Home Posts tagged "low back pain"

Strength and Conditioning Stuff You Should Read: 4/13/17

I hope you're all having a great week. I'm a few days late with posting this because we were a bit more content heavy earlier in the week, but the good news is that it gave me a few more days to round up some excellent content for you.

Kabuki Strength Chat with Eric Cressey - I joined Chris Duffin and the rest of the Kabuki Strength crew for a podcast last week. We talked baseball strength and conditioning, business development, and fitness industry trends. Check it out!

STEM-Talk with Dr. Stuart McGill - Any podcast with Stu is a must-listen podcast! This one doesn't disappoint - and I particularly enjoyed his commentary on the flawed medical model as it relates to treating lower back pain. 

It Took Me 10 Years to Become an Overnight Success - This was an excellent post from my business partner, Pete Dupuis. He shares some awesome insights on little things that can lead to long-term success - if you're patient.

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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.

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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.

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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.

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Wrap-up

These are obviously only a few of seemingly countless ways to keep your lower back healthy in a strength and conditioning program, so I'd love to hear some of your suggestions in the comments section below!

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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.

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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:

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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:

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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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3 Barbell Hip Thrust Coaching Cues

We utilize both barbell hip thrusts and supine bridges on a regular basis in our programming. Popularized by Bret Contreras, we started utilizing these exercises in 2011 - and haven't looked back since.

They're great alternatives to squatting and deadlifting for those with a history of back pain, and can be awesome options for training the posterior chain in those with upper body conditions that may be exacerbated by certain squat and deadlift variations. They don't create a ton of soreness, so they can be awesome in-season exercises for athletes. And, they'll build bigger, stronger glutes that seem to carry over better to athletic performance because of the horizontally directed force (as opposed to the vertically directed force we see with squats and deadlifts). In short, I think they're awesome on a number of fronts - and they're here to stay.

While even the most inexperienced athlete can pick these drills up relatively quickly, that's not to say that there aren't a few common technique mistakes for which you need to watch out. Check out this video to learn how to correct these issues:

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5 Lessons Learned From Training Those With Low Back Pain

Today's guest post comes from Dean Somerset. Dean's made a name for himself as a "low back and hip" guy, and this post demonstrates this expertise. It's especially timely, given the release of his new resource, Advanced Core Training.

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I’ve had the distinct honor of working with a wide variety of clients. Some have been fresh from spinal surgical intervention following an injury, others had congenital issues where they were born with some sort of spinal irregularity, others just had low back pain. I’ve also worked with some Olympic champions, Paralympic hopefuls, professional sports teams, and pretty well every type of client in between, and today’s post is all about highlighting some of the commonalities among these very broad and different types of clients.

#1: They Usually Do Something Poorly.

I had the opportunity to do end-of-season testing on a local professional hockey team a few years ago. This meant I had direct access to some of the best hockey players in the world to see how they moved. While they could likely outskate and maneuver anyone on the ice, their ability to control their movements in the specific tasks asked were somewhat shaky on occasion, and in some instances, consistently so through the entire team.

Consider hockey players live their entire lives with their sticks on the ice and bent over. Shoulder pads prevent a lot of overhead movement, and getting checked into the boards frequently can cause some significant wear and tear on the shoulder joints, not to mention the rest of the body. Its no surprise very few of them had the ability to score well on an overhead squat assessment since they only ever put their arms overhead when they score a goal, and if you’re on an offensively challenged tem, that won’t happen much.

Additionally, since flexion is such as important position for their sports, they had no problem doing that, but had a lot of trouble controlling their spines into extension. The goalies could hit the splits in any direction, but many of their leg movement testing would have indicated that they were “tight” and required more stretching. If someone can go in and out of the splits in multiple directions, they don’t need more stretching.

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With many people who aren’t elite athletes, they’ll also have some sort of a wonky movement pattern here or there. These may not directly cause injury, but they might increase the relative risk that something could happen. Think of a hip hinge, for example. A known mechanism of injury is low back flexion with loading and some degree of rotation. This is the common first timer setting up for a deadlift and not knowing what the heck they’re doing. In fact, that’s how Rob Gronkowski injured his back when he was a standout at Arizona and almost cost him a shot at the NFL.

The thing about increased risk is it won’t guarantee an injury occurs, just that there’s more likelihood that it would. If I bought a lottery ticket, there’s a 1 in 15,000,000 chance that I win big. If I bought 1000 tickets, there’s now a 1,000 in 15,000,000 million chance that I win, or 1 in 15,000 chance. It doesn’t mean I will win, just that my odds are higher.

