Today's guest blog comes from former Cressey Performance intern Eric Oetter. Eric was one of the best interns we've ever had, and writing like this is just one example of why.
In Thomas Myers’ groundbreaking work Anatomy Trains, several “lines” of fascially connected muscles are presented. Myers denoted these lines as “anatomy trains” (thus giving rise to the title of his now famous book). For those unfamiliar, fascia is a seemingly endless web of connective tissue, which envelops and unites the musculoskeletal, nervous, and circulatory systems of the body. Though manual therapists have treated the fascial system for centuries, Myers has played a pivotal role in introducing the concepts fascia and musculoskeletal tensegrity to the strength and conditioning community.
Tying the bottom of the foot to the scalp through fascial connections up the posterior surface of the body, the superficial back line remains the most referenced of Myers’ anatomy trains. While this line certainly has implications in extension (above the knee), propulsion, and full-body pronation, it’s far from being the only line yielding practical application and solutions for strength and conditioning coaches and movement therapists.
Patrick Ward wrote an excellent guest piece on Mike Robertson’s blog last year concerning the deep front line and its effect on diaphragm functionality. I’ll follow suit with some examples of how the functional back line can produce stability across the posterior lumbo-pelvic-femoral complex.
Functional Back Line Anatomy
Tying one humerus to the contralateral tibia, the two functional back lines take the following path across the dorsal surface of the body:
Shaft of humerus --> Latissimus dorsi --> Lumbodorsal fascia --> Sacral fascia --> Sacrum --> Gluteus maximus --> Shaft of femur --> Vastus lateralis --> Patella --> Subpatellar tendon --> Tuberosity of tibia
From behind, the lines look like a giant “X”, intersecting at the pelvis. The two key components in this discussion will be the latissimus dorsi and the glute max, as well as how their muscular actions can affect the sacro-illiac joint.
Sacro-Iliac Joint Stability: Form Closure vs. Force Closure
The sacro-illiac (SI) joint is comprised of the articulation between the illium and the sacrum and lies right in the middle of both functional back lines, deep to the lumbosacral fascia. Much like a crack in the sidewalk, the joint acts as a predetermined fracture to defer stress across the pelvis.
Viewed from the back, the SI joint resembles a key fitting into a lock– the grooves on either side of the posterior illium are congruous with the lateral sacrum. This “lock-and-key” structure can be described as an instance of form closure. Essentially, the innate stability of the joint is provided by bony approximation.
While form closure can create stability, it’s not truly authentic. For example, we can create stability in the lumbar spine by shearing it into extension and using bony approximation to prevent movement. I hope all reading agree that such a situation is less than ideal.
A superior option would be the force closure of a joint system. As opposed to form closure, where the morphology of the joint system creates stability, force closure entails the surrounding musculature dynamically stabilizing a joint by “pulling it tight”.
Relating to our previous example of the SI joint, imagine how much better it would be to stop relying solely on the ligaments that cross the joint andinstead employ the powerful glute max and lat, which cross superficially as part of the functional back line, as both become continuous with the lumbosacral fascia.
While using the functional back line to create force closure is useful in cases of general instability, it can be especially valuable in the instance of sacral torsion, where, as shown in the CT scan below, the sacrum rotates one way and creates strain on the contralateral tissues/ligaments as they are pulled taught.
Training this line in isolation can certainly provide benefit, but why not implement a big-bang strength exercise that integrates the entire line at once?
Here are two great examples of how to train the functional back line in a more dynamic fashion.
Split-Stance Low Cable Row
The split-stance low cable row provides an excellent presentation of shortening the functional line from both ends, thus force closing the SI joint. The latissimus dorsi aids in the horizontal pull while the contralateral glute max stabilizes the pelvis in the transverse plane to fight rotation. (Remember, any unilateral movement is inherently rotational.)
Coaching Cues:
Place the cable stack with a D-handle attachment at its lowest height.
Set up facing the stack with feet about hip width apart. Imagine that you’re standing on railroad tracks – when you take the step back to set up, the only movement should be in the sagittal plane.
