CategoriesCorrective Exercise Exercise Technique Exercises You Should Be Doing

Exercises You Should Be Doing: Supine Straight Leg Hip Extension with Alternate Hip Flexion

Admittedly, today’s “Exercise You Should Be Doing” doesn’t highlight anything visually badass like, say, deadlifts vs. chains, recoiled sled high pulls (<– seriously, check that out), or, I don’t know, juggling chainsaws while balancing on a BOSU ball.1

25682290 - detail of the chainsaw isolated on the white background

Copyright: photozi / 123RF Stock Photo

Nope, today’s exercise recommendation is very plain looking and is about as vanilla as they come. It’s not flashy and it (probably) won’t win anyone any additional Instagram followers. But oh is it a doozy and one I feel is going to raise some eyebrows and surprise people at how challenging it really is.

Supine Straight Leg Hip Extension with Alternate Hip Flexion

 

Who Did I Steal It From: NYC based coach and AMP Training Active Movement & Performance owner, Chris Cooper.

What Does It Do: Not only is this great for glute activation, but because of the alternating nature of this drill (bringing one leg towards you chest at a time) it also serves as a fantastic core exercise as you must resist the hips from rotating to any one side. In fancy schmancy technical terms: you’re working on rotary pelvic control, or rotary stability.

Many people are incapable of controlling their lumbo-pelvic region and it’s no surprise we see a high incidence of SI joint issues, chronic low-back pain, and many other dysfunctions up and down the kinetic chain within this population.

Drills such as deadbugs, birddogs, Pallof presses, and planks are all exercises that tackle this head on. However, I hope this quick post will encourage people to add this exercise to their repertoire as well.

Key Coaching Cues: Place your feet (heels) on an elevated platform (no higher than 12″) and extend (elevate) your hips off the floor. From there place your fingers on the front of  your pelvis (ASIS) and slowly flex on hip, bringing your knee towards your chest. The idea is to use the kinesthetic feedback of fingers on the ASIS to keep your pelvis level throughout the duration of the exercise.

For added badassery, you can progress things by place a light band around your toes.

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

CategoriesAssessment Corrective Exercise Program Design Rehab/Prehab

The Forgotten, Often Overlooked Cause of Low Back Pain

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

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

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

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

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

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

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

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

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

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

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

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

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

A term he uses often is “Spinal Hygiene.”

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

From McGill’s book Back Mechanic:

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

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

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

What’s the Fix?

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

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

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

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

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

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

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

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

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

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

I think by now you know my preference.

 

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

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

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

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

What’s up with that? And bless you.

Spinal Instability – That’s What’s Up.

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

The body doesn’t operate in one plane of motion, and it’s when people meander out of the sagittal plane and venture into frontal and/or transverse plane movements, when they begin to get into trouble.2

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

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

 

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

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

However, I’d like to offer some insight on what exercises might be part of the repertoire in terms of “pain free movement” when spine instability is a factor.3

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

One word: planks.

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

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

This does no one any favors.4

RKC Plank.

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

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

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

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

 

NOTE TO SELF: do more of these.5

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

Deadbugs

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

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

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

 

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

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

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

1. Offset Loaded Lifts

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

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

 

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

 

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

2. Shovel Deadlift

3. Farmer Carries

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

 

4. 1-Legged Anti-Rotation Scoop Toss

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

 

5. Anti-Rotation Press

 

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

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

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

Categoriescoaching Exercise Technique Program Design Strength Training

Why Train the Posterior Chain?

Today’s guest post comes courtesy of Zak Gabor, a MA-based physical therapist and strength coach. His alma mater – Ithaca College – also happens to be my alma mater’s – SUNY Cortland – sworn enemy.

But he’s cool…;o)

Enjoy!

Not only can tapping into your posterior chain get you extremely strong, help improve athleticism and give you the butt of your dreams, it can leave you significantly less injury-prone, especially with low back and knee injuries.

