Having the ability to extend the thoracic spine is a game changer for many people, especially for those who tend to be sequestered for hours on end in front of a computer on a day-to-day basis.
For lack of a better term, a lot of cool shit happens with extension:
The shoulder blades can retract and upwardly rotate.
It’s much easier to get the arms overhead.
It’s easier to keep the chest up during squats and deadlifts.
It makes for a “better” bench press. I.e., shoulder blades can retract and depress providing a more stable base of support.
The thoracic spine (thorax for the nerds in the room) is the “anchor” of the shoulder blades. Ideally we like to see congruency between the ribcage/thorax/t-spine/whatchamacalit and the shoulder blades.
When someone is a bit more kyphotic (rounded) in that area it makes it almost impossible for this to happen because the shoulder blades will often be more abducted and anteriorly tilted.
This can setoff a domino effect of other shenanigans such as a narrowing of the acromion space (for example), which in turn leads to rotator cuff issues, which then leads to not being able to bench press without pain, which, as we all know, means the Apocalypse is upon us.
Let’s avoid the Apocalypse.
To that end I’d like to take this time to share some of my “go to” T-Spine Extension drills I use with my own clients and athletes on a weekly basis.
1. T-Spine Extension Off a Foam Roller (Performed In a Way That Doesn’t Make Me Want to Swallow Live Bees)
Likely the most recognizable drill many gravitate towards – and for good reason (it’s a good one) – is T-Spine Extension off a foam roller.
However, many tend to go waaaaaaay too far with their total range of motion on this to where it becomes more of a lumbar spine movement.
Here’s how to do it correctly:
2. Prone T-Spine Extension
I reserve “fancy” for choosing a nice restaurant for a date night with my wife.2
I don’t feel the need to get fancy with my T-spine extension drills.
The Prone T-Spine Extension drill is a fantastic way to build mid-back endurance.
3. Child’s Pose Back Extension Off Med Ball
What’s great about this variation is that when we adopt the “child’s pose” (knees tucked underneath) we OMIT the lumbar spine.
So now the only area we can get movement is the t-spine.
4. Pigeon Stance w/ Reach Through & Extension
Taking the previous concept and upping the ante a little bit is this exercise I “stole” from Dean Somerset.
If we want to talk about a drill that provides a TON of benefit for our training buck this is it.
Here we get a stellar hip mobility/glute stretch, while at the same time taking the lumbar spine out of the equation (because that’s NOT where we want movement from).
Too, with the reach through (and then extension) we’re getting a double whammy effect of mid-back mobility goodness.
NOTE: I like to add in an inhale (through the nose) on the reach through and then a FULL exhale (out the mouth) as the individual extends back up.
NOTE #2: My tricep looks fucking amazing in this video.
5. Wall T-Spine Extension w/ Lift Off
This drill is a doozy as well.
Pushing the hips back and “settling” into your accessible t-spine extension ROM is money enough for most people. But when you add in the end-range “lift off” (lifting the hands off the wall) at the end, it adds that little “eff you” component not many people will like.
Be careful not to crank through your lower back on this one!
This one is more challenging than it looks, so way on the side of conservative when choosing the loads you use.
I’m using a 10 kg kettlebell in this video and am pretty sure I blacked out after shooting this video.
Want More Shoulder Magic?
Join me IN-PERSON for two upcoming Fall workshops I am putting on. I cover shoulder/hip assessment, programming strategies, the concept of the TRAINABLE MENU, favorite Decepticons, and much, much more.
As a card carrying member of the Y chromosome I did not write today’s article.
This isn’t to say I lack the confidence or knowledge to do so – in fact, I’ve gone out of my way in recent years to educate myself more on postpartum issues so that I am better prepared to work with & help my female clients.
It’s just I feel this is a topic in better hands with a woman. And not only that, a woman who has had firsthand experience with diastasis recti.3
If you’re someone – man or woman – who works with postpartum clients it will behoove you to read this article via Certified Personal Trainer and Postpartum Exercise Specialist Gina Paulhus.
She does an excellent job providing actionable solutions to a complex problem.
I Can Teach You How to Improve Diastasis Recti with Exercises Anyone Can Do
Have you been told you have diastasis recti? Or have you figured it out on your own while spending some quality time with Google?While it can be scary to think that you have a “hole” in your abs, take heart – there are many non-surgical options available.
