Home Posts tagged "Spondylolysis"

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

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

Show Outline

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

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

Sponsor Reminder

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

Podcast Feedback

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

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

Thank you for your continued support!

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

Name
Email
Read more

Advice From a Former College Baseball Player: What If?

Today's guest post comes from current Cressey Performance intern, and former D1 college baseball player, James Cerbie. -EC

What if?

It’s the age-old question that has haunted athletes and competitive people for ages.

What if I had done this? What if I had done that? What if I hadn’t been stupid and done <fill in the blank>?

Unfortunately, these questions will never have answers. It’s impossible to go back and revisit what could have been. Rather, we’re left to look at the now, learn from our “what if” moments, and share our new understanding with another generation. That is where I now find myself.

I’m in the middle of my internship here at Cressey Performance, and to say I’m greeted with the “what if” question on a daily basis would be an understatement. Everyday I get a glance at how we train and prepare athletes, and get to reflect on how I was trained and prepared.

cerbie

And just to bring you up to speed, I’m speaking to the training and preparation of baseball athletes. I’m currently 24 years old and spent approximately 19 of those years playing baseball. It was my greatest passion growing up and I devoted countless hours to my craft. My hard work eventually paid off as I got to play Division 1 baseball at a great school (go Davidson). But, nevertheless, it’s impossible to wonder what could have been if I had known what I know now.

Here are 6 things I really wish I would have known, or done more of during my baseball career, courtesy of my experience here at Cressey Performance.

1. Get assessed.

I’ve always been a good athlete. That’s not to toot my own horn because I have my parents to thank for that more than anything; it just is what it is.

Because I was always a good athlete, however, I believe certain aspects of my training got overlooked. Number one on that list being an assessment.

Not once, throughout my entire athletic career, did I ever get assessed.

If I got injured or came up short on a certain task it was just chalked up to being an athlete:

“James…these things just happen. You’re a good athlete and getting injured is just a part of what you do.”

Oh really? A stress fracture in my back, multiple hip flexor strains, a pulled quad and a host of other injuries just happen for the sake of happening? Sorry, but that answer always frustrated me. What I really heard was:

“James…you keep getting injured but I really don’t know why.”

Don’t get me wrong, I understand that getting injured is a part of sports. Here’s the difference though: there are fluke injuries that pop up on the rare occasion, and then there’s being “chronically” injured which entails always being nagged by one thing or another.

Throughout my collegiate baseball career, I fell in the “chronically” injured category and would constantly be met with suggestions like:

“Oh, your hamstrings are tight. Just stretch those bad boys a couple times a day and that’ll help.”

“Oh, your hips are tight. Just stretch that and things should start feeling better.”

For those of you who haven’t tried the “stretch it because it’s tight” routine, let me save you the time and effort: it doesn’t work. There’s far more to it than that.

I don’t want to start sounding like a repetitive drumbeat, so let’s get to the point: you need to be assessed. It’s the number one most important thing you can do; it’ll help you stay healthy and take your performance to the next level.

I’ll use myself as example.

The first time I met Eric was about a year after I stopped playing baseball. Having heard great things about him, I visited Cressey Performance for a one-time consultation. Here’s an excerpt from the email Eric sent me, highlighting my “problems.”

“1. Your sit in significant scapular downward rotation, and your humeral head dives forward whenever you extend or externally rotate. These are super common in overhead throwing athletes, and you just took them a step further by also becoming an overhead pressing athlete! You simply don't get enough upward rotation when your arms elevate - and that's a big thing we'll address with these warm-ups.

2. Getting upward rotation and good overhead motion is also heavily dependent on building up anterior core stability. You're extremely lordotic and heavily overuse your lats to not only pull the spine into extension, but also take the scapula into depression/downward rotation. When lats are this overactive, your lower traps don't want to do their job. So, core stability closely relates to shoulder mobility and stability (not to mention breathing patterns and a host of other things). You could also see how your anterior weight bearing negatively affected your squat pattern, and why that counterbalance made so much of a difference.”

