CategoriesAssessment Corrective Exercise Exercise Technique Rehab/Prehab Strength Training

Everything and Nothing Causes Low Back Pain

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.

Copyright: olegdudko / 123RF Stock Photo
Copyright: olegdudko / 123RF Stock Photo

Everything and Nothing Causes Low Back Pain

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.

top view of ground coffee in portafilter on coffee beans background

…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:

via GIPHY

But that would be woefully uncouth of me.1

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

Pretty blonde relaxing on the couch at home in the living room

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.

via GIPHY

Hell, even something as simple as how you coach a plain ol’ vanilla Prone Bridge/Plank can shed some light here.

What’s the point if the end result looks like this?

Contemporary Woman Doing Plank Exercise

Which brings us to another golden rule.

3) Finding Spinal Neutral (Pain Free ROM) is Kinda Important

In light of a past gem by Dean Somerset on what the term “spinal neutral” even means, I realize this comes with a bit of grain of salt.

I just want to find a pain-free ROM and to help people with low back pain to own that ROM.

It’s the McGill Method 101.

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:

slump-test-start

Then, have them purposely “slump” into excessive flexion:

slump-test-end

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.

low-back-extension

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.

I hope this helped.

And, again, sorry about the Care Bear comment.

CategoriesExercise Technique Exercises You Should Be Doing

Exercises You Should Be Doing: HBT Front Squat March

In my career as a strength coach I’ve worked with numerous athletes and non-athletes alike dealing with back pain. And while much of the time my initial “go to” exercises are things like the McGill curl-up, birddogs, deadbugs, and various planks I also recognize that, after awhile, some people would rather wash their face with broken glass than perform another rep of any of those exercises.

Copyright: stylephotographs / 123RF Stock Photo

 

Curl-ups, birddogs, and planks work. There’s no denying that. Coaching people up on those three movements alone and having them perform them on a consistent basis will clean up a lot of aberrant movement reduce pain in a symptomatic back.

However, it’s just, you know, they get boring after a while. As much as I’m a fan of those movements (and could care less how bored someone gets if it’s what they need to be doing to get better), part of my job as a coach is to help people not feel like a patient and to find other means to elicit a training effect.

I mean, raise your hand if this sounds familiar:

Athlete/Client: “Ready to train coach. What are we doing today?”

Coach: “You’re in for a treat. We’re getting after it with birddogs today. Holla!”

Athlete/Client:

via GIPHY

Like I said, it’s not to bemoan the birddog – it’s lovely exercise – but it’s not to say we can’t toss in alternative exercises that are just as conducive to working through low back pain AND more palatable for those looking to actually train.

HBT Front Squat March

 

Who Did I Steal It From? – a combination of Dr. Joel Seedman and MA based strength coach, Ryan Wood.

What Does It Do? – I’ve discussed the concept of HBT before in THIS article, but to reiterate:

“HBT = Hanging Band Training.

It’s exactly what is sounds like. You take some bands, hang some stuff off them, and do stuff. Because, science.

While at first glance it comes across as a bit gimmicky, HBT training does have a fair amount of efficacy. As Dr. Seedman explains in the article linked to above, the oscillatory characteristics of this brand of training provides a unique training stimulus that challenges stabilization, increases core demand, helps “excite” the CNS, and also has a bit of carryover to muscle gain due to the increase in time under tension.”

Germane to this exercise, the oscillatory effect of the kettlebells (or plates if you don’t have access to KBs) works wonders with regards to challenging the core musculature to stabilize and in helping to build a more resilient back.

The exercise itself can work in one of two ways:

1) If you have the space to do so, you can have someone unload a barbell from a rack and have him of her walk a specific distance.

2) Or, if you’re like me, and have a smaller studio, you can just as effectively have someone stand in place and march it out, like my client Dima is doing in the video above. Like a boss.

Key Coaching Cues: This is a fairly intuitive exercise. The KBs hanging from the bands is going to jostle the individual every which way if they’re too lazy and not CONTROLLING the barbell. The objective is to resist the movement of the KBs.

I like to tell my clients to “keep the KBs quiet.”

Some other things you want to be on the lookout for is too much leaning back and/or any excessive lateral flexion (side bending). The idea is to “stay tall” as one alternates back and forth from foot to foot.

You can either shoot for a specific time (say, 30-40seconds) or a specific number of steps. Give it a try and let me know what you think.

CategoriesAssessment coaching Corrective Exercise Exercise Technique

Porcelain Post: The Birddog Exercise: Please, Start Coaching It Right

NOTE: the term “Porcelain Post” first came to fruition last year between Brian Patrick Murphy and Pete Dupuis. Without getting into the specifics, it describes a post that can be read in the same time it takes you to go #2.

