Home Posts tagged "low back pain"

CSP Elite Baseball Development Podcast: Making Movement Better with Bill Hartman

We're excited to welcome physical therapist Bill Hartman to this week's podcast. Bill discusses how his approaches to training and rehabilitation have evolved over the years, and emphasizes the importance of range as a professional rather than early specialization. We converse on the common mistakes made with training rotational sport athletes, and delve into more complex topics like infrasternal angle and sacral positioning.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 20-pack of Athletic Greens travel packets with your first order.

Show Outline

  • How Bill became involved in the world of rehabilitation and how have his practices evolved since he first entered the field nearly 30 years ago
  • What tools have remained consistent throughout Bill’s professional career and how his perspective has changed despite this consistency
  • Why Bill is still constantly tweaking, adapting, and refining his processes as a physical therapist and how he is working to master his model and find true efficiency in his craft
  • Why professionals should be wary of specialization and should avoid limiting their perspective to the insights of one profession
  • Why the common hierarchical perspective of movement rehabilitation doesn’t capture how we truly drive adaptation in individuals
  • How coaches and rehab professionals alike can start at the ideal outcome and work backwards to create an actionable plan to drive change
  • Why asymmetry may actually be the recipe for elite athletic performance
  • What infrasternal angle is and how this measurement is utilized as an assessment tool
  • What specific insights does infrasternal angle give us for rotational athletes and their capabilities to move efficiently for their sport
  • What the two types of infrasternal presentations are and what action-based plan Bill has for dealing with each respectively
  • Why the dynamics of the rib cage are more important than static infrasternal angle presentation and how professionals can observe an individual's capacity for movement at the core of the body
  • Why the position of the sacrum is an overlooked factor for analyzing optimal movement
  • What sacral position demonstrates to professionals about an individual’s movement profile
  • Why quality training isn’t about changing someone but rather about reinforcing what someone was meant to do
  • Why exercise selection is vital for transforming athletes into the best version of themselves and how professionals can create programs for individuals that match their movement capabilities
  • How much strength is too much strength for athletes and how the dosage of training can drive adaptations that actually make an individual worse at their sport
  • Why defining the amount and rate of force production needed for a sport is essential for properly training athletes of the sport and how these insights set the parameters for training strategies
  • How blind exercise prescription and an overemphasis of strength training are limiting the capabilities of rotational athletes and what Bill’s big rocks for creating elite throwers are
  • Why more strength training is not always better and what key performance indicators professionals can monitor to maintain progress and limit the negative effects of training
  • Why strength training is not inherently bad, but professionals should be more particular about its implementation
  • What Bill’s key competencies for high level learners are and how you can be the best learner possible
  • What three books all performance professionals should read
  • What research Bill would like to see done to progress the field
  • You can follow Bill on Twitter at @BillHartmanPT and and Instagram at @BillHartmanPT. You can also learn more about him at www.BillHartmanPT.com.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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The Best of 2019: Podcasts

In 2019, I finally took the plunge in starting a long overdue CSP Elite Baseball Development Podcast. It's been a ton of time and effort, but the awesome feedback has made it worth it. Here are our top five episodes from the year:

1. Sparing the Spine with Dr. Stuart McGill - This might be a baseball podcast, but the world's most prolific spine researcher won't disappoint on any medium! Stu was outstanding and this is one for the ages.

2. To Ice or Not to Ice with Gary Reinl - Icing is a hot (terrible pun) topic in the sports medicine world. Gary touched on where this common practice began, and how we need to rethink its use.

3. Corey Kluber - The two-time Cy Young winner was our first podcast guest and didn't disappoint.

4. Making Nutritional Changes Stick with Dr. John Berardi - JB is one of the brightest nutritional minds out there, but he's also one of the best at understanding how to get through to people to create behavioral changes and, in turn, long-term success.

5. Building a Better Throwing Program with Alan Jaeger - This was a really fun discussion with Alan Jaeger that covered not only how to construct individualized throwing programs, but also how athletes can be advocates for their careers.

We're back to the regular EricCressey.com content this week. Thanks for all your support in 2019! We've got some great stuff planned for 2020.

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Elite Baseball Development Podcast: Sparing the Spine with Dr. Stuart McGill

We're excited to welcome an astonishingly accomplished and influential researcher and clinician, Dr. Stuart McGill, to the podcast for Episode #16 for an in-depth discussion on sparing the spine in rotational sport athletes. A special thanks goes out to this show's sponsor, Acumobility. Their products have been absolute game changers for our mobility approaches at Cressey Sports Performance, and they've got a great 10% off offer going for our podcast listeners who enter the coupon code CSP10 at https://csp.acumobility.com/podcast.

