While many people seem to at least generally recognize and understand the presence of acute injuries such as spraining an ankle, brusing a rib or tearing an ACL during a sport, the presence of cumulative injury disorder is not heard about quite as often in the general population. Interestingly, it is probably the most common form of injury out there. According to Michael Leahy, the creator of Active Release Techniques, it is the major injury problem in the workforce and the general population in the United States. According to federal statistics, it has worsened by 670 percent over the course of the last 5 years. Cumulative Injury Disorder is often responsible for things like carpal tunnel syndrome, bursitis, nerve entrapment, back pain, elbow pain and much more. So what is cumulative injury disorder and what can be done about it?

    Cumulative injury disorder can be defined as a group of injuries to muscles, tendons, fascia, nerves, blood vessels and bones. The cumulative injury cycle involves a lovely and vicious little circle consisting of weak/tight musculature/tissues, friction/pressure/tension, decreased circulation and nutrient delivery and adhesion/fibrosis. This is the cycle that is responsible for many cases of chronic pain that people have.

    There are generally three types of injuries that can lead to this frustrating cumulative injury cycle. Acute injury, which we mentioned earlier, is the type of injury that most people know of. What many do not realize, however, is that an acute injury (i.e. muscle tear) can lead to the cumulative injury cycle if not treated correctly.

    A very common yet not often talked about type if injury is repetitive motion injury. This results from many common tasks and postural patterns that people undertake daily. To get a better sense of this injury type, we will look at what is known as the law of repetitive motion. This can be defined by the formula I=NF/AR. I= tissue insult; N=number of repetitions; F=force or tension of each repetition in relation to one's max strength; A=amplitude of each rep; R= rest time between reps. Bad posture that is held for a long duration of time has a force that is high, an amplitude close to zero and pretty much no rest time. This yields a high insult to your tissues. What this means is that even though you may not be “exerting yourself” as you sit at your wonderful computer all day or lounge on the couch eating potato chips and watching Wheel of Fortune, certain tissues are undergoing a heck of a lot of stress to maintain the posture that you are, although in fact should not be, supporting yourself with. Typing on a keyboard for a long period of time is a good example of a repetitive motion with constant stress that can cause problems with the hands and forearms, all the way up into the shoulders if the table and chair height are not right. Factory workers and mail office workers are two good examples that have repetitive motions that can be damaging if not combated with proper movement and exercise.

    Another nice little tidbit is the fact that someone who is weak or possesses a low level of max strength, has to use more energy and reserves to perform even the most mundane, itty bitty little tasks (like, say picking up a pen that was dropped while sitting at a desk) and will have a much easier time injuring themselves, regardless of the type of injury. What that means is that you should quit doing your hundred rep toning sets with your 2 pound dumbbells that your unqualified celeb trainer has you doing on the latest exercise video from Target, and get into the weight room and pick and squat some heavy freaking objects up. A good strength exercise will have good force (at least it should but probably won't if all you do is tracy anderson workouts :), a decent number of reps, a good amplitude and good relaxation time between sets/reps. This yields a nice equation and will help balance out the “bad” stress from the postural patterns of the day and will provide the body with a “good” stress to make those tissues stronger and healthier.

A constant pressure or tension injury decreases circulation and compromises cell recovery, resulting in poor repair, changed function, pain and inflammation. A poor static posture will usually be the culprit here.

    Whichever way you look at it, these situations will cause muscles to be weak and tight/taut. This can cause internal forces on the tissues to rise, creating friction, pressure or tension. What this all means is that injury and inflammation can result even if there is no external force occurring. In other words, you don't have to get laid out by Darrrren Sharper while rushing for the end zone in a football game to have an “injury.” Internal forces within your own body are probably causing some damage to your tissues right now as you read this awesome article.

    Soooo, once you have weak tissues and negative tissue stress, you then get decreased circulation. This means less blood flow, which means less nutrient and oxygen delivery.

    This decreased circulation then leads to the development of adhesions. Adhesions can develop between fibers of a single muscle, between fibers of adjacent muscles, between a muscle and a nerve or between any of these structures and tendons, ligaments and vessels. The longer these adhesions are left alone, the worse they get and the more issues they can potentially cause. Restricted oxygen makes pain receptors more sensitive, adhesions disrupt proper biomechanical movement with your body (which can lead to more problems) and a whole vicious cycle begins. If the tension or forces mentioned above are strong enough, a tear or crush can occur and severely disrupt the tissues. This can occur from internal or external forces.