I have healed my own diastasis as well as two large hernias with a natural, exercise-based approach. This outcome was confirmed by ultrasound. My healing happened after several surgeons told me that my only solution would be to get total abdominal wall reconstruction – with mesh!
Note From TG: puh!
What is Diastasis Recti, Exactly?
To answer that question, a bit of anatomy is in order. The two sides of your abdominal wall connect in the middle on a line of fascia called the linea alba.
This line appears between each and every person’s “six pack” muscle, otherwise known as the rectus abdominis. When that tissue in the midline thins out beyond a certain point it’s known as diastasis recti. Pregnancy is the most common reason a person develops a diastasis.
While more women develop diastasis, it can totally happen to dudes as well.
Certain workouts and non-optimal daily movement patterns can both make a diastasis worse, which is why it’s important to identify when you have a diastasis so that you can take steps to nip it in the bud.
Hey, Fancy-Pants: You Can Measure Your Own Diastasis
You can measure your diastasis by barely lifting your head and checking the width and depth between the two sides of the rectus abdominis muscles. Anything greater than two and a half finger widths is going to qualify you as a card-carrying member.
You also want the area to feel on the firm side – think trampoline-like. Broken trampolines are no bueno. A doctor, PT or Postpartum Exercise Specialist will be able to assist you in checking if you’re unsure. It’s always going to be a bit of an estimate when using fingers. Ultrasound is the gold standard on whether or not a diastasis is present.1
Every pregnant woman has a diastasis at their due date, so it’s normal at that point in time. By some estimates 39% of women have a diastasis at six months postpartum.2Because of that peeps, we can’t necessarily assume that everyone will bounce back the same way after giving birth! In other words, stay clear of those show offs on the ‘gram who are hoisting cars overhead a few weeks out from giving birth. The other thing to know is that diastasis can become a greater problem with each subsequent birth because the tissues will stretch faster the more times they have been stretched out before.
Oftentimes if a woman is “fine” after one child she is shocked when, by her second or third child, things have changed a lot in her abs. For other women, the first pregnancy has already led to a diastasis that didn’t resolve.
Everyone is different and each pregnancy is different. I CAN’T EMPHASIZE THAT ENOUGH. The nice thing is, once you know how to correct diastasis recti, the same principles can be utilized during any future pregnancies to keep yourself safe.
And then maybe, you too can hoist a car after giving birth next time (I mean, I wouldn’t).
What’s the Big Deal About Having a Diastasis?
A huge part of our core’s job is to be able to handle pressure generated in our body. This pressure is generated when we work out as well as during daily activities. We generate pressure in our core in order to protect our spine. If pressure is generated poorly, it can result in a diastasis forming.
By learning how to fine tune our pressure management, we put our bodies into a position to undo the damage. HOW COOL IS THAT? IT’S LIKE MAGIK.
How do you know your limit of how hard you can push? If you see a doming out of your midline during exertion, it’s a telltale sign that you have a diastasis and that what you are doing is making it worse. A poochy lower belly that sags and protrudes is another red flag to watch out for.
Yes, surgery is an option. However, I will warn you – even if you choose to get surgery, that doesn’t mean your work is done.
If you haven’t taught yourself how to better manage pressure in your core, the diastasis could very well return. And if it does, the additional scar tissue you will have accumulated might cause more problems.
You also will become weaker while you lay dormant waiting for your surgery to heal – the exact opposite of what a diastasis needs, which is more core strength!
Rather than skip immediately to surgery, I would much rather see folks learn how to manage pressure in their core.
This sets them up for success in healing a diastasis naturally, as well as leads them to the best possible post surgical outcome if surgery is chosen. Either way, learning proper pressure management is where it’s at when it comes to healing a diastasis.
There are particular muscles that need to be called out and worked when you’re looking to correct diastasis recti.
Learning to contract a special “corset” muscle deep in your abs called your transverse abdominis (TAs) before you perform an exercise can help create tension across your midline. Once that tension is in place, it means that you get the green light to work your core. And working your core is what you so desperately need for healing. Fascia requires stress to heal. But like goldilocks, not too much and not too little is best.
