Today, we've got a guest blog from Jim "Smitty" Smith.
I was speaking with Mike Robertson the other day about life and we started talking about our next career moves. He was contemplating a run with Chippendales after his idol, Jeff Timmons of 98 Degrees, made a comeback. And I was telling him about my idea to get on the Deadliest Catch show and live my dream of being a fisherman. Both ideas were great and we are continuing to take steps forward to achieve our dreams — a little bit every day.
After that 3 hour discussion, we started talking about bracing.
Just Like the Volume Dial
I was telling Mike how I was going through Charlie Weingroff’s Training=Rehab | Rehab=Training and I had some questions about how he defines or explains bracing. I, of course, understand bracing as a whole and teach it for our max efforts and loaded means, but Charlie introduced me to the idea of the importance of the "inner core". That is what I wanted to discuss with Mike. Charlie stated that the inner core must fire first, neurologically, to setup up the foundation for the more intense loading or more sophisticated movements — this is when the "outer core" should kick in.
Mike told me to imagine the volume dial on your stereo. He asked me on the volume scale, where wouldplanks come in? I stated "1", and smiled like I just stole something. He then asked, "Where would the dial be for max efforts squats?" I was catching on and said "10"! Duh WINNING!
But Charlie and Mike threw up a caution flag.
If we brace at "10" all the time (force and brace our abdomen outward, anterior and laterally to create tension or irradiation to buttress shear and stabilize the torso) , it could "shut down" the inner core and leave us susceptible to injury. This is especially true if the establishment of bracing is not preceded by diaphragmatic breathing. The long term inhibition of diaphragmatic breathing can affect a whole host of things like pelvic alignment => which can inhibit and shorten certain muscles groups (lower cross and upper cross syndromes) => create kyphosis and lordosis and much more. The ramifications will be seen up and down the kinetic chain.
Turning Up the Intensity
There is a time for "breathing over the brace" at the lower intensities and there is a time for serious tension — take max effort strength exercises. If you look in most commercial gyms today, you might think talking on the cell phone or getting a drink at the water fountain is a max effort lift, especially with all of the cinched up velcro belts popping off. In reality, we’re talking about heavy compound movements performed with loads upwards of 80% + 1RM. These components of your strength training program require serious intramuscular and intermuscular coordination and full body engagement to remain injury free, stable and strong throughout the full execution of the lift. Also many times you’ll see novice, and sometimes experienced, lifters start the movement with a good brace, but lose it during the decent or accent. It is definitely a skill to keep "the brace" the whole time you are under load. Verbal and physical cues can be used to drill this technique. Training with an injury or other compensations will also directly impact your ability to keep the brace throughout.
Bracing for Max Attempts
If you talk to any elite powerlifter, bracing for max efforts involves not only keeping the tension (sequenced isometric contractions on the primary / synergistic / antagonistic muscle groups) but also holding your air. The air is taken (breathing through the belly) and held, and the abdominals are pressed outward forcibly. If you are pressing out against a stationary object (i.e. the belt) it will further secure the brace and improve torso rigidity. This is volume level "10". As you can see this is much different than the bracing required for a plank. Also remember, heavy bracing is not limited to just max effort attempts. Any high intensity movements could require sequenced bracing, if only for an instant.
The Ah-Ha Stuff
During simple, basic movements we should drill and become proficient at simply creating tension (bracing level "1") across the entire kinetic chain and "breathing over the brace" (Weingroff) through active diaphragmatic breathing. This will help to engage intra-abdominal pressure and lay the foundation for all of our movements. And as we progress, more intense bracing can allow for heavier loads and more powerful movements to be introduced safely.
It was very enlightening for me to understand how breathing incorrectly could have just as much of an impact on posture, strength and performance as injuries, immobility, instability, high volume | short ROM movements or even too much load with poorly performed exercises.
All this talk of volume has got me reaching for my glow sticks. Off to battle with Tony Gentilcore!