Huh, I guess that was more specific than I thought.

Enjoy.

Copyright: fizkes / 123RF Stock Photo

 

The Birddog Exercise: Please, Start Coaching It Right

The birddog exercise is a common drill used in many components of health/fitness. It’s most commonly utilized within yoga/pilates circles and referred to as either the donkey kick or chakaravakasana. Which, as we all know, is Elvish for, “doing something poorly and making my corneas jump out of their sockets into a fiery volcano.”

Okay, that’s not true.

But we all know that the bulk of people performing this exercise, whether they’re in a yoga class, performing it on their own, or following the tutelage of a strength coach or personal trainer, end up looking like this (not always, but enough to warrant an intervention in the form of this brief post):

Copyright: fizkes / 123RF Stock Photo

The birddog exercise not only targets the back, but also the hip extensors. It also, and more importantly, teaches the discipline of using proper hip and shoulder motion while maintaining a stable spine.

The picture shown above is the complete opposite of that. What we see instead is a gross exaggeration of lumbar (lower back) extension and a lengthening of the rectus abdominus compounded with excessive rib flare and cervical extension.

Essentially this person is tossing up a ginormous middle finger to any semblance of spinal stability.

Now, in fairness, maybe the woman pictured above was coached into that position for a specific reason:

  • Prepping for the World “How to Eff Up Your Back” Championships?
  • Because it’s Wednesday?

I don’t know the true details. Maybe I should lighten up.2 But what I do know is that I find little benefit in performing the birddog, and it’s likely doing more harm than good.

And when I see it performed this way it makes me do this:

via GIPHY

 

Lets Clean Things Up, Shall We?

What’s most frustrating is the reactions I get from some people when I ask them to perform the birddog. I’ll get someone coming in with a history of low-back pain, and after taking them through a series of screens to see what exacerbates their symptoms I’ll then have them demonstrate this exercise.

What follows is typically a few eye-rolls and a seemingly crescendo of “come on Tony, really? I’ve been doing this exercise all along, can we please turn the page?” 

Low and behold 9/10 (if not 10/10), the same person who has been complaining of weeks/months/years of low back pain in addition to a bevy of other fitness professionals espousing the merits of the birddog, when asked to demonstrate it, ends up looking exactly like the second picture above.

Case in point. I had an eval with a new female client last week. She was a referral from another trainer located here in the Boston area and she informed me that this client had been battling some chronic low-back shenanigans for the past few years. To the other trainer’s credit: much of what she had been doing with this client was spot on (and I have zero doubts this client was coached very well). However, the birddog lends itself to be one of those “hum-drum, don’t worry, I got this” exercises where people (I.e., the client), when left to their own devices, becomes complacent and lackadaisical in its execution.

Play close attention to the before and after videos below:

The birddog exercise is a well known exercise to help build core strength/endurance and spinal integrity, and many people do it very poorly. It’s one of those exercises that gets the “yeah, yeah, I already know how to do that one” treatment because it looks so simple and easy. Here’s a new client that came in yesterday for an eval and described a long history of chronic back pain. She actually presented with both flexion & extension intolerance. Sucks. I asked her to show me her birddog because she mentioned she had been performing it all along (top video). I wanted to swallow a live grenade. It wasn’t a great looking exercise. She’d fall into an excessive arch on every rep more or less “feeding” her symptoms. So I took a few minutes and coached her up to clean up the pattern. I got her to find “spine neutral” and cued her to instead of thinking about raising her back (moving) leg UP, to move it BACK instead. To help with this I also had her place her foot on a ValSlide so as she extended her leg back she couldn’t arch through her lower back (sorry my video taking skills sucked here and I didn’t show the ValSlide. I promise it’s there though). Once there, and her leg was fully extended, I had her ever so slightly lift her foot off the slide an inch or two (not much) and then “own” the position for a few seconds. As you can see a HUGE improvement. Talking the time to coach your clients up, even on the seemingly “easy” exercises can make all the difference. I suspect we’ll be able to accomplish a lot in the near future.

A post shared by Tony Gentilcore (@tonygentilcore) on

 

Before = her execution of the exercise was “feeding” into her symptoms and most likely resulted in a kitten dying.

After = ticker tape parade for coaching!

With a just a few subtle cues and a “molding” of the exercise to better fit her current ability level, we were able to significantly clean up her technique and the exercise not only felt more challenging, but she felt better.

