I suppose this blog title is more of a rhetorical statement than an actual question, but I'm going to write it anyway.
Just about every week, I get someone who comes to Cressey Sports Performance - either as a new client, or as a one-time consultation from out of town - and they have some issue that is bugging them to the point that they opted to see a doctor about it. This doctor may have been a general practitioner or an actual sports orthopedist. In many cases, the response from this medical professional is the same "Just rest."
"It hurts when you lift? Then stop lifting."
Huh? When did COMPLETE rest because a viable recommendation?
In case folks haven't noticed, a scary number of Americans are overweight or obese. Even if rest was the absolute key to getting healthy, telling them to not move is like not seeing the forest through the trees. Your bum knee will feel better, but you'll have a heart attack at age 43 because you're 379 pounds.
Oh, and nevermind the fact that exercise generally improves sleep quality, mooed, and immune, endocrine, and digestive function. I'm not going to lie: I would rather have an achy lower back than be fat, chronically ill, sleep-deprived, impotent, angry, and constipated.
But you know what? The good news is that you can still exercise and avoid all these issues - regardless of symptoms. I can honestly say that in my entire career, I've never come across a single case who couldn't find some way to stay active.
And, when I did an internship in clinical exercise physiology, we trained pulmonary rehab patients in spite of the fact that they often had interruptions during their sessions to cough up phlegm for 2-3 minutes at a time.
All over the world, people are using exercise to rehabilitate themselves from strokes, heart attacks, spinal cord injuries - you name it.
However, Joe Average who sleeps on his shoulder funny and wakes up with a little stiffness needs complete rest and enough NSAIDs to make a liver cringe.
Sorry, but you're going to need to be on crutches, in a back brace, with poison ivy and a punctured lung to get my sympathy. And, you're sure as heck not going to get it if you're just "really sore" from your workout routine. Seriously, dude?
I don't care what your issue is: "just rest" is almost never the answer (a concussion would be an exception, FYI). When a health care practitioner says it, it's because he/she either a) doesn't have the time, intelligence, or network to be able to set you up for a situation where you can benefit from exercise or b) doesn't think you have enough self control to approach exercise in a fashion that doesn't make it more harm than good.
There is almost always something you can do to get better and maintain a training effect. While adequate rest for injured tissues is certainly part of the equation, it is just one piece in a more complex puzzle that almost always still affords people the benefits of exercise.
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A buddy of mine - we'll call him Bobby Ballsofsteel - has been really working at it lately in a dedicated push to pack on a little muscle mass with his strength training program. He's somewhat of a classic "hardgainer" who needs to really forcefeed himself to gain every ounce. Nonetheless, Bobby's busted his butt in the gym (I train with him, so I know) and the kitchen over the past few months and has gone from 200 to 210 pounds. This is a huge deal, as we aren't talking about "newbie" gains; we're talking about a guy who had already gone from 160 to 200 over the previous two years.
Bobby was super-intimidated about starting a strength and conditioning program back in 2007 because, although he was a great athlete, it was unfamiliar territory for him because he immediately become the little dog at the pound.
It took a lot of guts to start things up - something we see with a lot of people from different walks of life who begin exercise programs with motivation and a desire to change, but a long way to go and a fair amount of intimidation and embarrassment in their minds about where they stand with respect to the challenge ahead. Whether you're an elite athlete who has never trained in an organized setting, an untrained 14-year old baseball player, or a 55-year-old female who is just getting into exercising to drop body fat, the first step is the toughest - and it's our job as fitness professionals to make this first step more manageable and less daunting. The problem is that we have outside influences with which to compete.
With many people embarking on a strength training program, there are other people in their lives - maybe it's relatives, spouses, employers, best friends, or others - who for whatever reason go out of their way to find fault with people for making the decision to start exercising or eating healthy. In many cases, these "disablers" sabotage people's efforts at the exact time when they need the most support from those close to them.
Usually, the ones doing the "disabling" are simply insecure about themselves. Maybe they are just comfortable eating poorly and not exercising, and they perceive it as a threat when someone close to them starts changing these habits, as it may have a spillover effect to them. Or, perhaps they're deconditioned and just don't want to be alone - so it's easier to try to bring someone else down a peg than elevate themselves. Maybe it's just that the world wouldn't be safe with only one overweight superhero as opposed to two. Batman wouldn't just leave Robin out to dry like that.