Show Outline

  • How Dr. McGill has become a prominent figure in the world of spine health
  • What the key considerations are for understanding the spine demands in rotational athletes
  • How the anatomical structure of the spine drives an individual’s movement capabilities
  • What qualities should be prioritized in elastic rotational athletes – and how much strength is enough?
  • Why power is plane specific and how this impacts rotational athletes expression of power in the three planes of motion
  • What spondylolsis is, how this injury occurs, and whether a back brace should be utilized
  • How fascial slings impact athletic performance and spine health
  • How effective is manual therapy in changing tissue quality and aiding in transforming movement capabilities
  • How clinicians can more effectively interpret scientific research and why they find value in variance rather than averages
  • How to differentiate between a “scar” and a “wound” on diagnostic imaging
  • How Dr. McGill preserves the human element in patient management
  • What has changed over the last 10 years in his understanding of the spine
  • Where future spine research is needed

You can follow Dr. McGill on Instagram at @BackFitPro - or visit his website at www.BackFitPro.com.

Sponsor Reminder

This episode is brought to you by Acumobility. While their product line is super expansive, the implement I use the most on a daily basis is the Acumobility ball, a patented flat based mobility ball that keeps the ball in contact with a trigger point so you can do active mobility. You can can use it against a wall, rack, or any floor surface and it won't roll away. As a result, it allows you to do incorporate some innovative and advanced active mobility exercises, including on hard to reach areas like the neck and shoulders. Perhaps most importantly, the folks at Acumobility do an awesome job with educational initiatives to accompany their products; this way, you can assess AND correct movement problems to improve performance. Head to https://csp.acumobility.com/podcast and enter coupon code CSP10 to save 10% on your order.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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Making Sense of Bad Rehab and Fitness Advice

"Don't assume; it makes an ASS out of U and ME." It's one of the most hackneyed expressions of all time, but it's a lesson many folks in the fitness industry - and casual observers to this industry - will never seem to learn. Assuming an exercise or methodology will help or hurt someone is one of the biggest mistakes I see across all training programs. Perhaps the most readily apparent example is in individuals with back pain.

“Your back hurts? You should try yoga.”

“Back pain? Just give up squats and deadlifts and only do single-leg work instead.”

"Your low back is cranky? Try McKenzie press-ups and it'll fix you right up."

You know what? I’ve seen people whose back pain got considerably worse when they took up yoga. I’ve also seen people whose low backs feel better when they avoid single-leg work and stay with bilateral exercises like the deadlift. And I've seen extension-intolerant individuals integrate McKenzie press-ups on a friend's recommendation and flare up their symptoms.

That doesn't mean any of these recommendations are inherently bad, or that the ones giving the recommendations aren't well intentioned. It's just that you're going to a podiatrist to get dental advice; it isn't a qualified recommendation, nor is it backed by a solid sample size of success.

Sometimes, the exercise selection is the problem (the wrong yoga poses).

Other times, it’s the technique is the problem (your squat form is horrific).

Occasionally, the timing is the problem (disc pain is worst first thing in the morning, so it's probably not the time to test out deadlifting for the first time in six months.

Often, the volume is the problem (maybe it would have been good to run 1/2 mile pain-free before trying to jog ten miles).

Rarely does an entire discipline (ALL of yoga or ALL of strength training) need to be contraindicated.

We need to avoid assuming that all back pain is the same and instead dig deeper to find out what works for each individual. The same can be said for shoulders, hips, knees, ankles, necks, and just about every other musculoskeletal malady we encounter. Good assessment and a solid library of knowledge from which to draw both help to solidify recommendations as sound.

 

Here, we basically have a missing infraspinatus. That's your largest - and likely most important - rotator cuff muscle. It's secondary to a suprascapular cyst. I usually see 1-2 of these in professional pitchers each offseason, and while most are usually completely asymptomatic, it has a dramatic impact on the way we approach their offseason arm care programs. We want to them to REMAIN pain-free. 😮 Here, we also have a friendly reminder of why you should always, always, always do upper extremity assessments shirtless (or in a tank top/sports bra, with females) if you deal with overhead athletes. 🤔 Never miss a big rock with your assessments. Know your population. #cspfamily #shoulderhealth #shoulderpain #rotatorcuff #SportsMedicine

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Injuries and conditions are usually very multifactorial. We rarely hurt simply from an isolated traumatic incident; rather, it's the accumulation of various aberrant movements over the course of time that bring us to a symptomatic threshold. And that's why we need to build broad skillsets that encompass assessments, programming strategies, coaching cues, and an appreciation for how all the pieces fit together in determining whether someone hurts or not.

That's what Mike Reinold and I aimed to do with our Functional Stability Training resources; give both rehabilitation specialists and strength and conditioning professionals the tools they need to help keep people healthy - or, in the clinical sense, help them get healthy in the first place. This four-part series is on sale for 25% off through Cyber Monday at midnight by using the coupon code BF2019 at checkout; for more information, check out www.FunctionalStability.com.


