I have an excellent guest post for you today. I was recently invited back onto the More Train, Less Pain Podcast hosted by my good friends Dr. Michelle Boland and Dr. Tim Richardt.
This season on their show they’re focusing on training around injury. This is one of my wheel houses (alongside deadlifts, how to look jacked even while wearing sweatpants, and Ted Lasso), as I am always preaching the benefits of finding each client’s or athlete’s TRAINABLE MENU.
My episode – #13 – dropped today (links below), but in concert with that Tim was kind enough to write a little “companion piece” that ties in nicely with the overall theme of the show.
Think back to the first time you consistently trained a squat- Linkin Park blaring, a thin haze of aerosolized pre-workout and chalk filling the air – and being able to add 5-10 pounds, like clockwork, week after week after week.
It’s the honeymoon phase of strength training- nothing hurts and there’s seemingly no impediment to riding this sweet, sweet train of linear progression to, inevitably, being able to sit down and stand up with the weight of a Honda Fit on your back.
But, like all marriages, reality eventually has to settle in.
Over the years, aches, injuries, and movement limitations accumulate and the simple strategy of adding more pounds to the bar is suddenly not so viable.
What, then, is an iron warrior to do?
I host a podcast called More Train, Less Pain (on which the venerable Tony Gentilcore has guested twice), along with another contributor to Tony’s blog- Michelle Boland- where we dive deep on strategies to keep people training hard in the gym despite injuries and mobility restrictions.
The focus of our current season is on maintaining a strength training practice in the setting of persistent pain, something of personal obsession of mine as I’ve struggled with persistent hip pain due to congenital structural hip defects for virtually my entire adult life. Over the past dozen or so episodes, we’ve talked with some of the brightest minds in the industry (Mike Boyle, Bill Hartman, some schlub we’ll call “Tony G”) about this very problem, and one theme keeps re-emerging over and over. We can’t keep progressing load forever. Infinite progression, in the weight room or any other endeavor, is a myth.
NOTE From TG: You can listen to my most recent chat with Tim HERE – titled “Easy Training, Stoplights, and Making Bigger Cups.”
In order to stay in the strength training game and continue to build muscle, power, and movement quality, we need to find ways to evolve our exercise selection and programming strategies so that we can continue to train without creating undesirable tissue damage or reducing access to comfortable range of motion.
Below are three strategies to do just that, lifted directly from this season’s podcast guests and thoroughly vetted by my own personal and professional experience.
1. Timed Sets
In the most straightforward manner of progressing lifts, we add load to the bar every week, keeping the set/rep/rest scheme the same, essentially the missionary of the strength-training world.
Not THAT missionary. Head out of the gutter
As we stated – this works…until it doesn’t. What if, instead of increasing load, we simply increase time under tension? In fact, what if we throw away the conventional “rep” dosing structure and just endeavor to dose an exercise by time, increasing the time (under tension) over the course of a 6 week training block.
In practice, that progression might look something like this.
Exercise Week 1 Week 2 Week 3 Week 4
Foam Roller Wall Squat 3×1′ 4×1′ 4×90″ 4×2′
In this way, we can accumulate absurdly high amounts of workload (and stimulus) with reduced axial loading. If you struggle with SI joint pain every time you get under a bar loaded with over your bodyweight, give a single set of a 2’ timed Roller Wall Squat a try.
With only a fraction of the loading required for a conventionally-dosed barbell back squat, you’ll still feel every bit as fatigued, and continue to stay engaged with the training process as you build time under tension across a program.
This strategy works particularly well for exercises where increasing weight isn’t convenient due to the nature of the position or loading- think anything with a zercher or goblet hold OR a position that requires a more involved set up.
2. EMOM Supersets
People in our industry love talking s&^t about CrossFit, but they’ve popularized several things that have impacted the general fitness landscape for the better – gymnastics skills, concurrent training, snorting lines of grass fed whey protein isolate before a set of 30 hang snatches, and EMOM sets.
In an EMOM set, you’ll keep the load of an exercise the same but perform a certain number of reps every minute on the minute (EMOM).
In my own training, I’ve found it useful to combine two exercises into an EMOM superset – meaning that every minute we’ll do a predetermined number of reps for each exercise, rest for the remainder of that minute, and repeat. In practice, a 6 week progression might look like this:
Exercise Rest Week 1 Week 2 Week 3 Week 4
A1. Trap Bar DL 0′ 4×3 5×3 6×3 7×3
A2. Alt. 1-Arm DB Bench Remainder of 60″ 4×8 5×8 6×8 7×8
Trap Bar DL EMOM
1-Arm DB Bench Press EMOM
The cool thing about EMOM sets, especially for athletes making the switch from conventional, load-obsessed strength training, is that they possess an entirely novel strategy for dramatically ramping up total load in a program without increasing axial load for any one particular set.
Mathematically, we can contrast a session of EMOM deadlifts with a session of conventionally-progressed deadlifts, which would look something like this:
Over time, this may represent a more sustainable long term strategy for continuing to progress workload when absolute loading on any given repetition can no longer be increased. Additionally, plugging a few EMOM supersets into your training each week can serve as a mild conditioning stimulus for those who struggle to fit in aerobic work.
3. Feel-Based Training
The previous two strategies have emphasized unconventional strategies for increasing the overall workload of a training session, but our final strategy is a different beast altogether.
We love to think about increasing an exercise’s output via weight on the bar or overall pounds lifted throughout working sets. But what if we got “stronger” simply by executing an exercise more efficiently, potentially using a larger range of motion, while making no changes to dosing or loading throughout a cycle?
Depending on a client’s goals and injury history, somewhere between 20%-50% of exercises I program will be progressed by “feel” alone. This means they’re not allowed to do anything “more” over their 4 week cycle. Not more load, not more reps, not faster reps, not even more cowbell.
We’re deliberately freezing these variables to clear cognitive bandwidth for getting as close as possible to *flawless* execution of the drill.
In something like a FFESS, for example, I may stick to 4 sets of 8 reps per leg throughout the entire cycle, loaded with a #25 KB in a goblet hold, but endeavor to improve other aspects of performance. Can a client maintain foot contacts on both the front and rear foot? Does their pelvis stay fairly level in the frontal plane? Do they control the degree of anterior and posterior pelvic tilt at the top and bottom of the range of motion, respectively?
Can they get the back knee further down towards the ground? Are they able to push UP and BACK to take advantage of the retropropulsive, joint-opening qualities of this drill?
In some ways, this is the most boring option for “progression,” but if you can get it into your and your client’s respective heads that we can freeze dosing and simply work on movement integrity and fidelity, a myriad of other training options open.
And options, more than anything else, help folks train consistently for years to come.
If you liked the content in this article, I’d recommend checking out More Train, Less Pain; Engineering the Adaptable Athlete- S3E13 with Tony drops today.
Tim Richardt is a Colorado-based Doctor of Physical Therapy and Strength and Conditioning Coach. He works with runners, climbers, CrossFitters, and tactical/mountain athletes to better help them manage long standing injuries and reach higher levels of physical performance. He also mentors young clinicians and coaches to help them develop their own unique treatment/training model. You can find out more about him at TimRichardt.com or through his IG HERE.
Before you move on, I wanted to let you know that Dean Somerset and I have just put our flagship product, the Complete Shoulder & Hip Blueprint, on sale this week.
You can purchase both CSHB 1.0 and CSHB 2.0 separately this week at 30% off the regular price using the coupon code EVOLVE at checkout.
Or you can purchase the bundle pack HERE which gives you the greatest value.1
“Oh, I forgot to tell you…my previous trainer said I have a winged scapula, my left hip is a bit internally rotated, and that my posture isn’t great.”
This was less than five minutes into an initial assessment with a new client and it took everything I had to prevent my eyeballs from rolling out of their sockets. The snarky side of me wanted to say something like, “Oh my god, yes, I totally see it. Did (s)he also mention how your left ear is lower than the right? That’s messed up. We need to fix that.”
But I didn’t.
Nope, all I did was sit there, nod my head, listen intently, and kept repeating to myself “don’t stab yourself with this pen, don’t stab yourself with this pen, no, Tony, NO!”
People Think They’re Broken
It never ceases to amaze me how some people will harp on the most inane things when it comes to their body and performance and then regale me with stories of how their previous coach or trainer was a “corrective exercise specialist.”
I won’t invalidate their stories or experiences, of course, but it’s hard for me to listen to sometimes.
They’ll outline their “training” for the past few months (if not years), and it’s rife with positional breathing drills (which, for the record, I’m a fan of), postural stretches, and describe a foam rolling series that rivals the length of a Ken Burns’ documentary.
I’ll follow with “So, did you actually ever follow a strength training program consistently?”
“Yeah, sure, we did a bunch of corrective exercises and, after 19 weeks, we finally worked up to a bodyweight squat. I still have to work on my big toe dorsiflexion, though. Fingers crossed I can improve that by December.”
As an industry – and I’ll call myself out on this too (particularly early in my career) – we’ve done a splendid job at helping people feel like a bunch of walking balls of fail:
Your shoulders and upper back are too rounded.
Yikes, your pelvis is anteriorly tilted.
