Home Posts tagged "Back Pain"

Register Now for the 6th Annual Cressey Sports Performance Fall Seminar!

We're very excited to announce that on Sunday, October 22, we’ll be hosting our sixth annual fall seminar at Cressey Sports Performance. As was the case with our extremely popular fall event over the past five years, this event will showcase the great staff we're fortunate to have as part of our team. Also like last year, we want to make this an affordable event for everyone and create a great forum for industry professionals and fitness enthusiasts alike to interact, exchange ideas, and learn. We're happy to have Perform Better as our official sponsor again this year as well.

Here are the presentation topics:

Pete Dupuis -- Gym Ownership In Hindsight: A Decade of Lessons Learned

After designing three different gyms, negotiating five different leases, and building a team of ten fitness professionals, Pete has an informed opinion on gym design and management. In this presentation, he'll introduce you to five of the best, and five of the worst decisions we've made along the way in ten years of operating Cressey Sports Performance.

Miguel Aragoncillo -- Improving Performance for Rotational Athletes

In this presentation, Miguel will analyze performance for rotational athletes, along with discussion on case studies and techniques as they relate to asymmetries, kinetic chains, and biomechanics. This two-part presentation will feature a lecture discussing the understanding the possible origins of dysfunction, and a hands-on component which will dive into a live assessment and exercise selection.

Chris Howard -- Low Back Pain: A New Perspective on the Same Old Problem

Nearly every fitness professional has encountered an athlete or client dealing with lower back pain. In this presentation, Chris will blend his experience of anatomy and muscular referred pain patterns with strength and conditioning and soft-tissue strategies to illustrate how he treats clients experiencing lower back pain. Whether you are new to strength and conditioning, or a seasoned veteran, you will see lower back pain from a new perspective following this presentation.

Nancy Newell -- Constructing Female Confidence in a Male-Dominated Gym

Some male coaches feel uncomfortable coaching female clients. They struggle to formulate an approach with which they're confident, and the client experience is often negatively impacted as a result. In this presentation, Nancy will help coaches learn how to “dance” the line between being awkward and awesome, while sharing her personal philosophy on how to build female confidence in a male dominated gym.

Eric Cressey -- How Posture Impacts Pain and Performance

Posture is one of the most controversial topics in the fields of health and human performance. In this presentation, Eric will look at the related research and present anecdotal evidence and case studies to bring some clarity to the debate on just how important having "good posture" - if it even exists - really is.

John O'Neil -- Foundational Strength: Laying Groundwork for the Untrained Youth Athlete

In this presentation, John will take a comprehensive look at how we acclimate our untrained youth athletes to the training process at Cressey Sports Performance. This information will include the technical and tactical aspects of executing training sessions in our semi-private group-training model.

Jordan Syatt - How to Build Your Own Successful Online Fitness Business

With this presentation, we kick off a new CSP Fall Seminar tradition: bringing back an accomplished former CSP intern to present from his/her realm of expertise. We're excited to have Jordan back for a no-nonsense open dialogue in which he fields your individual questions and outlines everything you need to know to make a name for yourself in the fitness industry while helping thousands of people all over the world.

**Bonus 3:00PM Saturday Session**

Frank Duffy w/Andrew Zomberg -- A New Approach to Mobility and Injury Prevention

It is important to understand the difference between functional mobility and flexibility in order to help maximize your movement capabilities. In this interactive presentation, Frank will demonstrate the protocols he implements in improving his CSP Strength Campers' movement quality for long-term success.

Location:

Cressey Sports Performance
577 Main St.
Suite 310
Hudson, MA 01749

Cost:

Regular Rate – $149.99
Student Rate – $129.99

Date/Time:

Sunday, October 22, 2017
Registration 8:30AM
Seminar 9AM-5PM

**Bonus session Saturday, October 21 at 3:00pm.

Continuing Education

0.8 National Strength and Conditioning Association CEUs (eight contact hours) Pending (each of the previous five CSP fall seminars have been approved)

Click Here to Sign-up (Regular)

or

Click Here to Sign-up (Students)

We’re really excited about this event, and would love to have you join us! However, space is limited and most seminars we’ve hosted in the past have sold out quickly, so don’t delay on signing up!

If you have additional questions, please direct them to cspmass@gmail.com. Looking forward to seeing you there!