 

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Strength and Conditioning Stuff You Should Read: 4/13/17

I hope you're all having a great week. I'm a few days late with posting this because we were a bit more content heavy earlier in the week, but the good news is that it gave me a few more days to round up some excellent content for you.

Kabuki Strength Chat with Eric Cressey - I joined Chris Duffin and the rest of the Kabuki Strength crew for a podcast last week. We talked baseball strength and conditioning, business development, and fitness industry trends. Check it out!

STEM-Talk with Dr. Stuart McGill - Any podcast with Stu is a must-listen podcast! This one doesn't disappoint - and I particularly enjoyed his commentary on the flawed medical model as it relates to treating lower back pain. 

It Took Me 10 Years to Become an Overnight Success - This was an excellent post from my business partner, Pete Dupuis. He shares some awesome insights on little things that can lead to long-term success - if you're patient.

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#Repost @cresseysportsperformance with @repostapp ・・・ More wise words from @ericcressey. #cspfamily #ArmCare

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5 Spine-Sparing Strength and Conditioning Program Strategies

In his book, Back Mechanic, Dr. Stuart McGill frequently uses the term "spine hygiene" to describe how individuals position themselves during various everyday and athletic tasks to manage their back pain. Most of the strategies speak to the positional side of things, but I thought it might be worthwhile to take a look at some strength and conditioning program strategies you can employ to keep the spine healthy over the long haul. 

1. Don’t pick up heavy dumbbells.

The stronger you get, the bigger a pain it is to pick up and position dumbbells, whether it's for rows, presses, or single-leg work. Things are even harder when the heaviest dumbbells are positioned on the lowest tiers of the dumbbell rack. We've been brainwashed for years that dumbbells are more spine-friendly than barbells, but this simply isn't always true. Being able to unrack a weight from chest height and not having to swing it into position can be invaluable once you're developed an appreciable level of strength. I'm not saying not to use heavy dumbbells, but rather to be very careful with this approach if you're someone who has dealt with low back pain.

2. Cycle in heavy bilateral loading.

Make no mistake about it: a barbell will allow you to move the most weight in your program on the overwhelming majority of exercises. Unfortunately, this also means that the compressive and shear forces on your spine will generally be highest with barbell exercises. That doesn't mean that you need to eliminate them, but rather that you need to cycle them out periodically to give you a little break. At the peak of my powerlifting career, I'd always stay away from squats, deadlifts, and good mornings for the first 10-14 days after a meet. It was all lower intensity work, anyway, so plenty of single-leg work and glute-ham raises was a perfect fit.

600x2DL

3. If you are going to do both in the same session, squat before you deadlift.

There are many theories as to why deadlifting is so much more exhausting both systemically and locally, but regardless of the one to which you subscribe, you'll surely recognize that heavy pulling before squatting is a recipe for a cranky back. After all, there is a reason you always squat first and deadlift last in every powerlifting. A few of my favorite approaches in terms of sequencing are:

a. Squat heavy, deadlift for reps
b. Squat heavy, deadlift for speed
c. Squat for speed, deadlift heavy
d. Squat for speed, deadlift for reps

Occasionally, you can dabble in some speed deadlifts before you squat, but once you've reached a solid level of strength, I think you'll find that it still just doesn't work out all that well.

4. Don't train in a fatigued state if you don't move well.

Experienced lifters with great core control can usually get away with training through fatigue as long as the training loads aren't outrageous. Interestingly, though, if you look at the typical recreational runner with back pain, it usually starts after they've already been running for a while. Fatigue changes the game, as they start to substitute lumbar extension (low back movement) for hip extension.

This doesn't just underscore the importance of gradual return to running progressions; rather, it reminds us that those with a history of low back pain need to spend a lot of time training with perfect technique in non-fatigued states. As McGill has discussed, they're better off doing multiple sets of shorter prone and side bridges than they are trying to hold one set for 60 seconds.

Back-Mechanic

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

5. Go to split-stance.

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

Cressey wall slide

Wrap-up

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

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Expanding the “Safe” Exercise Repertoire

In his outstanding new book, Back Mechanic, spine expert Dr. Stuart McGill speaks frequently to how he works with patients to “expand pain-free abilities” over the course of time. This begins with practicing good “spine hygiene” throughout daily activities while avoiding any positions or movements that provoke symptoms.

Back-Mechanic

As a patient gets some asymptomatic time under his/her belt, new movements and exercises are gradually introduced. Over time, the individual’s pain-free movement repertoire can be integrated into a comprehensive exercise program. Effectively, it’s a way to test the waters without simply jumping into the deep end. This is an especially important process for patients who have lived with chronic back pain and need to break the cycle to relearn what it actually is like to feel good. As Dr. McGill writes,

“The approach that has produced the best results for us over the years has been to teach the patient pain-free movement. This is based on the ‘gate theory’ of pain. Finding simple movements that do not cause pain floods the proprioceptive system with joint and muscle sensor signals, leaving little room for pain signals to get through the neural ‘gates.’ These pain-free movements are repeated to encode the pattern in the brain. Slowly, the patient’s ability repertoire of pain free movement increases until they are able to move well, and for longer periods. They successfully replaced the pain inducing patterns wired into their brains with pain-free patterns.”