Oh…my…god…we need to work on your scapular upward rotation.
Shit, your FABER screen tested positive. How are you able to walk?
Also, FYI: you have Chlamydia.
It doesn’t surprise me in the least why so many people walk around thinking they’re fragile snowflakes who need to correct or “fix” everything before they do any appreciable training.
It’s our fault.
Strength coaches, personal trainers, physical therapists, athletic trainers, sherpas, we’re all culpable.
We can and need to do better.
And it starts with re-acquainting ourselves with what our main role as fitness professionals actually is…
…to elicit a training effect with our clients/athletes.
Again…Getting Strong(er) is Corrective
I say this with a grain of salt because “strong” is subjective, and can mean different things to different people.
Being able to deadlift 2x bodyweight is strong.
Being able to perform 15 pull-ups is strong.
Walking from Trader Joe’s to your apartment without putting down the bags is strong.
The ability to pull off wearing white after Labor Day is strong.
Doing whatever it is Cirque du Soleil performers can do is strong.
However, since I’m a little biased “getting stronger” in this sense – and more cogent to the conversation – refers to TRAINING.
I.e., lifting heavy things.
Unfortunately, many people have been led to believe lifting weights is dangerous. It seems you can’t go more than three clicks on the internet (or investigate certain certifications available) before being told barbells, dumbbells, machines, kettlebells, squats, deadlifts, high-reps, low-reps, and/or kittens are dangerous.
Who, me? Dangerous? Noooo. I mean, I’ll slit your fucking throat in your sleep if you don’t pay me any attention, but all in all….cuddles.
And just to set the record straight, and to push back with all my will to those people (worst of all, doctors, PT’s, etc) who keep spreading the message that strength training is dangerous (particularly when addressing a current injury)…
…I give you the LAWS of Loading:
Wolff’s Law – Bones will adapt to loads under which it is placed
Davis’s Law – Soft tissue will heal according to the manner which they are mechanically stressed.
For the “you only have one back” guy…is this then not why we train?2 Squats and deadlifts, when properly loaded and progressed, will do far more good for someone’s recovery from injury than most alternatives.
I hate the “everything makes you dysfunctional or causes dysfunction” crowd.
To which I say…the fuck outta here.
My friend Bret Contreras has the perfect antithesis to this faulty mindset:
“If you think lifting weights is dangerous, try being weak. Being weak is dangerous.”
And this is why I’m a firm ambassador in encouraging people to get strong(er), or more to the point, helping them figure out their “trainable menu.”3
Rather than pointing out everything that’s wrong with someone, I’d rather use the initial assessment (and subsequent training sessions) to highlight what they can do.
Lets use the classic example of someone who has “computer guy” posture. I.e., rounded shoulders, forward head posture, an affinity for pens.
When someone walks in exhibiting this posture a lot of trainers will write down a laundry list of stretches, thoracic (mid-back) mobility drills, and other “corrective” exercises to do.
Well, first, some will go out of their way to make the person feel like Cersei Lannister during her walk of shame.
I’m not opposed to utilizing corrective modalities to address postural deficits or mobility restrictions.
But I find when these sort of things are accentuated and serve as the “meat-n-potatoes” of a training program, it often sets people up for failure; they become more fixated on perfection at the expense of progress.
And lets be honest: NO ONE gets jazzed-up at the gym to do more T-spine extension drills.
I don’t want my clients to feel like a perpetual patient.
I want them to train, because training tends to be more palatable than Scapular Wall Slides. It helps people stay on task and not bored to tears.
And on that note, wanna know an excellent drill that helps nudge people into a bit more thoracic extension?
Kipping pull-ups.
FRONT SQUATS.
As you descend closer to the ground you have to “fight” to keep from folding over. In many ways the proper execution of the exercise itself is self-coaching; or dare I say, corrective.
If you don’t maintain thoracic extension the barbell rolls off your shoulders.
I may come across as the cantankerous strength coach in saying this, but I find more value in having my clients train – in a way that emphatically demonstrates success to them (by matching the programming to their goals and ability level) – than to corrective exercise them to death.
Note From TG:This is a re-publication (with updated edits/additions) of an article I wrote a few years ago. I figured since I’m currently working with four women at the moment – three in person, and one distance based – who are pregnant, it was something I felt required a little dusting off.
Hope you enjoy it.
Okay, I know what some of you may be thinking: What does someone who has succumbed to male pattern baldness, hates The Notebook4, and pees standing up know about the female body, let alone speaking to something that’s arguably the most precious, magical, and delicate time of a woman’s life?
(insert shrug emoji here)
Close-up pregnant woman doing exercise indoors.
What to Expect (In the Gym) When Expecting
Well, first off: Not for nothing, I took health class in 9th grade, so I know where babies come from Smarty Pants. For those who don’t know, when a man and a woman love one another they place a note in a bottle and throw it into the sea.
Eventually a mermaid reads it, sends her pet seahorse to the Galapagos Islands where he then relays the message to Henry the stork.
And wah-lah…a baby arrives nine months later.
Don’t argue with me, it’s science.
Secondly, in the just over two decades I’ve been a strength coach I’ve worked with and trained a few dozen women through their pregnancies and I thought I’d share some of my own thoughts on the topic because I feel much of the information out there directed towards women is regurgitated, archaic, hogwash.
Admittedly I have a strong viewpoint and recognize that not everyone will agree with me (and that’s cool). But it’s my hope that this post at least opens up the conversation and helps encourage people to think outside the box.
For me there’s a massive dichotomy between what I do and what most (not all) of the research says we should be doing when working with someone who’s pregnant.
Obligatory Disclaimer: Every pregnancy is different; each woman needs to consider her own specific situation. And, to cover your bases, it’s best to consult with your physician. Preferably one that lifts…;0)
No one should be made to feel guilty or lazy if they need to take it easy; the health of the baby and mother are paramount.
While it always comes down to the individual, their comfort level, their ability to listen to their body, as well as their past training history, I find it somewhat disheartening that there are health professionals out there (both primary and tertiary, as well as many of us in the fitness industry), and even more articles, that suggest “training” should orbit around light walking and what mounts to folding laundry.
For me, when I’m working with someone who’s expecting, it’s about preparing them for something a helluva lot more significant than lifting pink dumbbells (or for that matter anything I’ll ever have to do as a member of the Y chromosome club).
I mean, I think it’s an accomplishment I can grow chest hair, but if you’re able to grow and push a human being out of your body, that’s next level shit.
If that’s the case, you’re also capable of lifting a barbell off the ground.
Repeatedly.
But let me be clear, and this is going to serve as the proverbial umbrella of the entire conversation:
It ALWAYS comes down to the woman’s comfort level.
Regardless of one’s experience in the gym, whether they’re a seasoned veteran or a newbie, I always instruct the women I work with to listen to their body. After a few hundred thousand years of evolution, the human body is pretty smart, resilient, and will let you know when it’s pissed off or doesn’t like something.
Now, I’m not insinuating that every expecting mother out there should go out and try to hit a deadlift PR on a weekly basis or snatch a mack truck over their head. But I’m certainly in the camp that feels we can offer a lot more than simply telling them to “go walk on the treadmill” or what mounts to playing patty cake for shits and giggles.
As an example, here’s one of my former female clients, Whitney, when I was a coach at Cressey Sports Performance performing some heavy(ish) deadlifts at roughly 32 weeks out.
And I say “heavy(ish)” because the weight in this video was no where near her best effort.
Because this is a gargantuan topic and because my head is spinning in several different directions – and because it’s something I can’t possibly cover in one simple blog post – I’m just going to shoot from the hip and blurt out some thoughts in random order.
Stuff
1. Before I begin I’d be doing a huge disservice to the discussion if I didn’t point people in the direction of Dr. Laura Latham,Julia Ladewski, and Stacey Schaedler all of whom are three very strong (and very smart) women who have written extensively on women training through their pregnancy.
Likewise, I’d be remiss not to mention Dr. Sarah Duvall’s excellent Pregnancy & Postpartum Corrective Exercise Specialist Certification – it’s not only THE best resource on the topic of training during pregnancy and postpartum, but, if I’m be honest, its THE best course I’ve ever taken.
2. Lightsaber Self-Defense Against the Dark Arts (and fit-fluencers)
3. CPR.
To quote the Dr. Duvall herself:
“You gotta lift shit to fix shit.”
If you’re a trainer, strength coach, physical therapist, or I don’t know, an Orc – it stands to reason this information applies to 50% of your current/potential client roster…
…you WILL need to know this stuff.
I’d also be remiss not to point to THIS amazing archive on the Girls Gone Strong website – everything from myths about strength training during pregnancy to pelvic floor dysfunction is covered. In addition, HERE is a FREE 5-day course by GGS dedicated to trainers who work with postpartum clients.
(On that same front, if anyone reading has any high-quality websites, blogs, or general information they’d like people to know about PLEASE link to them in the comments section below).
2. Just to give you a little insight into the type of information being regurgitated out there, one of the women I used to train had a friend who told her that when she was pregnant, her physician recommended that a great way to get more protein in her diet was to pound milk shakes.