Photo Credit: Dr. John Rusin

I am here to discuss how and why posterior chain strength needs to be a priority in training (that is, of course, if you want to decrease your chance of getting injured.)  Training your posterior chain doesn’t guarantee injury prevention but it sets you on the right track for building a strong foundation.

What is the Posterior Chain?

In the strength and conditioning world, the posterior chain consists of the erector spinae, gluteal muscles, hamstrings, and gastroc/soleus complex.

Note from TG: “Posterior Chain” was also the original name of Thor’s hammer.

But it actually wasn’t.

Why is the Posterior Chain So Damn Important?

This is an area that I am extremely passionate about. What can I say, I’m a butt guy, but for good reason.

I truly believe that incorporating posterior chain strengthening into training can save tons of money on healthcare costs for low back and knee injuries, but more importantly, keep you healthy! 

As the PT profession is constantly evolving, my goal is to get clients in the door and teach them ways stay healthier, versus having patients in for rehabilitative purposes.

Lets dive into two of the major joints that are especially vulnerable to injury in the lack of adequate posterior chain strength:

Low Back:

Oh yeah, baby.

Over $80 billion spent each year on low back in healthcare… simply unacceptable. 

To me, if you know how to strengthen your posterior chain, that means you know how to hip hinge (i.e. load the glutes and hamstrings effectively while keeping lumbar spine neutral).  For anyone who knows what a freak I am about preaching this movement pattern, this right here is the primary reason why! 

Am I saying that if you can hip hinge you will never get back pain? No.  I am saying that understanding the hip hinge pattern will give you a much better chance at preventing low back pain.  The simplified reason is two fold:

1) Lifting loads from the ground with a neutral spine= less likely to hurt low back

-Now, now, not trying to be dogmatic, but research don’t lie.

Spines ARE resilient, we need to be able to tolerate both flexion and extension. 

Yet, if you are like me, and respect the work of one of the most influential low back researchers (Dr. Stu McGill) then you know that repeated flexion especially under loads; leave the lumbar spine vulnerable to injury.

Therefore, learning how to properly hip hinge and maintain a neutral, stiff, spine throughout the movement can not only prevent injury, but can also get you the butt of your dreams.  Enter strengthening the posterior chain.

2) Strengthening posterior chain = less likely to hurt low back

Simply put, a strong butt (Gluteals) will decrease your risk of low back injuries. 

There is a ton of research out that indicates how important gluteal strengthening is for low back rehab.  Lets simplify this in the pre-hab lens. 

Glute Max is one of, if not the most, powerful muscles in the human body.  Unfortunately, most individual’s glutes are offline thanks to endless hours of sitting.  If we can strengthen the most powerful muscle in the body (which just so happens to neighbor and play intimately with the lumbar spine), wouldn’t it make sense that it would be good protection for the lumbar spine?  Just sayin’

Knee:

The knee gets a little bit more technical, but I will try to keep it simple.

The knee as a joint is extremely vulnerable, to say the least. 

It is literally two bones sitting on top of each other with little to no bony stability…meaning it gains its stability primarily from soft tissue structures both inert (meniscus, ligaments) and contractile (quads, hammies, and a whole lot more). 

Believe it or not, the knee actually has more evidence online than low back for its correlation of posterior chain strength preventing injuries.

A lot of the research is specific to ACL injury prevention, but honestly, mechanics resulting in various knee injuries are often similar to ACL mechanics.

One of the predisposing factors to knee injury is what is known as dynamic valgus (knee collapsing inward) mostly brought on by quad dominance. 

The other major way it can be brought on is by lack of posterior-lateral hip control. 

Most individuals are quad dominant because of sitting all day, turning off the glutes and hammies, and leaving the quads as primary movers.  Here is a photo of one of my favorite examples of a dynamic valgus brought on by quad dominance (i.e. the quads winning the tug of war on the femur and pulling into dynamic valgus:

This is called “RG 3’ing.” Named after NFL Quarterback, Robert Griffin III.