Your pelvic floor works as a team with your TAs, so we want to make sure that it is up to snuff. It may be tighter or looser than we want for optimal functioning. Leaking pee when coughing, sneezing or exerting is a sign that things are amiss.
Working on how you breathe can go a long way toward healing a diastasis. When our breathing technique is off, it loads excess pressure on your diastasis, preventing the fascia from healing. The diaphragm is a critical muscle for our breathing function.
Other muscles can affect how our core loads too. Take inventory of your serratus muscle (the muscle just in front of and under your armpit) as well as your glutes. Both can have a huge impact on healing a diastasis.
Muscles need time to heal after getting stretched out due to pregnancy or other causes. Rushing right back into all the exercises you did before is a recipe for keeping a diastasis present – or for making it worse. DON’T FEED THE MONSTER! Fascia can heal when we support it with the right environment, but the timing of when we challenge it versus when we let it rest matters. A lot.
Tackle Correcting Your Diastasis in these 4 Steps
Step 1: Work On Your 360 Breathing
This exercise will help improve the amount of pressure that is pushed out toward your diastasis, whether we are talking during exercise or during everyday life. Bad habits in daily life can undo a lot of high quality exercise, FWIW.
Step 2: Find Your TAs, Otherwise Known As Your “Corset” Muscles
You’d be surprised how many people’s TAs are completely out to lunch! It’s common for the bigger ab muscles to do all the work after a diastasis has formed. Unless we specifically perform an exercise that forces them to come back on board, the TAs could be lost forever.
Don’t let that happen people!
Step 3: Test How Stable You Can Keep Your Core While You’re Moving Your Limbs
If you feel any movement at all in your pelvis, slow the move down, or simply don’t extend your leg as far. This exercise will greatly improve the stability of your core – something everyone with a diastasis so desperately needs.
Step 4: If You’re Having Trouble With Any of the Above Exercises, You Might Need to Do Some Release Work
While a professional massage is great, ain’t nobody got time for that on the regular. This technique is great to do at the beginning of your workout to make performing the above exercises easier. And heck yeah, who wouldn’t want to make exercises easier?
What’s Up With Those Abdominal Binders?
They can be a good idea when you’ve just had a baby to use something to help support the abs. But hold up – after the first six weeks I don’t recommend wearing one, and here’s why.
Binding the abs can create more pressure down on the pelvic floor, which can contribute to other issues developing such as pelvic organ prolapse. Bottom-up support in the form of a pair of supportive shorts are safer if you must use some external support.
As I said before, fascia needs some stress to heal. It’s similar to the idea of wearing an ankle brace for the rest of your life – if you do that, your ankle will never get stronger.
You can always apply tape to your abdomen while trying to bridge the gap between wearing a binder and going with nothing. I know many folks who have healed their diastasis who swore by the tape. I like Rocktape best for this, although KT tape can also work. And you also get to cover yourself in brightly colored strips so that randoms can ask you questions.
It’s a great ice breaker.
What are the Keys to Healing a Diastasis To Completion Once and For All?
Why, I’m glad you asked.
1. Build a more efficient and effective breathing pattern.
Good breathing patterns help our structure and also prime our nervous system to push out the optimal hormones to heal. The 360 breathing drill in the video above is a great start.
2. Improve posture.
Poor posture puts a ton of pressure out on a diastasis, preventing healing. Good posture, in a nutshell, involves stretching tall and stacking our ribcage over our pelvis well. Make grandma proud, yo!
3. Perform exercises that strengthen the full body.
When the rest of your body is strong, less pressure is applied to the abdomen. Strong glutes and a strong pelvic floor in particular really matter for how a diastasis heals! Since your pelvic floor can be too tight or too weak for optimal functioning, it’s important to figure out what’s going on with yours. See my article on prolapse here for more information on the pelvic floor.
They need to be balanced! A corrective exercise specialist can check out how your muscle balance is looking and prescribe a workout plan to help. If you need help with the other muscles I mentioned as well, such as the serratus or the glutes, once again a corrective exercise specialist can save the day.
5. Whatever you do, STOP DRAWING IN YOUR BELLY in an attempt to support your diastasis!
This is only going to make things worse since it interferes with the natural functioning of your core. Take my word for it. The halter tops will have to wait.