He actually talks about some of these issues in this video:

In short, here were my issues:

- I was incredibly extended with an obnoxious amount of anterior pelvic tilt
- I had crazy overactive, short and stiff lats
- Lower trap strength equivalent to that of a 7-year-old girl
- A 6 pack that meant nothing because my core was actually really weak

Cue epiphany.

I finally had answers to my seemingly endless list of injuries throughout college. Almost all of them could be tied back in one way or another to the list above and here’s the frustrating part: nobody had ever looked at these things before or had ever written me an individualized program to address them.

I was merely given generic “athletic” development programs that fed into and compounded my dysfunction.

Moral of the story? Get assessed.

2. Movement comes first.

I always equated problems with strength. I thought strength could solve any deficiencies I had and approached my training likewise. Looking back, I now realize how dumb that was.

More times than not, especially as you get older and advance from level to level, it has far less to do with strength and far more to do with how well you move. Like Gray Cook says, “Don’t layer fitness on top of dysfunction.”

Well, I layered a whole bunch of fitness on top of dysfunction.

This happened because one, I was never assessed, and two, I was incredibly stubborn. The thought of taking a step back to work on movement quality irked me like no other.

“I can squat over 400 lbs. Why am I going to go do goblet squats with an 80 lb dumbbell?”

This was foolish, and something the coaching staff at CP does an excellent job of handling. Because Cressey Performance puts every client through an assessment, they know what a client needs to work on and how to do so properly. Many times, this means taking a small step backward (from the client’s point of view) in order to take an enormous step forward.

CP579609_10151227364655388_1116681132_n

Unfortunately, most athletes are like I was. They want to always push the envelope and the thought of taking a step back is almost insulting.

Dear athletes: Please change this attitude.

I can’t harp on the importance of movement before strength enough. Do what you need to do to make sure you move well before you worry about building up strength. Your body and your career will thank you as you stay healthy and reach the highest levels of performance.

3. Focus on the little things.

It’s often the little things that get overlooked the most. These are things like prone trap raises, breathing patterns, soft tissue work and your posture outside the gym. They aren’t sexy and are, to be quite honest, boring.

It’s these boring and non-sexy items, however, that make a big difference.

Putting your full attention into the tiny details of arm care, how you breathe, how you stand, and how you often you foam roll will make the difference between being good and being exceptional.

Luckily, the athletes at CP have a staff that understands this and harps on it daily.

4. Do more single-leg work.

There were few things I hated doing more than lunges, single leg RDLs, split squats, step-ups…really any single-leg exercises. I hated them because I sucked at them.

Tell me to do something on two legs and I crushed it. Put me on one leg (especially my right) and I turned into Bambi on ice.

Okay, so it wasn’t that bad, but it definitely wasn’t my forte.

Instead of forcing myself to conquer this deficiency, I merely found ways to implement as much bilateral work as possible. Seeing as the vast majority of baseball, and pretty much all sports for that matter, are played on one leg, this wasn’t the smartest decision. I would have been far better off doing like we do at CP and hammering single-leg work.

Not just doing lightweight, high rep sets though, but getting truly strong on one leg:

Ultimately, I believe a lot of the success CP baseball players have is because they are forced to get strong on one leg, while most people take my approach and only get strong on two.

Side note: that’s not to say CP athletes don’t get strong on two legs, because they do.

5. Get outside the sagittal plane.

Oh…the beloved sagittal plane.

BodyPlanes

 

Visit most weight rooms and you’ll see people living in the sagittal plane:

Squatting…sagittal plane
Deadlifting…sagittal plane
Box jump…sagittal plane

And the list could easily go on. Most sports (and life for that matter), do not comply with this North-South straight-line orientation; they are lived in multiple planes of motion.

Just think through the complexity and mechanics of throwing a baseball. All the things that need to take place to ensure a ball is thrown at the correct velocity, with the right spin and the right trajectory to bring about the desired result. It’s pretty amazing stuff when you consider the minute details.

Here’s another cool little tidbit of info: power development is plane specific. Just because you can generate power in one plane doesn’t mean you’ll do so well in others.

cish62115_10150356086959953_2125131643_n

Yup…you guessed it. I missed the boat on this one also.

At CP, however, they get outside the sagittal plane, and do so often. First on this list is medicine ball throws.