Many women fall into the trap of “Well, I’m eating for two now,” and interpret it as a free-pass or opportunity to ramp up their caloric intake. Granted, there’s no doubt the metabolic demands of the body increases when another human being is growing inside of it, but lets not get too carried away here.
Most of the research and material I’ve read says that an increase of 400 kcals per day is more than enough to cover one’s bases, and to ensure adequate fuel for the body and the growing fetus.
Giving that a little perspective, 400 kcals mounts to roughly four (standard) tablespoons of peanut butter.
That’s it.
No need to go crazy with pizza buffets, a baker’s dozen from Krispy Kreme, or a daily liter of Coke challenge (the drink, not the drug). Don’t try to fool yourself into thinking that just because you’re pregnant, means you can go bonkers with the calories.
I am not saying it’s wrong, and I can attest to the weird food cravings that come about. For instance my wife was obsessed with tacos for a four-week span, and I’d be lying if I said I wasn’t more than happy to hit up our local taqueria several times per week; it’s not like she had to pull my arm.
However, just take this as a little dose of “tough love” and expectation management.
“Eating for two” is a bit overplayed and overstated.
3. While the topic of nutrition is HIGHLY individual, when in doubt stress protein. But really, I don’t care what side of the fence you preside on…low carb, Paleo, Vegetarian, Vegan, or whether you only eat foods that start with the letter Q:
The important thing to remember is to provide adequate calories.
Need a little nudge? Check out THIS amazing infographic from Dr. John Berardi of Precision Nutrition.
4. KEEP THINGS SIMPLE FOR THE LOVE OF GOD
But remember…
It all comes down to what THEY’RE comfortable with.
If I’m working with a current client it’s really more a matter of tempering down intensity (load) than it is reneging on any specific exercise. All of the women I am working with currently still deadlift, squat, row, press, etc. As their body changes we’ll of course modify things, but for all intents and purposes it’s business as usual.
I just make sure to check in prior to each session to see how they’re feeling and will make a judgement call on whether or not to adjust a specific session or not.
If I am working with a new client through her first pregnancy I will spend a fair amount of time on proper breathing mechanics and honing in on teaching basic stuff like Goblet Squats, TONS of core stability work (think planks, chops, lifts, Farmer carries, and Pallof Presses), teaching a proper push-up pattern, band resisted hip thrusts(<— video of my wife doing them at 24 weeks), single leg work, and the like.
You’ll notice it’s not that much different than working with a new client who isn’t pregnant, and that’s the point…
…a pregnancy doesn’t automatically mean you’re unable to go to the gym.
The last thing I want is for them to feel like a delicate flower.
Remember: Our job as their coach is to prepare them for something bigger…child birth. Assuming a thorough assessment, taking into consideration any contraindications, using appropriate progressions/regressions, and always checking in on comfort level, a barbell, used in a controlled setting, is no more dangerous than bathing in a tub of seed oils while drinking a diet soda on a yacht full of Paleo CrossFitters.
Likewise, HERE are some thoughts on postpartum considerations for those curious.
Putting things into context, Whitney G (from the deadlift video above) had been training with me for three years, and I knew she knew what she was doing – so I felt completely comfortable throwing deadlift and squat variations (and she still did chin-ups!) into her programs.
Speaking of chin-ups here’s my wife, Lisa, using (natural) progressive overload to complete a rest/pause set.
A video posted by Tony Gentilcore (@tonygentilcore) on
5. Look at Cara, another mom-to-be I worked with a few years ago who was still training and getting after it 34 weeks into her pregnancy.
Here she was deadlifting 200 lbs for eight reps:
Cara trained with me at CSP for well over two years prior to becoming pregnant, and, slight humble brag, was coached very well. We had no problems staying on task with her training when she was expecting.
Which is to say…while certain “tweaks” and modifications were made trimester to trimester, we were still able to maintain a significant training effect.
While she’s definitely an exception to the rule, despite being a first-time mom, she never experienced any morning sickness – something she attributed to not flaking on her training.
From Cara herself:
It was hard to find information specific to heavy weight lifting. Most “advice” given about exercise has to do with cardio, probably because that’s what doctors expect most women are doing. In general, there’s an attitude that if you are already fit, you can continue what you are used to. So I made my own decision to continue what I was doing, to the best of my ability, just paying attention to what felt comfortably to me personally. Taking longer breaks, adjusting weights and positions as needed.
Others might think I lift “too much” or let my heart rate get “too high” but I don’t believe in one-size-fits-all limits on what pregnant women should be doing. We’re all accustomed and able to do different things when not pregnant, and I think the same can apply during pregnancy.
6. By that same token, I don’t want to give the impression that every woman who’s pregnant has to lift heavy things. There are quite a number of other things to pay close attention to.
Shedding some light here are a few thoughts provided by Boston-based trainer Laura DeVincent, who’s Pre/Post Natal Certified through FitForBirth:
The first ten minutes of a session are spent diaphragmatic breathing, which I think is vital for keeping connected with the core. Although kind of awkward to coach, kegals are also important to prevent problems down the road. The next 30-40 minutes are spent on corrective exercise and strength training, and the last 10 minutes are spent interval training.
7. Expounding a bit further, something else to consider is stretching. Does it have a place? Many women (and fitness professionals) are under the assumption that stretching is an important factor, but I’d actually caution against it in this case.
In fact I’m actually not a huge fan of stretching in general – as most people suck at it, only stretch what they’re good at, and, what’s more, you’re not actually “stretching” anything anyways (only increasing the tolerance to stretching).
But that’s a debate for another time.
As the pregnancy progresses the body produces more of a hormone called Relaxin, which, as the name implies, makes the tendons and ligaments (soft tissue) “relax” or more “pliable” as the body gets closer and closer to the due date.
This can make activities such as running, yoga, and group classes not as much of a better or “safer” alternative as many will have you think.
Mirroring my thoughts, Laura notes:
In my experience, most women that are used to doing group ex classes feel nervous doing intense plyometric and cardio workouts, so they love the fact that they can get intense with weight training!
What most women deem “intense weight training” can be left to interpretation, but it stands to reason that contrary to popular belief, weight training can be argued to be SAFER than most other options…if for no other reason(s) than it is generally more controlled, can be more easily individualized, and focuses more on improving stability (via strengthening).
8. Taking it a step even further, and touching on the whole heart rate issue, my good friend Dean Somerset offers his insight as well:
The big cautions come from not wanting to have large blood pressure fluctuations early on in the pregnancy or having too much of an anaerobic load that would cause stress to the fetus. If the muscles are pulling all the oxygen and not enough is going to the fetus, it can cause some issues, so most cardio is best performed beneath anaerobic threshold, or in short bursts where fatigue isn’t a major factor.
Loading tends to have to be decreased over time due to changes in core stability, pelvic dilation, presence of lumbosacral ligamental laxity, and increasing pressure on the bladder and bowels. It’s cool to deadlift in the second trimester, but something to avoid in the third trimester in favour of squatting, moving from a conventional stance to more of a sumo stance as the pregnancy goes on.
I’m not going to sit here and diss on CrossFit – because there is plenty about CrossFit that I like.
All I’ll say is that if you’re someone who’s pregnant and you’re still adamant on going to CrossFit every week (and that’s completely fine), please, please, PLEASE use some common sense and recognize that it’s okay to pump the brakes a bit and not feel like you’re going to cough up a spleen when you train.
9. Shedding some more light on this topic, here are some sage words from strength coach, John Brooks:
The problem with training pregnant women is no two pregnancies are the same. With our first born my wife hit rep PRs into the early third trimester, did chins, and lots of unilateral leg work deep into the pregnancy. This latest (due in march) had some complications and bleeding early on, so she was on pelvic rest (which means you can pretty much do somewhere between jack and crap) now she’s back up to some basic body part split stuff. Totally different response to training stress in those conditions.
I’ve worked with a couple other women who didn’t have complications and for me the HR monitor was the key, Keep their HR down below threshold, keep a training effect going, and (especially if this is the second+) no movements that abduct the legs either quickly or under load (if you don’t know why ask your mother).
10. And bringing everything to a nice succinct stopping point, I want to share one of my former distance coaching client’s, Laura, (whom I trained through her second pregnancy), perspective on everything:
I was one of those lucky women Tony trained through a pregnancy. During this time, I also regularly attended kettlebell classes in preparation for my RKC certification, which I passed 7 month after delivery.
With solid programming from Tony that included a lot of heavy compound lifts and modifications where necessary (no barbell glute thrusters), I was fitter at the end of the pregnancy than I had been at the beginning, with a slew of new PRs in my pocket as well – including squats and deadlifts.
My daughter presented in a posterior position (sunny side up), but I only had to go through 20 minutes of pushing — believe me that’s rare. With doctor approval, I was back swinging kettlebells in the gym the day after I was home from the hospital, and I healed like a champ.
Now, I’m not trying to blow sunshine up my own butt, but how many women do you know who are back in the gym a mere day after returning from the hospital? [Pats self on back].
Mind you: This SHOULD NOT be considered a standard goal for everyone.
That said, there’s no way Laura could have done that – let alone even think about doing it – if she had only resorted to yoga classes and basing all of her training sessions around weights that are lighter than the purse she carries around on her shoulder.