Remember, I have healed my own diastasis as well as 2 large hernias with this exact full body approach. This outcome was confirmed by ultrasound. My healing occurred from committing to an exercise plan after a few different surgeons told me that my only solution would be to get total abdominal wall reconstruction with mesh!
About the Author
Gina Paulhus, CPT and PCES Certified, has been a personal trainer for over 20 years. Through her company Home Bodies she offers in home as well as Zoom 1:1 Personal Training. Gina’s passions include helping men and women heal from a diastasis as well as from hernias. She is a two time author. Gina is also the creator of the world’s first Adult Gymnastics Camp.
Sources
1 A T M van de Water 1, D R Benjamin 2. Measurement methods to assess diastasis of the rectus abdominis muscle (DRAM): A systematic review of their measurement properties and meta-analytic reliability generalisation. 2016 Feb;21:41-53. DOI: 10.1016/j.math.2015.09.013
2 Patrícia Gonçalves Fernandes da Mota, Augusto Gil Brites Andrade Pascoal et. al. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Observational Study Man Ther. 2015 Feb;20(1):200-5. doi: 10.1016/j.math.2014.09.002.
I know this seems very uncharacteristic of me and something I normally don’t write about, but I recently collaborated with my good friend Andrew Coates and wrote an extensive article on hornets deadlifts.
I don’t know the exact number, but it’s around my 37th article on T-Nation on the topic…;o)
Andrew and I spent a lot of time on this article attempting to peel back the layers and to focus on the cues, tips, and programming suggestions that really matter for most lifters in order gain the most benefit from the exercise and to stay safe.
I’m biased, but I think this article turned out great.
There are shady characters in every industry, but it’s seemingly within the nutrition and supplement industry where the shadiest of shady characters reside.
How else to explain an industry where (celebrity) doctors cut their ties to integrity and shill the miraculous fat loss properties of Raspberry ketones?
Or where some of the product descriptions on the backside of a bottle or package resemble that of a science-fiction movie?
Like this one for example:
“The World’s strongest vaso-anabolic psychoactive experience. Our secret cellular volumizing formula is patented to nanomolecularize your vascular expanders.”
For those scratching their heads, in supplement speak, I’m pretty sure “nanomolecularize” means you’ll cause an earthquake when you flex your pecs.
Or you suddenly gain the ability to fly.
I don’t know, something will happen.
Whatever the case may be, now, more than ever, with all the varying pills, powders, and diets being “sold” to us as the next great thing, we need someone we can trust to cut through the BS and help filter through the phony facade.
We need someone to serve as the “shadiness police.”
My friends at Examine.com have just launched their new and vastly updated Examine.2.0. They’ve built an amazing resource; one that’s hands-down THE most extensive, thorough, and UN-BIASED tool at our disposal as fitness/health professionals (or people who are generally more curious and proactive with their health information).
They stick to their lane – cute kitty pictures analyzing research information – and that’s it.
No fluff
No opinions
No up-sells
No BS
If one of my clients or athletes walks in and asks about Keto, creatine, vitamin D, caffeine, or whether or not Deer Antler Root dipped in Unicorn tears harvested from a remote mountain range in Minas Tirith is worth trying…I can usually provide a competent, well-informed answer.
However, if I ever get stumped – which definitely happens – I can gather all the information I’d ever need from Examine 2.0.
And I know it’ll be the most recent, relevant, and scientifically peer-reviewed information out there.
What’s more, they include monthly updates and they also provide CEUs for American RDs, NASM, as well as the NSCA.
Starting today (through 8/25) you can take advantage of their re-launch sale:
Monthly Membership – usually $29/month will be $19/month
Yearly Membership – usually $199/year will be $144/year
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).5
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.6
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,
As I type these words on my keyboard I am aboard an Irish Rail train en route to Galway. We just spent the past five days in Dublin being tourists making the typical pit stops at sites like Trinity College, the Temple Bar neighborhood, and I even had a Guinness at the renowned Gravity Bar atop the Guinness factory.7
We still have several more days lined up exploring the sites of Ireland with everything culminating in Belfast where we plan to hit up the Titanic Belfast Museum as well as the Giants Causeway and a few filming locations of Game of Thrones.
#nerdlife.
Suffice to say I am in no mood to write new content. Thankfully my man Paul Levitin was thoughtful enough to send me a guest post before I left on my trip. He’s written a handful of excellent posts in recent months and this one no different.