They use a lot of different medicine ball throwing routines to help their athletes develop power in the transverse and frontal plane. A great example of such an exercise is the rotational med ball scoop toss:

Second, they implement exercises like the 1-arm kettlebell lateral lunge and heiden:


Lastly, they use off-set loading on exercises; this provides a rotational component to the movement because the body has to resist rotating towards one side vs. the other. A good example of such a movement would be a 1-arm 1-leg kettlebell RDL:

Although this barely scratches the surface when it comes to exercises used by Cressey Performance and the importance of training outside the sagittal plane, I hope it has given you a good frame of reference.

6. More doesn’t equal better.

There’s a time to push it and a time to back off. Being an in-season athlete is not one of the “push” times. Many coaches, however, forget this and continue pushing their athletes as if nothing has changed.

If you read Eric’s blog often (which I hope you do) you’ll know he says, “You can’t add something without taking something else away.” I really wish that quote could be plastered on the walls of weight rooms around the country.

When the volume of swings, throws and sprints picks up because you’ve started the season, then you have to start taking something away.

Having been lucky enough to spend the past few months at CP, I’ve gotten to witness this first hand. As pitchers begin entering their competitive season (when they’re obviously throwing more often), you see a change in the program to reflect the increased volume outside the weight room.

Medicine ball throws are scaled back, if not eliminated completely. Lifts move towards a two-day per week full body structure, and extra movement days are limited.

As an athlete, it’s easy to forget how everything you do adds up. Every swing, every throw, every sprint and every lift leaves traces in your nervous system. And, although you may be awesome, your body can only handle so much. I understand the desire to get in and work hard, but you have to remember that a lot of times, less is more.

Closing Thoughts

At the end of the day, this barely scratches the surface when it comes to things I wish I would have done differently. As opposed to dwelling on that, however, I’d rather write and share my experiences with coaches and athletes so they can avoid making the mistakes I did. Feel free to post questions or discuss your own experiences in the comments section below.

About the Author

James Cerbie is a cecerbie1rtified strength and conditioning specialist and USA weightlifting sports performance coach who is Precision Nutrition Level 1 and Crossfit Level 1 certified. He has been blessed to work with athletes from the middle school to professional level, including powerlifters, Olympic lifters and Crossfit athletes. Cerbie gets no greater enjoyment than seeing people improve, succeed and achieve their goals. He’s the owner of Rebel Performance and currently works as a strength and conditioning intern at Cressey Performance. You can follow him on Twitter and Facebook.

Sign-up Today for our FREE Baseball Newsletter and Receive Instant Access to a 47-minute Presentation from Eric Cressey on Individualizing the Management of Overhead Athletes!

Name
Email
Read more

Youth Strength and Conditioning Programs: “He’s a Big, Strong Kid.”

Recently, while discussing one particular athlete we encountered at Cressey Sports Performance, my staff members and I got on the topic of how it's more of a challenge to train bigger (taller and heavier) young athletes than it is to work with smaller guys.  Interestingly, the challenges come less from the actual physical issues they present and more from the social expectations that surround their size. Here are seven reasons why I cringe when I hear parents say "he's a big, strong kid" when describing their children on the phone.

1. Bigger kids are often forced into sports and positions that may impede their long-term development - When you're the heavy kid, you're automatically pushed toward football and put on the line.  If you're playing baseball, it's first base or catcher.  If it's basketball, you're the power forward.  You get the picture - and similar "pushes" are made on tall kids to play basketball or volleyball.  The problem is that in most cases, these sport and positional "predispositions" put bigger kids in situations where they don't develop in a broad sense because there simply isn't enough variety.

2. Bigger kids usually start weight-training on their own - This point relates closely to point #1.  Unfortunately, when you're already labeled as the next star offensive lineman or power forward and you can already push your buddies around, chances are that you learned to lift with Dad in the basement, from a misinformed football coach, or be screwing around with your buddies.  I would much rather have a completely untrained 16-year-old start up with me than be presented with a 16-year-old with years of poor strength and conditioning programs and coaching under his belt.  This is true regardless of body type, but especially problematic in bigger kids for reasons I outline below.