Notice how his knees cave in as he develops power, this is a great example of when even “healthy” people can be predisposed to injury. Don’t RG 3….

How do we combat this? Well, this answer is multi-faceted, but Ill give you a hint… one of the best ways it to strengthen the posterior chain. 

It’s really that simple.

There are TONS of ways to strengthen and target the posterior chain.  As a matter of fact, just peruse Tony’s awesome website, and you will find tons of exercises… as I did when I was just a newbie in the S&C world.

Here are a few of my favorites:

1) Glute-centric: Bridging, every bridge variation….

2) Hamstring-centric: Nordic Hamstring curls (also AWESOME evidence for preventing hamstring strains)

 

Note From TG: This is an older video. So, relax internet trainer who doesn’t even perform this exercise in the first place, but is quick to point out how it’s not perfect technique. Am I bending a little too much from the waist? Yes. Is the music on point? Yes.

Here’s a nice regression:

3) Compound post chain: DEADLIFT, RDL, KB swings

Conclusion

You still need to train your anterior chain too! However, in a world where we’re stuck sitting for hours on end and prone to training our “mirror muscles,” placing more of a premium on the posterior chain is never a bad idea. For many reasons.

Anyone who might be interested in learning more and truly mastering the hip hinge, we will be hosting workshop July 24th at RX strength training in Medford, MA.

Either way, feel free to email me should you have any questions or anything about this you would like to discuss!

Peace, love, and glutes

About the Author

Zak GaborDr. Zachary Gabor, PT, DPT, CSCS, USAW, is a 2015 graduate from Ithaca College where he earned his Doctorate of Physical Therapy.
Prior to that, he earned his Bachelor of Clinical Health Science degree from Ithaca College in 2013. Zak is also a Certified Strength and Conditioning Specialist (CSCS) through the National Strength & Conditioning Association (NSCA), and a Sports Performance Coach through USA Weightlifting (USAW).
Throughout his doctorate program, Zak served as a Teaching Assistant for several physical therapy courses including gross anatomy and musculoskeletal examination and evaluation. He also spent over three years providing personal strength training to clients and athletes.
Zak is passionate about teaching and educating, both of which are very important cornerstones to any patient’s plan of care. In addition, Zak’s clinical experience is rooted in sports-based orthopedic rehabilitation and physical therapy, with an emphasis on strength training and sports performance.
A firm believer in continuing education to better serve the patients, clients and athletes he works with, Zak is dedicated to constantly learning. His future post-gradation coursework will include: manual therapy courses, dry needling certifications, and sports certification specialist designation.
CategoriesAssessment coaching Corrective Exercise Program Design

A Thoughtful Discussion on Low Back Sparing Strategies. Actually, Less “Thoughtful” More “Meandering”

I often joke that “lifting weights isn’t supposed to tickle.”

When you’re pushing, pulling, carrying, thrusting, and otherwise hoisting things around for the heck of it…you’re bound to end up with a few bumps and bruises along the way.6

Honestly, I can’t think of the last time my body was 100% devoid of any type of soreness or semi-nefarious “huh, well that doesn’t feel fantastic” sort of vibe.

I’m not referring to pain. Nothing that diminishes my ability to live my day-to-day life. Just, you know, sometimes my first step out of bed or sitting down to drop it like it’s hot isn’t the most enjoyable experience in the world.7

(Anyone who’s performed heavy squats the day prior can commiserate).

A lifetime of playing sports and training will do that to a body.

But that’s the point.

Lifting weights and pushing the body outside it’s comfort zone is what allows us to adapt and come back stronger and more resilient; to take on the world (or the squat rack) and tell it to GFY.

All that said: it still sucks donkey balls when the inevitable happens. We take things too far, go too heavy, or move juuuuust the right way for something wrong to happen.

Arguably, nothing stagnates or deflates progress more in the gym than a jacked up lower back.

Statistics will say that we’ve all been there. Or, alternatively, as fitness professionals, have worked with someone who’s been there.

