I attended the Perform Better Summit in Chicago this past weekend for the second year in a row and as expected, it was another great learning experience.  I got to listen to and observe many great presenters and catch up with and meet friends and professionals from all over the country.  One great presenter that I saw was John Berardi, of Precision Nutrtition.  Berardi is one of the best, if not the best, nutrition experts on the planet.  He put forth a very simple, yet amazingly effective idea.  It is the concept of focusing on one small habit or goal at a time. 

Whether we are talking about exercise or nutrition, this concept can go a long way.  It is something that is overlooked far too often by many. Instead of trying to accomplish a hundred things at one time, picking one or two key things is usually much more effective.  With an exercise program, trying to get as strong as possible, as lean as possible, as aerobically endurable as possible, as powerful as possible and also trying to balance out the muscles around the pelvis and trunk because you have lower crossed syndrome along with a right external oblique that is not up to par with the left external oblique, all at the same time will most likely lead to less than desirable results.  Can it be done? Maybe.  With the right person and situation; but in most cases it will work much better to focus on a couple of key qualities at one time and progress/shift focuses when needed. 

This same concept carries over to coaching exercises. When I'm coaching, I usually coach one or two key things at a time.  New variables can be added in the next workout or maybe the next set depending on the situation and the person.  For example, if I am teaching a beginner how to squat, it would not be very effective if I said get tall, sit back, chest up, push your knees out, push your stomach out, keep your trunk tight, back locked in, grip the floor, drive through your glutes as you stand, etc. all at one time.  It would be ridiculous and overwhelming.  With a beginner in this situation, I might say get tall and sit back.  These are two key things that will help develop a good squat pattern.  Once they are nailed in, I can add in some more detail such as pushing the knees out/spreading the floor and filling the stomach with air before descending.  Keeping it simple and focusing on one aspect of technique at a time goes a long way.

When it comes to programs, many uninformed trainees constantly try the newest program that they see in a magazine or on the internet that promises to add 5 inches to their arms or 50 pounds to their bench in 5 weeks, without ever allowing ample time for their bodies to adapt and make any kind of real progress.  Of course, it is important to advance to different programs after a certain amount of time (depends on the physical quality and situation) but enough time must be given on one program to allow actual progress and progression to be made.  Changing programs every week will usually lead to no real progress and even regression.  Keep it simple. Allow the results to come and focus on the task at hand.  You aren't going to add 5 inches to your arms or a thousand pounds to your bench in 5 weeks anyway.  It takes time and dedication to get real results. 

This can also carry over to exercise selection.  You don't need fancy machines and crazy weight/bosu ball combos to get a great and effective workout.  Stick to the tried and tested basics.  Do your squat variations, deadlift variations, push, pull, move heavy stuff, sprint, etc. and give your body a stimulus to make it get better.  If you had to, you could make an entire workout out of a bodyweight squat.  You don't need a building full of fancy crap to get an awesome workout in and make yourself better.

Berardi related this concept to nutrition.  Instead of telling someone to eat protein at every meal, get 5 servings of veggies, 4 servings of fruits, take fish oils, drink more water, eat grass fed beef, eat a cup of almonds, get protein after a workout, cut down on soda and candy, etc. all at once, it can be much more effective to pick one small habit at a time.  He uses this concept effectively with many many clients through his Precision Nutrition coaching program.  One small and attainable habit or goal is focused on for two weeks and if that habit is successfully established after the two weeks, a new habit is introduced.  If it is not, a different one might be tried.

Nutrition is often the hardest thing to get clients to be compliant with because I am not following them around all day when they aren't at the gym.  During a workout, I can see technique, instruct on what to do next, etc. but I do not have direct control over what goes on the other tons of hours that they are outside of the gym on their own. For people who have had bad nutrition habits for any appreciable amount of time, it can be very hard to get things on track.  Coming into the gym and busting your ass a few days a week is great but if you go and eat processed garbage the other hundred some hours that are outside of the gym, progress will be halted, straight up.  So helping the client to decide on a small habit that they believe they can adapt can help tons. An example may be eating a serving of vegetables at 3 meals for the day.  This would be the goal for the next two weeks.  Not too hard to achieve, right?  Eventually this habit will be automatic and a new one can be added in.  These things will add up and the client will be much more successful.  It is something that I plan on using much more often with certain clients and their nutrition habits. 