Pack the chin, brace the core, and then flex the hips to the point that the torso is angled at about 45°. Put most of your weight through the outside of your up-foot heel.
Perform a row, holding at the top for a one count.
Potential Corrections:
Look for lumbar extension in two places – the initial set-up and as a substitution for scapular retraction. Think “neutral spine” throughout.
Scapular elevation and shoulder hyperextension are common compensation patterns during horizontal pulling. Think of rowing “back-and-down” and only to the point that the scapula gets to the thoracic spine.
Make sure that you or your client feels the front-leg hip musculature kick on to stabilize – if not, play with the set-up a little until those external rotators are contracted.
The split-stance low cable row can be a great horizontal-pull variation for any client, but especially for those experiencing lumbosacral instability. I’d recommend placing it as an accessory exercise on upper body days – 3-4 sets of 8-10 reps.
1-arm Cable Rotational Row
Serving as a progression to the split-stance low cable row described above, the cable rotational row is a fantastic movement to dynamically integrate the functional back line into a more advanced pulling variation with much greater demand placed on the glute max. I view this movement much like the horizontal pull version of a push-press – the lower body drives the action with the upper body coming along for the ride.
Coaching Cues:
Set up a few feet away and perpendicular to a cable stack with feet about a step outside of hip width. The D-handle should be about waste height.
Offset the feet so that the toes of the inside foot (closest to the stack) line up with the middle of the arch on the back foot. This positioning is crucial to maximize external rotation/abduction of the front hip.
Grab the D-handle and allow the load to pull you toward the cable stack. Maintain an erect torso and packed chin throughout. You’re allowed to let the back foot toes come up, but keep the front planted in position.
Once you’re facing the cable stack with arm outstretched, drive hard through the front heelto extend the front hip/knee while simultaneously pulling the D-handle across your torso.
Hold the end position – hip extended/abducted, scapula retracted, and eyes straight ahead – for a count of one before reversing the movement.
Potential Corrections:
I find some clients tend to lead the row with cervical rotation, finishing the movement looking away from the cable stack. These biomechanics are sub-optimal, so make sure to cue a packed chin.
Rowing from this position can prove awkward, as there is a tendency to try and row around your torso. Fight this urge by keeping the cable close to your body – it should be in contact with your shirt as you finish the row.
Achieving full hip extension on the front leg is a must – make sure the movement is initiated by driving the lateral heel into the ground almost as if you were going to step away from the stack.
The benefits of the rotational cable row are numerous, but two stick out in my mind. First, it drives a powerful and dynamic contraction of the functional back line, which as we’ve seen can have ramifications for pelvic/SI stability. Secondly, this variation has huge carryover for some of our rotary sport athletes who rely on the connection between shoulder and contralateral hip to develop force.
As mentioned above, use this as a progression to the split-stance low cable row or with some of your athletic clientele – think in the range of 3-4 sets of 6-8 reps per side.
Conclusion
The functional back lines can be powerful players in creating stability across a region of the body that demands it. In cases of lumbo-pelvic-femoral instability, utilization of these lines can be as crucial for correction as they are for performance enhancement.
I hope the two exercises described above help give some practical application for the functional back lines in action – let me know in the comments!
About the Author
Eric is currently a senior at the University of Georgia majoring in Exercise and Sport Science, with plans to pursue a Doctorate of Physical Therapy. After concluding a Division-1 football career at the Georgia Institute of Technology, Eric has ardently pursued his passion for coaching, garnering experience with clients of all ages and ability levels through internships at both Indianapolis Fitness & Sports Training and Cressey Performance. He can be reached at ecoetter@gmail.com.
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Here's this week's list of recommended strength and conditioning reading:
Thoracolumbar Fascia: An Area Rich with Activity - This was an outstanding guest blog from Patrick Ward on Mike Reinold's site. I'm a big fan of Patrick's writing; he really does an excellent job of blending manual therapy with corrective exercise.
