It's widely known that approximately 80% of the population will suffer from lower back pain at some point during their lives. What isn't widely known, however, is that even those who are asymptomatic are usually walking around with a host of nasty stuff going on with their spines. Don't believe me?
A 1994 study in the New England Journal of Medicine found that in a study of MRIs of 98 asymptomatic individuals, 82% of those MRIs came back as positive for a disc bulge, protrusion, or extrusion at one level. And, 38% actually had these issues at more than one level. You can read the free full text HERE.
As the others discovered, it doesn't stop with disc issues, either - and that's where a great study from Soler and Calderon comes in. They looked at the incidence of spondylolysis (vertebral fractures) in elite Spanish athletes, and found that 8% of those they examined had them. Only about half of those diagnosed via imaging actually had back pain, though. The incidence was highest in track and field throwers, rowers, gymnasts, and weightlifters - and I'd expect that this figure is actually higher in the U.S., where we have more sports (hockey, baseball, lacrosse) involving violent extension and rotation, more contact sports, and more participation in weight training.
What does this mean for us? Well, as Chou et al. reported in The Lancet, "Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition." That's not the point of my article today, though; I'll leave that stuff to the physicians to decide and rehabilitation specialists to interpret and treat.
As fitness professionals, strength coaches, and even just fitness enthusiasts and athletes, we need to assume that there is are probably a lot of structural abnormalities going on in the spines we encounter - including our own. The programs we write and follow need to be sound and take these issues into account, considering differences in age, gender, sport participation, and injury history. The technique we use needs to position us so that we can avoid causing them to reach threshold. And, we need to appreciate that there is a risk-reward balance to be "struck" with everything we do in training because nobody will ever be "perfectly prepared" for the demands to be placed on their bodies.
Rather than lay all my thoughts out here, I'm going to direct you to some previous writing of mine:
About a year ago, Mike Robertson came out with an outstanding product, The Single-Leg Solution - and it reminded me of an experience I once had at a seminar. A guy posed the following question to a panel of speakers in which I was included:
"If you could only choose one exercise to do, what would it be?"
We all agreed that it was a pretty stupid and unrealistic question, but reluctantly, we each answered. In spite of my distaste for the question, I responded without hesitation: "Lunges - or any single-leg exercise, for that matter."
In my eyes, single-leg work really is that valuable - and for a lot of reasons.
(Gold star to none other than me for thinking of up the title for him. Booyeah.)
So why is single-leg work the best thing since sliced bread?
First, there is obviously going to be some direct carryover to the functional demands of life and athletics, as we spend most of our life on one foot in one capacity or another. Muscular recruitment patterns are different for bilateral and unilateral exercises, so in terms of specificity, single-leg work really can't be beat.
Second, it's much more lower-back friendly, as you can load single-leg exercises appreciably without axial loading. And, to take it a step further, it is easier to maintain neutral spine (and avoid lumbar flexion with compressive loading) with a split-stance - regardless of whether you axially load or hold the weights in the hands at one's sides. Simply stated, while single-leg exercises will never (at least in my eyes) take the place of squatting and deadlifting, they are absolutely essential supplemental exercises for one's training repertoire.
Third, in the case of back pain (or hip pain, with femoroacetebular impingement being an example), they're hugely helpful in allowing one to maintain a training effect in spite of whatever pain is present.
Fourth, single-leg exercises are hard. Let's face it: most people exercise like pansies and pick the exercises they like the most, not the ones that they need the most - or the ones that are the hardest. This is 225 pounds for eight pretty effortless reps, which makes girls want him and guys want to be him (or something like that).
Fifth, Robertson insists they are good, and this guy knows as much about knees as anyone I've ever met. If you want to keep your wheels strong and healthy for the long-term, including them is a no-brainer.
This is just five reasons to include single-leg work in your programming, and frankly, Mike includes a heck of a lot more in the 96-page tag-along manual that accompanies the 60-minute DVD in The Single-Leg Solution Package.
Knowing that single-leg work is important isn't enough, though, as I see exercise enthusiasts and fitness professionals alike absolutely butchering the technique on these exercises. And, they have absolutely no rhyme or reason for the "who, what, when, where, why" they include them; it is just throwing a wad of turd on the wall to see what sticks. Optimal progress is dependent on population-specific exercise selection, pristine technical execution, and pinpoint exercise progressions - and this is where Mike really shines with this product.
So, whether you're a personal trainer, bodybuilder, powerlifter, runner with knee pain, desk jockey with a bad back, or just some random dude who wants to get stronger, move better, and be just a little more awesome, I'd highly encourage you to check out The Single-Leg Solution..
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Thus far this week, we've covered the top articles, product reviews, videos, and guest submissions of the year. Today, I just wanted to cover the stuff that was fun for me to write (or film) - and it isn't just exclusive to EricCressey.com.
Birthday Blogging: 28 Years, 28 Favorites - I just remember that this thing rolled off my fingertips as I wrote it on my 28th birthday.
What Folks are Saying about the Cressey Performance Majestic Fleece - I just remember that we had to film this about 47 times because none of us could stop laughing.
