day to day life with shoulder pain or discomfort is sometimes second nature.  Analogous to riding a bike, putting your left sock on before the right, or reaching for that second cup of coffee. Or fifth, don’t worry I won’t judge.

What’s more, some view it as a proverbial right of passage or badge of honor, as if living with daily pain comes with the territory for those who spend their free time lifting heavy things.

While true, there is some semblance of “risk” involved, and many will undoubtedly have a few bumps and bruises along the way (we’re lifting weights here not doing origami), just “dealing” with pain  and sucking it up isn’t an option in my book.

That said, not many things can derail one’s progress in the gym like a banged up shoulder.  Okay, a Zombie apocalypse or a raging case of explosive diarrhea rank fairly high on the list for sure.  But a nagging shoulder injury bites the big one, too.

Below, while not an exhaustive list, are some of the more common “reasons” why your shoulder may be hating you.

1.  No, Seriously, Your Technique Is Horrible

I won’t beat a dead horse here, but it stands to reason that half the reason your shoulder hurts all the time is because your exercise technique is less than exemplary.

I know, I know:  you’ve been lifting weights since stone washed jeans were considered a cool fashion trend, and there’s no conceivable way you’re doing something incorrectly.

Well, I’m here to tell you otherwise!

Taking the time to actually learn how to perform a push-up correctly or how to bench press correctly – or at the very least tweak things to make them more “shoulder friendly” – will go long ways in keeping your shoulders healthy.

It’s akin to lightly tapping your thumb with a hammer.  While seemingly not a big deal at first, before long, it’s excruciating.

Constantly performing your exercises with shitty technique day after day, week after week, and month after month will eventually lead to some bad things happening.  Namely a shoulder ouchie.

And this goes for rowing variations, too.  You’d be surprised as to how many people butcher these on a day to day basis.

A perfect example would be something as innocuous as a face pull.

* Video courtesy of the one and only Mike Robertson

I was training at a commercial gym not too long ago and watched a gentleman perform this exercise with the exact opposite form Mike demonstrates above.

For starters, he held the rope with a pronated (overhand grip) which locks you into more internal rotation and thus compromises the acromion space.

Secondly, he’d allow his scapulae to go into posterior tilt with each rep, and worse he’d substitute scapular retraction with an excessive forward head posture.

While I’m sure he had good intentions for including the exercise in his program, the execution was less than to be desired and was probably causing more harm than good.

And this goes for just about every rowing variation out there.  You’d be surprised as to how many people butcher technique and aren’t even close to performing them correctly.

Take the time do things right, and your shoulder will thank you.

 2.  Your Program Kinda Sucks

More to the point: it’s the structure of the program thats sucks. It’s common in the strength and conditioning community to talk about programming imbalances, especially as it pertains to the upper body.

Dissecting most training programs, it’s not uncommon to see significant favoritism or preponderance towards pushing exercises compared to pulling.  It’s no secret:  guys like to bench press.  And as such, many develop muscular imbalances (overactive/stiff pecs and weak/inhibited upper back musculature) which results in a less than happy shoulder.

To counteract this, many fitness professionals will advocate more pulling motions compared to pushing – oftentimes to the tube of a 2:1 or even 3:1 ratio.

In other words: for every pushing exercise prescribed, they’ll “counteract” it with two to three pulling exercises.

This is sound advice, and definitely a step in the right direction for many trainees.  But we’re omitting another less obvious (yet equally as important) component, and it’s something Eric highlighted last year and that we’ve been addressing at Cressey Performance for a while now.

And that is:

While anterior/posterior imbalances are important to address, not many people give any credence to superior/inferior imbalances.

Translated into English, we also have to be cognizant of the interplay between upward and downward rotation.  More and more (especially with our baseball guys, but even in the general population as well) we’re seeing guys walk in with overly depressed shoulders. For visual reference, cue picture to the right.

Most baller t-shirt, ever ================>

This can spell trouble for those whose livelihood revolve around the ability to get their arms over their head (baseball players) as the downward rotators of the scapulae (levator, rhomboids, and especially the lats) are kicking into overdrive and really messing with the congruency and synergy between the scapulae, humeral head, glenoid fossa, and acromion process.

And this doesn’t just pertain to overhead athletes either.  We’re seeing this quite a bit in the general population as well, as we as fitness professionals have been shoving down their throat  “shoulder blades together and down, shoulder blades together and down” for years now.