4 Tips I’d Give Myself on Day 1 of My Fitness Journey
After working in a gym for nearly a decade, and collecting every certification under the sun, it’s easy to become jaded and say “everyone knows this stuff.”
Factually, most people do not.
Today, instead of thinking about where I am now, with 10 years of experience, I want to go back.
It’s easy for me to say “I don’t count calories anymore,” but that’s because I counted calories for nearly a decade, and I have more nutrition labels memorized than I do phone numbers at this point.
So If I had to start from scratch, if today was day 0 of my fitness journey, where would I begin?
Knowing what I know now, what would I do to most leverage my time and energy?
One thing is for sure: When I first started, I had no clue what I was doing. I wasted a lot of time, literally years doing the wrong things. I wasted money, buying useless supplements and other gimmicky products like sauna suits.
So if i could travel back in time to the first day of my fitness journey, here are my 4 tips that I would give my 17 year old self:
1. Don’t Overlook the Simple. Don’t Overvalue the Complex
Some things are so simple, so easy, I just couldn’t understand how they might be helpful
Things like, parking farther away at the parking lot, taking the stairs instead of the elevator, walking to the store instead of driving.
Like, yea, I get it, you get some steps, but could the hundred steps it takes to get from one end of the parking lot to the other, or the extra two minutes it takes to walk three flights of stairs instead of taking the elevator really make a difference?
Most people think that exercising, whether it’s lifting weights or doing cardio or anything else, represents a huge amount of calories being burned.
In reality, an hour of even the most high intensity exercise will only burn a few hundred calories, a small percentage of your daily calorie intake and burn.
The vast majority of your calories are spent each day simply living. Between bodily functions, like keeping your blood pumping and keeping the lights on in your head, to doing daily tasks like walking, eating, typing, and everything else you tend to do.
It makes sense, since simply proportionally, even if you spend an hour in the gym five days a week, that’s only five hours out of 168, which is 8.4%. Just logically, we have much more opportunity during the remaining 91.6% than we possibly could in the exercise time, no matter how hard we try to push it during those 4 or 5 hours.
A key step towards health then becomes trying to do more in your non exercise time. That walk from the end of the parking lot here, taking the stairs there, getting off your train a stop early and walking, or deciding to explore a new city on foot rather than take an Uber, these things can seem trivial, but over days, weeks, months, and years, they add up.
They keep you moving, they keep you burning, and it’s a key habit that all healthy people adopt, either consciously or unconsciously.
2. Eating for Health and Eating for Weight Loss Are Not Necessarily the Same. Exercising for Health and Exercising for Aesthetics Are Not Necessarily the Same
This one throws people through a loop. It definitely took me some time to wrap my head around.
I saw countless clients as a nutrition coach, as well as myself, getting frustrated saying “I’m eating so healthy, but I’m not losing weight!” That’s because these goals are not one in the same, and taken to extremes, can actually be counter to one another.
The problem comes from the ambiguous definition of “healthy.” To many people seeking to lose weight, they use the terms interchangeably.
A doctor, nutritionist, or health blog however, might use the term “healthy” to mean more nutritious, with more healthy fats. This however might mean more calories, which means that a big bowl of almonds every day might be hurting your weight loss, more than helping it.
Or, some “naturalist” type, might say “healthy” to mean less artificial ingredients. To them then, a 200 calorie kombucha would be “healthy,” but a zero calorie, zero sugar diet coke, would not, even though the latter would result in less calories consumed, and thus more potential weight loss than the former.
The same can be said for exercise. Hang around any heavy duty lifting gym for long enough, and talk to enough jacked and shredded bodybuilders and powerlifters, and you know what you’ll hear?
Stories of torn rotator cuffs, blown out backs, and bad knees. Probably some disordered eating as well, and quite potentially, the use of some illicit substances.
People might look “good” (whatever that means), but their health is actually suffering because of it
Now, does this mean these things are mutually exclusive?
Of course not.
You can eat in a way that is both healthy and ideal for weight loss, and you can exercise in a way that makes you look and feel sexy af, while also improving your overall health and longevity.
I am simply saying that this is not inherently the case, and the sooner that you come to grips with that, the less frustrated you will be.