As I read through Dr. McGill’s work, I couldn’t help but think about how it can be adapted to other realms of the rehabilitation and fitness communities. As an example, speaking to my main realm of interest – training baseball players – we have to consider how this applies to return-to-throwing programs in the baseball rehabilitation world. Truth be told, this approach traditionally has not been applied well in most rehabilitation scenarios in overhead throwing athletes because they have just about the most specific kind of mechanical pain there is. In other words, the elbow or shoulder only bothers them in this position, and usually at higher velocities:

layback

Most of the significant upper extremity throwing injuries you see don’t involve much pain at rest. Rather, the arm only hurts during the act of throwing. Unfortunately (or fortunately, depending on how you look at it), nothing in our daily lives really simulates the stress of throwing. As such, for a thrower, expanding pain-free abilities really have just traditionally meant:

throwingprogression

You’d actually be surprised to find that there often aren’t any progressions that “link” one phase of this progression to the next. In the “not throwing” phase, we often see a lot of generic arm care exercises, but little attention to speed of movement, integrating the lower half and core, and incorporating training positions specific to an athlete’s arm slot. Unfortunately, just laying on a table and doing some exercises with a 5-pound dumbbell won’t necessarily prepare you to throw the ball on a line at 120-feet.

For this reason, we always seek out physical therapists who treat the athlete “globally” and appreciate the incremental stress of various phases of throwing. The name of the game is to incorporate several “test the water” steps between each of these three categories. We do the exact same things as players ramp up their off-season throwing programs. As physical therapist Charlie Weingroff has astutely observed in the past, “Training = Rehab, Rehab = Training.”

How do we bridge the gap between not throwing and flat-ground throwing as much as possible? For starters, rotator cuff exercises need to take place near 90 degrees of abduction to reflect the amount of scapular upward rotation and shoulder elevation that takes place during throwing. Moreover, it’s important to work closer to true end-range of external rotation in testing strength that “matters” during the lay-back phase of throwing. And, we need to test how they do with the external-to-internal rotation transition.

To this point, in my career, I’ve seen a lot of throwers who have passed physical exams of cuff strength in the adducted (arm at the side) position, but failed miserably in the “arm slot” positions that matter. Picking the right progressions really matters.

Additionally, more aggressive rotational medicine ball drills can help to teach force production, transfer, and acceptance in a manner specific to the throwing motion.

Unfortunately, at the end of the day, the only thing that can truly reflect the stress of throwing is actually throwing. And this is also why there have to be incremental steps from flat-ground work to mound work (where external rotation range-of-motion is considerably higher).

Fortunately for most rehab specialists and the fitness professionals who pick up where they leave off, most return-to-action scenarios aren’t as complex as getting a MLB pitcher back on the mound. A general fitness client with a classic external impingement shoulder presentation might just need to test the waters in a progression along these lines:

(Feet-Elevated) Push-up Isometric Holds > (Feet-Elevated) Body Weight Push-up > Stability Ball Push-up > Weighted Push-up > Neutral Grip DB Floor Press > Neutral Grip Decline DB Press > Pronated Grip Decline DB Press > Barbell Board Press (gradual lowering) > Barbell Floor Press > Neutral Grip DB Bench Press > Low Incline DB Press > Close-Grip Bench Press > Bench Press > Bottoms-up KB Military Press > Barbell Incline Press > Barbell Overhead Pressing

Different people might start at different places on this continuum, and some folks might not need to progress all the way along. The point is that there needs to be a rhyme and reason to whatever continuum you create for expanding individuals’ pain-free abilities.

A lot of folks have a pretty good understanding of “progression.” This, to me, refers to how we sequentially teach movements and make training more challenging. Unfortunately, not nearly as many professionals understand “pain-free progression” under the unique circumstances surrounding injury.

This is one of many reasons why I think understanding post-rehab training is so important for the modern fitness professional. It’s a tremendous competitive advantage for differentiating oneself in the “training marketplace.” Moreover, on a purely ethical level, having a solid understanding of various injuries and their implications helps a coach deliver a safe training experience.

With all this in mind, I'd really encourage my readers to check out Dean Somerset's resource, Post-Rehab Essentials. It's a fantastic product that also happens to be on sale for $50 off through Sunday at midnight. You can learn more HERE.

PRE-header-final

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3 Barbell Hip Thrust Coaching Cues

We utilize both barbell hip thrusts and supine bridges on a regular basis in our programming. Popularized by Bret Contreras, we started utilizing these exercises in 2011 - and haven't looked back since.