3. "Strong" has different meanings - Sports require a combination of absolute and relative strength.  Strength is also highly specific to the range of motion (ROM) in which one trains. There is also a difference between concentric and eccentric strength.

What do most big young athletes do when left on their own?  Focus heavily on absolute strength (train what they're good at) through small ROMs (rather than fight their bodies) with concentric-heavy workloads (because pushing a blocking/tackling sled is sexier than a properly executed lunge).

I can count on one hand the number of teenage athletes who were called "big and strong" who have actually showed up on their first day and demonstrated any appreciable level of strength in any context - let alone usable strength that will help them in athletic endeavors.  Usually, we wind up seeing a sloppy 135-pound bench press with the elbows flared, legs kicking, bar bouncing off the chest...in a kid who can't do a push-up.

And this is where the problem arises: kids who have always been told they were strong don't like coming to the realization that they really aren't strong.  We don't have to directly tell them, either; taking them through basic strength exercises with proper form will reveal a lot.  And, there is typically an example of a smaller athlete like this kicking around not too far away.

The kids who check their egos at the door will thrive.  A lot might never come back until they're injured from poor body control or riding the pine because it turns out that their "strengths" really weren't that strong.

4. Bones grow faster than muscles and tendons - In young athletes who haven't gone through the adolescent growth spurt, you often don't have to do any additional static stretching, as a dynamic warm-up and strength training program through a full ROM can cover all their mobility needs.  Unfortunately, when kids grow quickly, the bones lengthen much faster than the muscles and tendons do, so we run into situations where bigger kids have truly short (not just stiff) tissues.  Effectively, this adds one more competing demand for their time and attention - and it's the worst kind to add, as most kids hate to stretch.

5. Being bigger changes one's stabilization strategy -  As I described in great detail in The Truth About Unstable Surface Training, the taller one is, the further the center of gravity is away from the base of support.  As such, taller kids are inherently more unstable than shorter kids - although this can be partially remedied by gaining muscle mass in the lower body to lower the COG and learning to "play lower" in appropriate situations.

cressey-flat-salespage-232x300

Not surprisingly, though, being heavier - particularly with respect to having a belly - can dramatically change one's stability as well.  Carrying belly fat shifts the center of gravity forward - which is why individuals with this "keg" instead of a six-pack appear more lordotic (excessively arched at the lower back).  Compensations for this occur all along the kinetic chain, but the two things I'd highlight the most are:

a. An increased need for anterior core strength - As evidenced by the high incidence of spondylolysis (lumbar spine fractures) and how badly most kids perform on basic prone bridging and rollout challenges, the inability to resist lumbar hyperextension (and excessive rotation) is a serious problem.  The bigger the belly, the more extended the lumbar spine will be.  Just ask any pregnant woman how her back feels during the last trimester.

ghr-300x300

b. Substitution of lumbar (hyper)extension for hip extension - You'll see a lot of big-bellied kids who can't fully extend their hip and instead just arch their back to get to where they need to be.  This is a problem on multiple fronts.  First, the hip extensors are far stronger and more powerful than the lumbar extensors, so performance is severely impaired.  Second, there are huge injury implications both chronically (lumbar stress fractures, hip capsule irritation) and acutely (strained rectus femoris or hamstrings).

Simply dropping some body fat and improving anterior core strength is a huge game-changer for many overweight athletes.  It's not always the answer they want to hear.

6. Bigger kids usually have less work capacity - I've never been a guy who jumped on the work capacity bandwagon, as I feel that it's very activity-specific.  However, it doesn't take a rocket scientist to observe that the more body fat one carries, the more work he'll do oxygenating useless tissue, and the less oxygen he'll get to working muscles.  More importantly, though, try doing your next training session with a 60-pound weight vest on and see what it does to your work capacity.

The lower the work capacity, the less quality work one can accomplish in a strength and conditioning program.  Gains simply don't come as quickly on the strength and fitness side of things - even if body fat is pouring off heavier athletes.  In other words, they've actually sacrificed one window of adaptation (athletic development) in order to make another one (fat loss) larger.