Now, if I were to teach that beginner how to hip hinge well and reduce the pressure on their low back while also using their hips to produce the power for lifting the weight, there’s a greater chance that they will be successful and less of a chance they will get injured. Gronk showed even a great athlete who is unfamiliar with a certain movement can still do it with risk, and still get injured, just like a beginner stepping foot inside a weight room for the first time.

#2: The Value of Isometric Exercise Can’t be Overstated.

Dr. Stuart McGill’s lab at The University of Waterloo just released a very interesting study that looked at the effects of using isometric exercises like planks and dead bugs as well as more dynamic exercises such as Russian twists and rotational throws to train the core in two very different groups:

a) beginners who were naïve to resistance training and exercise in general,

b) Muay Thai athletes who were savvy to training concepts and instructions.

Half of the naïve group did isometric training and half did more dynamic training, and the same went for the savvy group. There was a control group as well; they didn’t train for the 6-week duration of the study.

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Afterwards, all training groups saw improvements in both their fixed core strength and range of motion, and also in their response to more reactive stress to the spine. The isometric groups in both the naïve and savvy groups saw bigger improvements than the dynamic training groups.

While isometric exercises may seem very rudimentary and “beginner,” they can still prove beneficial to more advanced athletes and lifters, especially in terms of ease of set-up, relative risk to the individual doing them, and - most importantly - in quantitative outcomes, such as those measured in McGill’s research. It’s very exciting to see that a basic staple exercise, performed well, can benefit individuals of all experience level.

#3: Breathing is More Than Just Inhale/Exhale.

Getting beginners to do core-intensive training usually results in one question from me, repeated consistently through the entire series:

“Are you breathing?”

A go-to response for many is to hold their breath through core intensive movements. While this isn’t a bad response per se - especially if they’re trying to use a valsalva to increase spinal stability during a movement like a deadlift - not being able to inhale and exhale in pace with an exercise can actually reduce the effectiveness of the exercise. Additionally, the speed of breathing can dictate whether a movement is more of a relaxation or mobility movement or whether the goal is speed and reactive capability development. In either case, being able to breathe through an entire set is vitally important to see the best potential improvements.

When breathing for improving mobility or parasympathetic activity, inhales and exhales should be long and full. I usually recommend 3-5 second inhalations and 3-5 second exhalations. For speed and power development, inhales are best with more of a sniffing action where air is taken in quickly and with some development of negative pressure through the ribs and abdomen, and exhaled forcefully and quickly, much like a martial artist throwing a strike. Boxers do this very well, exhaling on impacts to improve not only their ability to not gas out, but to improve the stiffness of their spine to improve the power of their punches.

This short, sharp exhale causes the abdominal muscles to brace very hard and very quickly, essentially momentarily turning the core into stone to allow for a solid strike to generate some impact.

Try this while you’re reading this article: place a hand on your stomach and sniff in quickly through your nose and feel what the abdominal muscles do. Then exhale sharply through pursed lips, like you would if you were throwing a very crisp jab. Did you feel how hard the abs became for the second you inhaled and exhaled? That’s your power center.

Clients along the entire continuum from rehab to elite performance can benefit from learning how to use their breathing to develop the specific goals they’re looking to accomplish. Rehab clients can use the sniff inhale and hard exhale effectively, as it doesn’t necessarily apply aberrant stressors to the spine or connective tissue, but does have a beneficial effect on the strength and reactivity of the core girdle as an entire unit. Simply doing forceful breathing, when appropriate to do so, is itself an effective conditioning tool for many.

#4: Core Strength Training Should Trump Core Endurance Training.

What’s more likely to lead to problems: having to lift 5 pounds 50 times, or having to lift 50 pounds 5 times? Most people would say lifting the heavier weight would be riskier, and I would say if the person didn’t know how to move it to reduce their risks and to take advantage of their leverages, then yes.

However, many training programs heavily prioritize development of core endurance, with higher rep ranges and longer duration isometric holds. While endurance is important, I would argue the ability to generate repeated bouts of higher threshold contractions would have much greater implications to spinal protection, athletic development, and resiliency, while also making the lower threshold contractions less stressful to the body.

