I am extremely fortunate to not only have a loyal group of newsletter subscribers, but also a very knowledgeable and passionate group of individuals who come from unique backgrounds. Collectively, you subscribers give me a ton of outstanding feedback that makes me better at what I do.

After Newsletter 95, I received a great email response from Dr. Jason Hodges:

Regarding the low back, I am a radiologist and I see MRIs every day describing what you said in the newsletter. Lots of people have bulging discs without symptoms. This is especially true of older patients who can have bulging discs at every level but without focal neurologic symptoms. In my experience, younger patients tend to have focal neurological signs with even mild disc bulges or disc herniations. But very often, the symptoms don't match up with the imaging findings. I have seen patients with symptoms down the right leg, but the disc herniation is on the left side, etc.

Needless to say, that “etc.” at the end of the last sentence got me intrigued, so I asked Dr. Hodges if he would be willing to do an interview for our subscribers. I think you’ll find it very enlightening – and forward-thinking.

EC: Thanks for joining us this week, Dr. Hodges. Could you please tell us a bit about both your professional background and health and human performance interests?

JH: Thanks for the opportunity, Eric. I did my undergrad at University of Kansas with a BA in biochemistry graduating in 1991, and received my MD degree from U. of Kansas School of Medicine in 1995. I finished my Radiology residency at U. of Missouri in 1999 and received my American Board of Radiology certification the same year. I am currently an executive partner in S and D Medical LLP in NYC. My interest in fitness really lies outside my professional duties although there is obviously some overlap. My Radiology training is not specific to fitness.

EC: In your reply to my newsletter last week, you not only confirmed some of the things I noted about MRI results in what we think are healthy lower backs, but also had some other very interesting experiences to share. Would you please fill our readers in?

JH: Often imaging findings do not correlate with clinical findings. Older patients often have very degenerative spines without symptoms. Whereas younger patients can have small bulging discs or herniated discs and have debilitating pain. The human body has a great reserve capacity. I see many “normal” kidneys that are in chronic renal failure

Medical imaging generally deals with anatomy: how organs “look”, not so much how they function. Obviously, they are linked, but function can decline long before anatomic changes occur. Symptoms can occur without imaging abnormalities. This leads doctors to conclude that nothing is wrong because the x-ray/CT scan/MRI looks normal. This is simply not the case.

Medical imaging is simply one piece of the clinical puzzle. An analogy can be made with astronomy. You can image the universe at visible light, x-ray, ultraviolet, infrared, etc. Each modality provides a vital, but incomplete picture of the universe. You have to put it all together to get the big picture.

EC: How about the knees? I know a lot of people are walking around with chronic ACL tears that aren’t symptomatic, but what else do you see?

JH: It is often easier to see acute injuries better than chronic images. We often see the secondary finding, such as edema or fluid collections rather than the direct injury itself. An acute ACL tear may show a gap in or fraying of the ACL, surrounding edema and joint effusion. A chronic ACL tear may show only a wavy appearance or abnormal signal as scar tissue has partially healed the injury. But it is important to recognize the chronic ACL tear because it alters the biomechanics of the knee, stressing other parts of the knee. This can lead to a higher risk of meniscal tear or premature arthritis. A common cluster of findings in acute knee injury is ACL tear, medial meniscal tear and medial collateral ligament sprain/tear and a joint effusion.

EC: Shoulders?

JH: The most common finding I see is tendinopathy of the supraspinatus tendon. It is the most likely to be impinged under the acromion and clavicle. The shape of the acromial hook can predispose to impingement, as can arthritic changes of the acromioclavicular joint. In radiology, we tend to use the term “tendinopathy” rather than “tendonitis”. “Tendonitis” implies white blood cell inflammation, which we cannot confirm on MRI. So we use the imaging term of “tendinopathy” which can certainly include tendonitis.

EC: So, what’s your take? Are we too heavily reliant on MRIs as a society? Certainly, it takes a lot more resources to get a MRI than x-rays, yet many people seem to request these at a moment’s notice to gain some peace of mind. What kind of accuracy are we talking?

JH: As I said, MRI is just a piece of the big picture. Some of the limitations include the fact that we image the joints in a static state, in one position. We image the lumbar spine with the patient lying down which is a whole different loading scheme than standing up. The tracking of the patella during extension is really best assessed by physical exam, not by MRI. It is a matter of putting too many eggs in the imaging basket, so to speak. MRI is the best imaging modality for the soft tissues, but it is not all-seeing/all-knowing.

