Home Posts tagged "low back pain" (Page 2)

6 Reasons Anterior Core Stability Exercises Are Essential

This time of year, I'm doing a lot of assessments on college baseball players who are just wrapping up their seasons.  One of the biggest issues that I note in just about every "new" athlete I see is a lack of anterior core control. In other words, these athletes sit in an exaggerated extension pattern that usually looks something like this:

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And, when they take their arms overhead, they usually can't do so without the ribs "flaring" up like crazy.

This is really just one way an athlete will demonstrate an extension posture, though. Some athletes will stand in knee hyperextension. Others will live in a forward head posture. Others may have elbows that sit behind their body at rest because their lats are so "on" all the time.

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This isn't just about resting posture, though; most of these athletes will have faulty compensatory movement patterns, too. Once we've educated them on what better posture actually is for them, we need to include drills to make these changes "stick." Anterior core drills - ranging from prone bridges, to positional breathing, to dead bugs, to reverse crunches, to rollouts/fallouts - are a great place to start. Here's why they're so important:

1. Breathing

The muscles of your anterior core are incredibly important for getting air out. The folks at the Postural Restoration Institute often discuss how individuals are stuck in a state of inhalation, with each faulty breath creating problematic accessory tone in muscles like scalenes, lats, sternocleidomastoid, pec minor, etc. These muscles aren't really meant to do the bulk of the breathing work; we should be using our diaphragm. Unfortunately, when the rib cage flies up like we saw earlier, we lose our Zone of Apposition (ZOA), a term the PRI folks have coined to describe the region into which our diaphragm must expand to function.

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(Source: PosturalRestoration.com)

Step 1 is to get the ribs down and pelvis into some posterior tilt to reestablish this good zone. Step 2 is to learn how to breathe in this position, emphasizing full exhalation.

Step 3, as you may have guessed, is to strengthen these "newly rediscovered" patterns with good anterior core training.

2. Resisting extension.

This one is the most obvious benefit, as the muscles of the anterior core directly combat too much arching of the lower back. If you aren't controlling excessive lumbar extension, it's only a matter of time until you wind up with lower back irritation - whether it's just annoying tightness, a stress fracture, a disc issue, or something else.

3. Better force transfer and lower back injury risk reduction.

The research on core function is pretty clear: its job is to transfer force between the lower and upper body. Spine expert Dr. Stuart McGill has spoken at length about how spine range of motion and power are positively correlated with injury risk. In other words, the more your spine moves (to create force, as opposed to simply transferring it), the more likely you are to get hurt. How do you prevent your spine from moving excessively? You stabilize your core.

4. Indirect effects on rotary stability.

For a long time, I looked at control of extension as "separate" from control of rotation at the spine. In other words, we did our anterior core drills to manage the front of the body, and our chops, lifts, side bridges, etc. to resist unwanted rotation. However, the truth is that these two approaches need to be treated as synergistic.

As an example, every time I've seen an athlete come our way with an oblique strain, he's sat in an extension posture and had poor anterior core control - even though an oblique strain is an injury that occurs during excessive rotation. All you need to do is take a quick glance at the anatomy, and you'll see that external obliques (like many, many other muscles) don't function only in one plane of motion; they have implications in all threes - including resisting excessive anterior pelvic tilt and extension of the lower back.

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What this means is that you can't simply ignore coaching in one plane when you think you're training in another one. When you do your chops and lifts, you need to prevent lumbar hyperextension (arching) . And, when you do your rollouts, you can't allow twisting as the athlete descends. Finally, you can add full exhales (a predominantly anterior core challenge) to increase the difficulty on rotary stability exercises.

5. Improved lower extremity function and injury risk reduction.

Lack of anterior core control directly interferes with lower extremity function, too. If the pelvis "dumps" too far forward into anterior tilt, the front of the hip can get closed down. As I described at length here, this can lead to hip impingement.

With a squat variation, while some athletes will stop dead in their tracks with this hip "block," others will slam into posterior tilt to continue descending. This is the "butt wink" we've come to see over and over again in lifting populations. When neutral core positioning is introduced and athletes also learn to manage other extension-based compensations, the squat pattern often improves dramatically. This can "artificially" be created transiently elevating the heels, turning the toes out, or by having an athlete hold a weight in front as a counterbalance.

Additionally, athletes in heavy extension patterns often carry their weight too far forward, throwing more shear stress on the knees during lunging and squatting. The more we can keep their weight back to effectively recruit the posterior chain, the better.