Jim Smith "Smitty" is the head strength and conditioning coach at Diesel Strength and Conditioning in Elmira, NY. Smitty has been called "one of the most innovative coaches in the industry" and has written for most major national fitness publications. He is also a featured writer for LIVESTRONG.com and on the EliteFTS Q/A staff. Check out some killer FREE gifts and his site at dieselsc.com. Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
Just a quick FYI for today's blog:
Jim "Smitty" Smith is re-launching his Combat Core e-manual. As some of you know, I think it's a fantastic product that I've heartily endorsed in the past. You can read a full review I wrote HERE.
Anyway, with the relaunch, Jim's offering a ton of new bonuses - from articles to audio teleseminars. Needless to say, it's a great product independent of these bonuses, so the deal is just even sweeter for now. Check it out HERE.
1. It's come to my attention that over 54 million people have come to recognize this young YouTube guitar dude as a total bada**, so it seemed only fitting that he be today's music selection:
Had I not won the Nobel Prize at age 12 and hopped up Mt. Everest on one leg at 16, I might be wondering what the heck I was doing with my life at age 27 after watching that. But, let's move on to the good stuff.
2. It wouldn't be a week in my apartment if my girlfriend didn't watch "The Biggest Loser" with me in the room contemplating ripping my hair out. I got a kick out of it this week when they had a 30" plyo box in the center of the gym. I don't know of many 400-pound folks with vertical jumps that good, but apparently, it does make a great platform on which you can set your bottle of water. Now that's training economy.
3. If you thought the kettlebell trend was getting out of hands, just have a look at this:
Bench Pressing Dwarves: I Kid You Not
As long as they don't call me "comrade," I'm cool with it. Success is all about adherence, so if it takes the weight and attitude of a feisty human exercise prop giving you hell on every rep to get the job done - and that person doesn't mind - so be it.
4. We do a lot of anti-extension work with our athletes. While these progressions start with basic prone bridging, you can progress them to overhead medicine ball throwing variations and (my personal favorite) ab wheel variations. We'll do isometric holds, regular reps, and - as seen below - band-resisted ab wheel rollouts.
This is just one of over a dozen innovative, effective exercises Jim Smith introduces in his Combat Core resource; it's definitely worth checking out.
5. It's come to my attention that a tiny portion of my readers get all huffy when I don't post references for my blogs. While I could go to the trouble of posting references in all of them, the truth is that it clutters things up and takes away the informal tone of this blog. And, frankly, I often write these in my boxer shorts and unshowered, with a raging case of bedhead and some kind of angry, belligerent, "my mother didn't love me" music in the background. It's not exactly academia.
Suffice it to say that I can provide references for most of this stuff, and if I can't, I can sure tell you about a ton of bright professionals who have seen awesome anecdotal evidence - as the research world is typically years behind the smartest people who are in the trenches. If that's not good enough, oh well.
And on that note, I need to get back to the trenches. Have a great weekend!
I've been following the Diesel Crew guys for a few years, but it wasn't until the past year or so that I had the opportunity to start interacting with Jim "Smitty" Smith regularly. In the short time that I've known him, Smitty has really impressed me; he is without a doubt one of the most knowledgeable and innovative guys in the "biz." The interview below is just a small sample of the tremendous amount Smitty has to offer; enjoy!
EC: Okay, Smitty, I know quite a bit about you, but that's not to say that our readers can be sure that you're not a complete poser. Tell is about yourself.
JS: I've been involved in strength training since 1995 and a strength coach since 2001. I have gotten a few certifications over the years, but have most of my knowledge from years of self study, competing in sports and strongman competitions.
I co-founded the Diesel Crew, along with Jedd Johnson, in late 2001 and have been developing the Diesel Method since then. We've been utilizing powerlifting, odd objects, kettlebells, weightlifting, and Grip strength protocols to build athletes to their greatest potential.
I believe we have a solid reputation for being innovators and hopefully provide strength coaches and fitness professionals with new ideas to improve their strength programs.
EC: You're about as creative a person in this industry as I've met. You're like MacGyver; you could train a blind man with no arms and legs with just a book of matches, some Blue Heat, and a burrito. How did you get so creative? Do you sniff glue or something?
JS: What have you heard? Let's not talk about college.