11. Something else to think about is the fact that Laura had a very progressive MD (which is rare, but a breath of fresh air) and midwife, who, according to her, “understood that pregnancy is not an illness or handicap.”
As well, according to her, “I also took a lot of comfort from the wonderful book Exercising Through Your Pregnancy by James Clapp, which examines study after study showing the value of continuing to engage in strenuous exercise during pregnancy.
The book also provides advice for people who go into pregnancy in more of a de-conditioned state.
So there you have it
While not an exhaustive list, and certainly a topic which deserves someone taking a more proactive approach into what’s the right course of action for HER, I feel this post provides a rather unique (and dare I say: anti-status quo) approach to how women should go about exercising through their pregnancy.
I’m in no way saying that my opinion is right or should be considered the gold standard. But it deserves every bit as much consideration as all the other advice being given.
Coming full circle, isn’t it funny how people will often scoff, give double takes (or worse panic) if they see a pregnant woman lifting appreciable weight in the gym, yet fail to recognize that women have been partaking in far superior activities – walking across continents, manually plowing fields, hunting, and gathering – loooooong before barbells existed.
The topic of low back pain (LBP) – how to assess it, diagnose it, and how to treat it – can be a controversial one. I italicized the word “can” because I don’t feel it’s all that controversial.
Cauliflower as an option for pizza crust or Zach being chosen as the bachelor on the current season of The Bachelor (when it’s 100% clear that a ham sandwich has more charisma) = controversial.
Simple stuff to consider to help with one’s LBP = not so much.
The topic of low back pain and how to address it is controversial because there’s no one clear approach or answer to solve it.
(And if the last 3+ years of this pandemic dumpster fire has taught us anything it’s that we looooooove to argue over what’s best and what works).
SPOILER ALERT: Everything and nothing causes LBP.
Have ten different doctors or physical therapists work with the same patient and it’s likely you’ll get ten different opinions as to what the root cause is and what tactics need to be implemented to resolve it.
One person says it’s due to delayed firing of the Transverse Abdominus (TA), while someone else states it’s due to someone’s less than great posture or tight hamstrings.
For the record, all are weak excuses at best.
The culprit can rarely be attributed to any ONE thing.
But it’s amazing how often “tight hamstrings” is the fall guy.
Low back pain? Tight hamstrings.
Knee hurts? Tight hamstrings.
Have Type II Diabetes? Tight hamstrings.
Brown patches on your front lawn? Hamstrings.
It’s uncanny.
I mean, I could just as easily sit here and say in worse case scenarios LBP results from drinking too much coffee. I have zero evidence to back that up, but whatever.
…neither do most of the other “culprits” people tend to use as scapegoats.
So, why not coffee?
Or Care Bears for that matter, those sadistic fucks.
What works for one person, may exacerbate symptoms for someone else. And as my good friend, Dr. John Rusin notes:
“Fact of the matter is: there is NO one right way. it’s a big mistake to lump all LBP into the same category and even a bigger mistake to assume all of it presents the same or should be treated the same.”
There’s no way for me to write a thorough blog post on such a loaded topic; especially one that will make everyone happy.
It’s impossible.
I have better odds at surviving a cage match with an Uruk-hai.
Part of me feels like the proper response to the question “what causes low back pain and what’s the best way to address it?” is this:
Most people reading aren’t clinicians or physical therapists. There’s very little (if any) diagnosing going on in the hands of a personal trainer or strength coach. And, truth be told, if you are a personal trainer or strength coach and you are diagnosing, YOU……NEED…….TO…….STOP.
Just stop.
It’s imperative to defer to your network of more qualified (and vetted) fitness/health professionals whom you trust to do that.
However, it’s important to also consider we (as in personal trainers and strength coaches) are often the “first line of entry” into the medical model. We’re the first to recognize faulty movement patterns, weakness, imbalances, and bear the brunt of questioning from our clients and athletes when they come to us with low back pain.
There’s quite a bit we can do to help people.
What follows is a brief look into my mind and what has worked for me in the past with regards to LBP; a Cliff Notes “big rock” brain dump if you will.
Sorry if I offended anyone who likes Care Bears.
1) Rest Is Lame
My #1 pet peeve (and many agree with me) is that “rest” is the worst piece of advice ever.
“Go stick your finger in that electrical socket over there” would be better.
This isn’t to say there aren’t extenuating circumstances where taking a chill pill is absolutely the right choice; sometimes we do need to back off and allow the body a window of time to heal or reduce pain/swelling/symptoms.
That said, I think it’s lame when a medical professional tells someone to “rest,” or worse, informs them that they’ll need to learn to “live with low back pain.”
It’s a defeatist attitude and will spell game over for many people. Before you know it they’re living on a foam roller and thinking about a “neutral spine” while washing their hands.
(NOTE: I am not anti-teaching neutral spine to people. It’s a lovely starting point for most people, but at some stage people need to learn to move in (and out) of precarious positions…because that’s life).
A common theme reverberated in the S&C community is to say “strength is corrective.” I wholeheartedly agree with this sentiment. In fact, why the hell has this not been made into a t-shirt yet?
However, I think a slightly better moniker may be to say:
“Movement is corrective.“
We can use movement (and yes, strength) to help people get out of pain. Rest has its time and place, but I find stagnation to be more of a problem.
The body is meant to move and is wonderfully adaptive. And that’s the thing: adaptation and forcing the body to react to (appropriate levels of) change and stress is paramount to long-term success with LBP.
Sitting on a couch watching Divorce Court in the middle of the day isn’t going to help.
2) Move, But Move Well
I was watching Optimizing Movement with Mike Reinold recently and he noted there are three key elements to movement and why someone may not do it well:
Structural Issues
Coaching/Technique
Programming
It’s important to understand that, in this case, everyone is a unique snowflake.
Structure: Anatomically speaking there is huge variance amongst the population. Hip structure, for example, can have a large effect on someone’s ability to squat to a certain depth or get into certain positions. Likewise, who’s to say the hips are always the culprit? Even upper extremity considerations – like one’s ability to bring their arms overhead (lack of shoulder flexion) – can have dire consequences on back health.
The body likes to use the path of least resistance (also the most efficient) to accomplish any task. However in this case, “most efficient” doesn’t mean best. As Reinold notes:
“Efficient in this case refers to energy, not movement.”
Lack of shoulder flexion will often lead to compensation via more extension through the lumbar spine. It’s efficient movement, but it’s not better movement.
Coaching/Technique: I’m a firm believer that everyone should deadlift (it’s a hip hinge, learning to dissociate hip movement from lumbar movement, doesn’t mean we have to load it), but I don’t feel everyone should do it from the floor or with a straight bar.
Cater the exercise to the lifter, not the lifter to the exercise.
More on this below.
Programming: If someone lacks hip flexion why have them conventional deadlift? If someone lacks shoulder flexion why have them perform overhead pressing or kipping pull-ups? Some of the onus is on YOU, dear fitness professional.
Find what actions hurt or exacerbate symptoms, and stop doing it.
I know I just blew your mind right there.
For example:
1. Client says “x” hurts, and then places their body into some pretzel like contortionist position that would make a Cirque du Soliel performer give them a high-five.
Me: “Um, stop doing that.”
2. But that could also mean addressing how they walk or how they sit in a chair. Someone with flexion-based back pain, will like to be in flexion, a lot.
Maybe taking them through a slump test will offer some pertinent info.
Have them start in a “good” position:
Then, have them purposely “slump” into excessive flexion:
Someone who is flexion intolerant – despite preferring to be in that position – will often say this causes pain.
Ding, ding, ding.
So, the “fix” is to coach them up and try to keep them out of excessive spinal flexion. Cueing them how to sit in their chair and to get up (wider base of support, brace abs, chest up), building spinal endurance (and strength) via planks, and having them hang out in more extension may be the right path to take.
3. On the opposite side of the spectrum is extension, which is often a problem in more athletic populations and in those occupations requiring more standing (ahem: personal trainers/coaches).
Here you might put them into extension and see what happens.
Much like people who are flexion intolerant “liking” flexion, those in excessive extension will like to live in extension.
This will likely hurt.
Finding their spinal neutral is key too.
Hammering spinal endurance/strength via planks (done well) still hits the nail on the head, as does nudging them towards exercises that emphasize posterior pelvic tilt (much of time cuing people NOT to excessively arch during their set up on squats and deadlifts), and even drills that promote spinal flexion…albeit unloaded.
Spinal flexion doesn’t always have to be avoided. In fact, it’s sometimes needed.
Either way, meticulous attention to detail on finding spinal neutral – or pain from ROM – is huge. Once that is addressed, and symptoms has subsided, we can then encourage them to marinate in more amplitude of movement, taking them OUT of spine neutral (cause, it’s gonna happen in everyday life) and use the weight-room to help strengthen those new ROMs.
But I digress.
4) Don’t Treat People Like a Patient
I know this will rub some people the wrong way, but I still use the deadlift for the bulk of people I work with you have LBP.
Nothing sounds so absurd to me than when I hear someone say how the deadlift is ruining everyone’s spines.
To recap:
Deadlift = hip hinge.