6. Improved shoulder function and injury risk reduction.

The lats can be your best friend and worst enemy. On one hand, they have tremendous implications for athletic performance and aesthetics. On the other hand, if they're "on" all the time (as we often see in extension-based postures), you can't get to important positions with the right movement quality. Overactive lats will limit not only shoulder flexion (overhead reaching), but also upward rotation of the shoulder blades. I covered this in quite a bit of detail in Are Pull-ups THAT Essential?. Moreover, with respect to elbow function, overactive lats can be a big issue with allowing throwers to get true external rotation, as I discussed here:

If you're using your lats as an "all the time" core stabilizer, you aren't just at risk of extension-based low back pain, but also problems at the shoulder and elbow. If you can get your anterior core control under control and normalize the length and tone of the lats, your "healthy exercise pool" for the upper body expands dramatically. Getting overhead is easier, and you'll feel stronger in that position. The same goes for external rotation; not surprisingly, pitchers always say that their lay-back feels smoother after soft tissue work on the lats, as an example.

Wrap-up

These are just six benefits of training the anterior core, but the truth is that they could have been broken down in much more detail as they relate to specific injuries and functional deficits. If you're looking to learn more on this front - and get a feel for how I like to train the anterior core - I'd encourage you to check out my presentation, Understanding and Coaching the Anterior Core. It's on sale for 40% off this week; just enter the coupon code SPRING at checkout to get the discount.

AnteriorCore

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How Chronic, Prolonged Sitting Impacts Your Body – and What to Do About It

Last week, over the course of two days, I made the long drive from Hudson, MA to Jupiter, FL. Suffice it to say that all those hours in the car gave me a newfound appreciation (or distaste?) for just how hard sitting is on the body. As such, it was really timely when my friend Michael Mullin emailed along this guest post on the subject. Enjoy! -EC

Disclaimer:

In this article, the author describes a fictional scenario in order to demonstrate a point related to the degree of information and misinformation there is in the layman and professional literature. It is in no way an attempt to create alarm that these facts apply to every person and every situation. While this article is not scientifically based, the published references are meant as an example of what some studies have found of the impact prolonged sitting and being in a stressful environment has on the body. Please read this article with the intent with which it was written—to provide concrete tools to use if you have to sit for extended periods of time.

I would like to have you read the scenario below and let me know if you would want this job.

“Congratulations on being selected for the position of top minion here at Do Everything Against Design, Inc. (DEAD).  Our company is a prestigious purveyors of thneeds—and a thneed is a thing that everyone needs (5). We pride ourselves on our commitment to being on the cutting edge of business and we use only the best, most up-to-date information possible to dictate how we run our business.”

“Let me start off by saying that this job will provide all kinds of potential benefits. It is up to you to decide how committed you are. The potentials are endless—overuse injury, chronic pain, depression, increased alcohol use, drug or medication use, cancer, increased general mortality, even bullying—that’s right, just like when you were a kid—are all very real possibilities here at DEAD, Inc.”

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“So first thing we will do is get you set up with your work area and station. Here is your cubicle which studies have shown are detrimental to not only work life but also your personal life (1). And here is your ergonomically correct chair so that your body doesn’t have to move, because research has shown that sitting 90% of your day, will almost double your risk of developing neck pain (2). We are also well aware of the fact that this increased time sitting will ultimately yield to a higher mortality rate for you (3), and make you feel generally crummy, but we are willing to take your chances. In fact, don’t even bother trying to counter all this sitting with exercise, because it will increase your risk for certain cancers by up to 66% regardless of how active you are when not sitting! (4)”

“However, placing this degree of stress and strain on your body is mainly so that we can reduce the organization’s costs and increase productivity (5), which is what is most important to us. Because ‘business is business and business must grow, regardless of crummies in tummies you know’ (6). And you do want to be a team player, don’t you?”

“In fact if you do end up having any physical problems, there is a greater than 63% chance that it is actually due to work (7). And if it isn’t from sitting too much (8), then it is due to the psychological stress that this position places on you. Heck, it might even be due to me and the stress I place on you! I will give you an 80% chance that our workplace stress will be the most important factor you will have to deal with here (9).”

forward head posture man

“We have also found that this job can also really give you a great chance on becoming an alcoholic or binge drinker (10), so you have that going for you as well.”

“If stress does become greater than you can learn how to cope with, which is apparently one important part of your employment here (11), then rest assured that we don’t really have a plan in place, because 80% of facilities do not have formal programs in place to deal with workplace stress, and of those that do, only about 14% say it is effective (12). Since that’s what the research suggests, then I mean, how important can establishing a plan be?”