Seriously, when people first see our products, I am sure they say to themselves, "Damn, I would have never thought of that exercise." I take a lot of pride in that.
When Jedd and I first started, we had no money and no equipment. All we had was a great desire to succeed. If we had an idea for an exercise, but we didn't have the equipment, we had to make it or improvise.
For instance, in the EliteFTS Q&A Exercise Index, you'll see one unique way to train atlas stones right in a commercial gym without atlas stones and even a cool way to train farmer's walks without farmer's walk implements. These are just two quick examples.
But it is much more than being creative with equipment when you are poor.
If athletes or coaches are participating in or training with powerlifting components, they typically only use powerlifting techniques. If people are utilizing odd objects in their training, they also typically only use these techniques and exercises.
But, we saw great potential benefit trying to combine techniques from each protocol into one system. We called it the Diesel Method.
One example would be to take typical keg lifting (odd object) and perform beyond the range (powerlifting) bear hug good mornings. This BTR hip extension has huge carryover for gluteal firing and neutral lumbar stability endurance.
EC: You and Jedd are the go-to guys when it comes to grip training. What are the most common mistakes you're seeing people make with their grip training?
JS: Grip training is not only about getting your hands stronger; it is also about preventing imbalances, training specificity (General, General Specific) for your sport and finally learning how to channel the power generated by your body through your hands. The body works in integration and everything is connected. Grip is typically the weakest link in this coordinated kinetic chain. Strength programs focus on developing limit strength, rate of force development, power, speed, agility and so on - but we still must be able to express this strength through our hands to play any sport! That is why Grip strength is so important.
For example, if you're a boxer whose hands, wrists, and elbows are weak or beat up from tons of sparring, you are very quickly going to:
- become injured from impact - cannot provide adequate contraction of musculature
- become injured from too much tendon and soft tissue trauma - poor restoration
- become limited in your ability to generate a powerful punch - poor neural expression
To determine how to implement Grip protocols into your training, check the Needs Analysis for the sport and go from there.
EC: I know you're got a pretty good corrective training background; have you been able to apply some of this grip work in that capacity to prevent/rehabilitate injuries to the elbows, forearms, and wrists?
JS: Eric, you know we need to create balance in our movements. If we have balance in movements, improved soft-tissue quality, neural grooving of firing - then we'll have proper functioning. The same goes for Grip.
You used the example in your Sturdy Shoulder seminar of people who sit in flexion, type in flexion, watch TV in flexion, play video games in flexion all day long. These people MUST do extension, mobility, and soft tissue work.
Similarly, a comprehensive grip protocol would include; flexion (fingers, wrists), extension (fingers, wrists), supination, pronation (radial/ulnar), ulnar / radial deviation (wrist), internal / external rotation (humerus), adduction / abduction (fingers) - everything from the fingertips to the shoulders. Remember, everything is connected.
Now, once these movements, imbalances, and injuries have been addressed, we move to Level II, where we start to learn how to express power through the hands. That is where irradiation or co-contraction comes into play.
The lower arm musculature is part of the whole kinetic chain. You'll immediately see this when you move into finger into extension against a rubber band or sand (bucket), and the musculature that crosses your elbow contracts. Why is that? Because we know that if a muscle crosses a joint it affects that joint. That is why when you clench your fist as hard as you can, your forearm, biceps, triceps, deltoid, and lat contract as well. That is how the kinetic chain works, and we can utilize this to our benefit in our training.
EC: Let's talk about the Jim Smith library. What are your top five resources?
JS:
1. All the standards:
-Essentials of Strength and Conditioning, by Baechle and Earle
-Supertraining, by Siff
-Science and Practice of Strength Training: 2nd Ed., by Zatsiorsky and Kraemer
-Designing Resistance Training Programs, by Kraemer and Fleck
2. The Ultimate Off-Season Training Manual, by Cressey
3. Starting Strength, by Rippletoe and Kilgore
4. Afterburn I & II, by Cosgrove
5. James Smith's Manuals
6. The Coach's Strength Training Playbook, by Kenn
7. Chu's Plyometric books
The list goes on and on. Some I reread regularly, some I use as a reference.