This concept can also carry over to many other things in life.  For me right now, I train clients during the day, have school at night and then have plenty of things to do to stay on top of these major things. Instead of trying to accomplish fifty things at once, I will pick a few select goals each day and get them done.  If I have something due for school, I'll focus on getting that done.  If I have a program that needs to be written for a client, I'll get that done.  If you have to pay some bills, go to the bank, play with the kids, get reading done, catch up on stuff for work, etc.,  pick the most important things and focus on them at one time.  Prioritize and keep things simple.  Guess what, exercise and proper nutrition should always be at the top of the list.  I always hear people complain about how they have no time to exercise.  This is just not true.  I don't care if its 20 minutes a few times a week.  There is always a way to make time.  Make that workout one of your habits or your focus for the day and it will happen.

Simple can go a long way.  End of story.

Does anybody have any examples or thoughts on this concept?

This man knew a thing or two about keeping it simple

I had a couple of really great workouts this past week and figured Id share them. Wednesday looked something like this.

Wednesday   Today was my max effort/high intensity lower body day.
Yoke bar reverse lunge 132lbsx3 172lbsx3 222lbsx3 237lbsx3 PR 172lbsx5 
This was the third week of a heavy cycle for this exercise; felt pretty strong.  I've been cycling between single leg work and bilateral work to make sure I give my back a break and keep things balanced out. I can definitely say that when I do squat or pull now, I feel more stable and stronger than ever.  All of the heavy single leg work and special hip and oblique work has paid off.
One leg rdl w/ farmers bar 90lbsx3 130lbs 2x3 110lbsx3
Felt good; really hammering out the single leg work right now.  The farmers bar works great for one leg rdl's.  I put 35's on and load it up from there; this allows you to pull the weight off the floor like a regular deadlift each rep. Killer exercise all around.
Bulgarian split squat 76lbs of chain 35lb db’s (70lbs) or 146lbs x8 130lbs2x8  These are killer in the middle of the workout; I believe this was the fourth week I did these for reps. I've been doing them with a slight pause in the bottom. They smoke me every time.
Roller Reverse Hyper +50lbs 3x12 +70lbsx12
I did these with a slight pause in the top.  The entire back side of my body feels great after them.  Great exercise to strengthen your posterior chain, improve glute function and keep your back healthy.
Single lying leg curl 50lbs 3x6-8
Noticed a difference in where my feet were trying to press into the plate during glute ham raises a couple of weeks ago so I've been doing these to make sure I hit my hamstrings evenly.
Bird dog w/ abduction  blue mini 2x8 each way
Finishing off the glutes and low back extensors nicely
Half kneeling cable hold 40lbs 2x6-8 each way
Training the obliques and hips to stabilize squarely; these are killer
Standing abs 50lbsx12 60lbsx12  One of my favorite ab exercises for carry over to deads and squats.  I do these with a neutral spine and move through the hips like a reverse deadlift

Wall press abs for reps, calf work.  No conditioning today as I was feeling pretty cashed and was running out of time.