7. I speculate that bigger athletes have an increased prevalence of "subclinical" musculoskeletal pathologies/deviations from normalcy - I've written in the past about how many athletes are just waiting to reach threshold because their MRIs and x-rays look terrible - even if they are completely asymptomatic.  You can see this just about anywhere in the body; most basketball players are just waiting for patellar tendinosis to kick in, and many football lineman are teetering on the brink of a lumbar stress fracture or spondylolisthesis (or both).

The heavier one is - especially in the presence of insufficient relative strength, as noted above - the more pounding one will place on the passive restraints such as the meniscus, intervertebral discs, and labrum.  A bigger belly and the resulting lordosis will drive more anterior pelvic tilt, femoral/tibial internal rotation, and pronation.  How would you like to be the plantar fascia or Achilles tendon in this situation?

Tall athletes tend to slouch more because they have to look down at all their peers.  Get more kyphotic, add some scapular dyskinesis, and see what happens to the rotator cuff, labrum, and biceps tendon over time.

There are countless examples along these lines.  And, to make matters worse, obese individuals are more likely to have inaccurate diagnostic imaging.  In an interview I did with radiologist Dr. Jason Hodges, he commented:

By far, the biggest limitation [to diagnostic imaging] is obesity. All of the imaging modalities are limited by it, mostly for technical reasons. An ultrasound beam can only penetrate so far into the soft tissues. X-rays and CT scans are degraded by scattered radiation, which leads to a higher radiation dose and grainy images. Also, the time it takes to do the study increases, which gives a higher incidence of motion blur.

doctor-1297054_960_720

I want to be very clear; I love dealing with bigger kids just like I do all my other athletes.  We don't lock them in a closet with celery sticks and an exercise bike; we work them hard, but make training fun and support them fully in their quest to fulfill their athletic potential.  Having been an overweight teenage athlete myself, I know that weight management in young athletes is a hugely sensitive subject that must be approached with extreme care.

I also know, however, that in my overweight years, I would have much rather been worked hard like the other athletes and given the opportunity to choose my sport and position of interest rather than pigeonholed into one specific avenue because of my build.  That's where the "big, strong kid" label really concerns me and makes me want to plan out my strategy - both in terms of the physiological and social approach to training - very carefully.

For more information on how we train young athletes, I'd encourage you to check out the IYCA High School Strength Coach Certification, which I co-authored.

hssc_400_wide-300x243

Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!

Name
Email
Read more

Newsletter 162

Tis the Season...for Spondylolysis? I've written previously about the prevalence of spondylolysis (lumbar fractures) in young athletes - and particularly those in rotational sports.  You can read my in-depth newsletter on the problem HERE.  It's a huge problem in young athletes; I'd estimate that I've trained more than 15 athletes since 2006 through their entire 12-16 week back-bracing periods.

spondylolysis

Now, while July is usually recognized for barbecues, baseball, and beaches (and anything else that's exciting and begins with a "B"), I've begun to recognize it as "back-bracing season."  What gives? Well, for starters, I've seen two new spondy cases come through our door in the past week.  Considering that prevalance is estimated at anywhere from 15-63% in the general population, it isn't a huge surprise.  However, why would more present with symptoms at this time of year? Think about the sports we play in the spring and summer: baseball, tennis, and lacrosse.  And, many soccer and hockey players have been going non-stop since the fall.  In other words, rotational sports have been going on for a long time, and kids are getting more and more detrained - with less flexibility and strength - as these neverending seasons go on. Likewise, as a great article in the Portland Press Herald observed this past weekend, many high school athletes are riding multiple horses with one saddle. In other words, now that they're out of school, you've got kids participating in basketball/hockey (winter) and lacrosse/baseball at the same time - and doing their best to attend fall sports (field hockey, soccer, football) practices.  And, just when they are ready for a day off, they're going to play golf with Dad on Sunday.  When are these kids removing the rotational challenges and preparing themselves physically with good strength, stability, and flexibility training? Anybody who says that the era of the three-sport athlete is dead doesn't know his arse from his elbow.  While early sports specialization has definitely taken off, now, multi-sport athletes are expected to "specialize" in three different sports at once.  They compete all the time, but never prepare their bodies to compete - or play at all. In The Ultimate Off-Season Training Manual, I go into great detail on how those athletes who do choose to specialize should do so.