Why Finger Pointing at Carbs is Missing the Point - Brian St. Pierre kicks off what is sure to be a great series by focusing on yet another area in which we overreact on the nutrition side of things.
Why You Need More Strength - In my eyes, this is one of the best things Chad Waterbury has ever written - and Chad is a super-bright guy who has written a lot of excellent stuff.
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Change is all around us, and if we're not recognizing that and changing with it, we'll be in a bad position in no time.
It's imminent in the business world, where previous giants Borders and Blockbuster (and a host of other companies) have declared bankruptcy because they couldn't adapt to a changing marketplace.
As the son of a teacher (and now principal), I've watched how my mother has changed education with the introduction of the International Baccalaureate program at my old high school. This program engages students and makes them more aware of the world around them, as opposed to just having them stare at chalkboards and textbooks all the time.
The internet has changed the way shoppers shop, teachers teach, campaigners campaign, and ninjas "ninjer."
Joking aside, change is something that applies to strength training programs as well. In addition to fluctuating training stress and rotating strength exercises, you have to be able to modify a program based on how you feel from day-to-day. When I was younger, I would just barrel through many training sessions even if I didn't feel good - and I'm convinced that this stubbornness not only limited my progress a bit, but also led to some injuries along the way.
Nowadays, I'm older and wiser (and balder), and I listen to my body a lot more. Plus, I'm a much better coach than I was back then, so I know how to make substitutions in strength and conditioning programs to maintain a training effect. Pulled rectus femoris? Go to step-ups because they don't extend the hip and flex the knee simultaneously (as you'd get with a lunge). Shoulder hurts? Try a feet-elevated push-up instead of a bench press, as elevating the feet increases serratus anterior activity and you can draw stability from the floor.
More generally, though, I'm honest with myself about where my life is right now. I'm 31 years old - which is definitely not 21 - and not competing in powerlifting anymore (although that doesn't mean that I'm not still training hard on a daily basis). I have a wife, a dog, a house, a travel schedule, and a ton of stuff going on professionally with training athletes, writing, consulting, and lecturing. In short, there are a lot of competing demands.
What does this mean in the context of my strength training programs? Well, to be straight, the "highs" aren't quite as high, and the lows are actually "lower." Let me explain.
Take this training session, when I warmed up on trap bar deadlifts and felt pretty good, so made the decision to push the envelope a bit. I wound up pulling 700lbs.
As you can see, it came up surprisingly quickly. In years past, I probably would have jumped to 720 for another attempt, or drop back down to 630-650 for some additional singles at a weight over 90% of that day's best lift. I might have even done some backoff sets of 3-4 reps at 600. Instead, I just called it there and moved on to my assistance work, as I was feeling a little banged up and wanted to make sure I still got plenty of quality work in over the course of the rest of my strength training session. That's not to say either of these follow-up approaches would have been the wrong choice; they just weren't the right choice for me on that day. The "high" wasn't so high.
Likewise, when it comes to deloading, I wind up cutting back on things a bit more than I did in the past. In my e-book, The Art of the Deload, I outline ten different methods for deloading in strength and conditioning programs, and nowadays, I tend to go with the most conservative of the bunch.
Some might look at this piece as me telling people how to be soft and do less in their strength training programs. The way I see it, I'm just encouraging folks to train hard, but intelligently, listening to their bodies along the way. Along those same lines, what modifications have you made to your strength training programs as life has gotten busier and you've gotten older? Please post your comments below!
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Since we released it two months ago, The Fitness Business Blueprint has received some excellent reviews from fitness professionals who have been enable to effectively employ the strategies Mike Robertson, Pat Rigsby, and I outline in the product. Here's one such individual:
“The thing I love about Mike, Eric and Pat is the consistently high quality of all of their products. I’ve been following Mike and Eric’s work for years now, and as a direct result, I was already a great coach with a solid assessment procedure in place. After Eric’s presentation in the FBB, I was able to streamline this procedure, and make it run that much more smoothly – for me, this alone was worth the price of the product. But it didn’t stop there. Mike and Pat followed up Eric’s presentation with some great back end business ideas and systems advice that have had an immediate effect on my bottom line. You won’t be disappointed with this product”.
