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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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 BCpatterning – 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 Mobility – Charlie 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.
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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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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 OkayWho 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.
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I wrote yesterday about how fantastic I think Charlie Weingroff's new DVD set, Rehab=Training, Training=Rehab is. Now that it's on sale, I thought I'd use my next few posts to highlight the top ten key points he made that really stood out in my mind. Here are the first five.
1. I hear people saying all the time that they need to find a niche – and I’ve written in the past about how I found my own niche. As Weingroff points out, we’re all working with the same platform and set of rules: how the body works. A “niche” just comes about because we get good with working with those rules in specific populations to create a subspecialty. I train baseball players using my unique methodology, but there are others out there getting results in this population with different modalities, too, because they're performed correctly and these folks keep the original set of rules in mind. Likewise, there are folks with similar thought processes as mine - and they're getting results in populations outside of the baseball world.
The take-home message on this point is that if you want to be a specialist in your niche, you need to understand general principles first.
2. We’re always trying to find the “link” between terrible movement and pathology/diagnosis – and Charlie offered a good perspective in light of the joint-by-joint theory of movement (a central piece of his two-day presentation). When mobile joints become stable, we get degenerative changes (arthritis) and poor recovery. When stable joints become mobile, we end up with dislocations, positional faults, muscle strains, and disc herniations. Want to prevent or address these issues? Work backward along this line of logic with your corrective exercise strategy.
3. Speaking of the joint-by-joint approach, Charlie offered the most comprehensive approach I’ve seen. Traditionally, this approach has been discussed largely in the context of the sagittal plane only, but it definitely has frontal and transverse plane implications as well. Weingroff also went into more detail on the neck and foot than I’ve seen – as you have alternating mobile/stable joints within these entities, too.
4. Typically, a joint in this school of thought will only really have two direct impacts: the joint above it and the one below it. The hip might impact the knee or lumbar spine, for instance.
The thoracic spine, however, has more far-reaching effects, though, and that’s likely why it’s such a crucial area of focus. It affects four systems: the neck, ribs (respiration), scapula/clavicle, and the lumbar spine. So, if you’re seeing a lot of “gross” dysfunction above the hips, it’s often the best place to start with your corrective exercise.
5. Charlie goes to some great lengths in defense of the vertical shin (tibia) as compared to the angled shin during various tasks, most notably squatting. He raises an interesting question in asking whether it’s really a good thing for both the femur and tibia to move simultaneously during the angled shin squat – as it essentially works in contrast to the joint by joint theory of movement he proposes.
Meanwhile, almost every day, we see folks whose knee pain disappears when we teach them to squat with a vertical shin – effectively letting the femur move as the tibia stays still. The same goes for teaching folks to deadlift, do pull-throughs, or anything else that emphasizes “hips back” as opposed to “knees forward.”
Admittedly, Charlie says it much better than I do, though! And, I should note that he emphasizes mastering the movement far more than simply loading it up - especially if we are talking about loading up a dysfunctional pattern (not a good idea).
I'll be back with five more takeaways tomorrow, but in the meantime, check out Charlie Weingroff's Rehab=Training, Training=Rehab at the introductory price HERE.
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Today, we move forward with more strategies for correcting bad posture. In case you missed it, be sure to check out Strategies for Correcting Bad Posture: Part 1. We pick up with tip #5...
5. Don't overlook a lack of glenohumeral (shoulder) joint internal rotation. When it comes to bad posture, everyone thinks that the glenohumeral joint is only a "player" when it's stuck in internal rotation; that is, the ball - or humeral head - is rotated too far forward on the socket - or glenoid fossa - meaning that the individual just doesn't have adequate external rotation. And, this is often true - especially in non-athletic populations.
However, you'll also very commonly see poor posture folks who present with big glenohumeral internal rotation deficits (GIRD), particularly on the right side (for very legitimate reasons that go well beyond the scope of this article). This is much more common in athletes, particularly overhead throwers (read more: Static Posture Assessment Mistakes). When the posterior rotator cuff is stiff/short and there is an internal rotation deficit, we have to substitute excessive scapular protraction (winging) or thoracic flexion/rotation each time we reach for something.