They're great alternatives to squatting and deadlifting for those with a history of back pain, and can be awesome options for training the posterior chain in those with upper body conditions that may be exacerbated by certain squat and deadlift variations. They don't create a ton of soreness, so they can be awesome in-season exercises for athletes. And, they'll build bigger, stronger glutes that seem to carry over better to athletic performance because of the horizontally directed force (as opposed to the vertically directed force we see with squats and deadlifts). In short, I think they're awesome on a number of fronts - and they're here to stay.

While even the most inexperienced athlete can pick these drills up relatively quickly, that's not to say that there aren't a few common technique mistakes for which you need to watch out. Check out this video to learn how to correct these issues:

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5 Lessons Learned From Training Those With Low Back Pain

Today's guest post comes from Dean Somerset. Dean's made a name for himself as a "low back and hip" guy, and this post demonstrates this expertise. It's especially timely, given the release of his new resource, Advanced Core Training.

Advanced-Core-Training-Box-Cover-300x196-2

I’ve had the distinct honor of working with a wide variety of clients. Some have been fresh from spinal surgical intervention following an injury, others had congenital issues where they were born with some sort of spinal irregularity, others just had low back pain. I’ve also worked with some Olympic champions, Paralympic hopefuls, professional sports teams, and pretty well every type of client in between, and today’s post is all about highlighting some of the commonalities among these very broad and different types of clients.

#1: They Usually Do Something Poorly.

I had the opportunity to do end-of-season testing on a local professional hockey team a few years ago. This meant I had direct access to some of the best hockey players in the world to see how they moved. While they could likely outskate and maneuver anyone on the ice, their ability to control their movements in the specific tasks asked were somewhat shaky on occasion, and in some instances, consistently so through the entire team.

Consider hockey players live their entire lives with their sticks on the ice and bent over. Shoulder pads prevent a lot of overhead movement, and getting checked into the boards frequently can cause some significant wear and tear on the shoulder joints, not to mention the rest of the body. Its no surprise very few of them had the ability to score well on an overhead squat assessment since they only ever put their arms overhead when they score a goal, and if you’re on an offensively challenged tem, that won’t happen much.

Additionally, since flexion is such as important position for their sports, they had no problem doing that, but had a lot of trouble controlling their spines into extension. The goalies could hit the splits in any direction, but many of their leg movement testing would have indicated that they were “tight” and required more stretching. If someone can go in and out of the splits in multiple directions, they don’t need more stretching.

BadHFStretch

With many people who aren’t elite athletes, they’ll also have some sort of a wonky movement pattern here or there. These may not directly cause injury, but they might increase the relative risk that something could happen. Think of a hip hinge, for example. A known mechanism of injury is low back flexion with loading and some degree of rotation. This is the common first timer setting up for a deadlift and not knowing what the heck they’re doing. In fact, that’s how Rob Gronkowski injured his back when he was a standout at Arizona and almost cost him a shot at the NFL.

The thing about increased risk is it won’t guarantee an injury occurs, just that there’s more likelihood that it would. If I bought a lottery ticket, there’s a 1 in 15,000,000 chance that I win big. If I bought 1000 tickets, there’s now a 1,000 in 15,000,000 million chance that I win, or 1 in 15,000 chance. It doesn’t mean I will win, just that my odds are higher.

Now, if I were to teach that beginner how to hip hinge well and reduce the pressure on their low back while also using their hips to produce the power for lifting the weight, there’s a greater chance that they will be successful and less of a chance they will get injured. Gronk showed even a great athlete who is unfamiliar with a certain movement can still do it with risk, and still get injured, just like a beginner stepping foot inside a weight room for the first time.

#2: The Value of Isometric Exercise Can’t be Overstated.

Dr. Stuart McGill’s lab at The University of Waterloo just released a very interesting study that looked at the effects of using isometric exercises like planks and dead bugs as well as more dynamic exercises such as Russian twists and rotational throws to train the core in two very different groups:

a) beginners who were naïve to resistance training and exercise in general,

b) Muay Thai athletes who were savvy to training concepts and instructions.

Half of the naïve group did isometric training and half did more dynamic training, and the same went for the savvy group. There was a control group as well; they didn’t train for the 6-week duration of the study.

mcgill-300x192

Afterwards, all training groups saw improvements in both their fixed core strength and range of motion, and also in their response to more reactive stress to the spine. The isometric groups in both the naïve and savvy groups saw bigger improvements than the dynamic training groups.

While isometric exercises may seem very rudimentary and “beginner,” they can still prove beneficial to more advanced athletes and lifters, especially in terms of ease of set-up, relative risk to the individual doing them, and - most importantly - in quantitative outcomes, such as those measured in McGill’s research. It’s very exciting to see that a basic staple exercise, performed well, can benefit individuals of all experience level.

#3: Breathing is More Than Just Inhale/Exhale.