PS - If you're looking for hotel information, The Extended Stay America in Marlborough, MA offers our clients a heavily discounted nightly rate of just under $65.00. Just mention "Cressey" during the booking process in order to secure the discount. Their booking phone number is 508-490-9911.

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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.

Back-Mechanic

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

5. Go to split-stance.

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

Cressey wall slide

Wrap-up

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

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Does “Feel” Matter with Core Stability Exercises?

Just the other day, an online consulting client asked me why he didn't "feel" an anti-rotation chop in his abs if it was supposed to be a core stability exercise. This is a common question in folks who are being exposed to more "functional" core training for the first time.

Really, there are multiple reasons why you won't necessarily feel chops, lifts, and other drills in this regard. I figured I'd use today's article to highlight why that's the case.

1. You're not near the end-range of a muscular action.

The muscular "burn" we're accustomed to feeling at the top of a dumbbell fly or top of a biceps curl is occurring because it's the completion of the concentric phase and the muscle is fully shortened. The length of the rectus abdominus, external obliques, etc. shouldn't change if the drill is done correctly.

2. You're working isometrically.

Most of the time, the "pump" lifters feel with various exercises coming from the "pistoning" action of going through concentric and eccentric motions to bring blood flow to the area. You won't get that feeling as easily when you aren't bringing a muscle in and out of these positions - and with a chop like the one featured above, the goal is to keep the core positioning unchanged. You're working to resist extension and rotation.

Additionally, while you can get a good feel of muscular activation on some isometric drills (e.g., holding the top of a supine bridge with the glutes activated), it can prove to be difficult on drills where adjacent joints are moving simultaneously - as with a chop or lift. With the chops and lifts, you want good rigidity - but not outrageous rigidity that doesn't allow for good movement through the thoracic spine (upper back).

Think about a prone bridge. I can make it be a drill with incredible core stiffness by adding full exhalation and an aggressive bracing strategy; this would really light up the "abs."

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If, however, I want to add a reaching component, or even just transfer this bridge into a push-up variation, then I need to tone down my rigidity a bit. The reach can't happen if I don't.

On this front, spine expert Dr. Stuart McGill has spoken about the importance of learning to differentiate between high-threshold and low-threshold core stability exercises. You don't need to brace as hard on a bowler squat as you do on half-kneeling cable chop, and you don't need to brace as hard on a cable chop as you do on a heavy deadlift. Different movement challenges and external loading parameters must equate to different core stabilization patterns. Nobody ever worries about feeling their abs on a heavy deadlift - and it's because it's so far to one end of this low-to-high-threshold continuum.

3. Some muscles can't get a "pump" easily - and potentially without risk - from an anatomical standpoint.

If you do a biceps curl, you can feel a good burn "feel" at the top of the rep because it's not hard to get full elbow flexion and supination. It's easy to shorten the muscle and go through sufficient reps to make that pump happen.

Your spine is a lot different. You've got to go through quite a bit of spinal flexion to truly shorten your rectus abdominus to get that burn - and some people (particularly those who sit all day) don't handle this position well, especially if repeated "cycles" of flexion-extension are needed to get to this burning point. In fact, if you look at the research, repeated flexion/extension cycles is how you herniate an intervertebral disc in a laboratory setting. This is why a lot of military recruits develop back pain with sit-ups.

In short, sometimes, finding that "feel" is a quick path to musculoskeletal pain - so don't force it.

The take-home message is that you don't have to necessarily "feel" an exercise in a particular place in order to have it be a productive inclusion in your training programs. Sometimes, we have to fall back on the fact that if the movement looks good, the muscles are doing what they're supposed to be doing.

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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.

BadHFStretch

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.

mcgill-300x192

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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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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How to Deadlift: Which Variation is Right for You? – Part 1 (Conventional Deadlift)

It’s no secret that I’m a big fan of the deadlift.

It’s a great strength exercise for the posterior chain with excellent carryover to real life – whether we’re talking about athletics or picking up bags of groceries.

It’s among the best muscle mass builders of all time because it involves a ton of muscle in the posterior chain, upper back, and forearms.

It’s a tremendous corrective exercise; I’m not sure that I have an exercise I like more for correcting bad posture, as this one movement can provide the stiffness needed to minimize anterior pelvic tilt and thoracic kyphosis.