  • The difference maker was placing a ValSlide underneath her moving leg so that she’d be less likely to fall into extension.
  • From there, with the leg fully straight, I then had her lift her foot off the ground an inch or two and then “OWN” the movement/position.
  • She then held for a 3-5s count, performed 3-5 repetitions per side, and we then fist pumped to some Tiesto.

Coaching oftentimes involves paying closer attention to the details, even with the more mundane exercise that we often take for granted. With the birddog it often behooves us to slow people down, get a little more hands on with them (provide more kinesthetic awareness), and hold then accountable to be SPOT ON with their technique each and every rep.

This is what separates correctives and programs that work (and serve a purpose) and those that lead to less than exemplary results due to haphazard execution.

CategoriesAssessment coaching Exercise Technique Rehab/Prehab

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

Back pain can be tricky. First off, anyone who’s ever dealt with it (pretty much everyone) knows it’s no fun. Second, there’s no overwhelming agreement as to what actually causes it. One person says weak glutes, another says tight hip flexors or hamstrings, and yet another may point to a bad hair day (NOTE: read this footnote, it’s a doozy —>).3

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

Copyright: olegdudko / 123RF Stock Photo

 

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

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

In short:

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

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

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

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

BOOM

For the Record: TG Life Bucket List

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

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

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

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

Yes, avoiding spinal flexion is a thing, especially if someone is symptomatic and flexion intolerant.4. It’s that point, though, “avoiding spinal flexion” that has gotten the best of us for the past decade or so.

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

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

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

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

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

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

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

Birddog w/ RNT

 

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

Birddog – Off Bench

 

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

Your Spine, Move It!

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

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

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

Segmental Cat-Cow

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

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

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

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

 

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

CategoriesCorrective Exercise Exercises You Should Be Doing

Exercises You Should Be Doing: Prone Hip Flexion-Extension

Admittedly today’s Exercise You Should Be Doing won’t win a “sexiness” award like, say, pretty much any deadlift variation would, or maybe a pistol squat5, or pillow-fighting. Truth be told it’s a relatively unexciting, mundane looking exercise, but whoa Nelly! does it humble even the meatiest of meatheads.

But first pillow fighting.

Copyright: dgm / 123RF Stock Photo

 

Don’t knock it: pillow fighting is an excellent way to address core stability, primitive patterns, appropriate scapular upward rotation, basic combat skills, (and every teenage boy’s fantasy).

Okay, in all seriousness…lets get to today’s exercise

Prone (Val Slide) Hip Flexion-Extension

 

Who Did I Steal It From: this exercise has its roots in many arenas, but the person I need to give the most credit to is strength coach Dan Hechler. I saw him use this exercise with a client of his a few weeks ago and really liked it.

UPDATE: Dan actually refers to this exercise as a glorified Mt. Climber. I need to figure out a catchy name for this one other than the one I gave it. I’m so lame.

Sliding Mt. Climber?

Mt. Climber McSuckington?

I don’t know, I’m lame.

What Does It Do: It’s challenging to pin-point what, exactly, I like most about this exercise. Of course most long-time readers know I’m a huge fan of push-ups. Yeah, yeah there’s that whole broken record diatribe on improving lumbo-pelvic-hip control and how I feel that’s one of the main advantages.

It still is.

However, what I also love about push-ups is their ability to allow people to reach. Meaning, pushing into the ground (reaching) to promote 1) better scapular movement and 2) more of a canister position so that the diaphragm and pelvic floor are more in line with one another. Promoting a position of alignment/stability is almost always going to allow people to express better movement and strength.

As you can see, we’re not performing a standard push-up with this exercise. Instead, there are a few other components at work.

1. We’re adding hip flexion-extension. The idea here is to work both hip flexion and extension simultaneously so that we can learn to dissociate hip movement from lumbar movement.

2. We’re adding in a full EXHALE. As a bring one leg into hip flexion I’m pushing/reaching into the floor as best I can while also performing a full exhale (which will help to maintain the canister position mentioned above).

Key Coaching Cues: Some cues I gave away above. Assume a strict push-up position with both feet on a pair of Val Slides or standard furniture gliders or even a slideboard. There should be no excessive forward head posture or lumbar extension (hips sagging). Inhale and as you bring one knee towards your chest, push into the ground with your hands and slowly exhale. The idea is to maintain a strict torso position and to limit any lumbar movement. Return back to starting position, again, controlled, and repeat.

I like to perform 3-4 reps per side.

This would be a fantastic progression for those clients with chronic low-back issues once they have conquered the plank. But I also like to use it with my “healthy” clients too as a way to make them hate life for a few seconds.