That brings me right to the next point…
3. Optimal Is Only Optimal if You Do It. Don’t Optimize Yourself Out of Consistency
For a long time, I tried to force things,
I was a personal trainer, so I studied the science. I studied the studies.
Squats are more optimal for muscle development than leg press. Cool, no more leg press, only squats.
The optimal weekly routine has you hitting each body part 2 to 3 times per week, that means more focus on big muscle groups like back and legs, and less on arms, abs, and anything smaller.
Optimal cardio is low intensity steady state, those HIIT days are killing your gains. Ok, no more HIIT, only walking. (Jury is back out on this one).
As time went on, I continued to optimize and tweak and adjust, until where I started was nowhere at all where I began.
Now, this in and of itself, certainly isn’t a bad thing. It was the constant learning, optimization, and tweaking that allowed me to achieve the results that I had, like reaching a 500lb deadlift or sub 10% bodyfat.
But that was me. I was a personal trainer, spending seven days in the gym, eating, breathing, and sleeping fitness and nutrition information. It was my life. I was uniquely dedicated, and there was nothing that was going to throw me off course.
Often, people would see what I was doing, be it friends, family, or clients, and try to do the same. Unfortunately, they weren’t me (Sad, I know).
What I mean is, they weren’t coaches. They had lives outside of the gym, they had responsibilities, they had families, they had limited time.
Because of that, often what the science might have said was the most OPTIMAL workout might not fit with their lives.
Beyond that, what is more important, is that what is OPTIMAL does not take into account what is ENJOYABLE.
I was nut, I was going to do whatever it took to get lean and strong.
Normal people, which you might consider yourself to be, might want to, oh, I don’t know, enjoy their exercise routines?
Eat food that doesn’t look like it could be fed to a rabbit?
Crazy huh?
The thing is, in the quest for optimization, individuality is lost.
If we are assuming that there is ONE optimal way, (which we can argue about, and people on the internet surely will) that means that anything other than optimal is inherently deemed “wrong” or “worse”.
That can be disheartening for people who are already struggling with just getting to the gym or getting off the couch, now they are being told they are doing it wrong too.
So while I do think there is a time and place for doing what’s best, not if it comes at the expense of actually doing the damn thing.
So many people these days hear that strength training is the end all be all of exercise. And for good reason, it’s the bee’s knees, the benefits are basically endless.
BUT, if you’re someone who loves Zumba and going for long runs, should those be poo-poo’ed because they aren’t as optimal as lifting weights?
If you try to force yourself into a box, there’s a chance you might fit, but there’s always also a chance you might get claustrophobic and go crazy
This takes experimentation, and some knowledge of self
I’m not saying don’t try to optimize or ever do what’s best. Just saying, tread carefully, and a non-optimal workout routine done consistently for years is infinitely better than the most scientifically optimal workout that you do for 6 weeks then quit because you hate it
Which, brings me to point four,
4. In the Long Game, Consistency Wins. This is the Long Game, Whether You Like it or Not
When I was 17, I cared about one thing, and one thing only: looking good. More specifically, looking good right now. If I absolutely had to wait, I would accept results tomorrow, but beyond that we were really starting to push it.
Unfortunately, at the time, I was living in this dumb stupid super annoying place called “reality.”
It really was the worst.
Every day, I’d go to the gym and do abs, then lift my shirt up, and NO ABS. It was like a cruel joke.
Now you might be saying, been there Paul. And if you have, maybe you know what my next step was: obviously, logically, it was, more.
More abs!
More cardio!
More more more!
Looking back now, I can see how the logic might have been a little flawed. What I’m not doing isn’t working? Hmm, let’s do more of it!
Poor exercise selection and actual workout programming aside, this route couldn’t work for one key reason: it was unsustainable.
I’d sit doing abs in the gym for 2 hours some days, and be so sore the next day I couldn’t move, or so tired and lethargic I’d skip the day’s planned workout.
And simply logistically, there was no way for me to do 2 and 3 hour workouts like that consistently.