Thursday   Had a good lifting crew today for once.  Four of us going at it with good intensity and hard music blasting.  Awesome session. Today I did my max effort work, heavy upper back and lat work and and incline db work; then hammered my arms especially triceps; finished with some cuff and scap work.
Floor Press w/ red band (adds ~60lbs at the top) 185lbs+bandsx1 225lbs+bandsx1 255lbs+bandsx1 275lbs+bandsx1 285lbs+bandsx1 PR 185lbs+bandsx12
This was the third week of a max effort cycle for banded floor presses.  I hit a nice pr with the 285+bands.  I did 5's and 3's the previous two weeks.  Will do db presses for reps the next couple weeks then go to a new max effort exercise after. 
Rack Lockouts 315lbsx5 345lbsx3 365lbsx3 400lbsx1
I set the pins so that I'm pressing the top half of the press.  Loaded these up and felt real strong.
Half kneeling cable row 100lbsx5 110lbs3x5 75lbsx12
Been really focusing on getting quality retraction and proper lower trap recruitment with these
Incline db press 85lbs 3x8
Neutral grip pullups 22lb chain 3x8-10 bwx8
Rolling db extensions 40lbsx8 50lbs 3x8 /  One arm band pushdown orange 3x8-12      Gotta have strong triceps for a strong press
High incline db curls 40lbs 3x8 / One arm rev cable curl 50lbs 3x7-8
Incline db flies 35lbs 3x12 w/ pause  (extra pec work)
I’s/T’s 10lbs 3x12-15 Y’s 5lbs 3x20  (gotta have strong scap function and strong, balanced trapezius muscles.  My lower traps have come a long way and are feeling good.
Face pull on pulldown machine 3x8-12
External rotation at side 3x10-12

Added in a few rounds of battle ropes to get some conditioning in.
Overall great workout; felt very strong all day.

Basically combining some powerlifting and bodybuilding stuff right now.  The upper day from this write up is basically my more intense day and has more of a chest and back focus after my max effort work.  The other upper day is done on Sunday or Monday and involves an overhead press followed by more of a delt and arm focus.  I do hit everything to some extent on both days however.  For lower, I have one day that is more intense like the one from this write up and one day that is a little bit easier depending on how I feel.  One day I usually do either a heavier single leg exercise or semi heavy squat or pull and the other I do either a moderate single leg exercise, speed squat or pull, or sled or prowler work.  Glutes, hamstrings, and obliques are hammered out during both workouts (I work quads too; they just don't need as much focus right now).  I definitely try to blitz my legs extra hard on Wednesday (like the one on this writeup).  I then have a couple of extra workouts I do on other days or later on these days that involves some type of mild conditioning workout or weak point/recovery work.  One might look like this:  light sled drags, side bridges, high rep reverse hypers, calf work.  My training regimen is ever changing depending on my goals and focus at the time so its hard to explain everything but this is a current idea of how my training looks.

Back feels good; not quite ready for max effort deads yet but getting there. (had a tear near the 12th rib attachment site of QL and iliocostalis)  I'm thinking about doing a bench only meet or possibly a bodybuilding show.  I need to compete in something soon; thats for sure. 

Perform Better summit in Chicago this weekend; should be a great time and a great opportunity to learn some great new things.

Train hard !

I gave a presentation for a class the other night on back pain and how massage can help with it and decided to do an article with some of the concepts I covered in my presentation as well as some added info.

Low back pain is extremely prevalent today and its not unlikely that you have experienced or do experience issues; or know someone who has or does experience issues.  Some interesting statistics on low back issues follow.  These are taken from the amazing book Low Back Disorders by Stuart McGill, which is basically a must read for anyone who deals with client's backs in any way, shape or form. 

The American Medical Association guidelines for quantifying degree of back disability are based largely on loss of spine range of motion although excess ROM has actually been shown to exacerbate and/or create problems in many people.   This is something that appears to have been chosen for legal convenience rather than positive impact on low back troubles.  (McGill, Low Back Disorders, P. 3)
Now, loss of spine ROM could be an issue for some individuals but could never apply for everybody across the board.  It really is unfortunate that something like this is the case.

It is often said that 85% of back troubles are of unknown etiology.  The limiting factor here is specialists and clinicians who only look in their area of expertise.  The "one size fits all approach" simply does not work.  Back troubles do not just magically come about.  There is a reason that causes them.  The reason that so many cases are of "unknown etiology" is that many specialists either don't know what to look for outside of their area of expertise or don't refer out where or when needed.  For example, if an orthopedic doctor doesn't see something going on with someones passive tissues (discs, ligaments, vertebrae, etc.) they might simply assume that the pain is just there. In reality, it could come from a repetitive movement fault and/or soft tissue problem.  This is not always the case but does occur across the health field in various professions. 

There are many inadequacies in care and prevention of low back disorders. A few major ones follow.