“The single greatest thing about this whole situation is that I will actually pay you to let me break you down, little by little, bit by bit, until you feel beaten and broken. Don’t you see? It’s a win-win situation for both of us here at DEAD, Inc!”

I decided to title this article differently from my original title, “Your Employer Is Trying to Kill You” because I thought it might be a little less inflammatory. But, if you think about it, if data were used to truly guide what we should be doing, than many jobs where employees have to sit the better part of the day are truly a form of abuse. OSHA should be having a field day with these kinds of stats!

This is not about trying to bash many of the companies that have these incredibly sedentary work environments, though. Moreover, it's also not about the fact that I disagree with how our ergonomic evaluations and standards currently are. This is more about trying to create a "Movement/Movement."

Michael Mullin

Our bodies are designed for movement. Period. Our brains are designed for processing and trying to create efficiency so that we can process more. Now that’s pretty smart, however, highly detrimental when it comes to the importance of movement. Because if we continue to listen to what our brain is telling many of us, then it will constantly suggest that we just continue to sit to conserve energy.

So what to do for those of us who have to sit regularly during the day?

  • Get up regularly, even if it means setting a timer at your desk to walk down the hall a couple of times. Not only good for the body, but also good for the brain.
  • Stand every time the phone rings in your office, even if it means you have to sit back down to do something at your computer for the call.
  • Every hour, independent of getting up for regular walks:
    • Sit at the front edge of the chair, hands resting on thighs and body in a relaxed position—not too slouched or sitting up too straight. Take a slow breath in through your nose, feeling your ribs expand circumferentially. Then slowly, fully exhale as if you are sighing out and exhale more than you typically would, without forcing or straining. Inhale on a 3-4 count, exhale on a 6-8 count, then pause for a couple of seconds. Re-inhale and repeat for 4-5 breaths.
    • Staying in this position at the front edge of the chair, reach one arm forward, alternating between sides, allowing your trunk and torso to rotate as well. Your hips and pelvis should also shift such that your thighs are alternately sliding forward and back. Perform 10 times on each side, slowly and deliberately and while taking slow, full breaths.
  • Consider using your chair differently, depending on the task:
    • When doing work on the computer, sit with the lowest part of your low back (i.e. sacrum) against the seat back, but don’t lean your upper body back. This will give the base of your spine some support, but also allow for good trunk muscle activity as well as proper thoracic circumferential breathing.
    • When doing general work such as going through papers, moving things around your desk, filing, etc., sit forward on your chair so that you are more at the edge of the chair. This will allow your legs to take more load and your trunk muscles better able to aid in support, reaching and rotating tasks.
    • When reading items or reviewing paperwork, recline back with full back contact to give your muscles, joints and discs a rest. Make sure to hold the items up at roughly shoulder height—even if you support your arms on armrests or desk.

Remember, chairs and sitting is something that WE as humans created and the current norm is in no way optimal. We were not put on this planet to sit on chairs, and in particular not ones which shut our system off and limit our movement and ability to breathe normally. Until organizations and the general mindset changes to balance work requirements, work efficiency and human health, then we will be constantly be dealing with companies such as DEAD, Inc.

Note: the references to this article are posted as the first comment below.

About the Author

Michael J. Mullin, ATC, PTA, PRC: Michael is a rehabilitation specialist with almost 25 years of experience in the assessment and treatment of orthopaedic injuries. He has published and lectured extensively on topics related to prevention and rehabilitation of athletic injuries, biomechanics and integrating Postural Restoration Institute® (PRI) principles into rehabilitation and training. He has a strong interest in system asymmetry, movement, rehabilitation and respiratory influences on training and their effect on athletics. He has extensive experience with dancers, skiers, and professional and recreational athletes of all interests. You can find him on Twitter: @MJMATC

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The Deficit Deadlift: A Strength Exercise You Can Do Without

The deadlift from a deficit is a strength exercise that has gained some popularity in recent years, and it's popping up in more resistance training programs.  Unfortunately, it's an exercise that sounds a lot better on the internet than it plays out in the real world.  I have a lot of one-time consultations at Cressey Sports Performance with people who have a history of lower back pain after deadlifts, and not surprisingly, a lot of them have attempted the deficit deadlift when they have no business performing it, as the risk-reward ratio is far too high.