So I figured today I’d shoot from the hip and fire back some quick-hitting suggestions/insights/alternatives to consider when working with someone dealing with low-back pain.

In No Particular Order

1) Except for this one. This is super important.

I’ll kick things off with the grandiose, off-kilter statement that if something hurts…don’t do it.

https://www.youtube.com/watch?v=a1Y73sPHKxw

 

Fucking profound, right?

Dr. Stuart McGill will advocate for provocative tests/screens to be performed – slump test, toe touch, McKenzie drills, etc – in order to figure out the root cause or possible source of someone’s back pain.

The stark contrast should be done outside of that window. It’s imperative as a coach, trainer, clinician, wizard, to demonstrate pain-free movement to the client/athlete. The objective should be to mute or pump the brakes on pain and start to mold more of a “movement quality” campaign.

Dr. McGill often refers to this as “spinal hygiene.”

2) Speaking of Dr. McGill

You should read his book Ultimate Back Fitness Performance. Specifically pages 1-325.

Spoiler Alert: it’s 325 pages long.

A more “user-friendly” text would be his latest book, Back Mechanic.

3) Back to “spinal hygiene.”

The good Doc refers to this as:

“The daily upkeep of your back. It includes your recovery exercise routine as well as changes to your existing daily motions all day long. Success in removing back pain requires removal of the movement flaws that cause tissue stress.”

This could refer to something as simple and innocuous as teaching someone how to sit in a chair properly, or even how to stand up from a chair.

As counterintuitive as it seems, those who have more flexion-based back pain will feel more comfortable in flexion. Likewise, those with extension-based back pain will feel at home in extension.

It’s weird.

So, often, taking the time to clean up activities and endeavors outside of the gym will be of most benefit.

As the saying goes: “we as trainers/coaches have 1-2 hours to “fix” things, and the client/athlete has 23 hours to mess it up.”

Other things to consider:

  • Walking. This is an excellent fit for those with low-back pain. It’s just important to make sure they’re not defaulting in forward head posture and a slouched posture. McGill refers to this as the “mall strolling” pattern. One should be more upright and swing the arms from the shoulders (and not the elbows). This provokes more of a “pertubation” to the body helping to build spinal stability.
  • Grooving more remedial hip-hinge patterns like I discussed in THIS article. Getting someone to dissociate hip movement from lumbar movement is a game-changer..
  • Pigging back on the above, the hip hinge creeps its way into EVERYDAY things like brushing one’s teeth or bending over to pick something up off the ground (golfer’s lift). Anything that can be done to spare the spine (discs) and make it less sensitive to pain is a win – no matter how trivial the activity.

4) Synchronous Movement

Learning to “lock” the ribcage to the pelvis is another key element to managing back pain. The abdominal brace is of relevance here. Basically the entire core musculature – not just any one muscle (ahem, transverse abdominus (drawing in method) – needs to work in concert and fire synchronously to spare the spine and offer more spinal stability.

One drill in particular that hammers the point home is the Wall Plank Rotation.

 

Here an abdominal brace is adopted and the objective is to “rotate” the entire body as one unit, locking the ribcage to the pelvis. Many will inevitably rotate through their lumbar spine and then the upper torso will follow suite.

5) Neutral Spine – Always (But Not Really)

The spine IS meant to move.

Neutral spine is paramount, but it benefits trainees to tinker with end-ranges of motions (in both flexion and extension) if for nothing else to “teach” the body to know how to get out of those compromising positions – especially when under load.

During our workshops together, Dean Somerset will often demonstrate to the trainees how squatting into deeper hip flexion (unloaded, and to the point where butt wink happens) can be of benefit to some people. The notion of learning where a precarious position is (and how to get out of it) is valuable.

I’ll use the simple Cat-Camel drill to teach people that it’s okay to allow the spine move.

 

Also of Note: I’d argue we’ve been so programmed into thinking that all spinal flexion is bad and that a baby seal dies every time we do it, that it’s caused a phenomenon referred to as reverse posturing.