And that's how we come back to my buddy, Mr. Ballsofsteel, and his great progress of late. Bobby came to the gym royally pissed off the other morning, and proceeded to tell me the story of how he had met up with some of his best (long-time) friends the previous night. While it had been good to see all of them, one of these friends - we'll call him "Tommy the Tool" - went out of his way to remark (in front of the entire group) that Bobby had "gotten awfully big suspiciously quickly." Effectively, he was implying that Bobby was using steroids (which is clearly not the case if you ask anyone who has seen him regularly throughout this time period). The accuser (or shall we say "disabler?") practically tried to turn it into a group intervention.
You can imagine what an awkward position this created for Bobby. On one hand, if he had gotten defensive in light of all the hard work he'd put in to do things the right way, they'd have thought he had something about which he should be defensive. On the other hand, if he had just shrugged it off, they'd have thought that the accusation is true and that Bobby just wanted to change the subject. Awkward situation, indeed.
Awkward situation aside, there is a "not-so-coincidental coincidence" that emerged in my eyes as Bobby told me the story. Apparently, Tommy the Tool presented to this gathering about 15 pounds of "not-so-good weight" heavier himself because he'd been on the road for work, eating poorly and not exercising.
It's funny how our disabler chose to call someone out and attempt to delegitimize someone else's progress at the exact same time when he was feeling the worst about himself. Actually, it's not really "funny." It's more "predictable" and "pathetic." You try to take someone down a peg to make your unfit, unhealthy status quo feel more acceptable; it's easier to take when everyone is miserable. Or, maybe it simply takes the attention off you, Tommy the Tool.
This happens in fitness, athletics, business, academics, and countless other components of our everyday lives. I always tell our athletes that the higher up you go, the more hot air you are going to encounter. Get negative people out of your life and surround yourself with those who are not only supportive of your goals and your progress, but can actually help to set you up for more success.
In Switch: How to Change Things When Change is Hard, one message from authors Chip and Dan Heath is that you will almost never effect quick change a person, but you can always work to change the situation that governs how a person acts - and do so relatively transiently.
As an example, we've had numerous high school athletes who have completely changed their family's nutrition for the better by applying the principles they've learned in nutrition consultations at Cressey Performance. It isn't that their parents didn't want to be healthy prior to that point; it was just that the situation in which they cooked and ate was different. Once a young athlete came home excited about nutrition armed with knowledge and recipes, though, their supportive parental instincts enabled him to adopt these new habits, and his enthusiasm and newfound education and resources enabled them to adopt new practices for the family. They were still the same people; they just happened to have new situations.
It's why I think our semi-private training model at Cressey Performance works so well. Sure, it makes training more affordable, and the strength and conditioning programs are obviously very individualized. However, I think that most important thing we've done is creates an unconditionally positive training environment where people can support each other - even if they may have different fitness/athletic goals. Success is both visible and encouraged.
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Back in 2006, Indiana Pacers Strength and Conditioning Coach Shawn Windle told me about a new piece of training equipment and connected me with the company that made it. A week or so later, my first pair of Lynx Grips arrived in the mail - and I've been using them extensively ever since. In fact, I found Lynx Grips to be so versatile that when the opportunity to buy a small portion of the company arose, I wrote a check immediately.
Originally, the grips were positioned as a better alternative than lifting gloves, especially for females who didn't want to develop "man hands" from lifting heavy stuff. They certainly prevent the issue completely. My fiancee loves them - and actually refers to them as her "tacos."
The more I used them, though, the more I realized that we could integrate them in our strength and conditioning programs with a multitude of other benefits.
I recommended Lynx Grips to my online consulting clients who trained in places (i.e., commercial gyms) that didn't allow chalk - and the grips made it easier to pull heavy without losing one's grip during sweaty training sessions. Problem solved.
Conversely, we also started using the Lynx Grips to make grip strength exercises harder - by doubling or even tripling them up to thicken a handle. Another problem solved.
Then, we turned around and used the grips to make things easier on the hands again - but wrapping them around the connector chains we use for reverse sled drags. This made it easier for us to haze interns (you'll notice him pick up the Lynx Grips at the 2:05 mark of this video). Problem solved...again.