A simple way to do this is to alter the methods used to get to a specific volume of training. For instance, let’s say you want to do three minutes of planking. You could do one long sustained plank for 180 seconds, or you could do 18 bouts of maximum intensity 10 second holds, where the goal is to try to contract everything so hard that your hair follicles turn into diamonds and you make it rain like never before. The three-minute sustained plank will challenge you, but you’ll be able to still do something afterwards. The 18 rounds of 10 seconds max effort planks will wreck you.

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Consider it for strength training as well. Instead of doing 3 sets of 10 with a moderate weight, use a more challenging weight to get through 6 sets of 5 and using an appreciably heavier weight.

For lower capacity clients, this can be a great way of building up volume for those who may not have the endurance to go through longer sets or bigger volumes all at once. It also allows for more set-up and learning opportunities for each exercise than doing one or two larger volume sets would allow.

#5: Core Training Should be Vector, Speed, and Intensity-Specific, Not Just Muscle Specific.

Training a movement like an anti-rotation press to overhead raise sounds awesome and does a lot to work on controlling stability through transverse and frontal plane, all in a relatively slow and controlled manner. Asking, “What does this work? Like, your obliques or something?” can be a fair question, but only scratches the surface of what’s going on.

For athletes who compete in relatively specific directions and actions without the elements of contact and chaos, they can benefit from training with a high degree of specificity to their goal activities. For the less specific athlete or for the non-athletic client, they can still benefit from more variable-dependent training, depending on their goals. For instance, a 50-year-old accountant with a history of low back pain may not need to do max velocity rotational throws, but they could still benefit from some rotational velocity training to help prepare them for the eventual frozen sidewalks that they’ll have to walk around in Edmonton in a few months, or perhaps for the games of golf they’ll play when they Snow Bird south for the winter.

For rehab clients, the direction-specific element speaks volumes to whether they have a directional intolerance to certain movements. For instance, some clients can’t handle flexion-based movements very well, so involving some flexion progressions they can work with would be good, whereas full range crunches probably wouldn’t be beneficial. Slower movements to develop control would be important, but involving some higher velocity movements they could control and replicate would also be beneficial in case they encountered those kinds of scenarios on their own. An example would be if they stepped off a curb and had to catch their balance before falling or jerking their spine into a potentially disastrous situation.

Closing Thoughts

To recap, everyone from elite athletes to recovering spinal injury clients and everyone in between can involve core training into their programs in very similar ways, but with minor differences here and there to accomplish their specific goals. Most of the time it’s pretty easy to do, if you know how to do it.

This is where Advanced Core Training comes in. Dean has created a comprehensive, user-friendly guide to programming and coaching core stability exercises. You'll pick up new assessment ideas, innovative exercises, and coaching strategies you can employ to improve outcomes with your clients and athletes. The resource also includes NSCA CEUs. Click here for more information.  
 

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Yoga for Athletes: Why Activation and Inhibition Matter More than Stretching

Today's guest post comes from yoga expert, Dana Santas, who is "changing the game" when it comes to yoga for athletes. Enjoy! -EC

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Ten years ago, I taught yoga to athletes; literally, that’s what I did. I spent my first year in the yoga-for-sports niche teaching athletes how to be “good” at yoga. My goal was to help them be-come more flexible. I didn’t know what I didn’t know. A decade later, after working with hundreds of pro athletes and dozens of teams, I’m extremely averse to the idea of “flexibility” as a priority.

But, like many yoga instructors, I started my career with a well-intentioned emphasis on length-ening muscle tissue that seemed short and tight. Despite that misguided intention, it was my Type-A, drill-sergeant insistence on precise alignment and proper breathing that inadvertently delivered results for my clients. Once I recognized the real reasons I was positively impacting them—which had little to do with stretching—I went from providing temporary relief of tension to creating lasting increases in functional mobility, stability, and mental stamina.

Yoga didn’t benefit my clients because of flexibility gains; rather, it helped them:

1. activate/inhibit muscles
2. use their diaphragm
3. initiate their parasympathetic nervous system

In this article, we’re addressing the first item. However, my next article “5 Compelling Reasons Athletes Should Practice Breathing,” will cover why proper diaphragm use and breathing biomechanics are not only paramount for leveraging the autonomic nervous system but also facilitating integrated core strength, pelvic floor function, shoulder girdle integrity, shoulder mobility, and more. But I digress….