    Whether the cycle begins with an acute tear or long term poor posture/repetitive motions, it will continue until something is done about it. With an acute injury, your body will generally try to heal things with the inflammation cycle. You have a window of opportunity here to stop the chronic cycle before it begins by breaking up scar tissue (your body's repair puddy) and realigning the muscle fibers with proper rehab and movement training. If this opportunity is missed, the cycle will begin and you'll have more work to do down the road. With long term poor posture or repetitive motion related issues (which can also result from an acute issue), the tissues can enter into this cycle that involves chronic inflammation, decreased circulation, multiple adhesions and fibrous tissue and weak, stiff musculature.

    The bottom line here is that you can cause much damage to your body by doing “nothing.” I have had more than a fair share of people ask me “Isn't lifting all that weight like bad for your back and stuff?!”; (to which I respond with a 45lb plate to their head ;jk although sometimes I would like to:) to which I respond well with bad form, it most certainly could be but with proper form, it is about one thousand million times less likely to cause any harm than you sitting on your couch with bad posture is. Sitting for long durations of time, doing nothing but repetitive motions every day, doing nothing but repetitive motions for exercise (excess running, ellipticals, biking, seated machine exercises,cough cough cough) and of course doing high rep power snatches after doing heavy triples in the squat and a balls out 100 yard sprint (big cough) are all much more damaging to your body than lifting 2-3 times your bodyweight with proper form for a few sets ever will be. (Ok the last example has nothing to do with this article but just had to throw it in :)

    So what all of this means is that there is a good chance that the pain in your forearm, elbow, knee, low back, wrist, hand, neck, shoulder or whatever pain it is that you have is not, in fact, from old age, arthritis, an old injury, “a bad back,” high school football, training arms 5 days a week at the gym, wait that one probably is really causing some pain sorry, or any of these common excuses and reasons that people often like to use. There is a good chance that you have some nice little adhesions (knots would be the more conventional term) that are restricting tissue motion and oxygen delivery, and are causing pain either at the adhesion site or far away from the adhesion site (trigger point referrals). Taut muscles can pull on their bony attachments causing pain, internal tissue forces can cause pain from lack of oxygen, trigger points (tiny tensed up piece of a muscle fiber) can refer pain all over the place via neural pathways, imbalances can cause overload on certain tissues either with poor movement or poor static posture, nerves can be entrapped by adhesions that don't allow them to slide around muscles how they are supposed to and the list goes on. People are usually doing something they don't realize that is causing issues and they can also usually do something they don't realize to get rid of issues. Sooooooooooo what the heck should we do Nick?!!

    Well, these adhesions that have developed either recently or over time as part of the chronic CID cycle can be broken up with the proper hands on treatment. There are many ways of doing this. The most important things are finding the location of entrapments and restrictions and finding out how and why they are there by analyzing movement, joint motion and daily activities. Whatever tool is determined most appropriate for releasing these adhesions (I am a big fan of Active Release Techniques as they have developed hundreds of specific protocols to treat many of the most common CID issues that people will have), the adhesions need to be broken up so that proper blood flow can start again and oxygen and nutrients can be delivered to the starved tissue. Once tissues can move freely and are nourished properly again, the muscle fibers need to be realigned and reatrained neurologically to fire correctly. This is where properly designed exercise programming and movement training come into play. One word of caution: Often times, there will be trigger points or adhesions in certain muscles in order to compensate for something going on somewhere else. Releasing them can make problems worse. If you take care of the root problem, these trigger points will often release themselves. For example, someone might have bad trigger points or adhesions in their quadratus lumborum (spinal stabilizing muscle that attaches at the top of the pelvis, 12th rib and lumbar spine) because it is overworked due to a lack of help from its synergizing muscle(s), such as the glute medius. Well, if you keep releasing QL and don't strengthen the glute med, the problem will keep coming back. This is why proper assessment and understanding of the whole picture with each individual is so important so that you can ensure that the correct areas are released. Opposing and synergizing muscles need to be balanced out appropriately, caught up tissue needs to be released and proper alignment and movement needs to be trained (both full body and relative joint motion). Doing any without the others will usually lead to less than optimal results.

So, here a few things that you can do to help yourself out if any of what you just read rings a bell for you.

1. Get a good assessment from a qualified professional
   
   
2. Once you learn what is causing your problems, be conscious of your posture and movement throughout the day. If you sit a lot, make it a point to get up every 20 minutes to walk around and stimulate your hip extensors. If you stand a lot, sit down once in awhile. When you are sitting, make sure you have decent posture with a neutral back position and hips underneath you.
   
   
3. Learn how to move correctly. Learn how to squat, hip hinge, rotate, walk (no, you might not walk right), balance out each side of your body, and make sure you are using the right muscles at the right time. Get your hips, thoracic spine and ankles all moving well.  This is where getting some coaching from a qualified strength coach or therapist goes a long way. Even the best still get coached. Drop the ego and get some help if you ever want to get better.
   