Hip Hinge = learning to dissociate hip movement from lumbar movement.
Mic drop.
Resiliency is key in my book. And not many movements make the body more resilient than the deadlift or any properly progressed hip hinge exercise catered to the individual’s goals, injury history, and ability level:
Assuming I have coached someone up enough to understand spinal neutral and they’re able to maintain it, why not poke the bear and challenge them?
A deadlift doesn’t always mean using a straight bar and pulling heavy from the floor until someone shit’s their spleen.
I can use a kettlebell and band to groove the movement:
I can also use a trap bar, which is a more user-friendly way of deadlifting as it allows those with mobility restrictions to get into a better position compared to a straight bar.
https://www.youtube.com/watch?v=p-sA3PG1kGY
Too, I have found great success with various other exercises:
Farmer and Suitcase carries
Shovel Holds
“Offset” loaded exercises like 1-arm DB presses or 1-arm rows, lunges or RDLs (where you hold ONE DB to the side and perform the exercise). It’s a great way to increase the challenge to the core musculature.
Or even outside-the-box exercises like Slideboard Miyagi’s
So long as we’re staying out of precarious positions or those positions which feed into the issue(s) at hand, we’re good.
Find a training effect with your clients/athletes.
Help them find their TRAINABLE MENU.
And That’s That
People have low back pain for a variety of reasons: They’re too tight, too loose, too weak, have poor kinesthetic awareness, or they’re left handed.
The umbrella theme to remember is that there is never ONE root cause or ONE definitive approach to address it across the board. However, that doesn’t mean there aren’t some “big rock” things to consider that will vastly improve your’s and their chances of success.
Starring at the barbell on the floor I couldn’t help but think to myself, “holy shit that’s a lot of weight.” Also, “I hope I don’t shit my spleen.”
The year: 2004. The place: Albany, NY, at some random Golds Gym.
I was visiting my sister and her family after a recent breakup with my then girlfriend and I decided to do what most guys would do when stuck in a vortex of rage, anger, sadness, and endless Julia Roberts movie marathons…
…I went to the gym to take my mind off of things.
This trip to the gym, however, would be different. I decided it was going to be the day.
No, not actually do some cardio.
I was going to deadlift 500 lbs for the first time.
I know this will surprise a lot of people when I say this, but I didn’t perform my first (real) deadlift until 2002 when I was 25 and still wet behind the ears with regards to my fitness career.
Mind you I had been lifting weights since I was 13, so it’s not like up until that point I had never seen a barbell.
It didn’t take long for me to become enamored with the deadlift. I loved that I was actually good at it, and I really loved how it made my body look and feel. It wasn’t long before I made it my mission to pull 500 lbs. It took me a little over a year to get there.6
Funnily enough, how I went about doing it was all sorts of contrarian compared to how I would approach the same task today.
Well, not 100% contrarian….but, you know, different.
1. I didn’t perform any traditional 90% work (working up to heavy singles). Instead I stayed in the 3-5 rep range, sometimes adding in some high(er) rep work for the hell of it. Whoever says you can’t improve your 1RM by working with sub-maximal weights is wrong.
As I like to remind my own clients today:
“you need to build a wider base with sub-maximal loads in order to reach higher peaks (in maximal strength).”
2. I didn’t use any special periodization scheme named after a Russian. I used good ol’ fashioned linear progression.
3. I didn’t rotate my movements every 2-3 weeks or follow some magical formula that had me incorporate the Mayan calendar. Nor did I perform some sort of dance to the deadlift gods every time there was a Lunar eclipse.
I performed the conventional deadlift almost exclusively.
Year round.
4. And maybe most blasphemous of all, I sometimes used wrist straps!!!
I know, I know…I didn’t want to be the one to break the news to you, but it’s true.
I believe straps should be used (sparingly) by pretty much everyone. For stark beginners it allows for more volume to be completed because grip becomes a limiting factor. For deadlifting terminators (I.e., really strong lifters) it also allows for more volume because grip becomes a limiting factor.
But this serves as a nice segue to a few question I receive almost without fail whenever I present:
Will using a mixed (under/over) grip when deadlifting cause any imbalances or is it dangerous?
Do you think straps should not be used during deadlifts?
First things first: Lets address the pink elephant in the room. I don’t feel utilizing a mixed grip is bad, and I do not think it’s dangerous.
This isn’t to say there aren’t some inherent risks involved.
But then again, every exercise has some degree of risk. I know a handful of people who have torn their biceps tendon – while deadlifting using a mixed grip. The supinated (underhand) side is almost always the culprit.
A LOT of people deadlift with a mixed grip, and A LOT of people never tear their bicep tendon. Much the same that a lot of people drive their cars and never get into an accident.
Watch any deadlift competition or powerlifitng meet and 99% of the lifters are pulling with a mixed grip. And the ones who aren’t are freaks of nature. They can probably also smell colors.
Pulling with a mixed grip allow someone to lift more weight as it prevents the bar from rolling in the hands. Sure we can also have a discussion on the efficacy of utilizing a hook grip, which is also an option.
I’m too wimpy and have never used the hook grip. If you use it I concede you’re tougher and much better than me.
Here’s My General Approach:
1. ALL warm-up/build-up sets are performed with a pronated (overhand grip).
2. ALL working sets are performed with a pronated grip until it becomes the limiting factor.
3. Once that occurs, I’ll then revert to a mixed grip….alternating back and forth with every subsequent set.
4. When performing max effort work, I’ll always choose my dominant grip, but I feel alternating grips with all other sets helps to “offset” any potential imbalances or injuries from happening.
Now, As Far As Straps
Despite what many may think, I don’t think it’s wrong or that you’re an awful human being or you’re breaking some kind of un-spoken Broscience rule if you use straps when you deadlift.
As I noted above, both ends of the deadlifting spectrum – beginners to Thanos – use straps. I think everyone can benefit from using them when it’s appropriate.
When I started deadlifting I occasionally used them because it allowed me to use heavier loads which 1) was awesome and 2) that’s pretty much it.
Straps allowed me to incorporate more progressive overload. My deadlift numbers increased. And I got yolked. Come at me Bro!
But I also understood that using straps was a crutch, and that if I really wanted to earn respect as a trainer and coach I had to, at some point, work my way up to a strapless pull. No one brags about their 1RM deadlift with straps in strength and conditioning circles. That’s amateur hour stuff for internet warriors to bicker over.
If you’re a competitive lifter, you can’t use straps in competition (outside of CrossFit, and maybe certain StrongMan events?)…so it makes sense to limit your use of straps in training.
If you’re not a competitive lifter, well then, who cares!?!
It’s just a matter of personal choice.
Note: If I am working with someone who’s had a previous bicep tendon or forearm injury, has elbow pain, or for some reason has a hard time supinating one or both arms, I’ll advocate that they use straps 100% of the time.
Offhandedly, straps do tend to slow people down which could be argued as a hinderance to performance. One mistake I see some trainees make with their setup is that they’ll bend over, grab the bar, and take way too long before they start their actual pull.
The logic is this: If you spend too much time at the bottom you’ll miss out on the stretch shortening cycle. As I like to coach it: Grip, dip, rip!
Digital Strategic Strength Workshop Coming Soon
For more insights on deadlifting, coaching, programming, assessment, and general badassery keep your eyes peeled for my upcoming continuing education resource which should be available this coming January!
It’s not lost on me that the title of this particular blog post may ruffle a few feathers out there. There are many coaches and facilities in the world who implement the OLY lifts with their athletes and find great success with this approach.
Conversely, there are also many coaches and facilities in the world who d0 not use the OLY lifts7and as a result have been blacklisted from S&C Twitter get resounding results as well.
What follows is one coach’s (Syracuse, NY based strength & conditioning coach Ricky Kompf) opinion with a solid rationale for why he falls into the latter category above.
First off I want to start this article off by saying Olympic lifts can be a great way to develop power.
(step away from the pitchforks, please)
This is in no way shape or form is a diatribe trying to bash Olympic lifts as a group of exercises. They are a tool and just like any tool in the weight room, they have their time and place.
And that time and place should not be in the college weight room as a main means of training power in their respective sport.
I see it every year, athletes who we have been working with for years in high school finally gain some respectable competency in the weight-room and reach the point where they can play their sport at the next level.
Their collegiate strength coach sends them their summer training program and there it is:
Hang cleans
Snatches
Power cleans
6 AM lifts
A little piece of me dies inside and I have to fight the urge not to go how and yell at my cats.
How can you except an athlete who you have never trained with or seen workout in person to execute the Olympic lifts correctly and effectively without your watchful eye? It then becomes our job to teach these lifts to the athletes which I’m happy to do, but it undoubtably takes away from the training due to the time and energy restraints it puts on our training.
To make things worse, when these athlete head off to college, train with these exercises as their key performance indicators and main source of power training, 9 times out of 10 they come back to our gym the next year weaker and many times slower.
I cannot fully contribute these exercises to the outcome, this is simply an observation I’ve noticed for years.
Here’s why I believe these lifts should not be apart of a college athlete’s training program and are actually causing a decrease in performance.
1. Competing Demands
The Olympic lifts are highly technical.