So, for many folks, posterior shoulder mobility and soft tissue work is an important inclusion in cleaning things up in terms of appearance, function, and shoulder health. If - and only if - you've been assessed and it's been determined that you have an internal rotation deficit that compromises your total motion at the glenohumeral joint, you can integrate some gentle sleeper stretches (scapula stabilized!) to get a bit more ROM in the posterior cuff.
6. Don't overlook a lack of glenohumeral (shoulder) joint flexion. The shoulder is a tremendously mobile joint, so we need to appreciate what goes on outside the transverse plane as well. In particular, I see shoulder flexion limitations as a big problem. These limitations may come from the lat, teres major, long head of the triceps, or inferior capsule. Another overlooked cause can be posterior cuff restrictions; it's not uncommon to see both GIRD and major shoulder flexion limitations on the same side. As the picture below shows, the infraspinatus and teres minor run almost vertically when the arm is abducted a mere 90 degrees - which means that they're struggling to lengthen fully to allow full shoulder flexion (and abduction, for that matter).
These restrictions that can contribute to both faulty compensation patterns in certain positions, as well as overall bad posture chronically. Let's have a look at what these issues look like in the real world. First, in someone with a shoulder flexion limitation, you'd first want to check them in the supine position, with the knees flexed and back flat (to avoid substituting lumbar extension for shoulder flexion). Ideally, the arms should rest flat on the table - so this would be a "not-so-hot" result (especially since the arms "fall" to the sides a bit instead of staying in "attempted flexion"):
Next, let's take this same shoulder flexion limitation, and look at what would happen actively. In the first three reps of the video below, take note of the position of our subject's head at the start and finish of each rep; you'll see that as he "runs out" of shoulder flexion, he substitutes forward head posture. On the next three reps, after I cue him to keep his cervical spine in a more neutral posture, he has to arch his back excessively (lumbar hyperextension) to complete the movement.
Now, imagine taking this walking disaster (only kidding; I had Dave fake it for the video, as he's actually a finely tuned trained killing machine who can't be stopped by conventional weapons - and he's single, ladies) taking up overhead pressing, Olympic lifting, or just reaching for a glass on the top shelf. Then, imagine him doing those tasks over and over again. Obviously, the posture will get worse as he reinforces these compensation schemes - but something is going to surely break down along the way; it's just a question of whether it's his low back, shoulder, or neck!
Correcting these issues is easier said than done; as I noted, there are several structures that could be the limiting factor. However, for those looking for a relatively universal stretch they can use to get a bit of everything, I like the wall lat stretch with stabilization, one piece of a comprehensive (but not excessive and boring) static stretching program included in Show and Go.
7. Don't ignore the thoracic spine. The previous two examples focused exclusively on the glenohumeral joint, but the truth is that it is tremendously dependent on thoracic spine positioning. Ask any physical therapist, and they'll tell you that if they can get the thoracic spine moving, they can instantly improve glenohumeral joint range-of-motion without even touching the shoulder (this is incredibly valuable with folks who may have stiff glenohumeral joints that can't be mobilized aggressively following shoulder surgery; they need ROM in any way possible). And, truthfully, you can substitute a lack of thoracic spine extension for the shoulder flexion problems and compensation schemes above, and a lack of thoracic spine rotation can work in much the same way as a GIRD (substitute excessive scapular protraction with reaching tasks).
If you ever want to quickly check to see what limiting thoracic extension does to someone's upper body posture, just put them in supine position and push the sternum/rib cage down - which will bring the thoracic spine into flexion. Watch what happens to the position of his chin, and the size of the "gap" between his neck and the table:
Now, just consider what kind of "yank" this puts on the sternocleidomastoid chronically...
...and you'll understand why a lack of thoracic spine mobility can give people enough neck pain and tension headaches to make Lindsay Lohan's hangovers look like a walk in the park. And this doesn't even consider what's going on with scalenes, suboccipitals, levator scapulae, subclavius, and a host of other muscles that are royally pissed off! Also, think about all those folks in your gym doing hours and hours of crunches (especially while tugging on the neck). Ouch.