The idea that more and more people are now “stuck” in extension, and thus at the mercy of a whole spectrum of other back issues (spondy, etc).

You can read more about that HERE.

Suffice it to say: we can’t discount Rule #1…helping to build improved spinal endurance/stability.

Plain ol’ vanilla planks come into the picture here.

This:

Not This:

This:

  • Keeping people honest and accountable on proper position (not “hanging” on passive restraints and dipping into excessive lumbar extension) is kinda of important.
  • Rule of thumb is to be able to hold a prone plank 120s, side plank (per side) for 90s. McGill will note it’s a RED FLAG if there’s a huge discrepancy between right/left sides.
  • I prefer more of an RKC style once someone is ready. This helps to build more bodily tension, to the point where everything – quads, abs, glutes, eye lids, everything – are firing. Ten seconds is torture when done right.

However, we can always graduate to less vomit in my mouthish exercises. As much as planks are baller and part of the equation to helping solve someone’s back pain, they’re about as exciting as watching a NASCAR race.

6) A few favs include:

Elbow Touches

https://www.youtube.com/watch?v=AUgz2U65KPc

 

Progressing lower and lower towards the ground.

Farmer Carries – all of them

 

Offset Loaded Exercises

 

I love offset loaded exercises for a variety of reasons. But most germane to this conversation is the fact that there’s a heavy rotary stability component when performing them.

Getting people moving and performing more traditional strength & conditioning drills – assuming they’re pain free and of high movement quality – will help to get them out of “patient mode,” and more excited to stick to the plan.

7) A Few Other Ideas to Consider

Don’t be an a-hole and marry yourself to the idea that everyone HAS to deadlift from the floor and that everyone HAS to pull conventionally.

The only thing people HAVE to do is sign up for my newsletter. (wink, wink, nudge, nudge)

Sometimes we have to set our egos aside and do what’s best for the client/athlete and what’s the best fit for them. I think the trap bar deadlift is a wonderful tool for people with a history of low back pain.

To steal a quote from Dr. John Rusin:

“Without sending you back to Physics 101, the forward position of the barbell causes a less than optimal moment arm to stabilize the core position in neutral while moving some serious loads off the floor.

During the traditional deadlift, the center of mass (barbell) falls in front of your body, therefore causing the axis of rotation of the movement to be farther away from the load itself.  This all translates into increased shearing forces at the joints of the lumbar spine, putting all the structures, including intervertebral discs and ligaments at increased risk of injury with faulty mechanics of movement.”

The trap bar deadlift results in a better torso position for most people and less shear load in the spine. For anyone with a history of low back pain this is a no-brainer.

Use an incline bench rather than a flat bench when programming pressing movements. It’s just an easier scenario for most people and less “wonky” of a position to get in and out of.

Too, program more standing exercise variations – standing 1-arm cable rows, pull-throughs, landmine presses, Sparta kicks to the chest.

CategoriesCorrective Exercise Rehab/Prehab

The Truth About a Healthy Spine – Part II

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

Enjoy the weekend!

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

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

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

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

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

So here’s my take:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So what should you do to prevent back issues?

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

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

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

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

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

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

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

What should you do to treat back issues?

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

Consider the 3 points below:

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

And see one quickly.

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

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

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

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

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

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

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

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

Author’s Bio

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

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

CategoriesCorrective Exercise Rehab/Prehab

The Truth About a Healthy Spine – Part I

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

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

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

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

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

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

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

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

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

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

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

The bracing vs drawing in debate

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

So let’s get to the original message:

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

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

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

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

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

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

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

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

I think the best insights gleaned from this are that:

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

Lumbopelvic Proprioception – lost in the shuffle?

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

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

The Very Limited Role of Imaging in treating Low Back Pain

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Author’s Bio

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

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

CategoriesExercise Technique Strength Training

The Post Where I Slap the Wrist of a Deadlift Troll

As it happens I don’t get a ton of hate mail or “troll” activity that’s directed my way.  Part of that is because I generally – not always – steer clear of controversial topics (CrossFit, intermittent fasting, Jacob vs. Edward) that somehow always gets people’s panties all up in a bunch.