College athletes are arguably at the peak for their sport’s performance (or at least very close to it). That means the demand of skill in their sport takes up a large portion of their training…
…and rightfully so.
They are trying to reach mastery in their craft.
They are not Olympic weight lifters. They are team sport athletes and should be treated as such.
Learning and training with the Olympic lifts takes a high level of skill, skill that is learned through years and years of training and working at it. By spending the time required to be proficient at these exercises you will be taking away from the motor learning time and energy that could be used in their sport.
You can only master so much at one time from a motor learning perspective and choosing a highly technical form of exercise during collegiate years will only take away from this mastery.
2. They Won’t Be Good Enough For It To Be Effective
The Olympic lifts do a great job of enhancing powerful triple extension, but you don’t reach peak power until you reach about 80% of you max in an Olympic lift.
For the bulk of collegiate aged athletes who have little experience training with the OLY lifts, they likely won’t truly reach this level for a number of years because of how long it takes to master the skill.
(ideally, one would have started at the age of twelve with a PVC stick and ample time…not at 18 with USC at home next week).
I’d rather utilize an exercise like the Trap Bar Jump, which has a much lower learning curve yet yields comparable peak power production in a matter of minutes (not years).
This way I can develop strength, power and speed with as little amount of time as possible. As a result, the athlete can spend more energy on their sport while still experiencing the benefits of a strength & conditioning program.
An argument can be made that you could, over the course of the four years, systematically teach a college athlete how to perfect the Olympic lifts in order to reap their benefit.
However, in my experience most (not all) collegiate strength coaches incorporate these lifts using max loads and testing them as a key performance indicator right away.
This is not ideal if you ask me.
Some strength coaches do a great job and implement the OLY lifts responsibly, but I’d still argue that teaching these lifts over the course of four years is a drain on athletes’ time, energy and resources.
I’d Recommend the Following Exercises Instead:
Trap Bar Jumps
Trap Bar High Pulls
Trap Bar Speed Pulls
Sumo Speed Pulls
Band Resisted Speed Pulls
Dynamic Effort Box Squats
3. Power Is Plane Specific
Team sport is rarely played in the same plane of motion as the Olympic lifts.
When developing power that transfers over to your sport it’s better to do it in the same or similar planes of movement and joint angles that you’ll see in your sport to have the most transfer.
Using sprints, jumps and throws are great ways to bridge the gap and usually are better options than the Olympic lifts.
Here’s some exercises that can train speed and power with great transfer to sport:
10 Yard Sprints
Max Velocity Sprints
Partner Chase Drills
Rotational Med Ball Toss
Skater Variations
Broad Jump Variations
Overhead Med Ball Throws
Box Jumps
4. Other Variations & Methods
Other variations and methods that have a great effect on power training and can be taught quickly include the use of accommodating resistance with bands and chains as well as contrast training.
Accommodating resistance allows you to accelerate through a full range of motion because the resistance increases as you get into joint angles that can handle greater loads. This allows you to train power at all joint angles in a lift.
In addition to that the use of bands provides a unique training stimulus in which the eccentric portion of the lift is accelerated forcing a great amount deceleration training as well as a high-level reversal strength by using the stretch shortening cycle.
There’re a couple examples of this is the exercises listed above.
Contrast training is a method to peak speed and power production in which you use a heavy compound movement like a squat or deadlift and go right into an explosive expression of speed and power like a sprint, jump or throw.
Note from TG: I posted about contrast sets recently HERE.
The heavy lift provides an activation of higher threshold motor units that will transfer into a more explosive athletic movement.
Here’s some examples of contrast training.
Pre-Season Football Contrast Set
Back Squat —-> Box Jump
Banded Bulgarian Split Squat —-> Half Kneeling Sprint
About the Author
Ricky Kompf is the owner of Kompf Training Systems located in Syracuse New York. His facility provides semi-private training for predominantly high-school and college level athletes with individualized programming.
To mirror yesterday’s conversation on training around pain, today’s post delves a little deeper into a specific area that many lifters tend to have issues with:
Not enough bicep curl variations in their program
Forgetting to remove their shaker bottle from their gym bag for week
Knees.
The knees are a vulnerable joint and there are myriad of reasons why they can become achy, sore, cranky, or any other similar adjective you want to put here.
Sydney, Australia based physical therapist and trainer, Dane Ford, was kind enough to write this straight-forward article on some of the root causes of knee pain and ways to address them on your own.
Squatting is an essential part of most people’s fitness routine, and it can be extremely frustrating when you experience sore hips or knees when you squat.
Today I’m going to share four killer exercise variations that will help take some pressure off your knee joints!
No matter what level your fitness is at – whether strength training or just getting healthy again after injury – these tips should work their magic in no time flat.
Let’s get started.
The Goods
Box squat.
The first variation for those who experience knee pain when squatting is the box squat. A box squat will strengthen your quads, glutes, and hamstrings. It’s also a great way to improve your squatting technique.
You’ll need a box squat or a bench around knee height to do a box squat.
Start by placing the box behind you.
Then, position your feet shoulder-width apart and push your hips back.
Next, bend your knees and lower yourself until your bottom touches the box. Pause for a second, then stand back up.
Step-Ups
Step-ups are another great variation for people who have knee pain when squatting. This exercise works your quads, hamstrings, and glutes and is a great way to build lower body strength.
To do a step up, start by placing your right foot on a box or bench.
Then, push off with your right foot and raise your body up until your leg is straight.
Pause for a second, then lower yourself back down.
Focus on keeping the hips level.
Start with a smaller step, and increase the step height as your body allows.
Hip Thrusts
Hip thrusts are a great exercise for people who want to build stronger glutes. This exercise can also help relieve knee pain when squatting by taking the pressure off your knees.
To do a hip thrust, start by sitting on the ground with your back against a box or bench.
Place your feet flat on the ground and raise your hips until your thighs and torso are in line with each other.
Pause for a second, then lower your hips to the starting position.
Progress this exercise by adding weight at your hips, like a barbell or plate.
Banded Crab Walks
Banded crab walks are an excellent exercise for people who want to build stronger glutes and legs. This exercise can also help improve your squatting technique by making it easier to push your knees out over your toes. This is a golden exercise for dealing with knee pain when squatting.
To do a banded crab walk, start by placing a resistance band around your feet. (You could place it around your knees or ankles, but the further down your legs, the harder the exercise will be).
Then, step one leg out to the side as far as the band will allow.
Keep the hips level, and the shoulders stacked over the hips.
Next, step in with the other leg.
Repeat.
Causes of Knee Pain
When addressing knee pain during squats, it’s important to understand some of the common causes. This way, you can be sure that you’re taking the right approach to fix the underlying issue. Here are three common factors which can contribute to knee pain when squatting:
Improper Form
Whilst there is no such thing as textbook technique, using ‘adequate’ form allows you to engage the right muscles when you lift and minimize injury risk. If you don’t utilize adequate form when you squat, the load in certain areas like your knee joints will be increased, instead of having the load evenly distributed through your entire body.
Our body’s tissues all have a maximum tolerable capacity. This means that we need to be able to go hard enough in the gym to stimulate adaptation and promote strength, whilst not overloading ourselves to the point of tissue injury.
Giving your body time to recover with rest or a de-load week every now and then is a great start, to allow proper cell regeneration, repair and adaptation to occur.
Adding variety into our movements is another great option to avoid overuse. Beyond the exercises we’ve covered above, mixing back squats with front squats, goblet squats, or other squatting variations will help to strengthen the squatting movement whilst providing a slightly different stimulus to our tissues, and reducing the overload injury risk.
Bad Shoes
If you’re wearing shoes that don’t provide adequate stability when you squat, then this can put unnecessary strain on your knees.
Be sure to wear shoes that provide you with a solid foundation from which to lift.
Health Conditions Related to Knee Pain
So now that we understand some of the mechanisms that can contribute to knee pain during squats, how do we know which structure in the knee is causing pain?
Knee pain can present as a number of different conditions depending on the injured structure. This can include:
Patellofemoral Pain Syndrome
PFPS or patellofemoral pain syndrome is a condition that affects the knee joint. It’s characterized by pain in the front of the knee and around the patella or kneecap, and is common in those who love to squat.
If you have PFPS, you might experience pain when climbing stairs, squatting, or sitting for long periods.
IT-Band Syndrome
ITBS is a condition that affects the iliotibial band, which is a long strip of connective tissue that runs down the outside of the thigh from the hip to the knee, and normally presents as pain on the outside part of the knee. But squatters need not worry too much about this – ITBS is much more common in runners rather than lifters.
Patellar Tendinopathy
Tendonitis is the inflammation of a tendon, which can occur in any tendon in the body. However, Patella tendonitis presents as pain just below the knee cap. If you perform a lot of explosive movements like box jumps, or fast tempo squats, you should be aware of patella tendinopathy.
Arthritis
Arthritis is a condition that causes inflammation in the joints. The two most common types that can cause knee pain are osteoarthritis and rheumatoid arthritis.
Osteoarthritis is a degenerative disease that causes the cartilage in the joints to break down. This can cause pain in your knees, as well as other joints in your body.