In this case, some dedicated upper trap work would be advisable so as to encourage more scapular UPWARD rotation.  And no, relax, I’m NOT referring to barbell shrugs.

These wouldn’t be useful because there’s no “real” scapular upward rotation involved, and you’re doing nothing but encouraging more depression anyways.

Instead drills like Forearm Wall Slides with Shrug;

And Back to Wall Shoulder Flexion will work wonders.

Too, it may come down to toning down things like heavy deadlifts, farmer carries, and anything that entails holding onto heavy dumbbells (since all will pull the shoulder girdle down promote significant shoulder depression) in favor of more overhead/waiter carries, Goblet variations (squats, reverse lunges, etc), and barbell related work.

Just some food for thought anyways.

And that’s it for today. Be sure to check back tomorrow for some more insight and conversation on why your shoulder is jacked up and not jacked.

SPOILER ALERT: your shoulder may not be the issue in the first place!

*Smoke bomb, smoke bomb.  Exit stage left*

Also, as an a side (and giving credit where it’s due):  Title inspiration came from THIS article I read a while back on Elitefts.com.

CategoriesCorrective Exercise Rehab/Prehab

Introduction to Spinal Health and Core Training

Some of you may recall I took a little trip out to Edmonton, Alberta back in June to take part in the Spinal Health and Core Training seminar alongside my fellow cohorts Rick Kaselj, Dean Somerset, and Dr. Jeff Cubos.

While I’d like to sit here and state that what transpired was a Hangover inspired two-day extravaganza of hookers, cocaine, tigers, and babies wearing oversized sunglasses, what really transpired was completely not that.

Nope, our Wolfpack was all about program design, corrective exercise, assessment, and anything and everything that you can think of as it pertains to core training and spinal health.

Okay, maybe there was a tiger involved……but that was Dean’s idea, not mine.

All kidding aside, it was an amazing weekend and everyone who attended walked away with a gulf of information.  Lucky for you we taped the entire thing and plan on releasing it as a product in the very near future.  And by “very soon,” I’m talking about within the next few weeks.

To wet everyone’s palette, Rick K. is releasing a series of “sneak peeks,” and for those interested below is a quick 22-minute clip of my presentation.

And there’s A LOT more where that come from. I ended up speaking for close to three and half hours that day (how, I have no idea), and Dr. Cubos finished off with another three hours himself.

Day 2 revolved around Rick and Dean, and while I had to take off for Vancouver that day for a friend’s wedding, I heard it was equally as informative and awesome.

Like I said, we’ll be divulging more information on the actual release within the next few weeks, so keep your eyes and ears peeled.

CategoriesCorrective Exercise Rehab/Prehab

The “Why” and Why It’s Still Important to Get People Strong

Today I wanted to share a recent email exchange I had with a friend of mine, Mike Anderson, who’s a local personal trainer and strength coach here in Boston.

Some of you might recognize Mike from the handful of guest posts he’e written on this site – namely HERE, HERE, and HERE.

I’d highly encourage you to check them out if you haven’t already, because Mike’s a really smart guy and offers a lot of insight and wherewithal that I only wish I had when I was his age.

Plus, he’s single.  Ladies?

Well, I think he’s single. If not, my bad Mike’s girlfriend!

Anyways, Mike sent me an email last week linking to a post he wrote on the seemingly screaming school girl “OMG-One-Direction-Is-On-the-Cover-of-TigerBeat” overreaction the fitness industry is going through with regards to corrective exercise. And more specifically, to it’s current obsession over breathing patterns.

Including but not limited to:

– What exactly does “breathing patterns” refer to?

– How do we assess it?

– What are we looking at?

– Seriously?  What are we looking at?

– Okay, I’m lost.

– Ohhhhhh, the diaphragm!  I get it.  Most people are woefully horrible breathers and have no idea how to use their diaphragm efficiently!

– Understanding breathing patterns can help “unlock” the key to understanding that symmetry – as much as we try to attain it, and think that it exists – probably ain’t gonna happen.

– Taking even a step further, it’s recognizing that we’re inherently designed in such a way where assymmetry is inevitable, and that how we breath plays a major role in that.

– Taking a brief glimpse into the PRI (Postural Restoration Institute) philosophy, we see that it tries to teach people how to breath more efficiently, which in turn, in conjunction with their corrective modalities, will help attempt to bring people back into a sympathetic state.