On the other side of the coin, I like to think I go out of my way to provide top-notch content with a little lightheartedness that doesn’t come across as me being an uppity know-it-all snob.  And even if I do take a strong stance on something, I’m always willing to keep an open mind and respect other’s opinions on the matter.

That said, on the off-chance that I do get someone going out of their way to be a big meanie head and write me a scathing email or comment, I’ve learned to politely say “thank you,” or ignore them altogether and move on with my life. It’s just not worth getting into a war of words with some people.

It was a hard pill to swallow when I first started writing. I took any negative feedback I received as a direct blow against my character, and I’d be lying if I sat here and said that it didn’t sometimes affect my mood.  I wouldn’t cower in the corner in the fetal position sucking my thumb or anything, but there were times back in the day where I’d be thiiiiiiiiiiiiiis close to turning on a Julia Roberts’ movie and crushing a pint of Ben & Jerry’s.

When you think about it though, anytime you open yourself up to the masses and decide to write in an open forum, whether it be blogging, articles, or any form of media, you’re going to expose yourself to criticism.  It’s the nature of the beast, for better or worse.

Throughout the years I’ve learned to pick my battles.  Sometimes I deserved to be called out and I was always appreciative (although maybe not right at that moment) in the long-run, because part of why I’m in this industry and why I write is to learn and help people.  I’m not that much of a conceited person where I can’t say “my bad, I’m wrong” and move on.

And then you just have those people who have nothing better to do with their lives than to be a big, fat meanie-head.  Like I said, normally I ignore stuff like this and use it as a good laugh, but for some reason I felt this particular person, based off his holier than thou tone alone, deserved a little taste of his own medicine.

I think most of you reading will agree.

Here’s the email that was sent my way in its entirety – with a few words/lines highlighted on my end.

Why are you stating that an upper rounded back in a deadlift is incorrect. Please explain the shear you speak of.

So I guess Konstantin Konstantinov must be a shitty deadlifter eh? The fact is it depends on body composition and the weight being pulled.

It would be nice if you trainer, no back and no trap, types get your shit correct before you put this crap on the web.

RD

+500lb deadlifter

So, essentially, what this guy was saying was that:

1. He read ONE blog post of mine (I don’t know which one) and decided that that encompassed my entire thought process on everything deadlifting. And….

2. Because he watched a Russian deadlift once, on the internet, that that somehow makes him an authority. And….

3.  He’s a +500 lb deadlifter (allegedly), so he obviously knows what he’s talking about.

For starters, one blog post doesn’t define me and my thoughts.

Secondly, here’s a picture of some random dude juggling some chainsaws.  Man that is nifty!  I could probably do that!  In fact, I know I could do that because I saw it on the internet.

Thirdly, isn’t it funny how everyone somehow deadlifts over 500 lbs????  Uncanny.

Anyways, here was my initial response to him (with more to follow afterwards):

Riiiiigggggghhhhhhttttt.

Well, if you actually read more of my stuff, you’ll understand that I’ve also said that when someone is lifting heavier loads it isn’t always going to be pretty.

And as a coach and trainer I’m certainly not going to teach someone to deadlift with a rounded back. It’s just not worth the risk. If or when they get to the level of Konstantinov then they’ll get a little more leeway..

Thanks for setting me straight, though, I really appreciate it.

+570 lb deadlifter (ie: more than you).

I’m sorry.  I just couldn’t resist closing off my response with that last line.  Childish, I know – but sooooooooo worth it.

So lets break this down in a more conducive, less confrontational way.

His main beef with me was stressing how I’m not a fan of people deadlifting with a rounded upper back.  Specifically he asked if I could explain this whole “shear” phenomena, as if I was pulling a random word out of my ass.

Let me clarify a bit before I proceed.