I would recommend that your subscribers also do the following:
1. Print out articles and categorize them by topic: nutrition, periodization, sport, protocol, etc. Now, take these articles and get a bunch of 3-ring binders and create a binder for each category.
2. Make a goal for yourself that each day you will: read one article, read one blog post, add one article to your binder(s), email someone on a question you have, start or create an article yourself.
3. With the idea of always trying to improve yourself, attend every seminar, clinic, and/or conference you can. I've spent thousands this year in the never-ending pursuit of knowledge.
EC: You've got a new manual: "Building the Ultimate MMA Athlete." Fill us in a bit on it.
JS: I've been a huge MMA for years and coming from a wrestling background, I have been formulating ideas for years to put in this manual, specifically training the functional movement patterns for combat athletics. It started as a small project and ended up being an eight-month project ending with a 300-page manual.
I have gotten an overwhelmingly great response to the book because it is not your standard deadlifts, pull-ups, and cleans type of manual. Of course, those exercises form the foundation of the program and are in there, but I wanted to go above and beyond that standard school of thought. I used every implement known to man and took the three functional positions; Standing/Clinch, the Guard, and the Mount, and built the programs and exercises around them.
My next manual, Chaos Training, is also going to open a lot of eyes and minds on what "functional" training really is.
EC: Cool stuff; thanks a ton for taking the time, Smitty. How can our readers contact you?
JS: The best bet is to go through our websites, www.DieselCrew.com .
EC: A note to our readers: Smitty's new Combat Coree-book is an absolutely awesome read that I highly recommend to everyone interested in learning about true "core stability" and "functional training." I reviewed it HERE.
1. This is my first post on the new blog, so apologies in advance if:
a) the font style or color is out-of-whack
b) it comes up in Portuguese (meaning that you’d have no idea what I am saying, anyway)
c) your computer freezes up on account of the complete and utter awesomeness that you’re beholding with the new site
Kidding aside, it’s been a royal pain in the butt thus far and I’m just anxious to have it done so that I can just go back to writing.
2. Believe it or not, as some of you probably have noticed, I haven’t blogged for a full week.There was just a ton of stuff to get gone for the new site as well as loads of other projects on my plate.
Interestingly, though, it was by far my best week of training since the spring.I had a great front squatting session on Tuesday, and although Wednesday was supposed to be a day off, I got antsy later in the day.So, I did a little sprint work – and it felt great.So, I figured what the heck: I might as well test my vertical jump and broad jump.I wound up jumping a personal best of 34.7 inches and then tying a personal best on the broad jump with 114 inches.As a cooldown, I wrestled a grizzly bear and then did walking lunges in the parking lot with an intern over each shoulder.Those whippersnappers will learn!
Random digressions aside, it’s very clear that this blog is completely counterproductive for my strength, power, and physique goals.In fact, I’d say that is roughly on-par with distance running as a competing demand for my attention and physiological recuperation.I’m going to take one for the team and keep writing, though; winners persevere.
(and in case you folks didn’t pick up on it, that was a joke)
Essentially, this is a survey of all the available research on the topic, and here is what they determined: “Only one trial was found that investigated the efficacy of PUFAs and antioxidants on tendinopathies. The findings suggest that some (low level) evidence exists to support the supplementation in the management of tendinopathies. Any conclusions based on this one article should be reached with caution. Subsequently, there is a distinct and clear need for well-planned randomized controlled trials that aim to investigate the efficacy of supplements in the management of tendinopathies including those of the rotator cuff.”
Meanwhile, we spend BILLIONS on NSAIDs, cortisone shots, and surgeries.Don’t you just love the medical model?While these options are certainly warranted in some situations, we’re studying for the wrong test by ignoring the role of PUFAs and antioxidants in the treatment of tendinopathies.
Chances are that the NIH won’t soon fund anything to look at this, though, as they are too busy doing the 38,736th study in history on creatine.
4. A good cartoon, in light of the week ahead:
5. Speaking of turducken, is anyone looking forward to listening to John Madden on Thanksgiving as much as I am? I mean, this is quite possibly the greatest broadcasting spectacle in football history, as Madden will be bouncing off the walls try to slip in as many Brett Favre references as possible - even if Favre and the Jets don't play until the following Sunday.