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These benefits, of course, are contingent on the fact that one can perform the deadlift correctly to make it safe.  And, sadly, the frequency of what I’d consider “safe” deadlifts has diminished greatly as our generation has spent more and more time a) at computers, b) in high-top sneakers with big heel lifts, and c) watering down beginner fitness programs so much that people aren’t taught to deadlift (or do any valuable, compound exercises) when starting a strength training program.

To me, there are two ways to make things “safe.”  The first is to teach correct deadlift technique, which I already did with a 9-minute video that is free to anyone who subscribes to my newsletter (if you missed it, you can just opt-in to view it HERE).  This video troubleshoots three common variations of the deadlift: conventional, sumo, and trap bar.

The second is to educate lifters on which deadlift versions are the safest versions for different individuals with different injury histories and movement inefficiencies.  That’s the focus of today’s piece.  We’ll start with the conventional deadlift.

While this version of the deadlift is undoubtedly the “one that started it all,” it’s also the most technically advanced and potentially dangerous of the bunch.  Shear stress on the spine is going to be higher on the conventional deadlift than any other variation because the bar is further away from the center of gravity than in any other variation.  Additionally, in order to get down to the bar and maintain one’s center of gravity in the right position while maintaining a neutral spine, you’ve got to have excellent ankle, hip, and thoracic spine mobility.  Have a look at the video below, and take note of the position of the ankles, hips, and thoracic spine:

You’ll notice that the ankles are slightly dorsiflexed (knees out over toes).  If you are crazy restricted in your ankles and can’t sufficiently dorsiflex, two problems arise:

1. You can’t create a “space” to which the bar can be pulled back toward (a lot of the best deadlifters pull the bar back to the shin before breaking the bar from the floor).  You can observe this space by drawing a line straight down from the front of the knee to the floor at the 2-second mark of the above video:

2. Those who can’t dorsiflex almost always have hypertonic plantarflexors (calves). These individuals always struggle with proper hip-hinging technique, as they substitute lumbar flexion for hip flexion in order to “counterbalance” things so that they don’t tip over.

You’ll also notice that the hips are flexed to about 90 degrees in my example.  I have long arms and legs and a short torso, so I have a bit less hip flexion than someone with shorter arms would need.  They would utilize more hip flexion (and potentially dorsiflexion) to be able to get down and grab the bar.

Regardless of one’s body type, you need to be able to sufficiently flex the hips.  You’d be amazed at how many people really can’t even flex the hips to 90 degrees without some significant compensation patterns.  Instead, they just go to the path of least resistance: lumbar flexion (lower back rounding).

Moving on to the thoracic spine, think about what your body wants to do when the ankles and hips are both flexed: go into the fetal position.  The only problem is that the fetal position isn’t exactly optimal for lifting heavy stuff, where we want to maintain a neutral spine.  Optimal thoracic spine mobility – particularly into extension – brings our center of gravity back within our base of support and helps ensure that we don’t lose the neutral lumbar spine as soon as external loading (the lift) is introduced.

As you can see, having mobility in these three key areas is essential in order to ensure that the conventional deadlift is both a safe and effective strength exercise in your program.  The problem is that in today’s society, not many people have it.  So, what do we do with those who simply can’t deadlift effectively from the floor?

We’ve got two options:

1. We can simply elevate the bar slightly (or do rack pulls) to teach proper hip hinging technique in the conventional stance – and train the movement within the limitations of their ankle, hip, and thoracic spine mobility.

2. We can simply opt to go with a different deadlift variation.  This is something that, for some reason, most previously injured lifters can’t seem to grasp.  They have near-debilitating low back injuries that finally become asymptomatic, and they decide to go right back to conventional deadlifts with “light weights.”  They still have the same movement impairments and flawed technique, so they build their strength back up, ingraining more and more dysfunction along the way.  They’d be better off doing other things – including trap bar and sumo deadlifts – for quite some time before returning to the conventional deadlift.

And, on that note, we’ll examine those two other deadlift variations in parts 2 and 3 of this series.  Stay tuned!

To see how all the deadlift variations fit into a comprehensive strength and conditioning program, check out The High Performance Handbook.

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Oblique Strains in Baseball: 2011 Update

Just over three years ago, during a period where oblique strains were on the rise in professional baseball and the USA Today profiled this "new" injury, I wrote an article on what I perceived to be the causes of the issue.  Check it out: Oblique Strains and Rotational Power. This year, the topic has come back to the forefront, as players like Joba Chamberlain, Sergio Mitre, Curtis Granderson, and Brian Wilson have experienced the injury this spring training alone.