For starters, as the co-owner of a gym (and as such: having the luxury of paying liability insurance), part of, if not the most crucial component of my job is to keep people from getting hurt.

Think about how much responsibility we accept when a parent drops off their 14 year old kid to train with us. How do you think it bodes for business if we have kids injuring themselves left and right because we don’t take the time to teach them how to lift correctly (but more on that in a bit)?

As someone on my Facebook page so succinctly noted, “it must be nice to Monday morning quarterback from a far. If they did have their butt on the line everytime an athlete picked up a bar, this junk would be the last thing you would be arguing about.”

More to the point, if we were to look at the biomechanics of the lumbar spine (or read anything Dr. Stuart McGill has written in the past 15+ years:  HERE and HERE would be a nice start), we’d understand that the spine can handle compressive loading fairly well (assuming it’s not loaded and someone is living flexion), but it’s shear loading that many fail to pay attention to.

What is shear loading?

When the (lumbar) spinal muscles – namely the erector spinae, longissimus, iliocostalis, etc – are doing their job when lifting heavy things off the floor, they’re mainly counteracting perpendicular forces to the axis of the spine which attempt to slide the components away from their normal axis.

As my boy Dean Somerset noted,  “McGill showed elite powerlifters could get their spines to within a few degrees of full flexion and maintain that position through the pull, whereas amateurs or intermediates would go beyond full flexion without control and wind up exposing their discs to stupid forces and injury, so teaching a rounded back to a beginner is completely different than allowing an experienced puller to creep into flexion during their max lifts.

It also doesn’t talk about how when the experienced lifters are training with less than max weight they get closer to neutral and work on maintaining and grooving that pattern while staying away from flexion.”

For the visual learners out there, it goes a little something like this:

Now, to be fair: guys like Konstantin Konstantinov have a TON more leeway because he’s trained his body to stay out of danger when the shit hits the fan. He’s the elite of the elite. Using him as an argument as to why lifting with a rounded back is advantageous is borderline the dumbest thing I’ve ever heard. Excuse me while I go throw myself in front of a mack truck.

Moreover, it’s important to note that as a coach I’m ALWAYS going refrain from teaching the deadlift with a rounded back because it’s just common sense.  It’s important to engrain the proper motor pattern, and CEMENT that pattern with smart, properly progressed strength training so that if or when they do start lifting heavier loads, they’ll be better prepared to not crumble like a deck of cards.

That and so their max pulls don’t end up looking like this walking ball of fail:

So that’s my more “polite” response. Agree?  Disagree?  Want to give me an internet high-five?  Please share below.

CategoriesUncategorized

The (Not So) Obvious Causes of Low Back Pain

Back pain is a bitch.  There’s really no other way to describe it. It’s been said that 80% of Americans will experience it at one point or another, which, when you run the numbers, is like four out of five people.  Yep, that’s what I like to call math.

Needless to say, back pain bites the big one and it’s easily the #1 cause for things like days missed from work, training days lost, not to mention the burden it places on health care costs.

The mechanisms for back pain are many, but can really be categorized into two camps:

1.  One, massive, blunt force trauma:  car accident, falling off a ladder, getting Terry Tated in your office for not refilling the coffee pot.

2. Repeated, low-grade, aberrant motor patterns which inevitably lead to something bad happening.  Sitting at a desk all day comes to mind. In addition, we all know of someone who either bent over to tie his or her shoe or simply to pick up a pencil who ended up blowing out their back. The body is going to use the path of least resistance to get the job done, and unfortunately, because most people have the movement quality of a ham sandwich (poor hip mobility, poor t-spine mobility, etc), the lumbar spine, literally, gets eaten up.

While it’s a bit overkill, our spines can be thought of as a credit card.  Bend it back and forth enough times, and eventually, it will break.

As a coach who works with elite athletes as well as people in the general population, I’ve seen my fair share of back issues, and I wholeheartedly feel that a structured strength training regimen geared towards improving movement quality, addressing any postural imbalances/dysfunctions, as well as “cementing” proper motor patterns is one of the best defenses in preventing low back pain in the first place.