And, Frank Caliendo as Madden is awesome. They played this on the airplane on the ride back from Georgia a few weeks ago and everyone on board was laughing hysterically.
6. Another interesting study that ought to make you think:
Basically, the researchers found that college baseball players and swimmers were 3.23 and 2.95 times more likely (respectively) than their non-athlete counterparts to have disk degeneration.And, there was a clear association between disk degeneration and lower back pain.
Now, here is something to consider…I would be willing to bet that if you took these athletes and actually trained their “cores” the right way, they would be better off long-term than the nonathletes – in spite of the amount of disc degeneration that’s present already.I feel very strongly that multidirectional lumbar stability goes a long way in overcoming any structural flaws – from vertebral fractures (spondylolysis) to disc issues; there are a lot of structurally jacked up backs out there that are completely asymptomatic.
To me, it’s the folks who do nothing that are most at-risk of debilitating back pain long-term.When s**t hits the fan for them, they are playing behind the 8-ball, as they’re older and completely untrained.So, they are starting from scratch when it’s the hardest to start from scratch.Food for thought.
In the meantime, pick up a copy of Combat Core and save yourself.It’s the best “core training” program out there.
7. That last thought was pretty heavy with techy stuff, huh?Did it blow your mind?You know, kind of like it blew your mind when David Hasselhoff talked to that car – and the car actually talked back?
Yeah, that was crazy.
Anyway, that's all for this week. Did you miss me?
Q: I noticed that you include reverse crunches in Maximum Strength, but not standard crunches. Why is it acceptable to have lumbar flexion during a reverse crunch, but not during a standard crunch?
A: This is a great question - and there are a few components to my response.
First, we use reverse crunches in moderation and only in our athletes who are healthy and those who have extension-based back issues (i.e., more pain in standing than sitting, tight hip flexors, anterior pelvic tilt, dormant glutes). We wouldn't use it in folks who have or have had flexion-based back issues (generally, this equates to disc problems and more pain in sitting).
Second, keep in mind that this is unloaded lumbar flexion; we wouldn't add compression to the mix.
Third, and most specific to your question, reverse crunches target the posterior fibers of the external oblique more. Given the points of insertion of these fibers, you can address anterior pelvic tilt without affecting the position of the rib cage.
Regular crunches shorten the rectus abdominus. While this can help with addressing anterior pelvic tilt, you also have to realize that shortening the rectus abdominus will depress the rib cage and pull people into a more kyphotic position. This is not a good thing for shoulder, upper back, or neck health.
So, in a nutshell, if we are going to have any sort of lumbar flexion in our training, it has to be a) unloaded, b) in the right population, c) implemented in lower volumes, and d) offering us something that addresses another more pressing issue (e.g., anterior pelvic tilt).
Combat Core is an exhaustive resource on high-performance core training that I'd encourage you to check out as well.
This morning, my girlfriend turned on Regis and Kelly. Now, before you start giving me a hard time, I’ll make it known that a) it was her choice and b) I was checking my emails, and my computer happens to be in the neighborhood of my television.
My attention shifted from emails to the TV when I saw that they were featuring a transformation contest where a bunch of ordinary weekend warriors went to different personal trainers to get “toned” (I knew I was in for it when I heard that word).
In the minutes that followed, I heard the word “core” mentioned approximately 487 times as trainers put clients through all sorts of stuff:
1. interval jogging on a treadmill (nearly made me vomit in my mouth)
2. playing basketball (You can charge for that? I would have gone with dodgeball so that I could throw stuff at my trainer for ripping me off.)
3. Curls while standing on a BOSU ball in a pair of Nike Shox (yes, you can actually find a way to make unstable surface training MORE injurious by exaggerating pronation even more)
Incidentally, this third trainer was featured with some hardcore Kelly Clarkson blaring in the background. I not only got dumber (and angry) by watching this segment; I also realized that if I ever go nuts and decide to write my suicide note, you’ll hear “SINCE YOU’VE BEEN GONE!!!!” blaring in the background as I sob over my pen and paper.