Getting beginners to do core-intensive training usually results in one question from me, repeated consistently through the entire series:

“Are you breathing?”

A go-to response for many is to hold their breath through core intensive movements. While this isn’t a bad response per se - especially if they’re trying to use a valsalva to increase spinal stability during a movement like a deadlift - not being able to inhale and exhale in pace with an exercise can actually reduce the effectiveness of the exercise. Additionally, the speed of breathing can dictate whether a movement is more of a relaxation or mobility movement or whether the goal is speed and reactive capability development. In either case, being able to breathe through an entire set is vitally important to see the best potential improvements.

When breathing for improving mobility or parasympathetic activity, inhales and exhales should be long and full. I usually recommend 3-5 second inhalations and 3-5 second exhalations. For speed and power development, inhales are best with more of a sniffing action where air is taken in quickly and with some development of negative pressure through the ribs and abdomen, and exhaled forcefully and quickly, much like a martial artist throwing a strike. Boxers do this very well, exhaling on impacts to improve not only their ability to not gas out, but to improve the stiffness of their spine to improve the power of their punches.

This short, sharp exhale causes the abdominal muscles to brace very hard and very quickly, essentially momentarily turning the core into stone to allow for a solid strike to generate some impact.

Try this while you’re reading this article: place a hand on your stomach and sniff in quickly through your nose and feel what the abdominal muscles do. Then exhale sharply through pursed lips, like you would if you were throwing a very crisp jab. Did you feel how hard the abs became for the second you inhaled and exhaled? That’s your power center.

Clients along the entire continuum from rehab to elite performance can benefit from learning how to use their breathing to develop the specific goals they’re looking to accomplish. Rehab clients can use the sniff inhale and hard exhale effectively, as it doesn’t necessarily apply aberrant stressors to the spine or connective tissue, but does have a beneficial effect on the strength and reactivity of the core girdle as an entire unit. Simply doing forceful breathing, when appropriate to do so, is itself an effective conditioning tool for many.

#4: Core Strength Training Should Trump Core Endurance Training.

What’s more likely to lead to problems: having to lift 5 pounds 50 times, or having to lift 50 pounds 5 times? Most people would say lifting the heavier weight would be riskier, and I would say if the person didn’t know how to move it to reduce their risks and to take advantage of their leverages, then yes.

However, many training programs heavily prioritize development of core endurance, with higher rep ranges and longer duration isometric holds. While endurance is important, I would argue the ability to generate repeated bouts of higher threshold contractions would have much greater implications to spinal protection, athletic development, and resiliency, while also making the lower threshold contractions less stressful to the body.

A simple way to do this is to alter the methods used to get to a specific volume of training. For instance, let’s say you want to do three minutes of planking. You could do one long sustained plank for 180 seconds, or you could do 18 bouts of maximum intensity 10 second holds, where the goal is to try to contract everything so hard that your hair follicles turn into diamonds and you make it rain like never before. The three-minute sustained plank will challenge you, but you’ll be able to still do something afterwards. The 18 rounds of 10 seconds max effort planks will wreck you.

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Consider it for strength training as well. Instead of doing 3 sets of 10 with a moderate weight, use a more challenging weight to get through 6 sets of 5 and using an appreciably heavier weight.

For lower capacity clients, this can be a great way of building up volume for those who may not have the endurance to go through longer sets or bigger volumes all at once. It also allows for more set-up and learning opportunities for each exercise than doing one or two larger volume sets would allow.

#5: Core Training Should be Vector, Speed, and Intensity-Specific, Not Just Muscle Specific.

Training a movement like an anti-rotation press to overhead raise sounds awesome and does a lot to work on controlling stability through transverse and frontal plane, all in a relatively slow and controlled manner. Asking, “What does this work? Like, your obliques or something?” can be a fair question, but only scratches the surface of what’s going on.

For athletes who compete in relatively specific directions and actions without the elements of contact and chaos, they can benefit from training with a high degree of specificity to their goal activities. For the less specific athlete or for the non-athletic client, they can still benefit from more variable-dependent training, depending on their goals. For instance, a 50-year-old accountant with a history of low back pain may not need to do max velocity rotational throws, but they could still benefit from some rotational velocity training to help prepare them for the eventual frozen sidewalks that they’ll have to walk around in Edmonton in a few months, or perhaps for the games of golf they’ll play when they Snow Bird south for the winter.

For rehab clients, the direction-specific element speaks volumes to whether they have a directional intolerance to certain movements. For instance, some clients can’t handle flexion-based movements very well, so involving some flexion progressions they can work with would be good, whereas full range crunches probably wouldn’t be beneficial. Slower movements to develop control would be important, but involving some higher velocity movements they could control and replicate would also be beneficial in case they encountered those kinds of scenarios on their own. An example would be if they stepped off a curb and had to catch their balance before falling or jerking their spine into a potentially disastrous situation.

