Home Posts tagged "Back Mechanic"

5 Spine-Sparing Strength and Conditioning Program Strategies

In his book, Back Mechanic, Dr. Stuart McGill frequently uses the term "spine hygiene" to describe how individuals position themselves during various everyday and athletic tasks to manage their back pain. Most of the strategies speak to the positional side of things, but I thought it might be worthwhile to take a look at some strength and conditioning program strategies you can employ to keep the spine healthy over the long haul. 

1. Don’t pick up heavy dumbbells.

The stronger you get, the bigger a pain it is to pick up and position dumbbells, whether it's for rows, presses, or single-leg work. Things are even harder when the heaviest dumbbells are positioned on the lowest tiers of the dumbbell rack. We've been brainwashed for years that dumbbells are more spine-friendly than barbells, but this simply isn't always true. Being able to unrack a weight from chest height and not having to swing it into position can be invaluable once you're developed an appreciable level of strength. I'm not saying not to use heavy dumbbells, but rather to be very careful with this approach if you're someone who has dealt with low back pain.

2. Cycle in heavy bilateral loading.

Make no mistake about it: a barbell will allow you to move the most weight in your program on the overwhelming majority of exercises. Unfortunately, this also means that the compressive and shear forces on your spine will generally be highest with barbell exercises. That doesn't mean that you need to eliminate them, but rather that you need to cycle them out periodically to give you a little break. At the peak of my powerlifting career, I'd always stay away from squats, deadlifts, and good mornings for the first 10-14 days after a meet. It was all lower intensity work, anyway, so plenty of single-leg work and glute-ham raises was a perfect fit.

600x2DL

3. If you are going to do both in the same session, squat before you deadlift.

There are many theories as to why deadlifting is so much more exhausting both systemically and locally, but regardless of the one to which you subscribe, you'll surely recognize that heavy pulling before squatting is a recipe for a cranky back. After all, there is a reason you always squat first and deadlift last in every powerlifting. A few of my favorite approaches in terms of sequencing are:

a. Squat heavy, deadlift for reps
b. Squat heavy, deadlift for speed
c. Squat for speed, deadlift heavy
d. Squat for speed, deadlift for reps

Occasionally, you can dabble in some speed deadlifts before you squat, but once you've reached a solid level of strength, I think you'll find that it still just doesn't work out all that well.

4. Don't train in a fatigued state if you don't move well.

Experienced lifters with great core control can usually get away with training through fatigue as long as the training loads aren't outrageous. Interestingly, though, if you look at the typical recreational runner with back pain, it usually starts after they've already been running for a while. Fatigue changes the game, as they start to substitute lumbar extension (low back movement) for hip extension.

This doesn't just underscore the importance of gradual return to running progressions; rather, it reminds us that those with a history of low back pain need to spend a lot of time training with perfect technique in non-fatigued states. As McGill has discussed, they're better off doing multiple sets of shorter prone and side bridges than they are trying to hold one set for 60 seconds.

Back-Mechanic

Over time, these good positions because second nature and accepted as the norm "subconscious awareness." Every second the individual spends in a bad position, though - either because of poor positional awareness or an inability to overcome fatigue - is a step in the wrong direction.

5. Go to split-stance.

Just as single-leg lower body work can be much more spine friendly than bilateral work, simply going to a split-stance on other exercises can be helpful for minimizing unwanted spine movement, too. As an example, we always teach our wall slide variations with a split-stance, and you'll also see this approach integrated with rowing and landmine press technique, too.

Cressey wall slide

Wrap-up

These are obviously only a few of seemingly countless ways to keep your lower back healthy in a strength and conditioning program. If you're looking for more ideas on how to structure a comprehensive program, I'd encourage to check out my flagship resource, The High Performance Handbook, which is on sale for $50 off. This is the largest discount we've ever offered on this popular resource, so don't miss this chance to get a super versatile training system at a huge discount. No coupon code is necessary; the $50 price reduction will automatically apply when you click to purchase at www.HighPerformanceHandbook.com.

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Expanding the “Safe” Exercise Repertoire

In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.

Back-Mechanic

As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,

“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”

As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:

layback

Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:

throwingprogression

You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.

For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”

How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.

To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.

Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.

Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).

Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:

(Feet-Elevated) Push-up Isometric Holds > (Feet-Elevated) Body Weight Push-up > Stability Ball Push-up > Weighted Push-up > Neutral Grip DB Floor Press > Neutral Grip Decline DB Press > Pronated Grip Decline DB Press > Barbell Board Press (gradual lowering) > Barbell Floor Press > Neutral Grip DB Bench Press > Low Incline DB Press > Close-Grip Bench Press > Bench Press > Bottoms-up KB Military Press > Barbell Incline Press > Barbell Overhead Pressing

Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.

A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.

This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.

With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.

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Strength and Conditioning Stuff You Should Read: 1/5/16

It's time for the first collection of recommended strength and conditioning reading in 2016 - and I've got some good ones for you!

Extreme Ownership - This leadership book was written by two Navy Seals who have moved on to the world of business consulting. They draw on lessons learned in training and combat, and the parallels with business and coaching success are quite strong. It was both entertaining and practical, and I would highly recommend it.

Back Mechanic - This is Dr. Stuart McGill's newest book, and it's an excellent resource more targeted at end-users (i.e., those with low back pain) than his previous works, which really catered to rehabilitation specialists and fitness professionals. There are some excellent pearls of wisdom in here and it's definitely something you should have in your library to remain current with a huge problem like low back pain.

Back-Mechanic

Natural Treatments for the Most Common Medical Problems - Precision Nutrition Drs. John Berardi and Spencer Nadolsky outline some lifestyle modifications that can make a big difference in your health - and potentially help you to avoid or reduce medications.

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