Rheumatoid arthritis is an autoimmune disease that causes the body’s immune system to attack the joints. It may cause swelling and pain around the knee, leading to pain, stiffness, and inflammation.
Load management is key in managing arthritis. This is because we want to keep the muscles around the joint nice and strong, without irritating the joint too much.
How to Prevent Knee Pain When Squatting
Aside from performing some of the killer squat variations listed above, you can do a few other things to prevent knee pain while squatting.
Warm Up Properly
A good warm-up will help to increase your heart rate, loosen up your muscles, and make your body’s tissues more elastic. I recommend doing a light jog or bike ride for 5-10 minutes, followed by some dynamic stretching.
Use the Correct Weight
Another important consideration to prevent knee pain while squatting is to use the right weight. If you go too heavy too soon, it will put extra stress on your knees and could lead to pain. Utilize progressive overload by starting with a light weight and gradually increase the amount of weight you’re using as your body gets stronger.
Blood Flow Restriction Training
Another great way to improve strength whilst using light weight is by incorporating Blood Flow Restriction Training into your routine. This involves using a BFR band to reduce venous blood return from your muscles, making them work harder.
This means that you can use lighter loads to achieve the same result from your workout. BFR training can be a great addition if you are struggling with knee pain from squatting or trying to train with an injury.
Use a Smaller Range of Motion
Squatting through a smaller range of motion by reducing squat depth will reduce the load going through the knee joint, and is a great way to modify the exercise if you are struggling with pain.
Listen to Your Body
If you still experience knee pain while squatting, stop the exercise and rest for a few days. If the pain persists, consult a doctor or physical therapist.
Wrap Up
If you’re experiencing knee pain when squatting, try one of the variations I suggested and see how they work for you. Remember to always start light and gradually increase the weight as your body gets stronger.
And, most importantly, have fun with it! Squatting can be a great way to improve your fitness level and get in shape, but only if you do it correctly and safely. Give these variations a try and let us know how they work for you.
About the Author
This article was written by Dane Ford, the founder of Lift Physiotherapy and Performance in Sydney, Australia. Lift Physio aims to help you overcome injury, optimize your health, and unlock your full movement potential.
It’s even more of a drag when you’re someone who’s used to being active and an injury prevents you from training consistently or prevents you from training as hard as you’d like.
There’s generally two approaches many people take:
1. Complete rest.
2. Conjure up their inner Jason Bourne and grit their teeth through it.
Neither is ideal in my opinion.
I take the stand that injury (or training with a degree of pain <— sometimes) is inevitable. As I’ve jokingly (but not really) stated in the past…
…”Lifting weights isn’t supposed to tickle.”
Pain, pain science, and how to train around pain is a very complex and nuanced topic. This is a blog post, not a dissertation.
To that end, today I want to take some time to discuss a few strategies on how to train around pain that don’t revolve around the extremes: Sitting on the couch watching Netflix or plotting to take down Treadstone.
Full Disclosure: Much of what I’ll cover below is in Dr. Michael Mash’s online resource, Barbell Rehab, which is currently my new spirit animal of favorite continuing education courses.
1. A localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease).8
2. That feeling you get when your significant other wants to talk about feelings or what your eyes see when you watch someone perform 117 kipping pull-ups.9
More precisely we often associate pain with actual damage. However, pain doesn’t always have to gravitate around that denominator.
Pain can also be equated to a smoke alarm alerting the body that something is awry:
Hey, bicep tendon here: I think I’m close to snapping, can you tone it down on the bench dips?
Hey, knee cap here: I’m about to end up on the other side of the room if you don’t fix your squat.
Look out – a ninja!
More to the point, pain is multi-faceted and can manifest a plethora of ways, which is why it’s imperative to educate people that it isn’t always centered around a physical injury.
Take for instance this cup analogy highlighted in a 2016 study from the medical journal Physiotherapy: Theory & Practice titled “The clinical application of teaching people about pain” by Louw, et al.
Pain is like a cup, and there are many factors that can fill it up.
Moreover, you can address people’s pain in one of two ways:
1. Reduce the contents of the cup.
2. Make the cup bigger (via appropriately progressed strength training)
As Michael addresses in Barbell Rehab, there are several ways to build a framework to train around pain that don’t involve being passive, subjecting yourself to corrective exercise purgatory, or in a worse case scenario…surgery.
1. Technique Audit
When someone comes to CORE for an assessment with me and they go into great detail on how bench pressing bothers their shoulder(s), rather than spending 30 minutes assessing how much shoulder range of motion they have, waxing poetic on the myriad of drills they can perform to improve thoracic extension, and/or going into the weeds on diaphragmatic positional breathing mechanics I’ll instead do this really out-of-the-box thing where I’ll ask them to…
…wait for it.
…wait for it.
…here it comes.
…show me their bench press.
More times than not, all that’s needed is a subtle technique fix on their set-up and execution of the lift itself and their shoulder hates them less almost instantly.
This isn’t to say we’d ignore other factors like thoracic mobility and breathing mechanics altogether; especially of deficits exists. However, I’ve found that most people are less inclined to want to light their face on fire from corrective exercise boredom if I just cut to the crux of the issue at hand.
Their shitty technique.
2. Programming Audit
This is a point I remember Dr. Quinn Henoch of Juggernaut Training hammering home when I listened to him present a few years ago.
How often do you audit your programs?
Has it ever occurred to you that maybe, just maybe, the reason why you (or your clients) are hurt is because you were a bit overzealous with an exercise variation – or, more commonly, you were too aggressive with loading – and that that was the culprit of your’s (or their) low back pain…?
…and not because your left ankle lacked two degrees of dorsiflexion, or, I don’t know it was windy yesterday?
Load management (or lack of it) is the lowest hanging fruit we often overlook.
Using the same person above who’s shoulder bothers them when he/she benches: Let’s say they like to bench press 1x per week, on a Monday of course.
Like clockwork, the day after they bench, their shoulder feels like Johnny Lawrence used it for target practice with his fists.
It feels like that for a few days, dissipates, and then by the time the following bench day arrives it feels better and the same cycle continues.
A more cogent approach may be to spread out the same volume over TWO workouts rather than one.
Here’s what they normally do:
Monday: Bench Press: 6×5 @ 185 lb
(Total Tonnage = 5,550 lb)
Here’s what they should do:
Monday/Thursday: Bench Press: 3×5 @ 185
(Total Tonnage = 2,775 lb) x 2
NO MERCY!
3. Change Modifiable Factors
Pigging back on the above, when something hurts or is painful always, always, always look at volume/load first.
From there you can ascertain at what load does something hurt – what’s the symptom threshold? Find that and when you do, train just below it to build tolerance and resiliency. The result will be twofold:
1. You’ll be encouraging an actual training effect.
2. Eventually, you’ll surpass the original symptom threshold because you forced an adaptation.
An easy example here would be squats. If someone experiences knee pain at a certain depth – maybe at parallel or just below it – have him or her perform a box (or free) squat ABOVE that spot.
Likewise, maybe all that’s needed to make the squat less painful is to change the stance width, or degree of toeing out?
You can also tinker with bar position or even the tempo. The point is: Assuming we’ve ruled out anything nefarious, I’d rather someone keep squatting with a variation/tweak that reduces their symptoms dramatically than omit them altogether,
Anyone who has been reading my blog for any length of time knows that I don’t take myself too seriously, and that much of what makes my blog so popular is that I’m able to combine great fitness and health information with a pinch (or two) of an entertainment value.
I mean, where else can you learn about program design, exercise technique, corrective exercise, femoral acetabular impingement, and gluconeogenesis10, all while being peppered with Lord of the Rings references, self deprecating humor, and cute cat pics?
Anyhoo, today’s post is going to be a shining example of finding that balance between educating people (hopefully) and me being a facetious asshat.
It’s going to be short and sweet, though.
Okay, ready?
If you’re like me, whenever you train at a commercial gym you try not to vomit all over yourself from all the asinine things you see. Now, don’t get me wrong: there’s PLENTY of trainers and facilities out there who do a fantastic job and are great at what they do.
And, more to the point, I don’t want to come across as combining everyone into one massive bowl of fail.
I.e., NOT a bowl of fail. Rather a bowl of deliciousness
But I think we can all agree that those examples are few and far between, and that for the most part, a small piece of our soul dies every time we walk through the doors of a commercial gym and Celine Dion is blaring over the stereo system and/or some asshole is performing their WOD taking up half the gym equipment.
Then again, who the hell am I to judge, right? Sure I can roll my eyes at the two dudes who have a combined weight of one hamster performing their 47th set of bicep curls. And yes, it’s hard not get a bit eye rolley at the woman over there performing her 317th glute exercise of the day.
But you know what: THEY’RE ALL EXERCISING
And that’s pretty freakin awesome.
At the end of the day, it’s far better than the alternative which is sitting on their butts watching America’s Got Talent.
Even still, I’ll give most everyone a free pass because most people don’t know any better. Most people could care less that their elbows are flaring out on their push-up, or that leg extensions place a lot more shearing force on the knees (and that doing them shirtless is borderline weird).
Whatever the case may be, they’ll read something online or watch something on tv that’s interesting to them, and then they’ll try it out at the gym. That’s usually how it goes – and everyone has to start somewhere. They’re exercising and that’s all that matters anyways.