Normally, my reaction wouldn’t have been so pronounced, but after this weekend, I was all about REAL “core stability.” You see, I got to catch up with my buddy, Jim Smith (of Diesel Crew fame), while in Pittsburgh to give a seminar. “Smitty” and Jedd Johnson gave an awesome presentation outlining their innovative and effective methods on everything from sled dragging to grip work – and most specific to the discussion at hand, they both raved about how much they love Kelly Clarkson! Plus, they’re HUGE Regis and Kelly fans.
Okay, so that last little bit wasn’t entirely accurate; I’m pretty sure that these guys would have Hatebreed or some other angry, belligerent, “my-mother-didn’t love me” music blaring in the background when they finally get their moment in the spotlight on Regis and Kelly. Anyway, they DO know a ton about non-traditional means of training “core stability.”
In addition to watching a great presentation, on the plane ride home, I finally got a chance to read through Smitty’s new e-book, Combat Core: Advanced Torso Training for Explosive Strength and Power. To say that I was impressed would be the understatement of the year.
You see, I spend a ton of money each year on seminars, books, DVDs, etc. – and if I can take away even one little thing from each of them, I’m thrilled. In many cases, it’s “same-old, same-old.” Smitty has quickly built a reputation for overdelivering, and this resource was no exception. In the 133 pages of photos and descriptions of loads of exercises you’ve surely never seen, I found:
-13 sweet modifications to exercises I’m already doing
-16 completely new exercises I can’t wait to incorporate to my own training and that of my athletes
-seemingly countless “why didn’t I think of that?” moments.
So, to put it bluntly, I think it’s an awesome read – and well worth every penny, especially when you factor in all the bonuses he’s incorporated (including lifetime updates to keep you up to speed on his latest bits of insanity). If you’re interested in some effective, fun, innovative ways to enhance TRUE core stability, definitely check it out:
Combat Core: Advanced Torso Training for Explosive Strength and Power
Subscriber-Only Q&A: Spondylolysis and Young Athletes
I received this email a few months ago and have been meaning to turn it into a Q&A for quite some time, as spondylolysis is a topic that I think everyone should understand.
Q: I read you spoke at a seminar this sinter on the topic of spondylolysis showing up in young athletes. I have a 16 year-old son who was diagnosed with this type of stress fracture in his lumbar spine. He had grown 7 inches over the previous 9 months and our doctor contributed the cause to supporting muscles growth not being able to keep up with the rapid bone growth along with hyperextension of the lower back. He has recovered quite nicely with rehab being initially rest, isolation and support of the lower back followed by core strengthening when the pain subsided.Occasionally, he will get very temporary flare up pain. Could you please give me your opinion on the "do" and "don't" exercises that could possibly help prevent Spondylolysis from recurring and your thoughts on the subject. Thanks for your help.
A: First off, here is some background for our readers. Spondylolysis refers to a fracture of the pars interarticularis portion of a vertebra (95% of the time, it's L5). The pars essentially connects the vertebral body in front with the vertebral joints behind. It's also known as a "Scotty Dog" fracture because the shape of the pars mirrors that of a dog - and when a fracture is present, it looks like that dog has a collar on (or has its head chopped off, depending on whether you're a glass-is-half-empty kind of person or not):
Symptoms may come on traumatically (contact injury) or insidiously (overuse, genetic predisposition, or rapid bone growth during puberty). Pain is typically more lateral to the spine than it is centralized.
We have had quite a few athletes come to us with the condition because we work with a ton of athletes in rotational sports, predominantly baseball. In my humble opinion, "spondies" are the new ACL epidemic. Don't believe me? Check out these numbers from a 2000 study from Soler and Calderon (1):
-8% of elite Spanish athletes affected
-highest prevalence (27%) in those in track & field throws
-17% of rowers, 14% of gymnasts, and 13% of weightlifters had spondylolysis
-L5 most common (84%), followed by L4 (12%).