EC: Let’s talk about lifters. What are you seeing in terms of chronic adaptations to lifting heavy stuff?

JH: To be honest, we don’t image many lifters except in the setting of acute injury. Lifters tend to be younger and healthier. Certainly, lifters have better bone density and have a lower risk of osteoporosis. Larger muscles and lower bodyfat are obviously the case.

EC: Aside from lifting, what other lifestyle habits have you found lead to less-than-stellar diagnostic imaging? Alcohol? Certain occupations?

JH: By far, the biggest limitation is obesity. All of the imaging modalities are limited by it, mostly for technical reasons. An ultrasound beam can only penetrate so far into the soft tissues. X-rays and CT scans are degraded by scattered radiation, which leads to a higher radiation dose and grainy images. Also, the time it takes to do the study increases, which gives a higher incidence of motion blur.

EC: So diagnostic imaging is less accurate with obese patients? One more reason to not get fat in the first place!

We often talk about how the best doctors are the ones who meet the lay population halfway. In other words, they’re the ones who can tell an injured patient what he CAN do, and not just what he CAN’T do. My experience has been that the best trainers and coaches are the ones that can meet the doctors halfway, and it’s something to which I attribute a lot of my success.

To that end, what resources would you recommend to trainers, coaches, and everyday weekend warriors looking to learn more in the direction of the clinical realm?

JH: Frankly, the mainstream media is not a great source of information. It is incumbent on us radiologists to let the primary care doctors know what we can image and, more importantly, what we can’t. Orthopedic surgeons tend to be the most knowledgeable regarding the musculoskeletal system, but don’t discount chiropractors. I am pretty open-minded to alternative medicine, unlike many of my fellow MDs. My chiropractor does a great job using ART on my trigger points in my traps. Also, never be afraid to get a second opinion.

My advice to all practitioners – be they doctors, chiropractors or trainers – is to learn as much as possible. Be confident in your knowledge and abilities, but don’t think that any one practitioner has all the answers. Medical knowledge is too vast for anyone to know everything about everything. I know my medical school training regarding fitness and nutrition was paltry. Sure, I learned about muscle fiber composition and the biochemistry of vitamins and minerals. But, most doctors just parrot the standard dogma of low-fat, high-carb diet, walk 20 minutes three times a week, etc. You and I both know that won’t lead to any significant body composition changes.

EC: Agreed. I actually know several doctors who have “seen the light” when they’ve started to read more of Dr. John Berardi’s work – not to mention the latest research of carbohydrate-restricted diets from the likes of Jeff Volek and Cassandra Forsythe. What else?

JH: Seek out those practitioners who aren’t afraid of the cutting edge. Just as you wouldn’t want a trainer who is a glorified rep counter, you don’t want a doctor who is simply going to give you the same old tired, old-school nutrition and fitness “advice,” if you can even call it that. That advice may promote health, but it won’t give the body composition changes most of your readers seek.

In addition to being confident in their abilities, practitioners need to know when to refer to other people. Some things need to be treated medically or surgically. They can’t be fixed in the gym or at the training table. Health and wellness should be a team effort with everybody working in their areas of expertise and not outside of it. Underconfidence and overconfidence in your abilities are equally bad for your client/patient.

Unfortunately, Western style medicine is very disease-oriented and body-part-oriented, often losing the big picture, especially regarding the whole kinetic chain of the musculoskeletal system. My opinion is that this is where trainers and chiropractors shine. I wish my fellow doctors would be more amenable to referring patients to trainers/chiropractors for problems that don’t need medical or surgical treatment. The human body has great ability to adapt and heal itself, if you give it a chance.

EC: Thanks again for taking the time to be with us!

JH: My pleasure. Thank you for inviting me. My kind gratitude to my colleague D. Dillon, RN, BSN for her assistance.

Two Quick Reminders

Upon my return, I’ll be headed to Pittsburgh for a seminar on March 29th. You can find details for the event on my Schedule page.