One of my biggest pet peeves, though, is when I watch a trainer do something dumb. That’s when my blood starts to boil.
Presumably these are people who are supposed to know what they’re doing, and it dumbfounds me at some of the stuff I see going down at some commercial gyms.
Take for example something I witnessed not too long ago as I watched a trainer spot his client through something as simple as a set of dumbbell bench presses.
Everything was fine and dandy until the client started to struggle and the trainer grabbed her elbows to help her out.
I thought maybe this was a one-time, fluke thing. But then I saw him do it again, and at this point I was just waiting for something bad to happen.
Luckily it didn’t.
I got home later that day and posted a casual status along the lines of “watched an inept trainer spot his client during DB presses by grabbing the elbows instead of the wrists.”
To me it’s common sense, and I didn’t think much of it and thought it would get some funny responses.
And it did.
But to my surprise I actually received two private message from personal trainers asking me why spotting through the elbows was wrong.
So, to review:
The Right Way to Spot Someone
If someone starts to struggle, you just guide their wrists to offer help. And try to refrain from being that guy who yells “all you, all you, all you.”
And the “Holy- S***-My-Client-Is-About-To-Crush-Their-Skull-And-Get-Face-Planted-By-That-Dumbbell” Way
Obviously this is said in a slightly tongue in cheek kind of way, but at the same time I feel this is something that should be obvious and that most trainers, coaches, and general fitness enthusiasts should understand.
In lieu of recent world events it’s been a challenge not to be a bit more introspective and to not get lost in a deeper train of thought.
Regardless of what side of the fence you reside on – relax I’m not here to judge11 – it’s hard not to be cognizant of and be disappointed by the cacophony of toxic rhetoric and word vomit being spewed in every direction possible.
I couldn’t help but notice some of the same parallels within health/fitness circles.
People like to argue.
A lot.
Admittedly, the vibe isn’t quite as dark and Apocalyptic in nature as the political/world scene, but people nevertheless have biases, like what they like, think what they think, and despite reason, science, or common-sense, cannot be swayed to see the bigger picture.
Or better yet…see the “middle ground.”
Alas, don’t be taken aback by the title of this post.
Zeitgeist.
It’s a word that looks and sounds scarier than it actually is. I mean, it looks like something someone screams as part of a finishing move in Mortal Kombat.
I promise it isn’t scary at all. The words that follow aren’t going to take themselves too seriously.
In his book The God Delusion, Richard Dawkins dedicates an entire chapter around the concept of morality. At the expense of walking on thin ice as it is – bringing up both politics and religion are generally two things I avoid (along with Coldplay) – all I’ll say here is that Dawkins notes how almost all societies and cultures have always had a knack for evolving.
No coincidence given his background as a Darwinian Biologist.
“In any society there exists a somewhat mysterious consensus, which changes over the decades, and for which it is not pretentious to use the German loan-word Zeitgeist.”
Zeitgeist = spirit of the times, or the dominant set of ideals and beliefs that motivate the actions of the members of a society in a particular period in time.
To drive the point home – and I promise I’ll be done with the serious talk – Dawkins notes how slavery, which was taken for granted throughout most of history, was abolished in civilized countries in the 19th century. Moreover, Women’s Suffrage, didn’t exist for a long time.
Here in the States, it wasn’t a law until the 1920s.
Today, in most societies, both events – rightfully so – would be considered egregiously absurd.
The point is: Societies change and evolve over time.
Although I’m still perplexed as to how skinny jeans have managed to last this long. It boggles my mind.
The health/fitness world mirrors this Zeitgeist phenomenon. Back in the early 20th century, when guys like Eugene Sandow were overhead pressing anything they could get their hands on – dumbbells, rocks, oxen (<— only a slight exaggeration) – they were considered odd and social misfits. Society as a whole deemed “lifting weights for pleasure or aesthetics” as something uncouth or what weirdos did.
Fast forward to the 1960-80s, often considered the golden age of bodybuilding, pretty much every adolescent kid had a poster of Arnold Schwartzenegger, Frank Zane, or Serge Nubret on their walls.
Using another example, prior to the 1970s the only reason to do any running was if you were 1) clinically insane or 2) happened to be being chased by a lion down Fifth Ave.
I suspect this was a common conversation:
Person 1 (1957): “Hey, wanna go for a jog?”
Person 2 (1957): “What in the name of Leave it to Beaver is a jog?”
Person 1 (1957): “It’s where we go outside and repeatedly run in a straight line for hours on end, you know, for fun.”
Person 2 (1957): “We can’t be friends anymore.”
“Going for a jog” didn’t exist.
Enter Jim Fixx’s best-selling book The Complete Book of Running (1977) espousing the many benefits of jogging for overall heart health, and the craze was born. Now millions of people use it as their main mode of exercise all around the world and entire events and social gatherings are organized around it.
Which begs the question: what other components of health/fitness have followed the same path? What has changed in the industry over the course of a few decades or years?
Here are some.
1) CrossFit
It started as a “fad” where people did stupid stuff in the name of hard-core workouts, shitting a spleen, and/or internet bragging rights.
A1. Trap Bar Farmer Carries (over a bed of hot coals) x 25 yds
A2. Run Over Right Arm with a Prius x AMRAP
First off: CrossFit can no-longer be considered a fad.
It, too, has evolved into a fitness powerhouse and bonafide spectacle of cultural achievement. It’s less popular today than it was in 2010, but it’s still relevant in today’s fitness culture. No one event in the past decade has gotten more people excited to exercise – specifically to pick up a barbell – than CrossFit.
For that I’d be remiss not to give it my nod of gratitude. If nothing else, CrossFit has served as an unparalleled vessel (or impetus) for people to train, and to train hard.
Are there still things about I don’t agree with? Of course. Are there still morons who open up a box who have no business doing so and end up hurting people? Absolutely. But those are few and far between, and CF is no where near the ocular train wreck it was once synonymous with.
I mean, to give credit where it’s due, CrossFit is so engrained into our culture now that there are people who think it invented lifting weights.
Oh, you squat? CrossFit.
That’s pretty impressive.
The time(s) of bashing CrossFit entirely are over. Some of it is warranted. However, it’s time we give it the respect it has rightfully earned.
2) Training For Life
To that end: can we please stop assuming that if a woman picks up a barbell or lifts anything heavier than a bag of groceries that she’s automatically “training for something specific.”
My wife is often approached in the gym by both men and women who see her getting after it, and while they certainly don’t mean any disrespect in asking, will inevitably say something to tune of, “Wow, that’s impressive, what are you training for? A competition? A show? Are you a secret assassin?”
My wife’s universal answer: “life.”
Women go to the gym to go to the gym.
Weird, I know.
Yes, it’s a bit facetious…but if we really wanted to respect the Zeitgeist mentality we’d respect the notion that women, much like men, view lifting weights in much the same way. As nothing more than something that’s simply done after work at 5 PM sharp.
It doesn’t have to be a thing.
3) Post Workout Window – Meh
I fell prey to the concept of the anabolic window in the early 2000s. The idea was that if you worked out and didn’t get some nutrients in your body12 within 30-60 minutes after, NONE OF IT COUNTED.
NONE OF IT!
Alas, the whole notion of the anabolic window, while a nice thought, is a bit of an over-exaggeration. We’ve come to understand that total calories over a 24-hour period matter more than some arbitrary caloric number ingested within a specific time-frame.
4) Cardio Will Not Steal Your Gainz
There’s been a bit of a renaissance on this front in recent years. There was a period of time where any thought of doing “cardio” would immediately zap your strength and make you look like Skeletor.
Although that doesn’t make sense, because, Skeletor is fucking jacked.
Regardless, for many years, mostly in the 90s into the early 2000s, the idea was cardio – any cardi0 – would zap your gainz.
It was, of course, a foolhardy way of thinking.
The body is a pretty resilient piece of machinery and if all it took was a 5k to lose all your muscle, we would have been wiped out eons ago.
Coaches like Alex Viada have played a huge role in the recent surge in popularity of “hybrid training,” or training for both strength and endurance simultaneously. The key to this approach is about working hard, but being lazy.
To quote Alex:
“In other words, do as little as possible to attain the necessary result. Lift less often than a powerlifter, run less than a runner, bike less than a cyclist, swim less than a swimmer… the body has limited recovery, and will quickly become overwhelmed.
Isolate what is truly important in each type of training, focus on those areas, and do them well. Cut out the junk miles, cut out the gym pissing contests, be draconian in how you approach routines – take those articles with the “ten exercises you should be doing” and toss them in the trash. The more you want to do, the less you should be doing.”
And it’s hard to discount the troves of research espousing the million and one benefits of cardiovascular health, not to mention the (positive) physiological adaptations that occur within the body (improved substrate utilization, better ability to buffer acid buildup from lactate metabolism) and the heart itself (stretching of the walls themselves eccentrically, more or less making a bigger pump and improving stroke volume) which makes it all worthwhile.
The fact of the matter is: improved cardiovascular health (when programmed accordingly and not to excess) will not only improve work capacity, but also improve performance in the weight room.
