Home Posts tagged "sacroiliac dysfunction"

Pelvic Arch Design and Load Carrying Capacity (Or, How the Heck Does EC Deadlift So Much?)

Today's guest post comes from Dean Somerset.  In reviewing his outstanding resource, The Complete Shoulder and Hip Blueprint (which is currently on sale for $100 off), I loved the section Dean devoted to pelvic structure as it relates to our ability to handle heavy weight training. I asked if he'd be willing to expand on the topic in a guest post, and he kindly agreed.  I really enjoy Dean's work and think you will, too. - EC

I love the deadlift, but it doesn’t love me back all that much. I can pull about 455 on a good day at a body weight of 230, but I haven’t tested a max pull in a few months. I just finished training for a kettlebell course, so it would be interesting to see if it’s gone up at all without specific deadlift training but more accelerative training, but that’s neither here nor there, nor is it relevant to today’s post. It’s just a cool thought.

One reason why I am at the mercy of the deadlift is a previous injury to my right sacroiliac (SI) joint. This causes the arch structure of the pelvis to be compromised, and limits my ability to withstand the shear forces of a heavy deadlift.

Arch structures are an integral feature of a lot of architectural structures, and for good reason. They help to disburse compressive loads across a span towards abutments on either side of the span. Think of ancient Roman aqueducts, bridges, or even more contemporary structures such as the arch in St Louis.


The ability to withstand compressive forces and maintain a powerful structure is so impressive in an arch structure that many ancient arches were constructed without the use of mortar between the joints of the stones. This compressive resistance is of massive importance not only in buildings, but in our own anatomy.

The pelvis is essentially an amazing structure that’s a composite of a single bone made of dozens of noticeable arch structures that integrate between the left and right sides, using the sacrum as the keystone.

As the pelvis and its arches form a span between the two abutments of the legs, it allows for a tremendous amount of compressive force to be relatively easily dispersed across it with relative ease.

The downside to an SI joint injury comes when in the bottom position of the deadlift, or any forward flexed position for that matter, as the arch structure runs directly across the back of the SI joint and it is required to be completely and perfectly integrated, much like the keystone in an arched doorway. If not, the structure comes down.

Now, I have some theories as to how you could use genetics to your advantage to lift heavy weights, as well as some observations about our mutual good friend Eric here as to why that bugger can pull so much weight, training, diet, and focus aside (hey, we all know he’s a cyborg, but there’s some advantages that a solid work ethic can’t provide everyone). A lot of it depends on how much compressive stress your pelvis can manage.

First, there are four different types of pelvis when looking at the width, breadth and angulations of the sit bones (technically known as the ischial tuberosities). This is important because the wider and shorter the arches, the less likely they can sustain during crazy heavy loadings. The best hips for heavy vertical loading are narrow and deep.

The Android and Anthropoid hip positions are the most favorable for pulling a sick deadlift off the floor, whereas the wider and shallower gynecoid and platypelloid hips would most likely result in an epic fail and probably injury.

It should come as no surprise to anyone who reads EricCressey.com that there are different types of pelvises (pelvii?). He’s mentioned a lot that there are different types of acromions in the shoulder and that specific angulations would affect rotator cuff function and risk of shoulder impingement. Everyone has different joints and bones, and it’s the combination of these that allows for some of us to do specific things that others can’t. For instance, I can get my hips way wider and longer in the sagittal and frontal plane than most people can, which means mobility isn’t a problem, regardless of what amount of stretching I do.

As a result of my pelvic angles, I’ve got that on lock down. Conversely, loading through a hip flexed sagittal plane loading means I have to brace like no ones business and use some of my active tissues as passive restraints instead of as drivers for the weight. The form closure of the joint is less effective with a wider pelvis than in a narrower one, and the form closure has to work harder, meaning the amount of weight I can pull is less than optimal, and the amount of weight Eric can pull makes grown men weep and kick walls in frustration.

However, it also means he has some minor issues getting unrestricted mobility outside of the sagittal plane. This video shows a very subtle restriction to femoral external rotation during abduction. Check out the kneecap of the extended leg.

Here’s another view of the same leg, but with a similar movement.

Hey, I’ve got a ton of my own movement restrictions, just like everyone else. Check this action out:

That was terrible! But did you see my earlier Cossack squat? Like a boss.

Eric owns sagittal plane, potentially due to a stacked pelvis that’s designed to bear weight like no ones business. However, in nature you typically don’t see the combination of excellent characteristics. In many cases the yin of mobility is in sharp contrast to the yang of max strength. For liner force production, the guy’s one of the best in the world hands down.

I can hit up lateral mobility like a champ, but sagittal force production is an issue.

So how would you assess each of us to develop a program that would help each of us, given our unique capabilities and hindrances? Would you focus on working towards building up the weakness in an isolative manner (as many corrective strategies employ) or would you look to hit up more of an all-encompassing manner, where we could still use our strengths to our advantage and make progress, without feeling like minor restrictions were a big issue?

I’d rather train like a beast than do stuff that may or may not provide much benefit based on my hip positioning and the arch structure of my specific anatomy any day of the week, so having a big tool box to draw from can make or break a program that gets both of us excited to train and fist pump like champs, which means we’re both going to be more likely to see it through to the end and get some sick gains.

The simple difference could be having me do way more loaded carries to use loading without exposing my spine to as much shear forces, as well as sagittal plane stabilization exercises like front planks and anti-extension presses. For Eric, it may mean using a lot more lower load hip rotational movements that still challenge the core, such as low crawl patterns a la Ido Portal.

Follow this up with stupid amounts of loading through sagittal plane dominant movements and he’d be a champ fo’ sho’.

At the end of the day, programming for the individual is most effective when you balance the “yin and yang” of their strengths and weaknesses, but understand the structural benefits the individual may have available to them, as well as the restrictions. Having a broad hip structure versus a narrower structure can be the difference between someone who loves deadlifts versus someone who wants to hit up rotational drills all day long. Having the tools to assess and develop an awesome program for them can be the difference between being a good trainer and a great trainer. 

Looking for more great information like this? Check out Dean and Ton Gentilcore's product, The Complete Shoulder and Hip Blueprint.  It's on sale through Wednesday for $100 off, and includes tons of fantastic information.

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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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