7. Look to your daily life as the root of joint injuries. The more we learn about joint injuries, the more we learn that damage is more likely the consequence of repeated micro trauma, versus a one-time, acute macro-trauma. Joints respond very well to frequent, intermittent, and gradual loading, as opposed to infrequent, sustained, or sudden loading. Joints receive their nutrition from the passive diffusion of nutrients in the synovial fluid, facilitated by movement and intermittent loading. Prolonged sitting and standing can often rob the joints of the stimulus required for optimal health. When our minds are occupied, it is amazing how we can find ourselves enduring prolonged and awkward postures. Even worse, we may not feel the adverse affects of this in the short term, thus we don’t have an impetus to modify them. This is usually because many structures, such as disc, meniscus, and joints are aneural is areas, and often do dot relay noxious stimuli until a higher degree of damage occurs. Clinical experience and research shows that countless joint conditions, including osteoarthritis, shoulder impingement, low back, and neck pain are all correlated with prolonged sitting or repeated bending and twisting. It’s obvious to focus on technique, program design, corrective exercise, and nutrition for optimal performance. However, neglecting to address movement patterns and postures with daily tasks can subvert much of your hard work and often contribute to injury.

9. Try the modified 1-leg squat to assess leg strength discrepancies. Strength discrepancies amongst the legs is very common, and often the cause of injury and decreased performance. A very simple technique to identify a unilateral strength deficit is as follows: perform a one leg squat or modified Bulgarian squat (non-stance leg moving backward). At the bottom of the movement, when the stance leg is at least 90 degrees and toes of the trail leg are in contact with the ground, lift the toes of the trail leg off the ground before ascending exclusively on the stance leg. Any strength discrepancy will be obvious based on the perceived difficulty from one leg to the other or the presence of compensation patterns.

10. Address your lumbar stability and position sense before overloading. Far too common is the failure to adequately master position sense and stability prior to overloading a joint. Doing so will lead to injury through structural damage and decreased performance through muscle inhibition. You cannot build the second floor before solidifying the foundation of a building. You cannot throw a punch with a limp wrist. Accordingly, you should not lift heavy before you can demonstrate proper joint position and stability.

Correlating Pec Tears and Benching

Preventing Striking Injuries

Changing Parameters: Volume and Intensity

Early in 2007, I interviewed physical therapist Michael Stare for one of our newsletters. As it turns out, that interview (featured HERE) was one of the more popular ones we’ve done – so I approached Mike about throwing a little more content our readers’ way. Here are five tips from Mike to get the ball rolling:

1. The sciatic nerve, not your hamstrings, is often the source of your chronic posterior thigh pain. It is alarming how often people are encouraged to stretch their hamstrings in response to an insidious onset of posterior thigh and buttock pain, often coupled with a nagging low back problem. In probably 90% of cases, the problem is not the hamstrings at all, but rather the sciatic nerve. So, if you have pain in the back of your leg and it wasn’t in the course of coming up lame after a sudden sprint, consider performing the following simple test before stretching your hamstrings:

Sit in a slouched position, head looking down to your lap. If this is pain-free, proceed to the next step. Dorsiflex the ankle on the side you are testing. Then, slowly extend your knee, stopping at the point where you first feel any symptoms, (stretch, pull, pain, tingling, etc). Next, while still holding this leg position, extend only your cervical spine. If this alleviates your symptoms, you are most likely dealing with an irritated sciatic nerve rather than your hamstrings. Why? Your hamstrings don’t connect to your head, so changing the cervical position shouldn’t influence the symptoms if the hamstrings are the source of the problem. Rather, the tension upon the sciatic nerve is alleviated with cervical extension as the dura of the spinal chord is connected with that of the sciatic nerve. So if your “chronic hamstring strain” isn’t healing, and your slump test is positive, you should stop stretching your hamstrings, and seek some professional advice.

2. Learn to posteriorly tilt your scapula. Poor control of the scapula is the root of most shoulder problems, as most informed conditioning and rehab experts will attest to. In fact, and anteriorly tilted scapula is the most common postural impairment found in those with shoulder pain. Posteriorly tilting the scapula removes a common mechanism of impinging the rotator cuff against the subacromial arch when elevating the arm. Furthermore, it helps to position the scapula to facilitate optimal length tension of the scapula and humeral musculature. So merely “pulling the shoulders back” doesn’t do the trick.

To practice scapular posterior tilt, lay supine on a firm surface, and attempt to bring the posterior aspect of the acromion to the table. If this is very difficult for you, you will likely require some activation work for your lower traps and stretching of your pec minor.