Lastly, we have certain bars - the giant cambered bars, safety squat bars, and farmer's walk bars - that are slightly thinner than other bars, so our muscle clamps don't keep the plates from sliding during one's set. Slide a Lynx Grip in the small space between the clamp and the bar, and you're good to go. Yet another problem solved. Look closely, and you'll see four of them being put to good use in this medley:
I'm not the only one who feels this way. Dozens and dozens of collegiate and professional sports teams are using Lynx Grips on a daily basis in our strength training programs.
What's the take-home message? Lynx Grips are the real deal: versatile, convenient, durable, and affordable. Check them out HERE.
(I'd recommend you pick up two pairs - which is four total grips - so that you can double or triple them up for grip work.)Sign-up Today for our FREE Newsletter and receive a deadlift technique tutorial!
In my strength and conditioning writing, I throw the term "efficient" around quite a bit; in fact, it's even in the title of our Building the Efficient Athlete DVD set. I'm sure that some people have taken this to mean that we're always looking for efficiency in our movement. And, certainly, when it comes to getting from point A to point B in the context of sporting challenges, the most efficient way is generally the best.
And, just think about strength training programs where lifters simply squat, bench press, and deadlift to improve powerlifting performance. The goal is to get as efficient in those three movements as possible.
And, you can look at NFL combine preparation programs as another example. Guys will spend months practicing picture-perfect technique for the 40-yard dash. They might not even get faster in the context of applicable game speed, but they get super efficient at the test.
However, the most "efficient" way is not always the right way.
In everyday life, efficiency for someone with poor posture means picking up a heavy box with a rounded back, as it's the pattern to which they're accustomed, and therefore less "energy expensive." This would simply prove to be an efficient way to get injured! I'd rather lift things safely and inefficiently.
And, take those who run long distances in hopes of losing fat as another example. The research has actually shown that runners burn fewer calories for the same given distance after years of running improves their efficiency. While this improvement is relatively small, it absolutely stands to reason that folks would be smart to get as inefficient as possible in their training to achieve faster fat loss. In other words, change modalities, intensities, durations, and other acute programming variables.
Training exclusively for efficiency on a few lifts might make you better at those lifts, but it's also going to markedly increase your risk of overuse injuries. I can say without wavering that we'd see a lot fewer knee and lower back injuries in powerlifters if more of them would just mix in some inefficient single-leg training into their strength training programs. And, shoulders would get a lot healthier if these specialists would include more inefficient rowing variations and rotator cuff strength exercises.
In the world of training for athletic performance, it's important to remember that many (but not all) athletes perform in unpredictable environments - so simply training them to be efficient on a few lifts fails to fully prepare them for what they're actually face in competition. A strength and conditioning program complete with exercise variety and different ranges-of-motion, speeds of motion, and magnitudes of loading provides athletes with a richer proprioceptive environment.
In other words, inefficiency in strength and conditioning programs can actually facilitate better performance and a reduced risk of injury.
Taken all together, it's safe to say that we want inefficiency in our training, but efficiency in our performance - provided that this efficiency doesn't involve potentially injurous movement patterns.
Related PostsWhy I Don't Like 5x5 Strength Training ProgramsWeight Training Programs: The Basics, but with VarietySign-up Today for our FREE Newsletter and receive a four-part video series on how to deadlift!
Q: I've read a lot from you, Robertson, and Hartman about including push-up variations in strength training programs is really important for shoulder health. Unfortunately, whenever I do them, I have pain in my bum shoulder. Any ideas what to do?
A: Well, obviously, there are two things we need to rule out:
1. You may simply have a really irritated shoulder, which (in most cases) means that any sort of approximation or protraction movement could get it angrier, even if it is a closed-chain movement like the push-up that is normally pretty shoulder-friendly. Likewise, if you have a significant acromioclavicular joint injury, the extension range-of-motion at the bottom of a push-up could exacerbate your symptoms. So, obviously, the first step is to rule out if something is structurally wrong with your shoulder, and if so, if the push-up even belongs in your strength training program.
2. Your technique might just be atrocious. If the elbows are flared out, hips are sagging, and/or you're in a forward head posture, simply changing your technique may very well alleviate those symptoms. In a good push-up, the elbows should be tucked to a 45-degree angle to the body, with the hips, torso, neck, and head in a straight line. The muscles of the upper back should essentially "pull" you down into the bottom position:
Once you've ruled out those two issues and still have some annoying issues, there is one more thing you can try: simply elevate the feet. Looking to the research, Lear and Gross found that performing push-ups with the feet elevated significantly increased activation of the serratus anterior (SA).