While my thoughts from the initial article are still very much applicable, I do have some additional thoughts on the matter for 2011:

1. Is anyone surprised that the rise in oblique injuries in baseball is paralleled by the exponential rise in hip injuries and lower back pain? I don't care whether you work in a factory or play a professional sport; violent, repetitive, and persistently unilateral-dominant rotation (especially if it is uncontrolled) will eventually chew up a hip, low back, or oblique; it's just a matter of where people break down.

In other words, pro athletes are generating a tremendous amount of power from the hips - moreso, in fact, than they ever have before thanks to the advances in strength training, nutrition, supplementation, and, unfortunately, in some cases, illegal "pharmaceutical interventions."  Assuming mechanics are relative good (as they should be in a professional athlete), rotate a hip faster and you'll improve bat speed and throwing velocity; it's that simple.  This force production alone is enough to chew up a labrum, irritate a hip capsule, and deliver enough localized eccentric stress to cause a loss in range of motion.  The Cliff's Notes version is that we've increased hip strength and power (more on this in a bit), but most folks have overlooked tissue quality (foam rolling, massage, and more focal approaches like Active Release and Graston) and mobility training.

If the hips stiffen up, the lumbar spine will move excessively in all planes of motion - and, in turn, affect the positioning of the thoracic spine.  Throw off the thoracic spine, and you'll negatively impact scapular (and shoulder), respiratory (via the rib cage), and cervical spine.  Hips that are strong - but have short or stiff musculature can throw off the whole shebang.

2. "Strong" isn't a detailed enough description. I think that it goes beyond that, as you have to consider that a big part of this is a discrepancy between concentric and eccentric strength.  Concentrically, you have the trailing leg hip generating tremendous rotational power, and eccentrically, you have the lead leg musculature decelerating that rotation.

Moreover, because the front hip can't be expected to dissipate all that rotational velocity - and because the thoracic spine is rotating from the drive of the upper extremities - you put the muscles acting at the lumbar spine in a situation where they must provide incredible stiffness to resist rotation.  It is essentially the opposite of being between a rock and a hard place; they are the rock between two moving parts.  Structurally, though, they're well equipped to handle this responsibility; just look at how the line of pull of each of these muscles (as well as the tendinous inscriptions of the rectus abdominus) runs horizontally to resist rotation.  That's eccentric control.

How do we train it?  Definitely not with sit-ups, crunches, or sidebends.  The former are too sagittal plane oriented and not particularly functional at all.  The latter really doesn't reflect the stability-oriented nature of our "core."  The bulk of our oblique strain prevention core training program should be movements that resist rotation:

While on the topic, it's also important to resist lumbar hypextension, as poor anterior core strength can allow the rib cage to flare up (increases the stretch on the most commonly injured area of the obliques: at the attachment to the 11th rib on the non-throwing side) and even interfere with ideal respiratory function (the diaphragm can't take  on its optimal dome shape, so we overuse accessory breathing muscles like pec minor, sternocleidomastoid, scalenes, etc).

So, to recap: I don't think oblique strains are a new injury epidemic or the result of team doctors just getting better with diagnostics.  Rather, I think that we're talking about a movement dysfunction that has been prevalent for quite some time - but we just happen to have had several of them in a short amount of time that has made the media more alert to the issue.  The truth is that if we worried more about "inefficiency" and not pathology," journalists could have "broken" this story a long time ago.

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Dean Somerset Interviews Me – Part 1

I recently was interviewed by Dean Somerset, and thought that interview might be of interest to all of you.  He asked some great questions that deviated from the hackneyed "tell us about yourself" and "what's your philosophy?"  Check it out below. DS: You have a very busy facility that trains pretty much every baseball player in the eastern seaboard, you write a daily blog, and write for T-Nation, Men's Health, etc, etc, etc. On top of that, you train like a demon and have a wife and puppy that need the occasional quality time. Have you found some rip in the space-time continuum or managed to clone yourself in order to get all this done?? What's your secret for time management and productivity? EC: I inherited my late grandfather’s love of coffee and managed to find a wife who is quite understanding (although she thinks I am a crazy workaholic as well). Kidding aside, while I have picked up on some good time management strategies over the years, the truth is that I am still very much a work in progress.  The main problem is that when things are going well, it’s tough to cut back – so instead, you keep pushing the bar higher.