3. Stretch your psoas and your rectus femoris separately. Although it is common to hear recommendations to stretch your hip flexors, two major hip flexors, the psoas and the rectus femoris, should be stretched separately. This is due to the fact that they have separate origins and insertions. To stretch the psoas, ensure slight lumbar flexion via a posterior pelvic tilt, lumbar contra-lateral side bend, and hip extension. This can be done in standing or half kneeling. These motions can be quite tricky, so be sure to have a qualified coach or PT teach you. For the rectus femoris, posteriorly rotate the pelvis, flex the knee to about 120 degrees while placing the foot upon a stationary surface, and extend the hip. With both stretches, the most common mistake is to hyperextend the lumbar spine, which will reduce the effectiveness of the stretch and could contribute to back problems.

4. Train hip rotation rather than lumbar rotation. Tasks that involve powerful rotary force production, such as swinging, throwing, and kicking, mostly involve hip rotation versus lumbar rotation, at least when they are performed by skilled athletes. Emphasizing hip rotation makes sense from an anatomical perspective too. The hips are very stable joints, with a network of dense musculature designed to perform rotation. The lumbar spine is relatively more fragile. In fact, the annulus of the disc begins to experience failure at only 4% elongation, which usually occurs at only 3 degrees of rotation at each segment! Furthermore, the lumbar facets are orientated such that the joint surfaces are aligned in the sagittal plane, and are impacted at 3 degrees of rotation. Clearly, our training should reflect these biomechanical factors.

5. Try performing balance activities with your eyes closed. Balance is simply maintaining your center of mass within your base of support and is facilitated by many different sensory and motor qualities. Proprioception is a component of balance that is very important to athletes and fitness enthusiasts, as the training of it can reduce the incidence of some injuries, and the loss of it is the by-product of any joint injury. This is well researched with ankle injuries in particular. When performing single leg exercises, closing your eyes reduces the contribution of visual input towards the task of maintaining your center of mass over your base of support. Therefore, you must exclusively rely on feedback from the joint structures, and as a result enhance proprioceptive input.

About Michael Stare

Michael Stare is the Director and Co-owner of Spectrum Fitness Consulting, LLC, in Beverly, MA, where he trains young athletes and clients of various fitness levels. Mike received his BS in Kinesiology from the University of Illinois at Urbana-Champaign, his MS in Physical Therapy from Boston University, and his Doctorate of Physical Therapy from the Massachusetts General Hospital IHP. Mike recently completed Fellowship training in Orthopaedic Manual Therapy and currently practices with Orthopaedics Plus in Beverly, MA as a Physical Therapist. To learn more about Spectrum Fitness Consulting, go to www.SpectrumFit.net. Mike can be reached at mike@spectrumfit.net.

New Blog Content for the Week

Public Access: Not Just for Wayne and Garth

Inefficiency vs. Pathology

One More Reason I Love My Job

Active vs. Passive Restraints

Eating on the Road: Nutritional Travel Strategies

Seminars – Possibly in Your Neck of the Woods

A few buddies of mine are organizing events that are definitely going to be very solid. I’m only making it to the one here in Boston (June 6), but I’m sure that the rest will be excellent. Check ‘em out:

April 26: 2008 Georgia Strength Coaches Association Strength and Speed Coaching Clinic: More Info

June 6, 2008: Second Annual Distinguished Lecture Series in Sports Medicine (Boston, MA): More Info

We’ll be back early next week with five more tips from Mike Stare and plenty of other new content.

All the Best,

EC

Cressey on TV

Click the link below to view an hour-long interview I did on the Audrey Hall Show alongside Rich Gedman (former Red Sox catcher and current manager of the Worcester Tornadoes) and Bunky Smith (head coach of Framingham's American Legion Team) on the topic of youth baseball training.

New Article(s)

I was a contributor on the T-Nation Strength and Size Roundtable:

Part 1

Part 2

Part 3

More Feedback on The Art of the Deload

“Eric Cressey has done it again! He's created another solid and easy to understand product with The Art of the Deload e-book. Deloading is more than just backing off on either volume or intensity during a training cycle and Eric gives great specifics about how to incorporate a number of different deload strategies. This is a must-have for anybody trying to write serious strength and conditioning programs.”

New Blog Content for the Week

From Old School to New School

Neutral Grip Multi-Purpose Bar Floor Press

Clarifying a Jaw-Dropping Study

Have a great weekend!