The Opportunity Cost of Your Time - I don't know why this one was fun to write, but it was. I suppose it might have something to do with the fact that I started out at business school, and then moved over to the exercise science world to complete my undergraduate degree.
The Truth About Unstable Surface Training - This was actually introduced at the end of 2008 (and written in sections between 2005 and 2008), but deserves mention in light of its first full year of availability. I'm most proud of this work because it took a ton of time to compile both the literature and our original research, which was the first of its kind. Nobody had looked at how a long-term training lower-body unstable surface training intervention would affect healthy, trained athletes' performance. This book presents not only those results, but a series of practical application recommendations that are of value to any strength coach, personal trainer, or other fitness professional.
Lower Back Savers Part 1, Part 2, and Part 3 - Featured at T-Muscle, these were really fun to write because I had a chance to be dorky and practical at the same time, blending research with what we've anecdotally seen in those with lower back issues. Honestly, I still have enough content to write a part 4, and that may come around in the next few months.
This week, I've already featured our top articles, product reviews, and videos of 2009. I was also really lucky to have some bright minds as guest contributors this year, and today I'll feature a few of their submissions.
The Rocker Inferior Capsule Stretch - This excellent submission from physical therapist Tim DiFrancesco shows a shoulder mobility exercises we've used with some of our guys with excellent results. It includes some great videos like this:
So What Does a Pitching Coach Do, Anyway? - I love this guest blog from Matt Blake, a great pitching guy with whom I get to work daily. It just goes to show you that there is a lot more to understand than mechanics when it comes to developing elite pitchers.
Real Activation: Modifying a Classic Core Movement - Jim Smith is perhaps best known for being a true innovator when it comes to exercise selection, and this post was an excellent one for that very reason.
This week, we've already covered the most popular articlesand product reviews from EricCressey.com in 2009. Next up are the popular videos.
One of my goals for 2009 with this site was to include a lot more video content - whether it was "built in" to the text, or serving as a stand-alone content source in itself. Here were some of the most popular ones for the year:
Correct Push-up Technique - This one got over 9,000 views in spite of the fact that I never even included it in a blog post (that I can remember). I guess my theory that most people really need to learn how to do good push-ups was right on the money.
My 660 Deadlift - I guess lifting heavy stuff is only about 89% as cool as body weight push-ups.
Tim Collins Can Jump - Great guy, stud athlete, bright future. Gotta' love him.
16x16 Sled Madness - This sled masochism was popular among our staff early in the year. There is more info on it HERE.
Rollouts: Friend or Foe - This video went hand-in-hand with this newsletter.
Anterior Core Progressions - This video was a follow-up to the previous one, and was found in this newsletter.
Measuring Hip Internal Rotation - This video was featured as part of this newsletter.
Lastly, there were a few newsletters that included a ton of video content. Here's my personal favorite, a follow-up from Mike Reinold and my shoulder seminar (available soon on DVD): Recap: Testing, Treating, and Training the Shoulder.
Tomorrow, we'll cover the top guest submissions for the year at EricCressey.com.
As you're reading this, I'm either watching a seminar in Arizona, or flying back from the trip. Luckily, I prepared this list of recommended reading for the week in advance:
Is the Seated 90/90 Stretch Safe? - This great Q&A with Bill Hartman emerged following a question from a reader after we released Assess and Correct. It's definitely worth a read.
The Best Exercise You're Not Doing - This was an excellent piece from Matthew Hertilus last week at T-Muscle. We use the Turkish Get-up quite a bit with our athletes, and this article does a fantastic job of teaching the lift - complete with video tutorials.
Returning to Deadlifting after a Back Injury - This newsletter from a while back was a popular one. If you've got poor deadlifting technique or you've had an injury performing the lift in the past, it's definitely worth a read.
Here's a quick continuation of last week's newsletter, which featured some introductory anterior core training exercises and the rationale for them. You'll need a TRX set-up to do these; it's an awesome investment, if you haven't picked one up already. They make it very easy to take your training anywhere you go.
For more information on my overall approach to core training and where these exercises fit in, I encourage you to check out Part 3 of my Lower Back Savers series.
Q: I recently purchased Show and Go and noticed that you include barbell rollouts in the weight training program. I did this exercise at the end of an aerobics class and was told by the fitness instructor not to do it, as it was a dangerous exercise. Given it's in your book, I gather you deem it a safe exercise. What is your opinion on this exercise? Do you know why some people say it's a dangerous exercise?
A: As with just about everything, the devil is in the details. For many individuals, this is a fantastic exercise. For others, it may be too advanced. And, for another group of folks, it just isn't good because it gets absolutely butchered technique-wise. Let's attack this piece by piece with a rationale for its inclusion/exclusion, and then some training options and coaching cues:
(yes, I know I said "A" and then "2." Gotta love live TV!)
You can progress this exercise a bit more by either elevating the knees slightly or going to a band-resisted ab wheel rollout. Just a heads-up: in this video, the athlete should have stopped a bit shorter in the top position to avoid the subtle lumbar rounding that took place; it's a good demonstration of technique that's good, but not quite perfect:
To learn more comparable exercises and see how they fit into a comprehensive weight training program, check out Show and Go: High Performance Training to Look, Feel, and Move Better.
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