When I’m tired and overworked, I usually just remind myself that this is how it’s supposed to be when you start a business.  While I’ve been writing articles since I was 20, the truth is that Cressey Performance is just 3.5 years old.  Read any entrepreneurship textbook and it’ll tell you that the first five years are the most challenging and include the longest hours.  Things have definitely gotten better since 2006-2007, which was undoubtedly the most hours I’ve ever worked, but I’m not ready to rest on my laurels and pat myself on the back. As for strategies on how to get things done, loving what you do is the most important thing.  If you don’t enjoy it, the hours go by very slowly. I actually outlined a few strategies in this blog post as well: How Do You Find Time for Everything? Lastly, I’m very lucky to have an excellent staff that does an awesome job.  When you have good people working all around you, time management is a lot easier – as you don’t have to waste time second-guessing everything they do. DS: I bumped into you waiting for a sandwich at the NSCA conference in Las Vegas last year and joked about how you were easy to pick out as you and your whole crew were wearing Cressey Performance T-shirts and other paraphernalia. For trainers looking to create an image or brand and increase their exposure, what should they do besides printing off kick-ass T-shirts and setting up Facebook pages to increase their drawing power? EC: Treat people right, overdeliver on all your promises, and focus on results.  I’ve had quite a few people tell me that I’m a good marketer over the years – but they are remarkably surprised when I tell them that we haven’t spent a penny on advertising since we opened Cressey Performance.  The truth is that we have grown 100% by word of mouth; our clients are our marketers.

If we make a t-shirt, it’s to give our athletes a sense of ownership in Cressey Performance and help them feel at home.  If we create a Facebook page, it’s to build camaraderie among our clients, disseminate information to make their lives easier, educate them, and help connect them.  If we write blogs about our athletes, it’s because we’re proud of them and want to recognize their achievements.  If we write blogs about our area of focus, it’s because we feel like we have valuable information to share that can really help people. In other words, the client experience – both in terms of enjoyment and results – is at the center of everything we do.  You don’t get exposure and build a brand unless you get results and make people happy. DS: The sacroiliac (SI) joint is a tricky bugger, it's not the low back and it's not technically the mobile part of the hip. What do you do with any suspected sacroiliac dysfunction issues to get them moving and reduce pain? EC: Well, I think that the first step is determining whether whatever is going on is clinically within my scope of practice, and if not, who the right referral is for them.  Two minds are always going to be better than one in solving a problem, and there are specific interventions (e.g., manual therapy) that I can’t offer that would expedite their recovery.  So, the first step is appreciating that I’d likely be working hand-in-hand with someone else to make sure that we’re covering all the important things.  It’s not feasible from a time or skill-set standpoint for me to handle everything, nor would it guarantee the best outcomes (even if that individual did wind up symptom free). That said, I think that one problem we run into nowadays with respect to this particular issue is that everyone just wants to call one-sided back pain “sacroiliac dysfunction.”  It’s almost become a “shin splint” or “impingement” garbage diagnosis that really doesn’t tell us a whole lot about how someone moves.  Many of the folks we’ve seen come through our doors over the years with “sacroiliac dysfunction” have actually been those with previous soft tissue injuries in the area, or even folks with femoroacetabular impingement (FAI) that has just led to chronic spasming in the area because they couldn’t flex or internally rotate the hip sufficiently (particularly in closed chain).  They don’t necessarily have sacroiliac dysfunction; they just have pain on one side that happens to be somewhat near the SI joint.