EC

HERE so that you don't miss out.

Inefficiency vs. Pathology

Q: I read with great interest your baseball interview at T-Nation, as I have two sons who play high school baseball. More interestingly to me, though, was this statement:

“Pathology (e.g., labral fraying) isn't as important as dysfunction; you can have a pathology, but not be symptomatic if you still move well and haven't hit "threshold" from a degenerative or traumatic standpoint.”

Is this something that can be applied to the rest of the body?

A: Great question – and the answer is a resounding “Absolutely!”

Many musculoskeletal issues are a function of cumulative trauma on a body with some degree of underlying inefficiency. People reach threshold when they do crazy stuff – or ignore inefficiencies – for long enough. Here are a few examples:

As I touched on in a recent newsletter, we put a lot of compressive loading on our spines in the typical weight-training lifestyle – and you’d be surprised at how many people have spondylolysis (vertebral fractures) that aren’t symptomatic. But there’s more…

A 1994 study in the New England Journal of Medicine sent MRIs of 98 "healthy" backs to various doctors, and asked them to diagnose them. The doctors were not told that the patients felt fine and had no history of back pain.

80% of the MRI interpretations came back with disc herniations and bulges. In 38% of the patients, there was involvement of more than one disc.

It’s estimated that 85% of lower back pain patients don’t get a precise diagnosis.

You’d be amazed at how many people are walking around with labral fraying/SLAP lesions, partially torn rotator cuffs, and bone spurs. However, only a handful of people are in debilitating pain – and others just have a testy shoulder that acts up here and there. What’s the issue?

These individuals might have a fundamental defect in place, but they’ve likely improved scapular stability, rotator cuff strength/endurance, thoracic spine range-of-motion, soft tissue quality, cervical spine function, breathing patterns, mobility of the opposite hip/ankle, and a host of other contributing factors – to the point that their issues don’t become symptomatic.

They do a lot of Tommy John surgeries and ulnar nerve transpositions for elbow issues that can often be resolved with improving internal rotation range-of-motion at the shoulder, or cleaning up soft tissue restrictions on flexor carpi ulnaris, flexor carpi radialis, pronator teres, etc.

According to Dr. Glenn Fleisig, during the throwing motion, at maximal external rotation during the cocking phase, there is roughly 64 Nm of varus torque at the elbow in elite pitchers. This is equivalent to having a 40-pound weight pulling the hand down.

The other day, I emailed back and forth with my good friend, physical therapist John Pallof about elbows in throwing athletes, and he said the following:

“Over the long term, bone changes just like any other connective tissue according to the stresses that are placed on it.  Most every pitcher I see has some structural and/or alignment abnormality – it’s just a question of whether it becomes symptomatic.  Many have significant valgus deformities.  Just disgusting forces put on a joint over and over and over again.”

I can’t tell you how many carpal tunnel surgeries can be avoided when people get soft tissue work done on scalenes, pec minor, coracobrachialis, and several other upper extremity adhesion sites – or adjustments at the cervical spine – but I can tell you it’s a lot.

Many ACL tears go completely undiagnosed; people never become symptomatic.

I know several people who have ruptured PCLs from car crashes or contact injuries – but they work around them.

Some athletes have big chunks of the menisci taken out, but they can function at 100% while other athletes are in worlds of pain with their entire menisci in place.

Many knee issues resolve when you clear up adhesions in glute medius, popliteus, rectus femoris, ITB/TFL, psoas, and the calves/peroneals; improve ankle and hip mobility; and get the glutes firing.

I’m of the belief that all stress on our systems is shared by the active restraints and passive restraints. Active restraints include muscles and tendons – the dynamic models of our bodies. Passive restraints include labrums, menisci, ligaments, and bone; some of them can get a bit stronger (particularly bone), but on the whole, they aren’t as dynamic as muscles and tendons.

Now, if the stress is shared between active and passive restraints, wouldn’t it make sense that strong and mobile active restraints would protect ligaments, menisci, and labrums? The conventional medical model – whether it’s because of watered-down physical therapy due to stingy insurance companies or just a desire to do more surgeries – fixes the passive restraints first. In some cases, this is good. In other cases, it does a disservice to the dynamic ability of the body to protect itself with adaptation.