Because many yoga positions require multi-planar movement in a controlled manner or positional hold, demanding perfect alignment in those poses forces athletes out of compensation patterns. Taking them out of these patterns activates muscles that have been dysfunctionally dormant, and inhibits the overactive compensators (effectively turning off the tension). It’s the activation and inhibition initiated in yoga—not stretching—that actually helps athletes become more mobile.

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When you simply stretch chronically tight, overactive muscles—without correcting the cause of the overactivity—you can provide temporary relief, but you risk tearing the muscle and increasing potential for injury. You might also reduce strength and power, since the athlete has likely been using that muscle as a primary source of movement in their sport.

Why do I assume that significant tension in athletes is due to compensation? I see it all the time! Consider the most popular, traditional strength and conditioning movements—the ones we love to do (i.e., squats, bench presses, bicep curls, crunches, etc.). What do they all have in common? The sagittal plane. And that’s where too many athletes place their training effort, despite the fact that most sports require multi-planar movement; think about a baseball swing. Consequently, athletes learn to compensate through powerful multi-planar movements in their sport by using the muscles they’ve strengthened in the weight room.

Understanding this phenomenon, we can better identify the contributing factors to areas of chronic tension and leverage yoga to concentrate on specific activation of the muscles that have been inhibited (agonists and synergists) by the tense area’s overactivity/compensation. In this way, you use reciprocal inhibition to not only relieve tension but restore kinetic chain firing and functional range of motion. Stretching, alone, can’t accomplish that.

Still not convinced? Let’s look at a typical area of tension: the low back.

I can’t even begin to tell you how many times I’ve been asked by teams and athletes to “stretch” tight low backs…almost as many times as I’ve been asked to “stretch out hamstrings.” Of course that’s not a coincidence, since most athletes with “tight” backs also have “tight” hamstrings…because they’re both part of a typical dysfunctional posterior chain firing pattern!

Before I explain my activation-and-inhibition rationale and strategy for approaching low-back tension, let me offer this interesting piece of info:

According to the National Electronic Injury Surveillance System (NEISS), in 2010, lower back strains were the most common reported reason for ER visits relating to yoga. I believe this is the case because the sequences of some popular yoga styles, including Bikram's Hot 26, feature poses that feed into compensatory back-extension patterns by promoting hyperextension, and counter them with stretches encouraging extreme low-back flexion. Understandably, that combination of movements can be especially dangerous for anyone with a tight low back!

Athletes with low-back tension usually have excessive anterior pelvic tilts that contribute to in-creased lumbar lordosis. Overactive hip flexors holding the pelvic tilt, inhibit glute firing, which then forces back extensors to compensate as hip extensors.

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If we just stretch the low back—which often isn’t even possible because the back extensors can’t release—we’re not fixing the problem because the low back will immediately reengage in response to the hip flexors pulling on the pelvis. And, as the ER-visit data shows, we could strain the low back in the process.

Here’s a sample breakdown* of an introductory activation-and-inhibition yoga strategy for low-back issues:

*Note that these are just a few examples and don’t represent all of the possible yoga-based movements that could be used to initially address low-back tension. Once you’ve had success with simple—yet challenging—postures and movements, like those below, you can move into multi-planar twisting poses variations that emphasize t-spine rotation while maintaining a stable low back, as well as more challenging positions that emphasize hip mobility through a functional range. Often, low-back issues are aggravated by a locked-up thoracic spine and/or hip mobility limitations that force compensatory rotation from the lumbar spine. But you don’t want to jump right into more complicated movements until you’ve reinforced low-back stability and function and ensured that the back extensors can actually shut off appropriately.

Start with movements that promote glute activation and hip flexor inhibition, like Bridge. Maintain pressure in the lateral heels and medial arches to facilitate glute and adductor engagement. Avoid lifting into back extension. Inhale as you lift your pelvis. Exhale to bring your pelvis down. If the knees bow out or you have trouble maintaining medial arch awareness, hold a foam yoga block or ball between your legs to ensure adductor engagement.

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Incorporate core and pelvic floor work to inhibit back extensors. This includes practicing poses, like my version of a Modified Boat pose with feet down. Keeping the knees and feet together integrates a focus on adductor engagement for hip and pelvic floor stability. Inhale as you reach arms out to the sides, aligned with shoulders. Exhale as you bring the arms back to the front (as pictured). Supinating the forearms as you take the arms out helps engage lower traps and re-lease upper traps to avoid drawing the shoulders up next to the ears.