– In doing so, with time (and proper programming) we’ll often see improved performance on and off the field – as well as on the gym floor.

– What’s that?  Zone of Apposition?  Apical expansion?  Okay, now I’m lost again.

– I’m hungry.

Appropriately, Mike brought up an interesting conversation:

“Here’s another thing that I’ve been thinking about: why is this all suddenly such a huge concern? People have been strong and healthy for quite a long time without worrying about their breathing patterns. I know the same can be said for things like mobility and soft tissue work, but those things have a readily apparent change on the way someone feels and moves.

Would Bo Jackson had been a better athlete if someone had focused on his left-smaller-diaphragm? Would Arnold have been more symmetrical and better proportioned if he’d be concerned about his Left Posterior Mediastinum Inhibition?

I’m personally having trouble figuring out where all of these other things fall into the role of a strength and conditioning coach. If getting someone’s diaphragmatic rhythm in sync with their scapulothoracic rhythm will get them to a 40″ vertical, a 10.2-second 100-yard dash or a 585 deadlift then I’ll be all about it.

For right now, however, my job is to get people stronger, faster and keep them healthy. I’ll keep doing that.

My Response (along with a massive brain dump/random thoughts)

Well said my man.  Well said.

I completely agree (for the most part), and think the whole breathing thing is starting to get out of hand.  Not out of hand in the sense that I don’t feel it’s efficacious to look into it, that I don’t feel it’s important 0r that I don’t feel it works.

On the contrary:  I think it’s powerful stuff and we’re only just cracking the surface.

I feel things are getting out of hand to the extent that everyone, and I mean everyone (personal trainers, strength coaches, physical therapists, athletic trainers, your Little League coach) are starting to look into this stuff.

And frankly, many have no business doing so.  Well, at least in the sense that many are overstepping their bounds and taking it too far.

I think a lot of the problem stems from those who don’t recognize scope of practice.  I remember when I first moved to Boston and worked at a swanky commercial gym downtown.  I’d watch some of the trainers walk around with Kendall’s Muscles: Testing and Function (a phenomenal book, mind you) as they were training clients.

Basically they carried the book around with them thinking they’d kill two birds with one stone and try to diagnose and train their clients.

Um, no.  That’s just asinine, and a lawsuit waiting to happen.

Of course, on one hand I’d commend any trainer to take it upon him or herself to further their knowledge base and to better understand the human body and how it works.

BUT YOUR JOB IS NOT TO DIAGNOSE!!!!!!!!!!!!!!!!!

Now you have those same trainers walking around thinking they’re on the same level as physical therapists, chiropractors, and manual therapists (people who went through additional schooling to do what they do) because they read a book.

Even worse, they get their hands on some of the PRI literature and now they’re assessing breathing patterns (which is fine, because assessing dysfunction what we do) and before you know it, they’re treating people and performing open heart surgery.

It’s crazy.  And pompous.  And completely unacceptable.

It hasn’t gotten to pandemic proportions yet, though. Those types of assclowns are few and far between, and there are far more who understand their limits and don’t step outside their scope of practice.

Having said that, I DO feel that looking into breathing patterns is something to consider with most people.  But the rub is that we SHOULD NOT be spending an inordinate amount of time on it.

At Cressey Performance, we LOVE the PRI stuff.  Eric has been to three or four of their seminars, and Greg Robins recently attended one as well.

Which brings up a valid point:  going to an actual seminar and seeing this stuff done firsthand is A LOT different than just reading about it.

Moreover, we’ve had staff in-services on it where PRI practitioners have come in, talked shop and helped  us comb through some of the finer points to see how we can implement SOME of their modalities with our clientele.

Here’s the deal: at CP we only use like 6-7 drills, total. And not all of them at the same time.

I like how Mike Robertson discussed it in his recent “Warm-Up” article on his blog.  Spend maybe 2-3 minutes on it, and move on.

We take a very similar approach with our athletes and clients.  We may (or may not) include specific breathing pattern drills into their warm-up. But if we do it’s like two or three….tops, taking all of 2-3 minutes to complete.

Afterwards we move on to the dynamic warm-up, and then it’s off to go lift heavy things.