I’m also of the belief that there are only a handful of exercises that are genuinely bad; upright rows, leg presses, and leg extensions are a few examples. The rest are just exercises that are bad for certain people – or exercises that are bad when performed with incorrect technique.

With these latter two issues in mind, find the inefficiency, fix it, and you'd be surprised at how well your body works when it moves efficiently.

Teleseminar Series Reminder

Just a reminder that this awesome FREE offer from Vince DelMonte starts next week, so don’t wait to sign up! My interview will be Monday, April 7.

Ultimate Muscle Advantage Teleseminar Series

A: Thanks for your email and kind words.

Now, you might be wondering, “What does this have to do with strength and conditioning, corrective exercise, or high-level performance?” It’s a reasonable question.

Truthfully, the answers exist all around you.

Go to your gym, and you’ll find the guy who has been doing full ROM leg presses and rounding his back under compressive loading for years – yet his back doesn’t hurt.

Then, glance across the room and you’ll see the guy benching with his elbows flared WAY out – just like he has three times a week for years – yet his shoulders don’t hurt.

Next to him, there’s that dude in the middle of his “abs circuit.” He’s done 400 hyperextensions and sit-ups – and is now looking to the seated oblique machine to see if he can completely annihilate his spine in one trip to the gym. The problem is, you’ve seen this every Tuesday since 1998 – and his back doesn’t hurt.

Look to the basketball court, and you’ll find some kid rocking the highest high-top sneakers you’ve ever seen; they look like cinderblocks on his feet. His ankles are taped, and his knees buckle in with every landing – yet his knees don’t hurt.

All these guys do crazy stuff that really isn’t good for the body, but they respond differently than the rest of us. They may just be waiting to reach threshold, or they might just be the lucky few that never become symptomatic – no matter how absurd what they do may seem.

The exception doesn’t make the rule. The rule is made from the research and anecdotal evidence from coaches who really know how to pick up on this stuff. They look at injuries, and then identify common causative trends they share.

Special Offer on Muscle Gaining Secrets

Last summer, I mentioned in newsletters 62 and 63 that I was impressed with Jason Ferruggia’s Muscle Gaining Secrets. In this resource, Jason does a great job of breaking down advanced concepts for the layman to apply to training and nutrition – and he provides a lot of solid bonuses from some bright guys like Keith Scott, Jim Wendler, and James Smith.

For the next three days, Jason is offering several extra bonuses alongside his original package at no additional charge. The entire package is very reasonably priced and well worth the investment.

Muscle Gaining Secrets

Blog Topics for the Week

Troubleshooting Shoulder Pain with Rows

Smith Machine Salaries

Feedback on "The Art of the Deload"

"The Art of the Deload is a great resource and reference for any strength coach, athlete, trainer, or everyday lifter.  Avoiding plateuing or hitting the wall in training can save coach and athlete alike days, weeks, and even months of frustration and backtracking.  Eric has done a wonderful job outlining a variety of ways to manipulate deloading to ensure continued progress and success in training."

Mike Kamal

Head Strength and Conditioning Coach – Merrimack College

Click HERE for more information.

EC

Strength Coach Podcast

I was recently interviewed by Anthony Renna for Strength Coach Podcast #6 – and there is also some good Q&A with Mike Boyle, Gray Cook, and Jamie Harvie of Perform Better. Check it out HERE.

New Article

I had a new article published at T-Nation last week. For those who missed it:

What I Learned in 2007

Q&A

Q: Are partial deadlifts (rack pulls) supposed to work your lower back harder than regular deadlifts? The reason I ask is that my lower back tends to be more sore when I do rack pulls; does it necessarily mean that my form is bad? Or, could it be that my lower back is weak?

A: No; they don’t hit the lower back harder in a relative (to the glutes and hamstrings) sense, but absolutely, sure. Assuming a pin setting close to the knees, rack pulls allow you to use more weight – so they’ll definitely hit the upper back and grip harder.  Like a regular deadlift, you still need to transfer force from the lower to upper body. However, the fact that your form falters with added load even with a reduction in range of motion tells me that the force transfer side of things is where you falter.

In reality, lower backs are rarely weak; most guys overuse them.  Research has shown that lower back injury risk is positively associated with lumbar spine range of motion. The more your lower back moves, the more likely it is to get hurt.