James Garland
Strength and Conditioning Coach - New South Wales, AustraliaClick here for more information on The Fitness Business Blueprint.
Today marks Part 2 of this mini-series covering just how much you can learn from looking at an elbow before writing up a strength and conditioning program. In Part 1, we talked about what can be learned from our first potential scenario, elbow hyperextension. Today, we'll focus on the lessons to be learned from three more scenarios.
Full Elbow Extension, Muscular End-Feel - This simply means that you have all your extension and no "empty" end feel; it eases to muscular stretch (of the elbow flexors).
This is probably the most common presentation pattern in the general population, and you can generally expect these folks to respond to need equal amounts of mobility and stability training. More thorough assessments will give you more information on where to focus your efforts.
Incomplete Elbow Extension, Bony End-Feel - These are, in many cases, guys who did not get full elbow extension back following a surgical procedure. Or, it may just be someone with bone spurs on the underside of the joint that interferes with elbow extension.
It's a bold assumption to make, but these individuals are almost always (in my experience) athletes who have profound limitations in other regions, as poor glenohumeral mobility, rotator cuff function, scapular stabilization, thoracic spine mobility, and terrible tissue quality can all contribute to these kind of issues presenting at the elbow. So, when I see and feel an elbow this "gross," I usually know that I have my work cut out for me. Generally, these guys wind up needing a hearty dose of mobility training, soft tissue work, breathing drills, and longer duration static stretching.
That said, with respect to the elbow itself, these guys need to be cognizant of maintaining every little bit they have. If you've got a 10° elbow extension deficit because of bony changes, you can probably get by. However, if you allow that 10° to become 30° because you pile soft tissue shortness/stiffness on top of it, you could be waiting for some serious problems to come around. To that end, I always encourage these guys to get routine soft tissue work and plenty of static stretching in to maintain whatever elbow extension they still have.
Incomplete Elbow Extension, Muscular End-Feel - These guys look very much like our previous category, but the end-feel has much more "give" to it; it's not a "concrete-on-concrete" end-feel. This is a very good thing, as you know you can work to get it back. This athlete, for instance, got 15° of elbow extension back in a matter of a few minutes following a Graston treatment with our manual therapist and some follow-up stretching.
I wouldn't expect him to maintain 100% of those improvements from treatment to treatment, but over the course of 3-4 bouts, he should get to where he needs to be.
Expect to see some of the same things with the rest of the body, as elbow extension deficits rarely occur in isolation. In throwers, they're usually accompanied by poor glenohumeral internal rotation on the throwing side, poor hip internal rotation on the front leg, and a host of other stiffness/shortness issues. In the general population, you see them in people who are locked up all over - especially in people who sit at computers all day long.
That wraps up our look at four elbow presentation patterns and what they may mean for your strength and conditioning programs and corrective exercise approaches. For more information, check out the Everything Elbow In-Service, an affordably priced 32-minute in-service where half of all proceeds go to charity.
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On Tuesday, we had our first ever "Night with the Pros" at Cressey Performance. At the event, 15 of the professional baseball players who train at Cressey Performance in the off-season sat in on a roundtable, answering questions about their careers, long-term developmental approach, college recruiting processes, weekly routines during the season, and a host of other topics. Marlins closer Steve Cishek discussed how he dealt with pressure as a rookie; Indians pitcher Corey Kluber explained why he wound up selecting a smaller D1 program over the baseball "powerhouses;" Royals reliever Tim Collins threw a live bullpen for the crowd and talked about his rise to the big leagues against all odds, and New Balance Baseball was there to provide some sweet prizes and showcase some of their great products.