Closing Thoughts

To recap, everyone from elite athletes to recovering spinal injury clients and everyone in between can involve core training into their programs in very similar ways, but with minor differences here and there to accomplish their specific goals. Most of the time it’s pretty easy to do, if you know how to do it.

This is where Advanced Core Training comes in. Dean has created a comprehensive, user-friendly guide to programming and coaching core stability exercises. You'll pick up new assessment ideas, innovative exercises, and coaching strategies you can employ to improve outcomes with your clients and athletes. The resource also includes NSCA CEUs. Click here for more information.  
 

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Yoga for Athletes: Why Activation and Inhibition Matter More than Stretching

Today's guest post comes from yoga expert, Dana Santas, who is "changing the game" when it comes to yoga for athletes. Enjoy! -EC

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Ten years ago, I taught yoga to athletes; literally, that’s what I did. I spent my first year in the yoga-for-sports niche teaching athletes how to be “good” at yoga. My goal was to help them be-come more flexible. I didn’t know what I didn’t know. A decade later, after working with hundreds of pro athletes and dozens of teams, I’m extremely averse to the idea of “flexibility” as a priority.

But, like many yoga instructors, I started my career with a well-intentioned emphasis on length-ening muscle tissue that seemed short and tight. Despite that misguided intention, it was my Type-A, drill-sergeant insistence on precise alignment and proper breathing that inadvertently delivered results for my clients. Once I recognized the real reasons I was positively impacting them—which had little to do with stretching—I went from providing temporary relief of tension to creating lasting increases in functional mobility, stability, and mental stamina.

Yoga didn’t benefit my clients because of flexibility gains; rather, it helped them:

1. activate/inhibit muscles
2. use their diaphragm
3. initiate their parasympathetic nervous system

In this article, we’re addressing the first item. However, my next article “5 Compelling Reasons Athletes Should Practice Breathing,” will cover why proper diaphragm use and breathing biomechanics are not only paramount for leveraging the autonomic nervous system but also facilitating integrated core strength, pelvic floor function, shoulder girdle integrity, shoulder mobility, and more. But I digress….

Because many yoga positions require multi-planar movement in a controlled manner or positional hold, demanding perfect alignment in those poses forces athletes out of compensation patterns. Taking them out of these patterns activates muscles that have been dysfunctionally dormant, and inhibits the overactive compensators (effectively turning off the tension). It’s the activation and inhibition initiated in yoga—not stretching—that actually helps athletes become more mobile.

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When you simply stretch chronically tight, overactive muscles—without correcting the cause of the overactivity—you can provide temporary relief, but you risk tearing the muscle and increasing potential for injury. You might also reduce strength and power, since the athlete has likely been using that muscle as a primary source of movement in their sport.

Why do I assume that significant tension in athletes is due to compensation? I see it all the time! Consider the most popular, traditional strength and conditioning movements—the ones we love to do (i.e., squats, bench presses, bicep curls, crunches, etc.). What do they all have in common? The sagittal plane. And that’s where too many athletes place their training effort, despite the fact that most sports require multi-planar movement; think about a baseball swing. Consequently, athletes learn to compensate through powerful multi-planar movements in their sport by using the muscles they’ve strengthened in the weight room.

Understanding this phenomenon, we can better identify the contributing factors to areas of chronic tension and leverage yoga to concentrate on specific activation of the muscles that have been inhibited (agonists and synergists) by the tense area’s overactivity/compensation. In this way, you use reciprocal inhibition to not only relieve tension but restore kinetic chain firing and functional range of motion. Stretching, alone, can’t accomplish that.

Still not convinced? Let’s look at a typical area of tension: the low back.

I can’t even begin to tell you how many times I’ve been asked by teams and athletes to “stretch” tight low backs…almost as many times as I’ve been asked to “stretch out hamstrings.” Of course that’s not a coincidence, since most athletes with “tight” backs also have “tight” hamstrings…because they’re both part of a typical dysfunctional posterior chain firing pattern!

Before I explain my activation-and-inhibition rationale and strategy for approaching low-back tension, let me offer this interesting piece of info:

According to the National Electronic Injury Surveillance System (NEISS), in 2010, lower back strains were the most common reported reason for ER visits relating to yoga. I believe this is the case because the sequences of some popular yoga styles, including Bikram's Hot 26, feature poses that feed into compensatory back-extension patterns by promoting hyperextension, and counter them with stretches encouraging extreme low-back flexion. Understandably, that combination of movements can be especially dangerous for anyone with a tight low back!

Athletes with low-back tension usually have excessive anterior pelvic tilts that contribute to in-creased lumbar lordosis. Overactive hip flexors holding the pelvic tilt, inhibit glute firing, which then forces back extensors to compensate as hip extensors.