My sense is that it's multidirectional lumbar spine instability that only gets better with:

b) training under PROGRESSIVELY heavier loads, meaning that you don't attempt a weight you can't lift in perfect form

c) keep focusing on anti-rotator/anti-sagittal-plane-motion training - side bridges, pallof presses, kneeling cable chops, bar rollouts, etc

d) optimizing range of motion at the hips and thoracic spine

Mike Robertson, Bill Hartman, Mike Boyle, and I have written quite a bit about strategies “C” and “D.”

“B,” however, might be the one issue that nobody seems to cover, so I thought I’d toss out an analogy in this regard. Just think of what I’m doing with my pro pitchers right now. Most report to spring training at the end of February or early March.

Right now, they're all throwing bullpens (2x/week) at 75-80% intensity with only 30-35 throws a session (mostly fastballs, just a few change-ups, and no breaking pitches).  Meanwhile, they’re just doing some long tossing on three “off-days” per week to help get their arms back in shape gradually and facilitate recovery.

During these bullpens, they take their time between pitches. The idea is technical perfection and precision.The guys won’t hesitate to talk mechanics (or watch videos of the previous pitches) for a minute or two between throws.  Apparently, they sometimes spend this time conspiring on how to throw fastballs at their strength coach while he tries to get videos for them, too.

How do you think their mechanics would improve with going out there and throwing 90mph+ every day from the get-go? It probably wouldn’t do much, and chances are that they’d chew up a shoulder, elbow, lower back, or knee in the process – either from faulty mechanics, excessive loading of tissues too early, or a combination of the two.

Now, why should improving deadlift technique be any different? As your “bullpen,” you do some technique work in the 75-80% range and keep it picture-perfect, adding 5-10 pounds a week.

Meanwhile, as your “long tossing sessions,” you do your assistance work (outlined above) and possibly some very light technique work to groove the movement pattern and facilitate blood flow.  Over time, these strategies bump that lift up.  Grinding against circa-maximal weights every week with poor technique won't get you anywhere except injured.

See you next week.

EC

Treats

One of the biggest perks of being in this business is that I get a lot of free stuff sent to me. I’m not going to lie: a lot of it is absolute garbage that is so bad that I can’t read or view the whole thing. I look at some fitness gimmicks and can’t help but think “why?” I’ve actually got an entire section on my bookshelf of stuff I’ve received that’s just flat-out bad.

Why do I even mention this to you? Well, for one, so that you’ll know that if something gets a thumbs-up in my newsletter or blog, it’s legit. Second, and more importantly, I’ve grown to see patterns – and one such pattern is that everything that John Berardi has sent me is pretty much gold. The newly introduced Gourmet Nutrition Cookbook (version 2.0) is no exception.

I received my copy on Monday night, and was impressed not only with the presentation of the book (well organized and easy to read), but obviously the content itself. There is an excellent and diverse selection of recipes, and I can’t wait to try them out.

One of my pitchers was in the office when it arrived, and I he asked if he could see it. That night, he made some of the bars and said that they came out great. Young athletes are a great measure of how good a nutrition product is; they’re impressionable, yet very stubborn. If something isn’t good, they’ll call BS or just ignore it altogether. Only two nutrition products have gotten my guys going; this one and the nutrition component of Jason Ferruggia’s Muscle Gaining Secrets.

Check it out for yourself: Gourmet Nutrition Cookbook 2.0.

Travel

The seminar I’ll be doing in Ireland on March 15-16 has now been confirmed. For more information, please email Kieran Dolan at one2onetraining@eircom.net.

Tirades (or something like that; it began with a “T,” so cut me some slack)

For whatever reason, within the fitness industry (at least in its online capacity), there’s been a lot of talk about the book, The 4-Hour Workweek. While it’s an excellent book, I feel like some folks from our industry have taken it out of context.

My good friend Alwyn Cosgrove has written and spoken about how less than 0.5% of personal trainers are financially independent. In other words, America doesn’t feel that their services are worth spending money – and this is in spite of the fact that the weight loss industry – including products, diets, surgery, and training – will exceeded an estimated $100 billion in 2006.  It's not surprising that trainers aren't perceived as worthwhile due to the lack of preparedness in the industry, as I wrote in a blog a while back - and I verified in a subsequent blog based on a reader's response.

While this number is staggering it itself, our industry’s response to it has been even more shocking: we need to work less. Scary. Great idea, guys; you recognize that you suck at what you do, and in turn decide to come out guns a-blazin’ and devalue yourselves even more!