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Functional Squat encourages the pelvis to move through a posterior tilt and release back ex-tensors. Like the traditional yoga Child’s Pose, functional squat also lengthens the low back; however, it does it actively rather than passively. Keep feet hip-distance apart with weight in the lateral heels and medial arches. Hold for three deep breaths.

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After going through the moves above, I recommend finishing with a longer-held, low-back stretch. Yes, I did say “stretch.”

I’m not a yoga trainer who doesn’t stretch my clients. I stretch them all! It’s just not the focus of my programs. But I use dynamic stretching (I call it dynamic “mobility”) in warm-ups, and I close out sessions with targeted, deeper stretches. For example, check out this video clip from a re-cent Tampa Bay Rays development camp. We'd already worked on glute and core activation to inhibit low-back extensors, so then we were doing targeted quadratus lumborum (QL) stretching.

In the interest of brevity, the sample yoga strategy I’ve shared above doesn’t specifically address asymmetry, but it’s important to note that there are typical contributing factors that lead to tension presenting more on one side than the other—particularly the right. These can include: left-to-right pelvic rotation with the center of gravity stuck in the right hip (the foundation of Postural Restoration Institute philosophy) and poor breathing mechanics causing the diaphragm to pull into the right low back, where it has a thicker, longer right lumbar-spine attachment.

Asymmetrical low-back tension is also exacerbated by an athlete’s sport, position and hand dominance. Using baseball as an example, consider how the movements of the following players would add to right low-back pain: a right-handed batter, a left-handed pitcher, and a right-handed a catcher, who stays on his toes due to an inability to posteriorly tilt the pelvis. Consequently, when developing a yoga-based program for an athlete with a low-back issue, the postures you select and the cuing and emphasis need to take into account the asymmetrical nature of the athlete’s tension and corresponding compensation patterns they’ve developed as a result of their sport.

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All this said, I’m not claiming that athletes can’t get anything positive out of flexibility-focused yoga. Stretching, in and of itself, can feel great and increase blood supply to muscle tissues. I just think it’s important to understand the risks versus benefits. And, as I explained from my own experience as a novice instructor, there can be “inadvertent” benefits. However, when you’re a pro athlete, whose body’s function determines the trajectory of your career, it’s probably not in your best interest to waste your time with anything that’s “inadvertently” good for you…and could possibly be detrimental. My advice for teams and athletes, who want to add yoga to their training program, is to seek out instructors who understand functional mobility and breathing biomechanics, and don’t over emphasize flexibility.

About the Author

Dana Santas is creator of Radius Yoga Conditioning, a yoga-based mobility and sports-training style designed specifically to help athletes move, breathe and focus in ways that enhance performance and decrease injury. Nicknamed the “Mobility Maker,” she’s the yoga mobility expert for CNN and team yoga trainer for the Toronto Blue Jays, Atlanta Braves, Philadelphia Phillies, Tampa Bay Rays, Orlando Magic and Tampa Bay Lightning, as well as sports mobility consultant to more than half a dozen other teams and hundreds of MLB, NHL, NBA, NFL, MLS, LPGA & WTA pros. You can learn more about her at www.RadiusYoga.com.

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6 Reasons Anterior Core Stability Exercises Are Essential

This time of year, I'm doing a lot of assessments on professional baseball players who are just wrapping up their seasons.  One of the biggest issues that I note in just about every "new" athlete I see is a lack of anterior core control. In other words, these athletes sit in an exaggerated extension pattern that usually looks something like this:

APT-250x300

And, when they take their arms overhead, they usually can't do so without the ribs "flaring" up like crazy.

This is really just one way an athlete will demonstrate an extension posture, though. Some athletes will stand in knee hyperextension. Others will live in a forward head posture. Others may have elbows that sit behind their body at rest because their lats are so "on" all the time.

latsPosture

This isn't just about resting posture, though; most of these athletes will have faulty compensatory movement patterns, too. Once we've educated them on what better posture actually is for them, we need to include drills to make these changes "stick." Anterior core drills - ranging from prone bridges, to positional breathing, to dead bugs, to reverse crunches, to rollouts/fallouts - are a great place to start. Here's why they're so important:

1. Breathing

The muscles of your anterior core are incredibly important for getting air out. The folks at the Postural Restoration Institute often discuss how individuals are stuck in a state of inhalation, with each faulty breath creating problematic accessory tone in muscles like scalenes, lats, sternocleidomastoid, pec minor, etc. These muscles aren't really meant to do the bulk of the breathing work; we should be using our diaphragm. Unfortunately, when the rib cage flies up like we saw earlier, we lose our Zone of Apposition (ZOA), a term the PRI folks have coined to describe the region into which our diaphragm must expand to function.