Even with 15 players on the panel, no two stories were alike; everyone has had a different path to success. Accordingly, when it came time to do my live demonstration, I wanted to emphasize the unique nature of every arm - and how a quick elbow assessment can provide quite a bit of information about what you need to do for a whole-body strength and conditioning program. More than anything, for a bit of "shock value," I used the elbow of one of our pro guys who came to use following a Tommy John surgery where he didn't get all his extension back during his rehabilitation. In speaking with a few of the young attendees the following day, seeing a 25-degree elbow flexion contracture with a "zipper" scar along the medial side was a big eye opener that they needed to be serious about arm care.
We can use the Beighton scale to assess for both generalized congenital laxity and specific laxity at a joint. The screen consists of five tests, four of which are unilateral:
1. Elbow hyperextension > 10° (left and right sides)
2. Knee hyperextension > 10° (left and right sides)
3. Flex the thumb to contact with the forearm (left and right sides)
4. Extend the pinky to >90° angle with the rest of the hand (left and right sides)
5. Place both palms flat on the floor without flexing the knees
So, at the end of the day, you can score up to nine points on the screen if you are ultra-lax. This would be something you'd certainly find more often in women than in men, and the incidence of laxity is going to be higher in sports like swimming, baseball, gymnastics, and tennis (that can benefit from increased range of motion) than it is in football, hockey, etc; it's just natural selection at work, to some degree.
That said, I mentioned earlier that the elbow assessment alone - which, in my eyes, is the quickest and easiest of the bunch - can tell you a ton about what your priorities are going to be when writing a strength and conditioning program. There are really four scenarios that I come across on a weekly basis. For the record, describing joint end-feel in the rehabilitation community is much more elaborate (and specific to each joint) than I make it out in these examples; I just want them to be user-friendly for the lay population. I'll describe the first scenario, Elbow Hyperextension, in today's piece, and come back tomorrow to cover the rest.
Usually, elbow hyperextension has a very soft or "empty" end-feel - as if the forearm could just pop off if it was pulled into further hyperextension. When I see this, I know that there is a very good chance that this individual will have a high Beighton score and I won't have to do much (if any) stretching for him whatsoever - especially in the upper body (you can expect to see upwards ot 200° of total motion at the shoulders, too). Of course, I'll follow up with additional specific and general screens to determine whether this hypermobility characterizes the elbow, upper extremity, or entire body.
Generally, these individuals need more stabilization exercises - so a hearty dose of strength training is in order. Unfortunately, many people like to stick to what they are good at doing, so it's not uncommon at all to see folks with raging congenital laxity going to yoga class after yoga class, wondering why their backs still hurt. It's simply because they're taking an unstable body into end-ranges of motion over and over again. I think specific yoga exercises have outstanding benefits for specific people, but those with congenital laxity need to approach them with caution. And, certainly, trying to turn young gymnasts into human pretzels probably isn't a great idea for long-term health; for every Olympian, there are 10,000 kids with stress fractures in their spines.
That said, if you have someone who presents with a high Beighton score, but still doesn't move well, there are four likely scenarios, in my opinion.
First, and most obviously, there can be an injury that doesn't become symptomatic until they weight bear. Refer out if that is the case.
Second, they can be "grossly" unstable and simply need familiarization and strengthening in the movements you're teaching them. Just because someone is lax enough to be put in the bottom position of a lunge doesn't mean that they'll have adequate joint stabilization to hold that position. As I've written previously, you need adequate stiffness at adjacent joints to allow each joint to move optimally.
Third, they can have breathing issues (those who live in anterior pelvic tilt and rib flair are examples) or soft tissue restrictions (not as likely, but it does happen). These issues might not present with a Beighton score alone, because people can "fake" joint ROM in a passive sense when they are relaxed enough. As an example, I've seen folks with outstanding abduction range-of-motion who are fibrotic soft tissue messes where the adductors insert on the pubis. I'll always go to breathing and soft tissue work well before I go to stretching with these folks.