uotm

However, in younger populations, a lot of these guidelines don't apply, as they're balancing multiple sports.  They need to hang out with their friends, play multiple sports, and get involved in less organized physical activity.  And, most importantly, they need to participate in strength training and flexibility programs, as these exercise modalities are different than traditional sports because they can be fluctuated on a regular basis to avoid imbalances. I know there are a lot of parents who read this newsletter and are trying to do the right thing for their kids.  It isn't fair to condemn them for signing their kids up for another travel team, as that's the game as it's played with respect to player development and college recruiting nowadays.  However, I would encourage those parents to "undo" some of the early specialization damage by encouraging sons and daughters to participate in training to prepare their bodies for this specialization. Lastly, for those of you who are looking to learn more about low back pain, I can't say enough great things about Dr. Stuart McGill's Ultimate Back Fitness and Performance book.  It's a great investment.

ubfp

A Quick Congratulations... Just a quick note to recognize CP athlete Danny O'Connor, who moved his professional boxing record to 7-0 last Saturday night.  Check out a great write-up in the Boston Globe featuring Danny, his coach, and some nutcase named Cressey: Punching His Ticket in the Pros
New Blog Content Random Friday Thoughts Stuff You Should Read A Sneak Peak at the New Project EC Finally Understands Women Have a great week! EC
Read more

Spondylolysis and Young Athletes

Subscriber-Only Q&A: Spondylolysis and Young Athletes

I received this email a few months ago and have been meaning to turn it into a Q&A for quite some time, as spondylolysis is a topic that I think everyone should understand.

Q: I read you spoke at a seminar this sinter on the topic of spondylolysis showing up in young athletes.  I have a 16 year-old son who was diagnosed with this type of stress fracture in his lumbar spine.  He had grown 7 inches over the previous 9 months and our doctor contributed the cause to supporting muscles growth not being able to keep up with the rapid bone growth along with hyperextension of the lower back.  He has recovered quite nicely with rehab being initially rest, isolation and support of the lower back followed by core strengthening when the pain subsided. Occasionally, he will get very temporary flare up pain.  Could you please give me your opinion on the "do" and "don't" exercises that could possibly help prevent Spondylolysis from recurring and your thoughts on the subject.  Thanks for your help.

A: First off, here is some background for our readers. Spondylolysis refers to a fracture of the pars interarticularis portion of a vertebra (95% of the time, it's L5). The pars essentially connects the vertebral body in front with the vertebral joints behind. It's also known as a "Scotty Dog" fracture because the shape of the pars mirrors that of a dog - and when a fracture is present, it looks like that dog has a collar on (or has its head chopped off, depending on whether you're a glass-is-half-empty kind of person or not):

Symptoms may come on traumatically (contact injury) or insidiously (overuse, genetic predisposition, or rapid bone growth during puberty). Pain is typically more lateral to the spine than it is centralized.

We have had quite a few athletes come to us with the condition because we work with a ton of athletes in rotational sports, predominantly baseball. In my humble opinion, "spondies" are the new ACL epidemic. Don't believe me? Check out these numbers from a 2000 study from Soler and Calderon (1):

-8% of elite Spanish athletes affected

-highest prevalence (27%) in those in track & field throws

-17% of rowers, 14% of gymnasts, and 13% of weightlifters had spondylolysis

-L5 most common (84%), followed by L4 (12%).

-Multiple levels of involvement in only 3% of cases

-Bilateral 78% of the time

-Only 50-60% of those diagnosed actually reported low back pain

-Males and females affected equally (although associated spondylolisthesis - or vertebral "slippage" was higher in females)

-Presence of spondylolysis is estimated at 15-63%, with the highest prevalence among weightlifters.

I suspect that these rates are even higher now (eight years later) - and in the U.S., where we have additional rotational and contact sports (as compared to Spain). These numbers - particularly the 40-50% asymptomatic figure - speak directly to the fact that inefficiency is on-par with (if not more important than) the spondylolysis pathology itself. Multiple inefficiencies are to blame for this specific pathology - and many people are just waiting to reach threshold. With that in mind, to be honest, I train all of our athletes under the assumption that they all have a disc herniation or vertebral fracture that we don't even know about - simply because, according to the research, that's probably the case! There are more opportunities than ever to participate in organized sports, yet athletes don't train any more than previously - and DO spend more time sitting.

