Home Posts tagged "lower back pain"

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

A post shared by Eric Cressey (@ericcressey) on

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; for more information, check out www.FunctionalStability.com.


 

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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.

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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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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.

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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.

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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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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.

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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.

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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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Strength and Conditioning Stuff You Should Read: 7/5/11

I hope you all had a great 4th of July weekend.  I'm a bit behind on things in light of the holiday festivities, so we're going to kick this week off with a list of recommended strength and conditioning reading for the week: Preventing Lower Back Pain: Assuming is Okay - This post of mine discusses why what you see on a spine MRI doesn't always depict exactly what's going on. When the Hips and Core Call BS on the Foot - I enjoyed this post from Charlie Weingroff, who continues to kick out quality information on a regular basis. Pick Your Deadlifting Poison - This is a good blog from Mike Robertson on picking your assistance exercises based on where you miss your deadlifts. Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
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How to Deadlift: Which Variation is Right for You? – Part 3 (Trap Bar Deadlift)

Today marks the third and final installment of this series on which deadlift variation is right for you.  Part 1 focused on the Conventional Deadlift, while Part 2 covered the Sumo Deadlift.  Today, we'll talk about another fantastic option: the Trap (or Hex) Bar Deadlift.

At Cressey Performance, we use the trap bar for all our initial deadlift technique instruction with new clients, as it tends to be a very safe option for just about everyone.

Because the handles are to the sides (instead of in front) of the lifter, it doesn't take as much hip and ankle mobility to get down to the bar.  Most trap bars also come with two handle settings - one of which is a little bit higher so that those with limited mobility can still get down to deadlift with a neutral spine.  So, it saves you the time and annoyance of having to put the plates on top of some sort of riser to elevate the bar.

Additionally, because the lifter is positioned "inside" the bar, the load is horizontally closer to with his center of gravity (COG), whereas the resistance is usually more anterior to that COG on a conventional or sumo deadlift. Note the white line in this photo that depicts the position of the load relative to the hip - and imagine how it would be a few inches further to the left in a conventional or sumo deadlift.

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As a result, there is less shear stress on the spine and presumably more compressive stress.  Our spines generally handle compression much better than shear, so this simple repositioning of the resistance closer to the axis of rotation (hips) can dramatically improve "comfort" during deadlifts in those with a history of back pain (or those who are looking to avoid it).  You'll often see lifters who try to go right back to conventional deadlifting after lower back pain and wind up with recurring symptoms.  They'd be much better of transitioning with some trap bar deadlifts to "test the waters."

The only problems I see with trap bar deadlifts are pretty subtle ones - and both have to do with the fact that the bar really never comes in contact with the legs on the way up or down.  As a result, there is a tendency is novice lifters to try to squat the weight up and down - and this is not what should be taking place; it's a deadlift - which means "hips forward, hips back."  This first common problem can be quickly corrected by simply teaching the movement correctly with a good hip hinge.

The second concern would be those in significant posterior pelvic tilt who have lost the lordotic curve of the lumbar spine.  When one gets to lockout on a conventional or sumo deadlift, we cue them to activate the glutes and "hump the bar" to complete the movement.  In those with posterior pelvic tilt, that same movement to finish hip extension without the presence of a bar to stop them will often lead to them going into full posterior pelvic tilt and lumbar flexion under load in the upright position.  In other words, the hips come through too far.  This is another problem that can be easily fixed with cueing on when the hip extension should end, and what the upright position should look and feel like.

A lot of those reading this piece may not have access to a trap bar for performing this strength exercise, but to be honest, I can say without wavering that for most people, it's well worth purchasing. You can pick one  up HERE through Perform Better for just $144.95 plus shipping.  And, this bar is actually surprising versatile addition to a strength and conditioning program relative to what people think; you can do deadlifts with it, but also farmer's walks, overhead presses, and (if it's your thing) shrugs.

To see how all the deadlift variations fit into a comprehensive strength and conditioning program, check out The High Performance Handbook.

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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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