Fourth, I've seen quite a few folks with hypermobility everywhere except their ankles. It could be because we have absolutely destroyed feet and ankles over the years with high-top sneakers, high-heel shoes, and ankle taping. It could also be protective spasming from a previous ankle sprain that wasn't rehabilitated properly. Or, it could be that folks have shifted their center of gravity so far forward (due to the aforementioned postural distortions) that they simply can't shut off their plantarflexors. So, it's up to you to determine if things are short (measure passive dorsiflexion or do a wall ankle mobility test) or stiff (provide a counterbalance - such as a goblet squat - to see if dorsiflexion increases).
As I mentioned earlier, this is just one of four scenarios that I commonly see when I first look at an elbow. Be sure to check out Part 2, where I introduce the other three and outline the implications of your findings on strength and conditioning program design.
In the meantime, for more information on assessing and managing the elbow, I'd encourage you to check out the Everything Elbow In-Service. In this 32-minute in-service, I cover everything from functional anatomy, to injuries, to injury mechanisms, to strength training program modifications. There are valuable lessons for both those in the baseball world as well as those who don’t have any interest in baseball. It's affordably priced at just $12.99 - and half of all proceeds go to charity.
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Here's a list of recommended strength and conditioning reading for the week:
Complete Core Fitness - This is Mike Robertson's newly-released product, and it includes seven webinars that covers functional anatomy, Mike's assessment process, and the four phases of core progressions that he used with clients. Admittedly, I have not finished reviewing it, but from what I have watched thus far, it is absolutely fantastic. Remember that Mike (like me) is one of the few guys out there who actually trains people in addition to creating information products; this alone should make you appreciate how valuable his perspective is. I'd strongly recommend you check it out.
Scars and Scar Tissue - Patrick Ward kicks out some fantastic blog content in a variety of contexts, but especially on the manual therapy side of things. This one is certainly no exception.
Magnificent Magnesium - Brian St. Pierre contributed this piece over at T-Nation. It was extremely well researched and definitely worth a read - especially if you're someone who enjoyed his recent series on dairy here at EricCressey.com (if you missed them, check out part 1, part 2, and part 3).
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I thrilled to announce that I'll be collaborating with Mike Reinold once again - this time on a seminar, Functional Stability Training, to take place on Sunday, November 20, 2011 at Cressey Performance in Hudson, MA.
Here's the agenda for the day:
Functional Stability Training – An integrated approach to rehabilitation and performance training – Reinold
Recent Advances in Core Performance - Understand the concept of Functional Stability Training for the Core, true function of the spine, and how this impacts injuries, rehab, and training – Reinold
Maintaining a Training Effect in Spite of Common Lumbar Spine and Lower Extremity Injuries – Outlines the causes and symptoms of several common injuries encountered in the lower extremity, and how to train around these issues to keep clients/athletes fit during rehabilitation – Cressey
Understanding and Controlling Extension in Athletes – Looks into the causes of and problems with excessive lumbar extension, anterior pelvic tilt, and rib flairs in athletes – Cressey
Lunch (Provided)
LAB – Assessing Core Movement Quality: Understanding where to begin with Functional Stability Training exercises for the core – Reinold
LAB – A Dynamic Progression of Core Performance Exercises - Progression from simple core control to advanced rehab and training techniques – Reinold
LAB – Understanding and Controlling Extension in Athletes – Progresses on the previous lecture with specific technique and coaching cues for exercises aimed toward those with these common issues – Cressey
LAB – Advanced Stability: Training Power Outside the Sagittal Plane – Traditional power training programs are predominantly focused on the sagittal plane, but in most athletic endeavors – especially rotational sports – power must be displayed in other planes of motion – Cressey
It's our goal to optimize the learning environment and have lots of interaction with all of those in attendance, so to that end, we'll be keeping the seminar to 50 people or less. Given that our Optimal Shoulder Performance seminar in 2009 sold out in under a week, this one is sure to do the same - so don't delay in registering, if this is of interest.
For more information, or to sign up, check out www.FunctionalStability.com.
Here's what some of our previous seminar attendees have had to say about their experiences seeing us live:
Related Posts13 Fun Facts About Optimal Shoulder PerformanceWeight Training Programs: Assess, Don't AssumeSign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