In fact, about 14 million people - or 3-7% of the general population - have spondylolysis (2), and previous research as shown that asymptomatic disc bulges and herniations may be up in the 80% range (3).

These issues - combined with the fact that 4.4% of six-year-olds present with pars defects - has led to a standard rule in sports medicine where any adolescent athlete with lumbar spine pain for more than three days duration is referred for a bone scan to rule out a fracture. If a pars defect is detected, most doctors will prescribe 12-16 weeks in a back brace: a practice that, while controversial, has yielded favorable healing results.

Risk factors for pars defects have been subdivided into intrinsic and extrinsic. The "*" indicates that these factors are at least partially under our control as strength and conditioning coaches and trainers:

Intrinsic:

-Poor bone mineral density (*)

-Poor lower limb alignment and foot structure (*)

-Faulty muscular recruitment patterns (*)

-Height - Taller (non-modifiable)

-Rapid growth (non-modifiable)

-Body Type - muscle mass, longer spine (* to a degree, some non-modifiable)

-Poor conditioning/muscular fatigue (*)

-Bone pathologies (refer out)

-Menstrual/hormonal irregularities (refer out)

-Genetic predisposition: Inuit > Caucasian > African-American (non-modifiable)

Extrinsic:

-Inappropriate training regimen or surface (*)

-Sporting discipline: Sports demanding repetitive lumbar hyperextension, trunk rotation, and/or axial loading (*short-term, potentially modifiable long-term)

-Footwear (*)

-Cigarette smoking (*)

-Insufficient nutrition - calories, calcium, vitamin D (*)

We can help build bone density with appropriate resistance training and encouraging athletes to consume plenty of calcium and vitamin D. We can train the lower extremity out of alignment problems and faulty recruitment patterns. We can put some meat on athletes to protect them from contact injuries. We can condition athletes so that they don't fatigue prematurely and break down in their technique. We have some control over the training surface. We can get young athletes out of the 10-pound cinderblock basketball shoes they're wearing and do more barefoot work. Kids know they shouldn't be eating the right stuff and not smoking.

So, in spite of all these means of preventing spondylolysis, as is the case with ACL problems, we've pursued a reactive - not proactive - model of addressing the issue. Trust me: you can save a kid a lot of pain and frustration if you prevent a fracture instead of bracing it after the fact. So, let's talk about what are in my opinion the most important things to address in young athletes to protect them from spondylolysis:

1. Train the feet and enhance ankle mobility. Think about what happens to someone who - thanks to modern footwear, muscular weakness, and/or structural predisposition - pronates too much. My good friend John Pallof describes the subtalar joint as a torque converter - meaning that tri-planar motion at/below the joint is converted into tibial and femoral internal rotation. In other words, when you pronate (land/decelerate), adequate stretch of the anti-pronators (particularly gluteus maximus and biceps femoris) is necessary to decelerate that motion. Most people - particularly young athletes - have very little posterior chain strength, and they don't activate their glutes well. So, this internal rotation isn't decelerated effectively - and the stress shifts up a bit from the hip to the lumbar spine. Instantly, a foot and ankle issue has become a lumbar spine issue (I could go on and on about how it relates to shoulder and elbow issues in pitchers, too).

2. Improve rotary stability. The more an athlete moves at the lumbar spine, the more likely he is to get injured. Using the baseball example again, there is considerable research demonstrating that young pitchers have higher rotational velocities than professional pitchers - and the younger subjects control their rotation in a less efficient manner. Rotate more, and do so in an inefficient (weak) way - and you're bound to run into problems at the lumbar spine (and elbow and shoulder, as well).

3. Improve their ability to resist extension. Most of the overuse spondy cases we see are individuals who also have a tendency toward hyperextension. If you can't fire your glutes in hip extension, you'll substitute lumbar extension to attempt to get "upright." Combine that rapid, repeated lumbar extension with rapid, repeated lumbar rotation - and pars defects kick in. For this reason, I love basic movements like prone bridges (and their variations) as well as more advanced progressions such as rollouts on the stability ball and ab wheel (or bar rollouts).