Coaching someone how to achieve and maintain a neutral spine (something I wrote about HERE and HERE) would be high on the priority list.

Coaching someone how to properly perform a hip hinge or helping them clean up their squat pattern – utilizing the appropriate progressions (and regressions) – would also be kind of important.

And, of course, we can’t neglect staples like encouraging spinal endurance (planks), as well as placing a premium on proper lumbo-pelvic-hip control (core stability exercises like chops/lifts, Pallof Presses, and the like).

All of these things are great, and certainly will set people up for success, but there are many (MANY) less obvious components that often get over-looked.

Stealing an analogy from the great Dr. McGill – it’s the hammer and thumb paradox.  Lightly tap your thumb with a hammer and not much will happen.  No big deal, right?  After a few thousand taps, however, you’ll be singing a different story.

Keeping this theme in mind, lets take the birddog exercise.  Simple exercise, that many fitness professionals use with their clients to help improve dissociation of the lumber spine from the hips, and to teach co-contraction of the anterior core and erectors with little to no spinal loading.

Simple exercise, for sure, but not quite so simple in it’s execution.  If you glance at the picture to the left, you’ll notice the concave shape of the back and see that she’s just hanging on her lumbar spine.  Not exactly ideal execution.

If this were someone suffering from low back pain, would this alleviate their symptoms or make them worse?  My guess would be the latter.

Taking it a step further, have you ever watched people foam roll?  There’s no questioning it’s efficacy towards helping to improve tissue quality, and we have every one of our clients do it prior to their training session.

The thing to consider, though, is that when you’re dealing with someone with a history of low back pain – whether they’re currently symptomatic or not – you need to stay on top of them so that they’re not making the same mistake as above and hanging on their lumbar spine; essentially living in a constant state of extension.

Rather, what should happen is that they “brace” their core and maintain more of a neutral spinal position as they roll around (reference the fine looking gentleman to the right).

It’s borderline OCD, I know……..but I can’t stress enough how important it is to make the small things matter.

Take away the hammer.

Using an example that’s a bit more exciting, lets take the overhead press and break that down.  Now, I have nothing against the overhead press – far from it.  But when you actually watch a vast majority of people perform it, don’t be surprised if your eyes start bleeding.  With a keen eye, what you’ll almost always witness is someone substituting excessive lumbar extension for shoulder flexion. But damn, it can look gooooooooooood at times.

When this happens, it’s usually beneficial to regress the exercise a bit and take some of the joints out of the equation, ALA the Gray Cook approach.

In the half kneeling position, I’m essentially taking my lower half out of the equation where I can now focus on pressing the weight over my head WITHOUT compensating with the lumber spine.  The key here is to “dig” the rear toes into the ground and to squeeze the glute of the trailing leg, hard!  As I press, I’m thinking “elbow to ear.”

Moving to a standing position, strength coach Dave Rak (he’s single, ladies) demonstrates a variation he showed me with one hip flexed:

Here, we’re still able to “lock” the lumbar spine in place and alleviate as much body english as possible.  What’s more, there’s an awesome glute activation component in the trailing leg.  Yes, I understand you won’t be able to use as much weight, but that’s not the point (yet). Once we can perfect the movement pattern, and take some of the burden off the lumbar spine, then we can load it and satiate our inner meathead.

Belly Breathing – The Right Way

One last point to consider, and this is something that I never even thought of until Bill Hartman pulled a Bill Hartman and made me realize how stupid I am, is the idea of belly breathing into the belt.

I’ve stated my opinion on weight belts in the past, and have always been told to PUSH OUT in order to increase intra-abdominal pressure (and thus, spinal stability).

As Bill demonstrates in this video, that’s not necessarily correct:

And there you have it:  just a few more things to consider when discussing the topic of low back pain.  Sometimes it’s not the quite so obvious things that are causing the issue(s).

Have your own ideas to share?  I’d love to hear them below.