Zone-of-Apposition-300x220

(Source: PosturalRestoration.com)

Bill Hartman has a great video demonstrating good vs. bad breathing here:

 

Step 1 is to get the ribs down and pelvis into some posterior tilt to reestablish this good zone. Step 2 is to learn how to breathe in this position, emphasizing full exhalation.

Step 3, as you may have guessed, is to strengthen these "newly rediscovered" patterns with good anterior core training.

2. Resisting extension.

This one is the most obvious benefit, as the muscles of the anterior core directly combat too much arching of the lower back. If you aren't controlling excessive lumbar extension, it's only a matter of time until you wind up with lower back irritation - whether it's just annoying tightness, a stress fracture, a disc issue, or something else.

3. Better force transfer and lower back injury risk reduction.

The research on core function is pretty clear: its job is to transfer force between the lower and upper body. Spine expert Dr. Stuart McGill has spoken at length about how spine range of motion and power are positively correlated with injury risk. In other words, the more your spine moves (to create force, as opposed to simply transferring it), the more likely you are to get hurt. How do you prevent your spine from moving excessively? You stabilize your core.

4. Indirect effects on rotary stability.

For a long time, I looked at control of extension as "separate" from control of rotation at the spine. In other words, we did our anterior core drills to manage the front of the body, and our chops, lifts, side bridges, etc. to resist unwanted rotation. However, the truth is that these two approaches need to be treated as synergistic.

As an example, every time I've seen an athlete come our way with an oblique strain, he's sat in an extension posture and had poor anterior core control - even though an oblique strain is an injury that occurs during excessive rotation. All you need to do is take a quick glance at the anatomy, and you'll see that external obliques (like many, many other muscles) don't function only in one plane of motion; they have implications in all threes - including resisting excessive anterior pelvic tilt and extension of the lower back.

Gray392

What this means is that you can't simply ignore coaching in one plane when you think you're training in another one. When you do your chops and lifts, you need to prevent lumbar hyperextension (arching) . And, when you do your rollouts, you can't allow twisting as the athlete descends. Finally, you can add full exhales (a predominantly anterior core challenge) to increase the difficulty on rotary stability exercises.

5. Improved lower extremity function and injury risk reduction.

Lack of anterior core control directly interferes with lower extremity function, too. If the pelvis "dumps" too far forward into anterior tilt, the front of the hip can get closed down. As I described at length here, this can lead to hip impingement.

With a squat variation, while some athletes will stop dead in their tracks with this hip "block," others will slam into posterior tilt to continue descending. This is the "butt wink" we've come to see over and over again in lifting populations. When neutral core positioning is introduced and athletes also learn to manage other extension-based compensations, the squat pattern often improves dramatically. This can "artificially" be created transiently elevating the heels, turning the toes out, or by having an athlete hold a weight in front as a counterbalance.

Additionally, athletes in heavy extension patterns often carry their weight too far forward, throwing more shear stress on the knees during lunging and squatting. The more we can keep their weight back to effectively recruit the posterior chain, the better.

6. Improved shoulder function and injury risk reduction.

The lats can be your best friend and worst enemy. On one hand, they have tremendous implications for athletic performance and aesthetics. On the other hand, if they're "on" all the time (as we often see in extension-based postures), you can't get to important positions with the right movement quality. Overactive lats will limit not only shoulder flexion (overhead reaching), but also upward rotation of the shoulder blades. I covered this in quite a bit of detail in Are Pull-ups THAT Essential?. Moreover, with respect to elbow function, overactive lats can be a big issue with allowing throwers to get true external rotation, as I discussed here:

If you're using your lats as an "all the time" core stabilizer, you aren't just at risk of extension-based low back pain, but also problems at the shoulder and elbow. If you can get your anterior core control under control and normalize the length and tone of the lats, your "healthy exercise pool" for the upper body expands dramatically. Getting overhead is easier, and you'll feel stronger in that position. The same goes for external rotation; not surprisingly, pitchers always say that their lay-back feels smoother after soft tissue work on the lats, as an example.

Wrap-up

These are just six benefits of training the anterior core, but the truth is that they could have been broken down in much more detail as they relate to specific injuries and functional deficits. If you're looking to learn more on this front - and get a feel for how I like to train the anterior core - I'd encourage you to check out my presentation, Understanding and Coaching the Anterior Core.