To that end, in our Functional Stability Training of the Lower Body resource, I devoted a segment of my deadlift presentation to the topic.  Here's a free preview:

To view the rest of the presentation (and eight others), be sure to check out Functional Stability Training of the Lower Body.

FST-DVD-COVER-LB

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Strength and Conditioning Stuff You Should Read: 8/19/12

Here's this week's list of recommended strength and conditioning reading:

Elite Training Mentorship - The August update at Elite Training Mentorship included some great content from all four contributors.  My in-services were "Shoulder Impingement: Internal vs. External" and "Preventing and Training Around Flexion-Intolerant Low Back Pain."  I also had an article and two exercise demonstrations featured.  If you haven't checked out ETM, definitely do so!

Do Eggs Cause Heart Disease? - In the past week, the "Eggs Are Worse than Cigarettes" shenanigans have gotten out of control.  Fortunately, Adam Bornstein (with contributions from Dr. Chris Mohr, Alan Aragon, and Mike Roussell) gets to the bottom of some very flawed research and reporting that is misleading the public.

6 Mistakes I Made - So You Don't Have To - I loved this post from Jim Wendler, as I've made all these mistakes myself! I wish he'd have published it in 1999!

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Q&A: Can You Overtrain on Core Stability Exercises?

Q: What are your thoughts on the right amount of volume, intensity and frequency on core exercises ranging from bridging variations to ab wheel rollouts from the feet for the intermediate to advanced lifter looking to decrease back pain and get out of anterior pelvic tilt? Is it possible to make progress for a while, but overdue it on volume, intensity or frequency and actually have your core get weaker or stop progressing/responding, and start to experience back pain and anterior pelvic tilt again?

A: This is an outstanding question, and I can really go in a number of different directions with it.

First, let me say that the single best way to get out of excessive anterior tilt is training oneself to not live in anterior tilt!  No amount of exercise will undo the damage you can do with your daily posture.  That’s the easy part of this response, though.

Next, I’ll say that I absolutely believe that we can overdo it with “core-specific” exercises.

As a parallel, just consider the shoulder.  The glenohumeral (ball and socket) joint is heavily reliant on both active (muscles/tendons) and passive (capsule/ligaments and labrum) restraints for stability. If you overdo it with rotator cuff exercises and train the cuff to excessive fatigue, individuals lose dynamic stability and can’t maintain the position of the humeral head in the glenoid fossa. Overuse conditions and injuries can occur.  I wrote about this in an old series, How Much Rotator Cuff Work is Too Much? - Part 1 and Part 2.

Similarly, the lumbar spine relies heavily on both active and passive restraints.  People can overcome lumbar ligament and disc injuries to live pain-free if they maintain adequate soft tissue control.  Likewise, many sedentary folks can live pain-free in spite of poor soft tissue function simply because the challenges of their daily activities don’t exceed the tolerance of the passive restraints (these are the folks who often blow out their backs trying move couches).

That said, we have to be careful about overreacting to this realization.  Just as the trend of doing thousands of sit-ups in the past few decades created a ton of back pain, you see a lot of completely deconditioned individuals who are hurting, too.  There has to be a middle ground between the two.  So, you could say:

Optimizing core function is really a delicate balance of exercise selection, volume, frequency, and intensity.

Unfortunately, I don’t know that we have a perfect (or even close to perfect) answer with respect to all of these factors, as everyone is different.  Consider the following:

1. Flexion-intolerant backs must be treated differently than extension-intolerant backs.

2. Trained athletes probably need a lower frequency because of their sport participation and neural efficiency, but can handle a greater intensity and more complex exercises – and need to prepare the core for fatigue over an extended period (e.g., soccer game, tennis match, 100-pitch outing).

3. A sedentary individual probably needs a greater frequency of low-intensity exercises.

4. In-season athletes must be careful not to do too much work and pre-fatigue the core before competition.

5. Those with congenital laxity (loose joints) likely need a greater frequency of core work for “neuromuscular reminding.”

6. The general exercises we can do in a weight room or rehab setting must be complemented by sport-specific activities in the appropriate volume.  When general volume goes down, specific can go up – and vice versa.

7. Athletes with a previous history of injury – or known diagnostic imaging red flags – may need to do more just to maintain.

8. Everyone’s definitions of “core” is different.  I view the core as pretty much everything between the knees and the shoulders – but the truth is that poor core control can also lead to elbow and foot/ankle issues; should we include those joints as part of the equation?