   
4. Get proper treatment from a qualified soft tissue therapist who knows their way around the body and can treat you properly (hopefully the person or company of the person who assesses you and teaches you the other things talked about).  Once treated, invest in some self massage tools. A la crosse ball, foam roller and body back buddy or theracane are all must haves in my opinion. Once you learn where you need to focus your massage tools on, these are all great tools to help you get the job done yourself.
   
   
5. Get strong. Get some coaching and venture into the world of lifting heavy. If you are weak, you will get hurt easily. If you are strong, you will not. Its that simple. Whether you are trying to get rid of pain or just get a wickedly developed, rockin body, you need to get strong.
   
6. Learn how to breathe properly.  This could probably go at number one.  If you are not breathing properly with good diaphragm function, you will not have good oxygen flow and your posture and alignment will not be optimal.  You will also be sympathetic dominant with your nervous system (your body thinks you are constantly being chased by a lion) and pain and stress will result.  Breathing sets the tone for everything else.  More on this soon. 
   
   
7. Get a good assessment, treatment and coaching from a qualified professional. I'll say this one again if I have to. If you want to get anywhere, you need to learn exactly what you have going on, which is almost impossible to do all alone.  You then need to have a properly designed program with rationale behind everything in it.  As I've said many times before, random workouts produce random results.
   
   

Ok, so there you have it. Hopefully this article helped spark something in you that will help you take a step in the right direction to get rid of pain or even to prevent it from happening in the first place. Next time you hear someone talking about pain they have, let them know that it could be from doing “nothing.”

A common mistake people tend to make with their lunge, or single leg squat variations in general, is caving or falling over as they go down or come out of the bottom.  This can be due to abdominal, low back or hip weakness, improper breathing or just poor neuromuscular coordination.  Whatever the reason, it is important to stay tall during the lunge (looking at the reverse lunge here) while driving through the hip.  Here is a great exercise to help teach proper hip drive while staying tall.  It is also just a killer exercise in general that can be loaded real easily and also hits the entire core real nice.  Peep the vid.

When is the last time you hurt your back? Yesterday picking up a grocery bag? Helping your buddy move last month? Getting up off the toilet wrong as you were reading the latest Mens Health magazine? Picking up your girlfriend to twirl her around until you dropped her when you spasmed up? Well if you answered yes to any of these then you better keep reading this article. If you didn't answer yes to any of these, you still better keep reading this article. If you are here for any reason at all, you better keep reading this article.

Building upon the last question, when is the last time you hurt your back intentionally? I'm going to go ahead and guess that for many of you, the answer to this question is never or not recently. I don't mean when is the last time you hurt your back as in intentionally injured yourself. I'm saying when is the last time you straight up went to war in the weight room and made a solid effort to train, strengthen and bulletproof your back muscles. If you don't know when that time was, then perhaps you deserve all of the aches, pains and injuries you sustain with mundane little tasks like picking up a grocery bag to get out your crap food that you don't need or the crap food that you think is good for you because some garbage magazine said that it was but it really isn't and is in fact, in all reality, crap.

Now, before going further, let me make it perfectly clear that hip mobility and stability, glute function, abdominal endurance and stability, lumbopelvic stability, proper movement patterns, good thoracic spine mobility and solid control all around the pelvis and spine is of huge importance and should always be developed for optimal back health. McGill's stuff, Sahrmann's stuff and all of the movement impairment and corrective stuff out there is all awesome and needs to be addressed. What I am going to write about today is something that, at least in my eyes, you don't hear a whole lot about anymore. Actually training the heck out of your low and mid back and developing bulletproof muscular support, strength and endurance all around your spine and back region. There are tons of muscles to be developed and while glute work, abdominal work, etc. are all important, the back needs to be trained and trained hard. It seems to me that many have almost become scared to train their back because of all of the info that is now out there about stability, hip function, etc. Iliocostalis, longissimus, spinalis, multifidus, rotatores, semispinalis, quadratus lumborum, lats, trapezius and even the deep little intertransversarii and interspinalis muscles make up just a general summary of the many muscles that make up the lower region of the back (many of which continue up into the rest of the back on up into the neck). Want to be freakishly strong? Better train these muscles. Want to get big and muscular? Better train these muscles. Want to get lots of chicks (or, umm, good looking guys)? Better train these muscles. Want to prevent unnecessary episodes of back pain? Better train these muscles.