Studies on "backache"
I'm going to go ahead and let this one speak for itself.  A broad, garbage term equals broad, garbage studies.

Relationship of intensity, loading duration, and rest periods- "Years of specific sub failure activity can cause progressive development of conditions.  This could possibly be avoided with evidence-based prevention strategies that include optimal loading, rest periods and controlling the duration of exposure” (Low Back Disorders, P. 8)  An example of this is the mechanism for herniated discs in the lumbar spine.  McGill has found that a large number of repeated flexions of the lumbar spine gradually leads to a herniated disc.  The nucleus is pushed out of the annulus more and more until finally one day someone bends over the wrong way to pick up a pencil and it fully herniates.  Correcting movement and doing the proper prevention exercises can prevent things like this from happening.  It seems that many professionals miss this point and simply treat symptoms instead of using clinically proven prevention strategies.  I have personally witnessed professionals in various fields giving clients exercises that have been clinically proven to cause spine issues (I know of someone who prescribed ill advised exercises from a friggin magazine!).  This is a problem.

There are also plenty of bad prehab/rehab recommendations that are given out (as I just mentioned).

Strengthen torso muscles to protect the back-  Although this can definitely help in certain situations, much research shows that muscular endurance is more important in the torso muscles when it comes to preventing and rehabbing back issues.

Sit up prescription- Each situp produces low back compression levels close to the National Institute of Safety and Health action limit!! and doing so repeatedly has been shown to cause issues.  This occurs because of the attachment of the psoas muscle to the lumbar vertebrae.  When you do a situp, the psoas contracts to flex the hip, which puts lots of compression on the lumbar spine (low back). Add in the fact that most people who do situps perform them incorrectly with a rounded low back and the problems get worse.  If someone has back problems, situps are probably not their best bet.

Bend the knees, not the back when lifting things-  As I've discussed many times, optimal movement patterns are absolutely essential to spare the back when lifting.  Broadly saying to "bend the knees to lift things" is not a good recommendation by any means.  It ultimately comes down to moving correctly through the hips while staying stable in the low back.  Bending the knees can put excess stress on the knees and still allow the back to move into less than desirable positions.  Furthermore, the optimal position and lifting pattern that is needed will vary depending on the situation at hand.  What is the size of the object? What are the biomechanical leverages of the person doing the lifting? It will always depend.

Tight hamstrings lead to back troubles
While they can, this is not the case for everyone.  As I've mentioned in previous articles, if someone's hamstrings actually are stiff (and are actually having a negative impact), then yes they may potentially need to be lengthened.  In many cases, stiff hamstrings is a misdiagnosis.  If any hip flexor muscles are stiff or short, the pelvis will be pulled into anterior tilt (see previous writeups to see more detail on anterior tilt). When the pelvis is pulled into this position, the hamstrings are put on stretch which will cause them to seem stiff; however, they are already on stretch.  It is the hip flexors that need lengthening (could also be that something such as the obliques need strengthening, see post on relative flexibility).  Once this is done and the pelvis is back to neutral, the hamstrings will be fine. 

I have a client who went to physical therapy for around 3 years and never got rid of his back pain.  He told me that they continued to stretch his hamstrings.  I looked at him for five minutes and discovered that his hip flexors (particularly rectus and psoas in his case) were extremely stiff; not to mention that he had little to no movement coordination.  By continually stretching his hamstrings, his pelvis was pulled farther and farther into anterior tilt, which made his back worse and worse.  We lengthened his hip flexors, turned on his glutes, taught him how to move properly and within a couple of weeks his pain was gone.  He is now in great shape and pain free.  Everybody is an individual with their own individual needs.  Simply doing something general like stretching the hamstrings for the heck of it is just unacceptable. 

Single exercise or back stability program is good for all cases
This is a big mistake that many people make and pretty much ties in with the last point.  Determine what needs to be strengthened, lengthened, stabilized, mobilized, etc.  Specific training is the only way to make backs optimal.

(The bold points are from Low Back Disorders; my own explanations following the headings)

Through my own experience working with people and learning from the some of the best in the industry, some of the major causes and contributors to back issues follow. I have touched on much of this in other articles so I'll keep it brief.
 