For that reason, we need to get our thoracic spine moving - and more specifically, we need to get it moving in both extension and rotation. I've mentioned in the past that the side-lying extension-rotation is one of my favorites (assuming no symptoms); remember that the overwhelming majority of the range-of-motion is coming from the upper back, not just the shoulder:
Here's another we're using quite a bit nowadays in our folks who have good internal rotation (which we want to keep!):
8. Watch your daily habits and get up more frequently. I'm at 1,140 words for this post right now - plus several pictures and videos. In other words, some of you might have been hunched over your computer screens trying to figure out what I'm saying for over 20 minutes now - and that's when "creep" starts to set in an postural changes become more and more harmful (both aesthetically and functionally).
With that in mind, make a point of getting up more frequently throughout the day if you have to be sitting a ton. Likewise, "shuffle" or "fidget" in your chair; as Dr. Stuart McGill once said, "The best posture is the one that is constantly changing." Now, shouldn't you get up and walk around for a few minutes?
Here are a few blasts from the past that you definitely ought to check out:
Lower Back Pain and the Fitness Professional - It's amazing how many fitness professionals know NOTHING about lower back pain even though it will occur at one point or another in every single one of their clients.
Can Little Leaguers Strength Train? - It's a question I get all the time - and this was my first response to the inquiry a few years ago. I updated this and got a bit more detailed and geeky in a follow-up, The Truth about Strength Training for Kids.Solutions to Lifting Problems - This T-Muscle article is a must-read for anyone who wants to be able to stay the course even when setbacks occur along the resistance training journey.
Lastly, for those who are looking to shed some pounds over the holidays while everyone else is packing 'em on, check out these two free Holiday Fat Loss special reports from Joel Marion. Joel's got some quick and easy to apply tips you can put to use right away.
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Today's guest blog comes from current Cressey Performance intern, Conor Nordgren.
We’ve all heard those stories about the training regimens of celebrities and how they do 500 crunches first thing in the morning and 500 more right before bed to get that perfect six-pack of abs. Many of you have probably also seen that infamous video of T.O. performing crunches while conducting an interview with reporters.
While exercises like crunches and sit-ups can bring out those abs and sculpt a nice six-pack, is this the safest method to train the core? Top strength and conditioning coaches like Eric Cressey, Tony Gentilcore, Mike Robertson, Mike Boyle, and Jason Nunn have recently written and talked on the subject and say that it is not.
As an intern at Cressey Performance, I’ve been exposed to a ton of programs and not a single one of them has included a crunch or a sit-up. Here’s why:
If you’re familiar with Mike Boyle’s joint by joint approach to training, you know that the lumbar spine requires stability as opposed to mobility. Think about the execution of a conventional sit-up: what is your lumbar spine doing? That’s right, it’s flexing. The lumbar spine is not designed for a great deal of movement (whether it is flexion or extension), let alone repetitive movement. Our spine as a whole is not meant for a ton of flexion or extension, either. While you may “feel the burn” in your abs when performing a set of crunches, you are essentially training spinal flexion. World-renowned low-back researcher Dr. Stuart McGill says that we have a finite number of flexion/extension cycles in our back until injury is caused. That number is different for every person, but the bottom line is that by performing exercises like crunches and sit-ups, you’re increasing your risk for injury with every rep! Dr. McGill has actually done experiments where he’s put pig spines in a crunch machine and after a certain number of crunches, or flexes, spinal disks explode.
Crunches and sit-ups also promote a kyphotic, or rounded back, posture. Visualize someone in the top position of a crunch or a sit-up. Now, keep that visual of their upper-back, but picture them standing up. Hello Quasimodo!
Would you consider this good posture? Of course you wouldn’t (well, hopefully not). So why would we want to reinforce it?
James Porterfield and Carl DeRosa have written that the core musculature is primarily designed to transmit force, not to produce it. While crunches and sit-ups are promoting flexion of the spine, our core should instead be trained in preventing movement. If we train our core to be rigid and prevent movement, the stronger it will be; this translates to more overall force production throughout the whole body which will allow for bigger lifts. Sounds pretty good, huh?
Thanks in large part to Mike Robertson, we’ve been introduced to four acceptable movement patterns that should be utilized when training the core. They are anti-rotation, anti-extension, anti-lateral flexion, and hip flexion with a neutral spine. While there are several variations of the following exercises, here are some of my favorites:
Anti-rotation: Tall Kneeling Pallof Press – the kneeling version really forces you to use your glutes and your core, since your quads are taken out of the picture (this exercise can also be done on a cable machine).