I think the point Mike’s making (and it’s an important one at that) is that far too many fitness professionals are going to get carried away and forget that giving people an actual training effect is kind of important too.  Even worse, many will forget (or neglect) to get their athletes/clients strong.

Just to reiterate:  the why IS IMPORTANT!!!!!!!  I think it’s fantastic when people go out of their way to dig deeper, try better themselves, and gain more knowledge.  I can’t bemoan that point.

What grinds my gears, though, is when people start to overstep their bounds and don’t understand, appreciate, or respect scope of practice.

Worse still: they neglect to actually train their clients.

What are your thoughts?  Agree?  Disagree?

On that note, for those trainers or general fitness enthusiasts reading interested in material that’s easily applicable, I’d encourage you to check out the Muscle Imbalances Revealed series, which features a collection of outstanding webinars from a lot of recognizable names in the industry.  Rick Kaselj, who organized the series, just put the entire package on sale at a huge discount ($210 off!) through this Friday at midnight.  Check it out here.

CategoriesCorrective Exercise Rehab/Prehab

Why Are We Breathing Inefficiently (and What Are the Ramifications)?

Last week I wrote a quick synopsis of a staff in-service we participated in that consisted of  Michael Mullin stopping by for a few hours and proceeding to melt our faces off with the number of knowledge bombs he dropped regarding some of the “inner workings” behind the PRI (Postural Restoration Institute) philosophy.

For those who missed it, you can check it out HERE (< — click me, don’t be shy).

In a nutshell (if that’s even possible to do):  we breath like poop.

I’m more of an analogy guy, so using one that most people reading can 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.

As a corollary to the above post I linked to, current Cressey Performance intern/coach (and resident break-dancing/ Gangham style guru), Miguel Aragoncillo, wrote a quick follow-up that I felt many of you would enjoy.

Why Are We Breathing Inefficiently?

Everyone is breathing incorrectly. We are all stuck, we are all patterned. The real question is… Do you want to get out of the pattern?

Take the blue pill, the story ends, you wake up in your bed, and believe what you want to (and still breath like an asthmatic Darth Vader).

Take the red pull, you stay in Wonderland, and I show you just how deep the rabbit hole goes.

The stance that the Postural Restoration Institute takes (pun intended) is that yes, we have two arms, two legs, two eyes, two ears, etc. To elaborate on the PRI aspects of Tony’s blogpost, we have one heart on the left/central part of our body, liver on the right, along with different diaphragmatic discrepancies such as more crural attachments on the lumbar spine, right versus left lung control, and lung structure.

With this anatomy refresher, you have to wonder: how does this affect our ability to use our diaphragm effectively?

To break down how the body compensates, here are a few factors that are involved in the PRI philosophy:

1. Posture

What is your posture like? If you are constantly standing or moving around (or coaching), you are subjecting ourselves to being in a more extended position.  Comparing by contrast, if you’re a desk jockey – a phone pressed to your ear, a keyboard to crouch over and work on, and more often than not, a not so comfortable chair that you plop yourself into everyday – you’re most likely a walking (or more appropriately, a sitting) ball of flexion.

Whether you are extended or flexed for the majority of your day, it is safe to say that the posture you assume for most of your day will definitely affect you in the long term.

2. Patterns

After attending a 2-day PRI seminar at Endeavor Fitness, my brain was mush on the ride home. So to spare your face from getting melted like Tony from our most recent in-service, understand that there are different patterns that we can be classified into, along with the breakdown of what exercise we should use to not only inhibit these patterns, but also “encourage” us into a better working posture.

Further, if you’re an athlete that has extreme unilateral demands (ie: baseball), it’s pretty much guaranteed that you’re an ideal candidate for PRI’s corrective exercises.

Personally, as a breakdancer, I’m full of dysfunction and asymmetry – rotating in one direction along with favored limbs for other dance movements falls neatly within the PRI philosophy.

During the PRI Seminar, I had many “A-ha!” moments as to why I move the way I do, along with why I favor one side versus the other during years of dancing.

Now take a look at any sport – baseball exhibits handedness (right-handed vs. left-handed pitcher), soccer shows favor for a dominant leg, and swimmers favor one side over the other to rotate towards their flip turns.

The constant demands of a chosen sport, coupled with your structural posture (thanks to the above reasons) will more often than not “feed into your dysfunction,” which in turn can often exacerbate common injuries seen in specific sports.