(Note from EC: Jim Smith's Combat Coreis the best resource I've seen with respect to #2 and #3; for those interested in further reading, it provides dozens of exercises for both objectives.)

4. Improve hip mobility. I have covered this above, but hip (and thoracic spine) mobility work hand-in-hand with lumbar spine stability. It's easier to stabilize a spine that's above a mobile set of hips.

5. Improve overall strength and power. The more force you generate in your lower and upper body, the less motion you'll need to utilize at the lumbar spine. Effectively, by making the extremities, hips, and torso stronger, you allow the core to focus on force transfer.

6. Implement appropriate deloading periods. Bone, like muscles and your connective tissues, needs a break to recover here and there. Regardless of how perfect your technique is, you lumbar spine will get chewed up if you swing a baseball bat for five hours per day, seven days a week. Physiological adaptation is all about matching tissue tolerance to tissue loading - and providing adequate recovery time for adaptation to occur.

Now, to get to the question at-hand, return-to-play after a period of bracing is a different story. Believe it or not, we've trained guys through their entire 12-16 week bracing protocols. When they're in the brace, aside from axial loading, there isn't much that can "get them" - meaning that they're completely protected from rotation and extension problems.

In fact, the brace does so much of the work for them that you need to make sure they're seeing a physical therapist at least 1-2 times a week during that protocol to get them out of it to entire that they don't detrain the deep core stabilizers. The brace also restricts full hip extension and flexion - and thoracic spine ROM, to a degree - so mobility work is very important. If I had to briefly summarize our training programs during bracing protocols, it would be "upper body, single-leg movements, pull-throughs, rotary stability training, mobility work, low-level linear plyos and medicine ball throws."

And, you know what? That would summarize my recommendations for the short-term when they get out of the brace - because it's what all athletes need! However, post-spondy athletes are different in several regards:

1. They cannot handle compressive loading the same way, so it must be gradually reintroduced. I have not allowed post-spondy guys to come back to squatting until at least nine months post-bracing - and I only do so if they have no residual symptoms. In terms of axial loading, we always test the waters with a barbell reverse lunge with a front squat grip. If that goes well, we'll try some front squatting. Most do well with trap bar deadlifts - although I do not bring them back to any Olympic lifts or straight-bar deadlifting in the first-year post-bracing.

2. Sprint mechanics are definitely altered after bracing. I suspect that it has mostly to do with the fact that kids lose hip flexion and extension range of motion and are therefore forced to develop extra hip rotation strategies (usually external rotation) to get range of motion. Others will simply lose hip flexion during the sprinting motion. Typically, cueing knee-drive with these folks and doing some psoas activation work will help to clear things up quickly.

3. We continue with training purely to resist rotation and only start to integrate rotational exercises - including medicine ball throws and cable woodchops - after three months. In most cases, though, the athlete will have returned to play by this point, so if he is involved in a rotational sport, he'll be encountering plenty of rotation already.

With respect to the athlete in question, if he is still having residual flare-ups (which do happen relatively frequently), he simply isn't ready for more aggressive loading - presumably because he has some degree of instability in one or more directions. When this is the case, we work around the issue - but check to see if there is a specific deficit that needs to be addressed. It may be as simple as poor breathing patterns or a lack of hip rotation - or it could be something that takes longer to address.

The important thing to remember is that athletes lift weights to get better at sports - not just to get good at lifting weights. Who is to say that a great football player can't be built without squatting? We have athletes and clients who do not squat - and they still get great results.

All the Best,

EC.

References:

1. Soler T, Calderon C. The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med. 2000 Jan-Feb;28(1):57-62.

2. Wineberg, EP. Spondylolysis. http://www.emedicine.com/Radio/topic650.htm

3. Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med.1994 Jul 14;331(2):69-73.
Read more
Page
LEARN HOW TO DEADLIFT
  • Avoid the most common deadlifting mistakes
  • 9 - minute instructional video
  • 3 part follow up series