The problem was, I was looking at everything with a short-sighted view. Life, on the other hand, is long. So all my plans revolved around getting results as fast as possible, even though I was a teenager, and barely even started my life
And this is unfortunately how most people look at exercise, eating, and health in general. It’s all about now. Some people think about longevity, but it’s an afterthought at best
The thing is, life is going to happen, whether you want it to or not. You are going to get older. You are going to be 30, 40, 60, 80, whatever, at some point. So for better or worse, you might as well start thinking about it now.
Internalizing these 4 tips will help you create a lifestyle that works for you, and you can keep up with. That way, you can be healthy and enjoy it, not for weeks, or months, but years and decades.
About the Author
Paul Levitin spent a decade as a personal trainer & strength and conditioning coach, becoming the number one trainer in his entire company, while collecting over 30 certificates (CES, CSCS, PRI, PN1, FRC, & many more).
Wanting to better serve his training clients, he began to study behavior change, and eventually became a Board Licensed Health & Wellness Coach (NBHWC). This led him to create his education and mindset coaching company “The Healthy Happy Human Academy,” where he now helps clients deal with things like self-sabotage and perfectionism, to allow them to build a healthy, happy life.
He seeks to bridge the gap between the worlds of fitness and nutrition, and the frustrated, overwhelmed masses who just want to move more, feel better, and live a little longer.
I had the lovely opportunity to be invited onto the Fitness Pain Free Show hosted by my man Dan Pope recently. Dan and I have known each other for several years (the facility he works out of, Champion Physical Therapy & Performance, is located about 20 minutes away from my training studio in Boston) and he and I have conversed over shared clients/athletes during that time.
I’ve long championed that personal trainers and coaches need to be proactive and go out of their way to develop and curate relationships and networks with local physical therapists.
it not only enhances the results for the (injured) client, but it never hurts to have two sets of biceps eyes on the same problem.
Training While Injured: A Thoughtful Convo With One of My Man Crushes
In this episode Dan and I break down how we connected and how we’ve continued to hone our professional relationship in order to get our clients the best outcomes possible.
We also discuss the idea behind the TRAINABLE MENU and how it came to fruition during my own achilles rupture rehab. What’s more, Dan and I also discuss why it’s important for fitness professionals to respect scope of practice and why it’s important to NOT treat injured clients like a patient.
I think you’ll really dig this episode.
You can listen to it on Spotify (HERE) or iTunes (HERE).
I was recently invited onto the Your Fitness Money Coach Podcast hosted by Billy Hofacker. Some of you may recognize the name because Billy has penned several informative guest posts on this site surrounding financial literacy in the past year.
I was thrilled to post his content here because he has expertise in a topic that many fitness professionals need dire help with. To speak candidly, I wish I had access to this kind of content earlier in my career.
Nevertheless, Billy invited me onto his show to discuss what ended up being a bevy of topics. He ended up titling it “Standing Out From the Crowd,” and I think it was the right call. I mean, I personally would have gone with something like “Tony is the Wind Beneath All of Our Wings,” or “Tony’s Pecs Had me at Hello,” but whatever.
Billy is an excellent conversationalist and I enjoyed going back in time to discuss how I went about differentiating myself from the masses creating content and building my own brand from scratch.
I hope you give the episode a listen and be sure to check out more of Billy’s stuff. I’m not kidding: He’s an abyss of information and practical knowledge around business and finances.
It was an absolute pleasure to be invited onto the Becoming Ronin Podcast recently hosted by Jim “Smitty” Smith & Brian Oberther.
SPOILER ALERT: We did not use the hour to break down or discuss the 1998 Robert DeNiro classic, Ronin, which has one of the best car chase scenes ever filmed.
(sad face).
Appearance on the Becoming Ronin Podcast
We did, however, dive into true Ronin territory. This show is not meant to solely cover sets & reps, the differences between concurrent vs. conjugate periodization, how to master a bicep peak, or anything related to lifting heavy things.
It’s no doubt imbued with those “ingredients” and themes, but the Becoming Ronin Podcast goes a bit deeper into other, more robust “takes” and conversations into what it takes to truly live a life of fulfillment and meaning.
It was an honor to be invited onto the show and I think you’ll dig the conversational style of the episode.
Give it a listen HERE (direct link) or HERE (iTunes).
Paul Levitin spent a decade as a personal trainer & strength and conditioning coach, becoming the number one trainer in his entire company, while collecting over 30 certificates (CES, CSCS, PRI, PN1, FRC, & many more).