Anti-extension: Ab Wheel Rollouts – progress to band-resisted or off of a box for added difficulty.
Anti-lateral flexion: Waiter Carries – can also be done with a kettlebell.
Hip Flexion with a Neutral Spine: Prone Jackknifes with a stability ball – you may find this to be one of the more challenging movements, so really focus on keeping that core tight!
Some of you may have a hard time imagining your workout without any crunches or sit-ups. You might be skeptical that the above exercises may not get you the results that you desire. Well, Tony “The Situation” Gentilcore performs these movements on a regular basis, and when he voluntarily and superfluously flashes his abs at us interns every day, let me tell you, I could wash my clothes on those things! But seriously, change is hard and not an easy thing to accept. However, the good thing about change is that it can be for the better. I’m not demanding that you immediately stop performing crunches and/or sit-ups; that choice is yours. It’s my hope that you think about how you’re currently training your core and ask yourself if this is the most optimal, functional, and above all else, SAFEST way to do so. This may help to keep you injury-free down the road so you can continue hitting the iron hard.
Conor Nordengren can be reached at cnordengren@gmail.com.Sign-up Today for our FREE Newsletter:
I suppose this blog title is more of a rhetorical statement than an actual question, but I'm going to write it anyway.
Just about every week, I get someone who comes to Cressey Sports Performance - either as a new client, or as a one-time consultation from out of town - and they have some issue that is bugging them to the point that they opted to see a doctor about it. This doctor may have been a general practitioner or an actual sports orthopedist. In many cases, the response from this medical professional is the same "Just rest."
"It hurts when you lift? Then stop lifting."
Huh? When did COMPLETE rest because a viable recommendation?
In case folks haven't noticed, a scary number of Americans are overweight or obese. Even if rest was the absolute key to getting healthy, telling them to not move is like not seeing the forest through the trees. Your bum knee will feel better, but you'll have a heart attack at age 43 because you're 379 pounds.
Oh, and nevermind the fact that exercise generally improves sleep quality, mooed, and immune, endocrine, and digestive function. I'm not going to lie: I would rather have an achy lower back than be fat, chronically ill, sleep-deprived, impotent, angry, and constipated.
But you know what? The good news is that you can still exercise and avoid all these issues - regardless of symptoms. I can honestly say that in my entire career, I've never come across a single case who couldn't find some way to stay active.
And, when I did an internship in clinical exercise physiology, we trained pulmonary rehab patients in spite of the fact that they often had interruptions during their sessions to cough up phlegm for 2-3 minutes at a time.
All over the world, people are using exercise to rehabilitate themselves from strokes, heart attacks, spinal cord injuries - you name it.
However, Joe Average who sleeps on his shoulder funny and wakes up with a little stiffness needs complete rest and enough NSAIDs to make a liver cringe.
Sorry, but you're going to need to be on crutches, in a back brace, with poison ivy and a punctured lung to get my sympathy. And, you're sure as heck not going to get it if you're just "really sore" from your workout routine. Seriously, dude?
I don't care what your issue is: "just rest" is almost never the answer (a concussion would be an exception, FYI). When a health care practitioner says it, it's because he/she either a) doesn't have the time, intelligence, or network to be able to set you up for a situation where you can benefit from exercise or b) doesn't think you have enough self control to approach exercise in a fashion that doesn't make it more harm than good.
There is almost always something you can do to get better and maintain a training effect. While adequate rest for injured tissues is certainly part of the equation, it is just one piece in a more complex puzzle that almost always still affords people the benefits of exercise.
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Here's a look back to some featured posts that might interest you:
Deloading in Maximum Strength - While The Art of the Deload goes into a ton of detail on a variety of deloading strategies, several folks have asked me how it specifically applies to the Maximum Strength program. This clears things up.
Lower Back Savers Part 1, Part 2, and Part 3 - This three-part series at T-Nation are among my most popular articles there.
Unstable Ground or Destabilizing Torques - This blog will make you think about what you see when you watch sports on TV - and, more specifically, how athletes prepare themselves for those demands.