9. Everyone’s definition of and “core stability exercises” is also different.  Rollouts – an anterior core stability exercise – were mentioned in the question above, but I’ve never had more soreness in my anterior core than after doing heavy push presses.  Simply holding a weight overhead forces our anterior core to work to prevent lumbar hyperextension (the photo below shows what happens when the anterior core isn't properly engaged).

As you can see, the “how much is too much” question is a big, fat, hairy one.  Ask 100 fitness professionals and rehabilitation specialists, and they’ll all have different answers – and even then, it will still be dependent on the athlete/client/patient.  We can’t even effectively define “core,” let alone “core stability exercises” to answer today’s question.

Taking it a step further, only 15% of low back pain has a definitive diagnosis.  One could make the argument, therefore, that only 15% of core function can be adequately assessed/interpreted.  We’d like to think that we know exactly what is going on with a spine, but it’s just not reflected in the research.

The good news, though, is that while most people encounter low back pain at some point in their lives, the overwhelming majority of them do get better with rehabilitation.  We just don’t know what’s optimal - and I’m not sure we ever will, but we are getting a lot better, thanks to the availability of both research and anecdotal experience of rehabilitation specialists, fitness professionals, and folks who have stayed healthy.

This is one reason why I’m so proud of the Functional Stability Training series from Mike Reinold and me. The two of us collaborated in the past to bridge the gap between rehabilitation and performance training, and we have done it again with project.

FST1

Whether you’re a fitness or rehabilitation professional, or exercise enthusiast or athlete looking to learn more about how to effectively prepare the core, train around various lumbo-pelvic injuries/conditions, or learn about developing power in the frontal and transverse planes with medicine ball drills, there is much to be gained from watching Functional Stability Training.

To sweeten the deal, the entire series is on sale for 20% off through the end of the weekend. You can check it out HERE.

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Strength and Conditioning Stuff You Should Read: 2/27/12

Here's a list of recommended strength and conditioning reading to kick off you week.

The Prevalence of Radiographic Hip Abnormalities in Elite Soccer Players - This recently published study in the AJSM shows us just how common hip issues are in soccer players - even if they're asymptomatic.  You can apply this to hockey players as well - and possibly on an even more pronounced level.  This goes hand-in-hand with some of my writings in the past about knees, shoulders, and lower backs.  Just because someone is asymptomatic does not mean that they are "healthy" - and this is why assessment and an understanding of population-specific norms are so important!

Band-Assisted 1-arm Push-ups: A Better Alternative - My buddy Shon Grosse outlines a good progression for those looking to build up to a one-arm push-up.

Causes International - This isn't so much fitness-related, but I think it's a great organization worth checking out. The folks at Causes International provide an opportunity for you to help raise money for your favorite charities by donating your used electronics (a process known as upcycling).  Most people have old gadgets kicking around the house, and these can easily be upcycled to benefit others and protect the environment.

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Stuff You Should Read: 4/25/11

To kick off the week, here's a quick rundown of things you might like to read (or watch): The 5 Most Common Deadlift Mistakes - I published this blog at Men's Health last week, and thought I'd give you a heads-up on it.  It's a good tag-along to the FREE video I provide HERE on how to deadlift (you can also subscribe in the opt-in box at the bottom of this blog to get access). Does Hip Range of Motion Correlate to Low Back Pain?  Maybe Not in Everyone - This is a good post from Mike Reinold that talks about how research on the topic can be tough, and that rotational sport athletes and sedentary folks need to be considered differently. Anti-Rotation Sled Dragging - Here's an innovative core exercise from Jim "Smitty" Smith utilizing the sled for your strength and conditioning program. Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
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Dean Somerset Interviews Me – Part 1

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So, to recap:

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

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

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

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

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Lower Back Pain, Diesel Little Leaguers, and Resistance Training Solutions

Here are a few blasts from the past that you definitely ought to check out: Lower Back Pain and the Fitness Professional - It's amazing how many fitness professionals know NOTHING about lower back pain even though it will occur at one point or another in every single one of their clients. Can Little Leaguers Strength Train? - It's a question I get all the time - and this was my first response to the inquiry a few years ago.  I updated this and got a bit more detailed and geeky in a follow-up, The Truth about Strength Training for Kids. Solutions to Lifting Problems - This T-Muscle article is a must-read for anyone who wants to be able to stay the course even when setbacks occur along the resistance training journey. Lastly, for those who are looking to shed some pounds over the holidays while everyone else is packing 'em on, check out these two free Holiday Fat Loss special reports from Joel Marion.  Joel's got some quick and easy to apply tips you can put to use right away. Sign-up Today for our FREE Newsletter:
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