-Multiple levels of involvement in only 3% of cases
-Bilateral 78% of the time
-Only 50-60% of those diagnosed actually reported low back pain
-Males and females affected equally (although associated spondylolisthesis - or vertebral "slippage" was higher in females)
-Presence of spondylolysis is estimated at 15-63%, with the highest prevalence among weightlifters.
I suspect that these rates are even higher now (eight years later) - and in the U.S., where we have additional rotational and contact sports (as compared to Spain). These numbers - particularly the 40-50% asymptomatic figure - speak directly to the fact that inefficiency is on-par with (if not more important than) the spondylolysis pathology itself. Multiple inefficiencies are to blame for this specific pathology - and many people are just waiting to reach threshold. With that in mind, to be honest, I train all of our athletes under the assumption that they all have a disc herniation or vertebral fracture that we don't even know about - simply because, according to the research, that's probably the case! There are more opportunities than ever to participate in organized sports, yet athletes don't train any more than previously - and DO spend more time sitting.
In fact, about 14 million people - or 3-7% of the general population - have spondylolysis (2), and previous research as shown that asymptomatic disc bulges and herniations may be up in the 80% range (3).
These issues - combined with the fact that 4.4% of six-year-olds present with pars defects - has led to a standard rule in sports medicine where any adolescent athlete with lumbar spine pain for more than three days duration is referred for a bone scan to rule out a fracture. If a pars defect is detected, most doctors will prescribe 12-16 weeks in a back brace: a practice that, while controversial, has yielded favorable healing results.
Risk factors for pars defects have been subdivided into intrinsic and extrinsic. The "*" indicates that these factors are at least partially under our control as strength and conditioning coaches and trainers:
Intrinsic:
-Poor bone mineral density (*)
-Poor lower limb alignment and foot structure (*)
-Faulty muscular recruitment patterns (*)
-Height - Taller (non-modifiable)
-Rapid growth (non-modifiable)
-Body Type - muscle mass, longer spine (* to a degree, some non-modifiable)
-Insufficient nutrition - calories, calcium, vitamin D (*)
We can help build bone density with appropriate resistance training and encouraging athletes to consume plenty of calcium and vitamin D. We can train the lower extremity out of alignment problems and faulty recruitment patterns. We can put some meat on athletes to protect them from contact injuries. We can condition athletes so that they don't fatigue prematurely and break down in their technique. We have some control over the training surface. We can get young athletes out of the 10-pound cinderblock basketball shoes they're wearing and do more barefoot work. Kids know they shouldn't be eating the right stuff and not smoking.
So, in spite of all these means of preventing spondylolysis, as is the case with ACL problems, we've pursued a reactive - not proactive - model of addressing the issue. Trust me: you can save a kid a lot of pain and frustration if you prevent a fracture instead of bracing it after the fact. So, let's talk about what are in my opinion the most important things to address in young athletes to protect them from spondylolysis:
1. Train the feet and enhance ankle mobility. Think about what happens to someone who - thanks to modern footwear, muscular weakness, and/or structural predisposition - pronates too much. My good friend John Pallof describes the subtalar joint as a torque converter - meaning that tri-planar motion at/below the joint is converted into tibial and femoral internal rotation. In other words, when you pronate (land/decelerate), adequate stretch of the anti-pronators (particularly gluteus maximus and biceps femoris) is necessary to decelerate that motion. Most people - particularly young athletes - have very little posterior chain strength, and they don't activate their glutes well. So, this internal rotation isn't decelerated effectively - and the stress shifts up a bit from the hip to the lumbar spine. Instantly, a foot and ankle issue has become a lumbar spine issue (I could go on and on about how it relates to shoulder and elbow issues in pitchers, too).
2. Improve rotary stability. The more an athlete moves at the lumbar spine, the more likely he is to get injured. Using the baseball example again, there is considerable research demonstrating that young pitchers have higher rotational velocities than professional pitchers - and the younger subjects control their rotation in a less efficient manner. Rotate more, and do so in an inefficient (weak) way - and you're bound to run into problems at the lumbar spine (and elbow and shoulder, as well).