If we can get more SA recruitment and less pectoralis minor contribution, it keeps us out of a position of scapular anterior tilt, which mechanically decreases the subacromial space through which the rotator cuff tendons pass. In the picture below, think of the area just below the word "acromion" being smaller, and then picture what would happen to the tendons that pass through that region; they get impinged. Serratus anterior (along with lower trapezius) can help prevent that.
That said, I've seen quite a few folks with persistent shoulder pain with bench pressing variations (barbell and DBs) and regular push-ups who were able to do the feet-elevated versions completely pain free in their strength training programs. Obviously, begin with just body weight and see how it goes, but over time, you can start to add resistance and use the single-leg version.
A topic of interest that seems to get thrown around quite a bit nowadays is whether front squats are a "safer" exercise than back squats. We don't do much back squatting at Cressey Performance, so a lot of people automatically assume that I'm against the idea of back squatting. This couldn't be further from the truth, as my answer to the question "which is safer?" is a resounding "IT DEPENDS!"
At last check, 74% of the Cressey Performance clientele is baseball players. The majority of these athletes have acquired actual structural changes to their shoulders that make the back squat set-up more of an at-risk position than in non-overhead-throwing athletes. To make a long story short, in this externally rotated, abducted position of the shoulder girdle, the biceps tendon pulls awkwardly on the superior labrum. This peel-back mechanism is exacerbated in the presence of a glenohumeral internal rotation deficit (GIRD) and scapular instability - two features extremely common in baseball players. So, for these folks, the front squat is a much safer alternative. We also use giant cambered bar and safety squat bar squat and lunge variations.
Conversely, take an athlete with either traumatic or chronic acromioclavicular joint problems, and the front squat will really irritate his shoulder because of the bar's position atop the shoulder girdle. Move this bar to the upper back, and the pain is avoided altogether. So, for AC joint pain suffers, the back squat is a safer bet.
Let's be honest, though; the entire front vs. back squat argument is about lumbar spine health. So, we'll attack it from that perspective. To kick things off, I've got a little announcement that may surprise you: I haven't back squatted in almost two years, and my back squat form isn't very good.
I know what you're thinking: "You're a strength coach, Cressey; you must really suck at what you do if you can't even back squat."
Well, I guess that would depend who you ask. I regularly squat well over 400 pounds with the giant cambered bar. Front squatting isn't a problem, and I can use the safety squat bar, too.
The issue for me with back squats is a bum shoulder from back in my high school tennis days - similar to what I outlined earlier. Because my shoulder doesn't like the externally rotated, abducted position, the only way I can get under a bar pain-free is to use an ultra-wide grip - which means my scapulae are winged out and my upper back is rounded over. My shoulder range-of-motion is just fine, but the structural flaws I have (partial thickness tear, bone spurring, and likely labral fraying) means that if I want to back squat pain-free, I have to do so like someone who lacks external rotation.
Who lacks external rotation? Well, just about everyone who sits at a computer all day, and every athlete who has spent too much time bench-pressing. Combine this with poor scapular stability and a lack of thoracic spine extension, and you realize that a large chunk of the weight-training population simply can't effectively put a bar on the upper back, let alone actually stabilize it.
Let's be honest: if you have poor hip and/or ankle mobility, both your front and back squats are going to look pretty ugly. You'll go into lumbar flexion or come up on your toes to get your range of motion, in most cases. You'd think that one potentially protective factor would be that in the back squat, the lifter can better utilize the latissimus dorsi (in a more shortened position) to help stabilize the spine.
The main problem with the back squat, in my eyes, is that not everyone has sufficient upper body mobility to position and stabilize the bar properly. As a result, it can "roll forward" on people - and that's where more of the forward lean problems come about. More forward lean equates to more shear stress, and an increased risk of going into lumbar flexion under compressive load. The front squat - even under heavier loads - keeps a lifter more upright, or else he'll simply dump the bar.
So, with all that in mind, while it may be a bit of a bold statement, I'd say that for individuals with excellent whole-body mobility and no upper extremity pain, a back squat is no more dangerous than a front squat. While the extra stabilization contribution from lats may reduce some of this risk, the simple fact that one can move more weight with a back squat probably "cancels out" this advantage in this comparison.