The truth is that in 85% of cases, lower back pain has no definitive diagnosis.  Even still, over 80% of people have disc bulges or herniations that they don’t even know are there; they’re completely asymptomatic. So, even if we could diagnosis what was structurally wrong in all the cases, we’d never know that it’s exactly what’s causing the pain.  So, we have to look to movement – and here’s what I’ve most commonly seen: 1. Left AIC/Right BC patterning – If you look at the Postural Restoration Institute philosophy, they talk extensively about how many people (especially right handed individuals) are “stuck” in right stance: right hip adduction, internal rotation, and posterior rotation.  Not surprisingly, you see more hip surgeries (labral repairs, sport hernia surgeries, and FAI cases) on the right side – but you also see a lot more sacral injections on that side.  Get people out of right stance – even if you just yell at them every time you see them sinking back into the right hip in standing – can make a big difference.  The PRI folks also have a myriad of corrective drills – from breathing patterning to muscle re-education – to bring people back to center (even if true symmetry isn’t a reality). 2. Poor Motor Control and Strength of the Glutes – We spend a lot of time on our butts – so much, in fact, that they shut down.  The gluteus maximus is active in the sagittal, frontal, and transverse planes, so it’s a big player in hip stability and femoral control. If you don’t use your glutes in the sagittal plane, you’ll hyperextend at the lumbar spine as a compensation (and increase your risk of excessive anterior glide of the femoral head secondary to hamstrings dominance in hip extension).  If you don’t control the femur in the transverse and frontal planes, you’ll end up in excessive adduction and internal rotation – which is “no bueno,” as I described in the previous example. 3. Poor Hip Rotation (and mobility in general) – This works hand-in-hand with the previous two factors, but warrants mention on its own. Vad et al. found that lead hip internal rotation correlated with a history of back pain in golfers, but the problem extends further than just rotational sport athletes.  You need a fair amount of hip internal rotation to squat, so if you’re lacking it – yet including squatting or athletic activity that requires it – it’s not unreasonable to assume that the lumbar spine (or sacroiliac joint) will get a big angry at you eventually.  Likewise, if you have a structural hip issue (like the aforementioned FAI), the lower back is often the first place where people become symptomatic. 4. Poor Thoracic Spine MobilityCharlie Weingroff made a great point that the thoracic spine is an even bigger player in the joint-by-joint approach than just about any other segment, as it interacts directly with the scapulae, rib cage (respiratory system), lumbar spine, and cervical spine.  Just about everyone is stiff in the T-spine, aside from some of the pitchers I see with freaky mobility.  Asymmetrical t-spine mobility is a centerpiece of the PRI philosophy in light of their heavy focus on respiratory function.  The area I see this being a big player the most is in rotational sport athletes, as the thoracic spine allows for continued creation of elastic energy when hip range-of-motion is maxed out – and it’s also essential for creating a longer deceleration arc – whether we’re talking about throwing or swinging/shooting.

5. Poor Core Stability – Here’s my turn to use a garbage term, but let’s be honest: most of the 25% of Americans in low back pain at any given point are the ones who don’t do anything that even closely resembles exercise.  Then they go out to shovel snow, play catch with their kids, or just put on their socks – and their backs go.  They don’t need to be absolute physical specimens to get through life pain free; they just need enough stability to buttress against shear stress and create enough multi-directional stability to handle compression. 6. Soft Tissue Quality – This one is a bit of an X factor and not the answer for everyone, but I won’t lie: I have seen people with years of back pain who get immediate and lasting relief from symptoms following more aggressive soft tissue treatments like Graston and Active Release.  If you use (or overuse) muscles, they can get fibrotic over time.  This tends to work more commonly in a trained population than an untrained population because they’ve accumulated more wear and tear over the years.  The point is simply that you can’t overlook tissue health, especially if there is a previous history of strain. Check back soon for the second half of this interview. Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
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Strength Training Programs and Squat Technique: To Arch or Not to Arch?

Q: I’m confused about when I should arch.  I was re-reading some of your older articles, and noticed that in the Neanderthal No More series, you and Mike Robertson advocate posteriorly tilting the pelvis while performing some core exercises, yet when it comes to performing squat and deadlift technique, you encourage people to maintain the arch.

My back tightens up a lot when I arch strongly, but if I just bend over to touch my toes in flexion, it doesn’t bother me at all.

1.  Could it be possible that I am arching too much during everyday movements and strength exercises?

2.  What really constitutes a neutral spine?  Is it different for each person?

3.  When is it (if ever) appropriate to have a flat spine?

A: The main thing to consider – at least in my experience – is whether there is compressive loading on the spine. In compression, you want an arch - or at the very least, the natural curve of your lumbar spine.  The discs simply don't handle compression well when the spine is in flexion (or flat).  We do more of the posterior pelvic tilt stuff when you are on your back (glute brides, as the glutes posteriorly tilt the pelvis) or on your stomach (if you arch, you're slipping into hyperextension, which defeats the purpose of trying to resist gravity as it pushes you down to the floor).