These dysfunctions alter how we breathe and how we respond to certain exercises or stretches.

3. Positioning

When we got into the practical portion of our in-service at CP, we were asked to get into some rather crazy positions, even blowing up a balloon. However, by getting into an ideal position, we are more readily able to get ourselves out of this pattern. So do not fear – most of us are able to get out of this pattern, much like Neo did in The Matrix. 

WARNING – I’m going to geek out a bit…

 “The activation/setting of the abdominals pulls the lower ribs down and in (caudad and posterior) and helps to inhibit/relax the paraspinals muscles (trunk extensors) which may help to decrease the patient/athlete’s lumbar lordosis and pain in the paraspinal region through reciprocal inhibition.”-1

(Side note: After performing these exercises, a few mentioned that they felt immediate results – loss of tension in their back, or even getting rid of back pain upon movement after being “repositioned”. Some pretty magical stuff.

On another aside: I asked Michael Mullin to walk me through some of the advanced tests, as I had only experienced the lower half of the assessments. After breathing into a few positions, I had seen immediate results with my shoulder issues. Craziness – I know.)

Putting It All Together

So putting the pieces of this puzzle together shows that a large majority of us may fall into a few of these categories from the get-go. What can we do now? Luckily for us, PRI gave us a few corrective exercises that they use often enough for the unlucky few that are still caught up in “The Pattern.”

Sounds like a Stephen King novel, I know, but bear with me.

One question that’s often been asked: where can we fit more exercises into an already jam packed session of foam rolling, mobilizations, and strength exercises?

The few things I’ve been experimenting with on my own along with coaching at CP are using these correctives after foam rolling, and before a dynamic warm-up, and also between sets of heavy compound lifts.

Note from TG:  For those who feel it a bit strange to use a balloon, you can also use a standard straw for this exercise.  Just be sure that when you inhale, you do so through the nose (which means you’ll have to block/pinch the tip of the straw in with your tongue against the roof of your mouth).

And for those who feel it’s a bit weird or “funky” to do this exercise in your gym, it’s no stranger than the moron who’s performing one-legged squats on an inverted BOSU ball while curling pink dumbbells.

Further, we have even gone on to emphasize with our athletes the importance of fixing our posture when we are standing during games, during our travels, and even at rest – sleeping and sitting. If your commute to work is long, making a conscious effort at shifting your posture can go a long way towards reducing overall symptoms.

What can we expect after appreciating these factors?

Whether you call it diaphragmatic breathing or the zone of apposition, we need to be mindful of how we position ourselves not only during exercise, but during our “resting” posture, and most importantly during our respiration.

With these things under our belt (or diaphragm!), I recommend watching the diaphragmatic video one more time to “see” how the above factors can affect our ultimate goal of performance and getting out of The Pattern.

Author’s Bio

Miguel Aragoncillo, CSCS, graduated from Temple University with a B.S. in Kinesiology. His focus as a trainer is getting people to move better and lift heavy things. Miguel is currently interning at Cressey Performance, and openly enjoys Techno Tuesdays, breakdancing, and powerlifting. Check out his writing at www.miguelaragoncillo.wordpress.com and follow him on Twitter @MAragoncillo1.

References:

-1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971640/ – The value of blowing up a balloon

CategoriesProgram Design Rehab/Prehab

What’s the Deal With Spondy? An Attempt to Solve the Riddle in Less Than 1500 Words.

Q: Hey Tony – I suffered a pretty severe L5 spondylolisthesis a couple years ago, and it took me nearly a year to recover.  I’m now back training again and feeling pretty good.  From what I’ve read, I realize I need to make sure I’m not in an anterior pelvic tilt position, so should I try to focus hard on developing glute, hamstring, and hip strength? 

I also realize that maintaining core strength is important.  Besides planks, side planks, anti-rotation exercises, and roll-outs, is there anything in particular you would do to make sure the lumbar spine is strong and healthy so I can prevent any possible re-injury?  Thanks for you input!  Really enjoy your educational videos and blog posts.

A: First off, I’m really sorry to hear about your injury. Speaking bluntly, back pain is about as fun as a bag of dicks – there’s really no way to sugar coat it. As someone who recently went through a spell of back issues (albeit not the same injury) I can commiserate.

Spondylolisthesis (along with it’s fraternal twin, spondylolysis) is definitely an injury that we’ve seen sporadically here at Cressey Performance, so we know how much work it takes to get back into groove of things – especially with regards to training.