3. Improve their ability to resist extension. Most of the overuse spondy cases we see are individuals who also have a tendency toward hyperextension. If you can't fire your glutes in hip extension, you'll substitute lumbar extension to attempt to get "upright." Combine that rapid, repeated lumbar extension with rapid, repeated lumbar rotation - and pars defects kick in. For this reason, I love basic movements like prone bridges (and their variations) as well as more advanced progressions such as rollouts on the stability ball and ab wheel (or bar rollouts).
(Note from EC: Jim Smith's Combat Coreis the best resource I've seen with respect to #2 and #3; for those interested in further reading, it provides dozens of exercises for both objectives.)
4.Improve hip mobility. I have covered this above, but hip (and thoracic spine) mobility work hand-in-hand with lumbar spine stability. It's easier to stabilize a spine that's above a mobile set of hips.
5.Improve overall strength and power. The more force you generate in your lower and upper body, the less motion you'll need to utilize at the lumbar spine. Effectively, by making the extremities, hips, and torso stronger, you allow the core to focus on force transfer.
6. Implement appropriate deloading periods. Bone, like muscles and your connective tissues, needs a break to recover here and there. Regardless of how perfect your technique is, you lumbar spine will get chewed up if you swing a baseball bat for five hours per day, seven days a week. Physiological adaptation is all about matching tissue tolerance to tissue loading - and providing adequate recovery time for adaptation to occur.
Now, to get to the question at-hand, return-to-play after a period of bracing is a different story. Believe it or not, we've trained guys through their entire 12-16 week bracing protocols. When they're in the brace, aside from axial loading, there isn't much that can "get them" - meaning that they're completely protected from rotation and extension problems.
In fact, the brace does so much of the work for them that you need to make sure they're seeing a physical therapist at least 1-2 times a week during that protocol to get them out of it to entire that they don't detrain the deep core stabilizers. The brace also restricts full hip extension and flexion - and thoracic spine ROM, to a degree - so mobility work is very important. If I had to briefly summarize our training programs during bracing protocols, it would be "upper body, single-leg movements, pull-throughs, rotary stability training, mobility work, low-level linear plyos and medicine ball throws."
And, you know what? That would summarize my recommendations for the short-term when they get out of the brace - because it's what all athletes need! However, post-spondy athletes are different in several regards:
1. They cannot handle compressive loading the same way, so it must be gradually reintroduced. I have not allowed post-spondy guys to come back to squatting until at least nine months post-bracing - and I only do so if they have no residual symptoms. In terms of axial loading, we always test the waters with a barbell reverse lunge with a front squat grip. If that goes well, we'll try some front squatting. Most do well with trap bar deadlifts - although I do not bring them back to any Olympic lifts or straight-bar deadlifting in the first-year post-bracing.
2. Sprint mechanics are definitely altered after bracing. I suspect that it has mostly to do with the fact that kids lose hip flexion and extension range of motion and are therefore forced to develop extra hip rotation strategies (usually external rotation) to get range of motion. Others will simply lose hip flexion during the sprinting motion. Typically, cueing knee-drive with these folks and doing some psoas activation work will help to clear things up quickly.
3. We continue with training purely to resist rotation and only start to integrate rotational exercises - including medicine ball throws and cable woodchops - after three months. In most cases, though, the athlete will have returned to play by this point, so if he is involved in a rotational sport, he'll be encountering plenty of rotation already.
With respect to the athlete in question, if he is still having residual flare-ups (which do happen relatively frequently), he simply isn't ready for more aggressive loading - presumably because he has some degree of instability in one or more directions. When this is the case, we work around the issue - but check to see if there is a specific deficit that needs to be addressed. It may be as simple as poor breathing patterns or a lack of hip rotation - or it could be something that takes longer to address.
The important thing to remember is that athletes lift weights to get better at sports - not just to get good at lifting weights. Who is to say that a great football player can't be built without squatting? We have athletes and clients who do not squat - and they still get great results.
All the Best,
EC.
References:
1. Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. 2000 Jan-Feb;28(1):57-62.
2. Wineberg, EP. Spondylolysis. http://www.emedicine.com/Radio/topic650.htm
3. Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med.1994 Jul 14;331(2):69-73.