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If we just stretch the low back—which often isn’t even possible because the back extensors can’t release—we’re not fixing the problem because the low back will immediately reengage in response to the hip flexors pulling on the pelvis. And, as the ER-visit data shows, we could strain the low back in the process.

Here’s a sample breakdown* of an introductory activation-and-inhibition yoga strategy for low-back issues:

*Note that these are just a few examples and don’t represent all of the possible yoga-based movements that could be used to initially address low-back tension. Once you’ve had success with simple—yet challenging—postures and movements, like those below, you can move into multi-planar twisting poses variations that emphasize t-spine rotation while maintaining a stable low back, as well as more challenging positions that emphasize hip mobility through a functional range. Often, low-back issues are aggravated by a locked-up thoracic spine and/or hip mobility limitations that force compensatory rotation from the lumbar spine. But you don’t want to jump right into more complicated movements until you’ve reinforced low-back stability and function and ensured that the back extensors can actually shut off appropriately.

Start with movements that promote glute activation and hip flexor inhibition, like Bridge. Maintain pressure in the lateral heels and medial arches to facilitate glute and adductor engagement. Avoid lifting into back extension. Inhale as you lift your pelvis. Exhale to bring your pelvis down. If the knees bow out or you have trouble maintaining medial arch awareness, hold a foam yoga block or ball between your legs to ensure adductor engagement.

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Incorporate core and pelvic floor work to inhibit back extensors. This includes practicing poses, like my version of a Modified Boat pose with feet down. Keeping the knees and feet together integrates a focus on adductor engagement for hip and pelvic floor stability. Inhale as you reach arms out to the sides, aligned with shoulders. Exhale as you bring the arms back to the front (as pictured). Supinating the forearms as you take the arms out helps engage lower traps and re-lease upper traps to avoid drawing the shoulders up next to the ears.

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Functional Squat encourages the pelvis to move through a posterior tilt and release back ex-tensors. Like the traditional yoga Child’s Pose, functional squat also lengthens the low back; however, it does it actively rather than passively. Keep feet hip-distance apart with weight in the lateral heels and medial arches. Hold for three deep breaths.

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After going through the moves above, I recommend finishing with a longer-held, low-back stretch. Yes, I did say “stretch.”

I’m not a yoga trainer who doesn’t stretch my clients. I stretch them all! It’s just not the focus of my programs. But I use dynamic stretching (I call it dynamic “mobility”) in warm-ups, and I close out sessions with targeted, deeper stretches. For example, check out this video clip from a re-cent Tampa Bay Rays development camp. We'd already worked on glute and core activation to inhibit low-back extensors, so then we were doing targeted quadratus lumborum (QL) stretching.

In the interest of brevity, the sample yoga strategy I’ve shared above doesn’t specifically address asymmetry, but it’s important to note that there are typical contributing factors that lead to tension presenting more on one side than the other—particularly the right. These can include: left-to-right pelvic rotation with the center of gravity stuck in the right hip (the foundation of Postural Restoration Institute philosophy) and poor breathing mechanics causing the diaphragm to pull into the right low back, where it has a thicker, longer right lumbar-spine attachment.

Asymmetrical low-back tension is also exacerbated by an athlete’s sport, position and hand dominance. Using baseball as an example, consider how the movements of the following players would add to right low-back pain: a right-handed batter, a left-handed pitcher, and a right-handed a catcher, who stays on his toes due to an inability to posteriorly tilt the pelvis. Consequently, when developing a yoga-based program for an athlete with a low-back issue, the postures you select and the cuing and emphasis need to take into account the asymmetrical nature of the athlete’s tension and corresponding compensation patterns they’ve developed as a result of their sport.

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All this said, I’m not claiming that athletes can’t get anything positive out of flexibility-focused yoga. Stretching, in and of itself, can feel great and increase blood supply to muscle tissues. I just think it’s important to understand the risks versus benefits. And, as I explained from my own experience as a novice instructor, there can be “inadvertent” benefits. However, when you’re a pro athlete, whose body’s function determines the trajectory of your career, it’s probably not in your best interest to waste your time with anything that’s “inadvertently” good for you…and could possibly be detrimental. My advice for teams and athletes, who want to add yoga to their training program, is to seek out instructors who understand functional mobility and breathing biomechanics, and don’t over emphasize flexibility.

About the Author

Dana Santas is creator of Radius Yoga Conditioning, a yoga-based mobility and sports-training style designed specifically to help athletes move, breathe and focus in ways that enhance performance and decrease injury. Nicknamed the “Mobility Maker,” she’s the yoga mobility expert for CNN and team yoga trainer for the Toronto Blue Jays, Atlanta Braves, Philadelphia Phillies, Tampa Bay Rays, Orlando Magic and Tampa Bay Lightning, as well as sports mobility consultant to more than half a dozen other teams and hundreds of MLB, NHL, NBA, NFL, MLS, LPGA & WTA pros. You can learn more about her at www.RadiusYoga.com.

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