My question to the fitness industry is: do you want to be remembered as someone who did just enough to get by, or do you want to be remembered as someone who did something special?

How many hours do you think Oprah Winfrey works each week? She’s got her show, book club, magazine, website, online community, African leadership academy for young girls, and a host of other things that I’m forgetting. Just last night, I heard she was starting her own television network. I’ve never heard her advocating The Four-Hour Work Week in her book club.

On Sunday, Facebook founder Mark Zuckerberg surprised a lot of people during his appearance on 60 Minutes. At age 23, he’s worth an estimated $3 billion and has over 400 employees working for him in multiple locations across the country. Meanwhile, he dresses like he shops at the Gap, and works at a regular desk alongside everyone else. For all intents and purposes, he looks and acts like another employee. How do you think his 400+ employees would feel if he decided to cut back to four hours a week?

How about Donald Trump? In 2004, he was already worth $2.5 billion, according to Forbes. Since then, he’s introduced a wildly popular television show, his own celebrity vodka (interestingly enough, the CEO is a former client of mine from when I was in CT), and about 15,000 new buildings that are earning him a lot of money.

These people make a lot of money and impact a lot of lives because they understand how to work more efficiently, not work less.

I’m going to go out on a limb and assume that Oprah doesn’t mow her own lawn, Zuckerberg doesn’t do his own laundry, and Trump doesn’t vacuum his own office. They outsource the less important tasks and leverage their abilities better with the meat and potatoes stuff – and time that’s left over is dedicated to getting better at what they do. How many 4-hour fitness professionals are using that leftover time to read the latest research, call other coaches/trainers, or attend seminars?

If you ever get good enough to be able to afford to work only four hours a week in the fitness industry, chances are that you’re someone who has learned to genuinely love what you do.

I can guarantee you that if Mike Boyle didn’t have a wife and kids to keep him sane, he’d still be sleeping in his office at the BU hockey arena on occasion like he did 25 years ago – and I bet he’s still working 60+ hours a week right now on top of seminar travel, etc. He loves what he does.

I had lunch with Chris Doyle (University of Iowa football S&C coach) late last spring. He was back in Boston on vacation to visit family, and he stopped off to see me and exchange ideas – in between stops to see his old high school football coach and Mike Boyle. He was working while on vacation – but I can guarantee that he didn’t see it like that. Chris is a big reason why walk-ons (Dallas Clark, among others) at Iowa get drafted almost every year, and NFL guys flock back to Iowa in the off-season to train with him. Chris, obviously, loves what he does, too.

This little rant came about on Saturday while I was downloading a video we had shot at the facility. On the surface, it’s just me being a goofball and doing stupid jumping stuff that I’d never let my athletes do.

50-inch Box Jump w/Approach

However, I thought about it in a little more depth. It was my seventh consecutive day at the facility – with another 13 more to go before I took a day off. We had already seen over 30 athletes that day, but I was still as anxious as a little kid on Christmas to jump in the action. I routinely work over 80 hours a week, and play host to my athletes from out of town for about 6-8 weeks per year. If I didn’t like what I do, they wouldn’t be sleeping on my sofa bed.

Holding the box is Cressey Performance’s newest employee, Brian St. Pierre. He had been up at 5:45AM to cover sprint work for the New England Ruffnecks, an AAU baseball program with which we’re affiliated, at the Harvard track from 7-9AM. Brian was at the facility by 10AM and coached right through until 3PM (when this video was taken) without any semblance of complaining over the fact that he’d worked more than four hours on Saturday alone. He also got a lift in with me right after this video was taken. Brian is a really bright guy who knows his stuff, but to be honest, we hired him for his passion first and foremost.

Doing glute-ham raises in the background is a stud catcher from the Class of 2010 who is already getting big-time D1 interest. He’d already caught for four hours before coming out to lift, and he’s routinely someone who needs to be held back from overdoing it. Isn’t it funny how the most enthusiastic kids who love training the most are the ones who seemed the most destined for long-term success in athletics and in life?

You won’t make it far in any industry if you hate your job so much that you only want to be involved with it four hours per week. The 4-Hour Workweek makes some great points on time management, eliminating unnecessary tasks, saving money, and a host of other value lessons. I’m just concerned that the fitness industry as a whole is studying calculus when it ought to be mastering algebra first.