AnteriorCore

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How Chronic, Prolonged Sitting Impacts Your Body – and What to Do About It

Last week, over the course of two days, I made the long drive from Hudson, MA to Jupiter, FL. Suffice it to say that all those hours in the car gave me a newfound appreciation (or distaste?) for just how hard sitting is on the body. As such, it was really timely when my friend Michael Mullin emailed along this guest post on the subject. Enjoy! -EC

Disclaimer:

In this article, the author describes a fictional scenario in order to demonstrate a point related to the degree of information and misinformation there is in the layman and professional literature. It is in no way an attempt to create alarm that these facts apply to every person and every situation. While this article is not scientifically based, the published references are meant as an example of what some studies have found of the impact prolonged sitting and being in a stressful environment has on the body. Please read this article with the intent with which it was written—to provide concrete tools to use if you have to sit for extended periods of time.

I would like to have you read the scenario below and let me know if you would want this job.

“Congratulations on being selected for the position of top minion here at Do Everything Against Design, Inc. (DEAD).  Our company is a prestigious purveyors of thneeds—and a thneed is a thing that everyone needs (5). We pride ourselves on our commitment to being on the cutting edge of business and we use only the best, most up-to-date information possible to dictate how we run our business.”

“Let me start off by saying that this job will provide all kinds of potential benefits. It is up to you to decide how committed you are. The potentials are endless—overuse injury, chronic pain, depression, increased alcohol use, drug or medication use, cancer, increased general mortality, even bullying—that’s right, just like when you were a kid—are all very real possibilities here at DEAD, Inc.”

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“So first thing we will do is get you set up with your work area and station. Here is your cubicle which studies have shown are detrimental to not only work life but also your personal life (1). And here is your ergonomically correct chair so that your body doesn’t have to move, because research has shown that sitting 90% of your day, will almost double your risk of developing neck pain (2). We are also well aware of the fact that this increased time sitting will ultimately yield to a higher mortality rate for you (3), and make you feel generally crummy, but we are willing to take your chances. In fact, don’t even bother trying to counter all this sitting with exercise, because it will increase your risk for certain cancers by up to 66% regardless of how active you are when not sitting! (4)”

“However, placing this degree of stress and strain on your body is mainly so that we can reduce the organization’s costs and increase productivity (5), which is what is most important to us. Because ‘business is business and business must grow, regardless of crummies in tummies you know’ (6). And you do want to be a team player, don’t you?”

“In fact if you do end up having any physical problems, there is a greater than 63% chance that it is actually due to work (7). And if it isn’t from sitting too much (8), then it is due to the psychological stress that this position places on you. Heck, it might even be due to me and the stress I place on you! I will give you an 80% chance that our workplace stress will be the most important factor you will have to deal with here (9).”

forward head posture man

“We have also found that this job can also really give you a great chance on becoming an alcoholic or binge drinker (10), so you have that going for you as well.”

“If stress does become greater than you can learn how to cope with, which is apparently one important part of your employment here (11), then rest assured that we don’t really have a plan in place, because 80% of facilities do not have formal programs in place to deal with workplace stress, and of those that do, only about 14% say it is effective (12). Since that’s what the research suggests, then I mean, how important can establishing a plan be?”

“The single greatest thing about this whole situation is that I will actually pay you to let me break you down, little by little, bit by bit, until you feel beaten and broken. Don’t you see? It’s a win-win situation for both of us here at DEAD, Inc!”

I decided to title this article differently from my original title, “Your Employer Is Trying to Kill You” because I thought it might be a little less inflammatory. But, if you think about it, if data were used to truly guide what we should be doing, than many jobs where employees have to sit the better part of the day are truly a form of abuse. OSHA should be having a field day with these kinds of stats!

This is not about trying to bash many of the companies that have these incredibly sedentary work environments, though. Moreover, it's also not about the fact that I disagree with how our ergonomic evaluations and standards currently are. This is more about trying to create a "Movement/Movement."

Michael Mullin

Our bodies are designed for movement. Period. Our brains are designed for processing and trying to create efficiency so that we can process more. Now that’s pretty smart, however, highly detrimental when it comes to the importance of movement. Because if we continue to listen to what our brain is telling many of us, then it will constantly suggest that we just continue to sit to conserve energy.