Bending over is a LOT different than squatting and deadlifting (and comparable strength exercises).  When you add load, the game changes.  Cappozzo et al. found that squatting to parallel with 1.6 times body weight (what might be “average” for the typical weekend warrior) led to compressive loads of ten times body weight at L3-L4. That’s 7000N for a guy who weighs about about 150.  Meanwhile, in a study of 57 Olympic lifters, Cholewicki et al. found that L4-L5 compressive loads were greater than 17,000N. It’s no wonder that retired weightlifters have reduced intervertebral disc heights under MRI! They get strong, but at a "structural price."

According to Dr. Stuart McGill in his outstanding book, Ultimate Back Fitness and Performance, the spine doesn’t buckle until 12,000-15,000N of pressure is applied in compression (or 1,800-2,800N in shear) – so it goes without saying that we’re always playing with fire, to a degree – regardless of the strength training exercise in question, as there’s always going to be compressive loads on the spine.  That’s a laboratory model, though; otherwise, the Olympic lifters above wouldn’t be able to handle much more than 12,000N without buckling.  In the real world, we have active restraints – muscles and tendons – to protect our spine.

If those active restraints are going to do their job, we need to put them at a mechanical advantage – and flexion is not that advantage.  The aforementioned Cappozzo et al. study demonstrated that as lumbar flexion increased under load, compressive load also increased. In other words, if you aren’t mobile enough to squat deep without hitting lumbar flexion (because the hips or ankles are stiffer than the spine), you either need need to squat a little higher or not squat at all. That said, I don't think that you have to force a dramatic arch when you squat (or any strength exercise, for that matter); I think you need to brace your core tightly and create stability within the range of motion that you already have – and, indeed, “neutral spine” is different for everyone.  For instance, females have an average of 5-7 degrees of anterior pelvic tilt, whereas males are more like 3-5 degrees - meaning that females will naturally be a bit more lordotic.

Having sufficient lumbar flexion to touch your toes with “uniform” movement through your lumbar spine is certainly important, and for most, it’ll be completely pain free (regardless of range of motion), but that doesn’t mean that a flat or flexed lumbar spine is a good position in which to exercise with compressive load.

So, to recap:

1.  Neutral spine is different for everyone.  What’s the same for everyone is the need to have stability within the range of motion that you’ve got.

2. Flexion is fine (and a normal functional task) when it isn’t accompanied by compressive loading.  And, there is a different between subtle lumbar flexion and end-range lumbar flexion.

3. Arching (lumbar extension) doesn’t need to be excessive in order to be effective in improving tolerance to compressive loads.  In most cases, that “arch” cue simply keeps a person in neutral spine as they go into hip flexion in the bottom of a squat or deadlift (or comparable strength exercise).  “Arch” doesn’t mean “hyperextend;” it means to maintain the normal lordotic curve of your lumbar spine.

Looking to learn more?  Check out Functional Stability Training, a comprehensive resource for assessment, programming, and coaching.

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All Young Athletes are “Injured” – even if they don’t know it

I've written quite a bit in the past about how one should always interpret the results of diagnostic imaging (MRI, x-ray, etc.) very cautiously and alongside movement assessments and the symptoms one has.  In case you missed them, here are some quick reads along these lines: Preventing Lower Back Pain: Assuming is Okay Who Kneeds "Normal" Knees? Healthy Shoulders with Terrible MRIs? While some of these studies stratified subjects into athletes and non-athlete controls, not surprisingly, all these studies utilized adult subjects exclusively.  In other words, we're left wondering if we see the same kind of imaging abnormalities in asymptomatic teenage athletes, which is without a doubt our most "at-risk" population nowadays. That is, of course, until this study came out: MRI of the knee joint in asymptomatic adolescent soccer players: a controlled study. Researchers found that 64% of 14-15 year-old athletes had one or more knee MRI "abnormalities", whereas those in the control group (non-athletes), 32% had at least one "abnormality."  Bone marrow edema presence was markedly higher in the soccer players (50%) than in the control group (3%). Once again, we realize that just about everyone is "abnormal" - and that we really don't even know what "healthy" really is.  So, we can't hang our hat exclusively on what a MRI or x-ray says (especially since we don't have the luxury of knowing with every client/athlete we train).  What to do, then? Hang your hat on movement first and foremost in an asymptomatic population.  Do thorough assessments and nip inefficiencies in the bud before they become structural abnormalities that reach a painful threshold. Sign-up Today for our FREE Newsletter and receive a detailed deadlift technique tutorial!
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