All that said, regardless of whether you front or back squat, I'd encourage you to regularly get video of yourself lifting - or find an experienced coach - to give you feedback on your technique.
Actually, this post should have been entitled, “Why 5x5 Workouts Works for Some People, but Not for Others.” That title would have been long and not “black and white” enough to get your attention, though.
The 5x5 workout (or 4x6, for that matter) approach works relatively well for taking people from beginner to intermediate. When all you’ve been doing is 3x10-12 (because the bodybuilding magazines said that was the way to do things), lifting heavier weights for continued progress makes perfect sense.
I feel strongly that not working below five reps on the main strength movements in your program is a huge mistake for lifters who are intermediates (or more advanced) – whether the goal is size or strength.
You see, in an untrained individual, you get strength gains on as little as 40% of 1-rep max (1RM). As someone gets more trained, that number goes up to 70%. However, you need at least 85-90% of 1RM in intermediate and advanced lifters to elicit strength gains.
For the average intermediate, 85% of 1RM corresponds to about a 5-rep max. In other words, only your heaviest set of five would be sufficient to stimulate a strength improvement. Now, what happens if you do a 5x5 workout? You’ve done 25 reps – and maybe five of them (the first set) were actually performed at a high-enough intensity to elicit strength gains.
As I show in my new book, Show and Go: High Performance Training to Look, Feel, and Move Better, if you want to get stronger faster, you need to spend time below five reps – and above 85% of 1RM (and preferably 90%). This isn’t just physiological; it’s also psychological. You’ll get more comfortable handling heavier weights.
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I’m going to let you in on a little secret: not all our athletes squat, and the older and more banged up they get, the less they squat.
We’ve all been told that “squats are king” when it comes to leg development, and the carryover of squat variations to athletic performance cannot be overstated. Squats even have a place in corrective exercise settings; I’ve frequently used box squats to help iron out quad-dominant vs. hip dominant imbalances. And, the eccentric strength attained from squatting is of undeniable importance in active deceleration in sports – thus taking the stress off of the passive restraints like menisci, ligaments, and discs. The list of benefits goes on and on.
As with anything in life, though, there’s a downside: you get some pretty crazy compressive loads on the spine when you get stronger:
Cappozzo et al. found that squatting to parallel with 1.6 times body weight (what I’d call “average” for an ordinary weekend warrior who lifts recreationally) led to compressive loads of ten times body weight at L3-L4 (1). 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 (2). It’s no wonder that retired weightlifters have reduced intervertebral disc heights under MRI.
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 playing with fire, to a degree.
Fortunately, our body can adapt reasonable well – but not if you train like an idiot and ignore marked inefficiencies. Think of it this way:
Roughly 3/4 of all athletes have disc bulges/herniations that go completely undiagnosed.
It’s estimated that 4.4% of six-year olds have spondylolysis (lumbar fracture[s] (3)).
Presence of spondylolyis is estimated at 15-63% in ordinary athletes (highest is among weightlifters) – yet only 50-60% of those diagnosed under imaging actually report lower back pain (4).
This isn’t the only place in the body where this happens. If you’re a pitcher, you’re going to have a ripped up shoulder labrum – but that doesn’t mean that you’re symptomatic. If you’re a pitcher with a junk labrum AND a lack of internal rotation range-of-motion, though, chances are that you’re hurtin’.
What does this tell us? Inefficiency is as important – and possibly MORE important – than pathology.
So, let’s assume for a second that everyone in the world had spondylolysis, disc bulges, and explosive diarrhea (just for shits and giggles – pun intended, if you’d like). To take it a step further, though, let’s say that everyone insisted that they squat and we didn’t have the option of saying “no.” What would I do, in this instance?
1.Avoid Lumbar Flexion. The aforementioned Cappozzo et al. study demonstrated that as lumbar flexion increased under load, compressive load also increased (1). In other words, if you aren’t mobile enough to squat deep, you need to squat a little higher. I’ll use light “tap and go” (to a box) variations in my strength training programs to teach proper depth to those who lack flexibility.
2. Optimize hip range-of-motion. If your hips are stiffer than your lumbar spine, you’ll move at your spine first. Those who move at the lumbar spine get hurt; spine range of motion and power are highly correlated with injury risk. Some schmucks named Cressey and Robertson made a DVD called Assess and Correct that seems to help on this front… I incorporate these in all of my weight lifting programs.