So what to do for those of us who have to sit regularly during the day?

  • Get up regularly, even if it means setting a timer at your desk to walk down the hall a couple of times. Not only good for the body, but also good for the brain.
  • Stand every time the phone rings in your office, even if it means you have to sit back down to do something at your computer for the call.
  • Every hour, independent of getting up for regular walks:
    • Sit at the front edge of the chair, hands resting on thighs and body in a relaxed position—not too slouched or sitting up too straight. Take a slow breath in through your nose, feeling your ribs expand circumferentially. Then slowly, fully exhale as if you are sighing out and exhale more than you typically would, without forcing or straining. Inhale on a 3-4 count, exhale on a 6-8 count, then pause for a couple of seconds. Re-inhale and repeat for 4-5 breaths.
    • Staying in this position at the front edge of the chair, reach one arm forward, alternating between sides, allowing your trunk and torso to rotate as well. Your hips and pelvis should also shift such that your thighs are alternately sliding forward and back. Perform 10 times on each side, slowly and deliberately and while taking slow, full breaths.
  • Consider using your chair differently, depending on the task:
    • When doing work on the computer, sit with the lowest part of your low back (i.e. sacrum) against the seat back, but don’t lean your upper body back. This will give the base of your spine some support, but also allow for good trunk muscle activity as well as proper thoracic circumferential breathing.
    • When doing general work such as going through papers, moving things around your desk, filing, etc., sit forward on your chair so that you are more at the edge of the chair. This will allow your legs to take more load and your trunk muscles better able to aid in support, reaching and rotating tasks.
    • When reading items or reviewing paperwork, recline back with full back contact to give your muscles, joints and discs a rest. Make sure to hold the items up at roughly shoulder height—even if you support your arms on armrests or desk.

Remember, chairs and sitting is something that WE as humans created and the current norm is in no way optimal. We were not put on this planet to sit on chairs, and in particular not ones which shut our system off and limit our movement and ability to breathe normally. Until organizations and the general mindset changes to balance work requirements, work efficiency and human health, then we will be constantly be dealing with companies such as DEAD, Inc.

Note: the references to this article are posted as the first comment below.

About the Author

Michael J. Mullin, ATC, PTA, PRC: Michael is a rehabilitation specialist with almost 25 years of experience in the assessment and treatment of orthopaedic injuries. He has published and lectured extensively on topics related to prevention and rehabilitation of athletic injuries, biomechanics and integrating Postural Restoration Institute® (PRI) principles into rehabilitation and training. He has a strong interest in system asymmetry, movement, rehabilitation and respiratory influences on training and their effect on athletics. He has extensive experience with dancers, skiers, and professional and recreational athletes of all interests. You can find him on Twitter: @MJMATC

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The Deficit Deadlift: A Strength Exercise You Can Do Without

The deadlift from a deficit is a strength exercise that has gained some popularity in recent years, and it's popping up in more resistance training programs.  Unfortunately, it's an exercise that sounds a lot better on the internet than it plays out in the real world.  I have a lot of one-time consultations at Cressey Sports Performance with people who have a history of lower back pain after deadlifts, and not surprisingly, a lot of them have attempted the deficit deadlift when they have no business performing it, as the risk-reward ratio is far too high.

To that end, in our Functional Stability Training of the Lower Body resource, I devoted a segment of my deadlift presentation to the topic.  Here's a free preview:

To view the rest of the presentation (and eight others), be sure to check out Functional Stability Training of the Lower Body.

FST-DVD-COVER-LB

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Strength and Conditioning Stuff You Should Read: 8/19/12

Here's this week's list of recommended strength and conditioning reading:

Elite Training Mentorship - The August update at Elite Training Mentorship included some great content from all four contributors.  My in-services were "Shoulder Impingement: Internal vs. External" and "Preventing and Training Around Flexion-Intolerant Low Back Pain."  I also had an article and two exercise demonstrations featured.  If you haven't checked out ETM, definitely do so!

Do Eggs Cause Heart Disease? - In the past week, the "Eggs Are Worse than Cigarettes" shenanigans have gotten out of control.  Fortunately, Adam Bornstein (with contributions from Dr. Chris Mohr, Alan Aragon, and Mike Roussell) gets to the bottom of some very flawed research and reporting that is misleading the public.

6 Mistakes I Made - So You Don't Have To - I loved this post from Jim Wendler, as I've made all these mistakes myself! I wish he'd have published it in 1999!

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