For those reading, scratching their heads and thinking to themselves, “spondy- say what?,” lets take a moment to clear the air.

Spondylolysis 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).

More pertinent to this conversation, spondylolisthesis is a lower back injury involving a forward slipping of one vertebra over another (far right picture above). It’s a very common diagnosis in athletes that participate in sports that have extreme axial strain on the low back (think powerlifters and strength athletes), but it’s also common in the general population as well.

With the geeky, spinal shenanigans out of the way, lets get to the fun stuff.

Off hand it sounds like you’ve got a fairly firm grasp on what to do moving forward, but I do have a few candid thoughts to add:

1.  Yes, correcting any EXCESSIVE anterior pelvic tilt would be wise.  You have to remember, though, that there is an “acceptable” range of APT (natural lordotic curve of the spine), but it definitely bodes in your favor to address any excessive tilt that may be playing into your symptoms.

2.  Expounding on the above point a bit more, most will say that you need to stretch the hip flexors, which, if you delve into the normal parameters of Janda’s lower cross syndrome (“tight” hip flexors, weak core/glutes) isn’t a bad place to start.  But as with anything, it’s not always quite THAT simple.

For instance, you can stretch your hip flexors until the cows come home (or George Clooney gets married, whichever comes first)…….but if your anterior core is weak – which is generally the case 100% of the time  – it’s a waste of time and effort.

Almost always, I place a premium on improving anterior core strength.  Things like Pallof press, various chops and lifts (done with spot on precision: abs braced, trailing leg glute firing, minimal compensation in the torso), as well as planks are a great place to start.

NOTE:  Most people will just haphazardly throw in planks because that’s what they’ve always been told to do.  Cool.  But most people absolutely BUTCHER technique.  To that end, you have to make absolutely certain that you’re doing these correctly!  Which is to say, they shouldn’t look like these epic balls of fail:

Or this:

In both scenarios each person is literally hanging on their spine and not doing their passive, ligamentous restraints any favors.

If you’re going to perform planks, at least do them correctly!

Another exercise to consider (for those who are a little further along in recovery such as yourself) is the reverse crunch.  As my colleague and business partner, Eric Cressey, has noted on several occasions: flexion from an already extended position to neutral is different than flexion from “neutral” to end-range lumbar flexion.

The external obliques help to posteriorly tilt the pelvis, but because they have no attachment points on the sternum (unlike the rectus abdominus) we don’t get all the nasty compressive forces on the spine.

Maybe serving as the rule of thumb above ALL of this is the notion that improving spinal stability is kind of a big deal.  Unless this addressed, all of the above won’t matter since all you’ll be doing is placing dysfunction on top of fitness.  Which, as we all know, would make Gray Cook punch a baby seal in the mouth!

On that point, my boy Dean Somerset wrote a fantastic post HERE which discusses in waaaaay more detail than I could ever cover.

3. Taking things a step further, anything that “encourages” more of a posterior pelvic tilt is most likely step in the right direction.

In addition to anterior core work, a healthy dose of glute work would be in order as well.  I’d start simple and perform supine bridges several times throughout the day.

While not shown above, I actually prefer glute holds, holding each rep for a 5-10 second count at the top.

You can then progress these to 1-legged variations and then proceed to perform 1-legged hip thrust, starting with your back on a bench and feet on the floor.  From there, if you’re feeling confident, you can add in a bit ROM and place your feet on a bench.

For my own edification – it’s important to note that there should be absolutely no lumbar compensation when performing these movements. Everything should be glute, glute, and more glute.  If you do tend to “feel” it more in your back, I’d regress the movement and make sure you’re firing the glute.

In case you missed it, you should feel these in your glutes.

Key Word: Glute.

4.  Above all, and this probably should have been point #1, you just need to make absolutely certain that you’re maintaining as much of a “neutral” spinal position as possible.

At. All. Times

We’ve had people with “spondy” deadlift with the trap bar with a lot of success, but we’re on top of them in terms of performing them correctly.  These may be a little too aggressive for you, so I’d be inclined to recommend exercises that won’t place a lof of direct loading on the spine to start:

Pull-Throughs.

1-Legged Hip Thrusts (see above).

Various single leg work.

And even Goblet squats may be acceptable here.