Excess Movement in the Lumbar Spine
The lumbar spine should generally be stable and many people move way too much through it.  Promoting motion here with bad stretches and exercises is not a good thing (certain yoga positions, cough:)

Poor Movement Patterns
We basically live in a society that has developed movement stupidity.  Most people you come across have absolutely no clue how to move properly.  You need to move and use the right muscles and joints at the right time.  Training does no good if you are practicing bad patterns and habits.

Stiff Hips and Thoracic Spine
Ideally, there will be mobility in these areas and stability in the lumbar spine.  Most people have the opposite.  If you can't move in the hips and tspine, then more movement and stress will go to the lumbar spine.  Another problem created.

Weak Gluteal Muscles and Stiff Hip Flexors (Lower crossed syndrome)
With overly stiff or short hip flexors, there is more stress on the back.  This also will often shut off the glute muscles.  No glute muscles equals less support for the low back which equals more back pain.  YAY!!

Weak and Improperly Trained Trunk Muscles
Having no support from the wonderful muscles that form a corset around the trunk and are supposed to protect the low back is not a good trait to carry.  The internal and external obliques, rectus abdominis (actually usually overdeveloped and dominant in many people), the quadratus lumborum and the transverse abdominis (very deep muscle that you can't see or touch) all need to be endurable and firing.  They also need to be trained to stabilize; not round the back and move in bad ways like many people do.

Poor Endurance in the Low Back Extensors
The low back extensors need to have good endurance in order to continuously support the passive tissues in the low back.  When they fatigue, things that we don't want to take up stress end up taking up stress and bad things happen. 

So taking care of these things is all wonderful and great but what if there are tissue restrictions that prevent someone from moving optimally or turning on muscles that need to be turned on?  This is where massage therapy and specialized soft tissue work is extremely effective and can play a huge role in developing an optimal back program.

I can try to teach you how to squat and pull correctly with quality hip movement and a stable trunk all day long but if your psoas is so stiff that you simply can't get lower than an inch into your squat then there is a problem.  If I work on your psoas and get it to relax, getting you to move properly becomes a whole lot easier and more effective. 

Following are some different things that massage can address in order to help with back issues. There are obviously tons of possibilities but here are a few common ones.

Stiff or Short Hip Flexors- If needed, treating psoas, rectus femoris, and/or tfl (whichever ones are overly stiff or short) can take tons of stress off of the low back and can free up the hips so that movement improves.  This also can make it much more possible to activate and strengthen inhibited gluteal muscles. In some cases, glutes might need work.  Always assess! 

Getting rid of adhesions and bunched up low back tissue-  As a result of cumulative trauma and stress, the low back tissues are often tensed up and fibrotic.  Massage can provide great relief here by freeing up the tissue, clearing out toxicity and built up metabolites and bringing new oxygen and nutrients into the tissue by way of increased blood flow.

Stiff or short pecs/anterior shoulder muscles that are leading to hyperkyphosis-  Treating these muscles can allow better thoracic mobility which can lead to a more stable low back and improve overall posture.

Neurological effects-  Releasing adhesions and trigger points can allow shut down muscles to retain their firing capacity, fix relative imbalances and improve overall patterns of movement.

With a combination of the proper movement and strength training and soft tissue work, low back issues can be dealt with very effectively.  While I have a lot to learn and a long way to go with massage therapy, I am very excited to be able to combine my own manual therapy with the strength and conditioning modalities that I already use in order to help people feel better, move better and perform better. 

In conclusion, if you are dealing with back pain and have been tossed around and told that there isn't a "known cause," don't give up because it is very possible that your true underlying issues have just not been found. While there can sometimes be a possibility of an underlying issue such as arthritis, spondylosis, etc., dealing with components that I discussed in this article can go a very long way in both preventing and clearing up back issues. Proper training and tissue work seems to finally be getting closer to the frontline where it should be. Hopefully more and more people can begin to see beyond "disc disease" and other copout diagnoses and get better and better.