3. Optimize ankle range-of-motion. Those with poor ankle mobility will turn the toes out considerable when they squat in order to make up for a lack of dorsiflexion ROM. When they can’t externally rotate any more, they’ll start to flex at the lumbar spine (mostly because their hip mobility is also atrocious).
4.Optimize thoracic spine range-of-motion. Look at the guys who are lifting the biggest weights injury-free, and examine the way their erector musculature is “allocated.” You’ll notice that the meat is in the upper lumbar and thoracic regions – not the “true” lower back. Why? They subconsciously know to avoid motion in those segments most predisposed to injury, and the extra meat a bit higher up works to buttress the shearing stress that may come from any flexion that might occur higher up. Novice lifters, on the other hand, tend to get flexion at those segments – L5-S1, L4-L5, L3-L4, L2-L3 – at which you want to avoid flexion at all costs. Our body is great at adapting to protect itself - especially as we become better athletes and can impose that much more loading on our bodies. Just ask Olexsandr Kutcher, who’s pulling close to 800 and squatting close to 900 at sub-200 body weights.
5. Stabilize the @#*$_@^ out of your lumbar spine. This does not mean sit-ups, crunches, sidebends, hyperextensions, or the majority of what you’ll encounter in yoga (although some variations are sufficient). Lumbar rotation, flexion, and hyperextension serve to make the spine less stiff relative to the hips. Your back may feel tight, but stretching it is quite possibly the silliest thing you can do, as you’d be encouraging more problems long-term in the process. Tony Gentilcore likes to talk about how it’s like picking a scab; it feels good in the meantime, but only hurts you in the long-run. Yeah, I think Tony is odd, too.
If I can get my act together, I’ll have a full detailed progression ready for you in a few weeks.
6. Deload the spine once-a-month if you’ve been at this a while. There’s nothing wrong with dropping squatting for a week each month to focus on extra single-leg work, movement training, pull-throughs…you name it. I know of a lot of powerlifters who do it for 3-4 weeks at a time, so one week won’t kill you. Having a balanced workout routine is key to healthy lifting.
7. Avoid training first thing in the morning. Because we’ve decompressed overnight, our spines are “superhydrated” when we first wake up in the morning; this places more stress on the ligaments and discs and less on the supporting musculature. As a little frame of reference, full flexion reduces buttressing strength against shear by 23-43% depending on the time of day – meaning that your spine might be 20% safer later in the day even if exercise selection is held constant. Give the spine a bit of time to “dehydrate” and you’ll be much better off.
8. Get Lean. Ever wonder why pregnant women are always having lower back pain? Could it be that they're hyperextending (overusing the lumbar erectors) to offset the new weight they're carrying in the abdomen? Beer bellies work the same way.
9. Keep moving throughout the day. It takes about 20 minutes for "creep" to kick in with your muscles - and the less you let that happen, the better. The best posture is the one that is constantly changing.
10. Fix asymmetries. Okay, so we know that compression is probably a necessary evil. And, we know that flexion + compression is even worse. And, wouldn’t you know? We can actually make things worse by adding in an element of lumbar rotation. Who rotates at the lumbar spine? Usually, it’s those with asymmetries in mobility or strength at the ankle, hip, or thoracic spine. Compare ROM side-to-side and check side bridge endurance time; fix what’s out of whack.
Obviously, a lot of this requires some more involved functional tests, a solid background in functional anatomy, and an understanding of how to fix what’s wrong. In my most recent product, The High Performance Handbook, I've outlined a Four Phase System that incorporates a self-assessment, proper strength routine, mobility exercises, and de-loading phases for healthy, rapid results. If you're ready to take a good hard look at your routine, you can find more information here.
References:
1. Cappozzo A, Felici F, Figura F, Gazzani F. Lumbar spine loading during half-squat exercises. Med Sci Sports Exerc.1985; 17:613 -20.
2. Cholewicki J, McGill SM, Norman RW. Lumbar spine loads during the lifting of extremely heavy weights. Med Sci Sports Exerc.1991; 23:1179 -86.
3. Morita T, Ikata T, Katoh S, Miyake R. Lumbar spondylolysis in children and adolescents. J Bone Joint Surg Br. Jul 1995;77(4):620-5.
4. Soler T, Calderon C: The prevalence of spondylolysis in the Spanish elite athlete. Am J Sports Med 2000 Jan-Feb; 28(1):57-62.
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