Nevertheless, getting lifting weights and attaining a training effect will undoubtedly help in that you’ll be making your active restraints (muscle) stronger and take the burden off your passive restraints (ligamentous tissue).

Anyways, that is in no way a thorough overview of the issue at hand, but my hope is that it sheds some light on the topic and points you in the right direction.

 

CategoriesExercises You Should Be Doing Rehab/Prehab

Exercises You Should Be Doing: Slideboard Push-Up vs. Band

It’s no secret that I love push-ups and that I feel they’re an important component of any well-rounded fitness program. They offer a bevy of benefits ranging from improved upper body strength (pecs for days!), improved scapular kinematics, and core activation.

As such, in relation to the last point, push-ups serve as an excellent assessment tool to gauge a person’s ability – from an anterior/posterior perspective – to control the entire lumbo-pelvic-hip area.

If someone can’t maintain a neutral spinal position doing something as standard as an (un-loaded) push-up, do you think it’s going to be a good idea to place a heavy barbell on their back?

They’re also really smart, love to go for walks on the beach, can cook like no one’s business. And OMG, I can’t tell you how funny they are. Just the other day we were watching an old episode of Friends – you know, that one where Joey’s lounge chair breaks and Chandler tries to replace it? – and push-ups was like “and that’s why you never bring two rams in heat to a tap dancing recital.”

HAHAHAHAHAHAHAHAHA.

Eh, I guess you had to be there. Trust me, it was HIL-arious.

Anyways, basically all I’m trying to say is that everyone needs more push-ups in their lives. I know they’re often deemed “wimpy” or a waste of time, but I truly feel they’re one of the rare exercises that provide a lot bang for our training buck, and can easily be “tweaked” to the lifter depending on his or hers needs or goals.

Which brings us to today’s Exercise You Should Be Doing

Slideboard Push-Up vs. Band

Who Did I Steal it From:  I originally heard about this variation from my buddy, Nick Tumminello, in an article he wrote for T-Nation a few years ago – HERE.

What Does It Do:  Well, we get all the prerequisite advantages – upper body strength, core activation, shoulder health, and we get a ton of leeway in that we can make them as easy (0r challenging) as we want depending on the person we’re working with.

The main advantage of THIS variation, however, and as Nick noted in the article linked above:

Slide board band push-ups increase muscle tension around the shoulder joint by forcing the posterior shoulder muscles to contract by resisting the band pulling the hands together. Many people who can’t perform a normal push-up due to shoulder pain can successfully perform this variation pain free.

Key Coaching Cues:  In terms of basic technique, all the same “ingredients” still apply.

  • Keep chin tucked – don’t poke it towards the ground.
  • Abs should stay tight or braced (sometimes I’ll gently tap the stomach to help the trainee engage their core).
  • Squeeze the glutes (provides more posterior pelvic tilt and keeps people out of lumbar hyperextension).
  • Hands/elbows should be directly underneath the shoulders.
  • Likewise, hands should be around shoulder width apart.
  • Knees should be locked and legs in a straight line.
  • The entire backside should make a straight line.
  • Elbows should not flare out during the set (it places far more stress on the shoulders), nor should they be glued to your sides (which causes too much “crowding” and will cause people to go into excessive scapular anterior tilt). Instead, the upper arms should make a 45-degree angle to the body.
  • Chest touches floor (or in this case, the slideboard) on every rep.

Another key point I want to note is how to “finish” each rep.  Try to push yourself away from the floor as much as possible at the top of each repetition (scapular protraction).  By doing so, you’re allowing the scapulae to function through a full ROM (adduction AND abduction), and you’re inviting the serratus anterior into the mix as well. Never a bad idea.

You’ll note in the video I do a fairly decent job of doing it correctly.  You’ll also note the lame music in

the background.

Specific to this variation, though, is you’ll need to grab a mini-band (or something equivalent) and wrap that around your wrists.  Place your hands on top of the “footsies” that come with the slideboard and as you perform your push-up, you’ll need to place tension in the band by pulling it apart and then preventing it from forcing your hands together.

This will help activate the posterior shoulder.

NOTE:  for those who don’t have access to a slideboard you could easily use a pair of ValSlides or even those cheapo furniture gliders you can purchase at your local Home Depot.  Either way, the objective is to perform these on a slippery surface.

Try them out today and let me know what you think!