More commonly than should occur, I have clients “alert” me that their backs hurt or were sore after certain workouts. Now, “pain” as in bad pain that occurs from a tear or passive tissue injury is not something we want and if this is in fact occurring, the program needs to be modified for that individual or you need to learn how to use proper form. However, muscular soreness from training hard with solid exercises like deadlifts, back extensions, reverse hypers and good mornings is something that we need to push through with. Now, if your back is completely torched all the time and you don't feel much in your glutes or hamstrings, then you should probably reevaluate your technique or program. But if your back is sore or hurting sometimes after a hard training session, then maybe your building up some tolerance in those tissues where it needs to be built up. Maybe your toughening those tissues up so that next time you want to pick up that bag of groceries or carry that piece of equipment across the yard, you won't curl over and use three forms of the “f” word. Because when it comes down to it, if you never train those muscles and tissues and are afraid to put some positive stress through those muscles and tissues, when you do put some unexpected stress through them, you can easily run into problems.

If you look at some stuff out there by guys like Louie Simmons and Chuck Vogelpohl, some of the strongest men to ever walk the planet, they even go as far as to say you should do some exercises with a “bad” or rounded back position to build some tolerance in the tissues so that if you do catch yourself in that position, nothing “bad” will happen. When I worked at a corporate wellness center in La Crosse, my boss at the time, Cori Cripe had general population clients do some exercises with “natural” form (which often was not textbook like) so that if they found themselves in a bad position in a real life situation, their body would be prepared for it. I think that this is an interesting concept because while we can train proper body mechanics as much as possible, there will usually be some odd situation where we might not be able to use picture perfect form. Look at some strongman activities or warehouse jobs. While I don't think doing tons of sets and reps with “less than perfect” positioning is a good idea and that people absolutely need to learn and train with proper mechanics first and foremost, I think this idea has some value for certain people. The main point that I am getting at is that we can't be afraid to train the low/mid back and put it through some work.

Deadlift heavy, do your back extensions, perform reverse hypers, do good mornings all morning, row and pull heavy, swing plenty of kettebells and do things like these until you have some nice steaks on each side of your spine. (Of course learn proper form and use good hip drive w/ a good back position) Train each side and get the deeper fibers with side holds, side bridges, cable chops, heavy carries and windmills. Get a little dirty with it. Build a fortress. Get rolling. Have a little soreness? Good!! Get stronger. Build some endurance in those fibers (research shows back extensor endurance is a huge part of preventing back issues). The more tolerance you have in the wide array of tissues back there, the easier everyday activites will be, the stronger your body will be as a whole, the more muscle you will build and the more members of the opposite sex you will attract. A strong, endurable, muscular and well developed back is the cornerstone of a fit and strong body (talking mainly about low/mid back in this article but upper is just as important; i.e. do your rows and face pulls:). That goes for males and females. While pecs, arms and abs get all the attention in many “circles,” the back is where its truly at. It is the base for everything else. So train it and reap the rewards.

As I mentioned in the last blog post, on August 11th, I made my return to powerlifting competition and Therese Miller and Samantha Skeen did their first competitions.  I won deadlift with my 500 opener and struggled with 540 at the knees (which is a weight I could usually get more than one rep with, just need to start pulling heavy more frequently again).  I also won the bench your bodyweight for reps competition by pressing 179 pounds for 28 reps (just missed 29).  Therese took second for females with a 305lb deadlift and a 125lb bench (almost hit 140).  Samantha pulled an easy 230lb deadlift and probably could have hit more.  Congratulations to Therese and Samantha for putting on amazing performances at their first meet.  Big things will be coming for both of them. 

As for myself,  I want to pull 600lbs by the end of the year and I want to post a 1500lb total in single ply gear and a 1350 total raw (as a 181).  I've been training on a mission since that meet and have been hitting some nice PR's weekly..  I hit a recent PR with a box squat of 375lbs+170lbs of band tension and have been pulling rack deadlifts from mid shin level (I got stuck right at the knees at the meet) with bands for sets of 5-8 reps (close to 500 lbs with these). I have been hammering out lots of hip hinge/back extension exercises to really strengthen my back itself as well as the glutes and hamstrings.  My hips and legs are stronger than ever with all of the heavy single leg work and now squatting work I've done.  I now need to get my back back up to speed and prepare myself to pull huge weights again.  Its been a long road back, but I'm primed to be stronger than ever (and really am with most things right now).  Good Mornings, rack deads, back extensions, kb swings and exercises such as these are going to be staples again.  I've added about 60-70 lbs to my squat compared to where it was before my injury and now once I get my "groove" back with my pulls, I think that big things are coming.  I'm pretty pumped. 

I've experimented with different training cycles over the last couple of years and what I have been doing that works pretty well is incorporating some block periodization methods.  On average, I'll do a heavy/intense cycle for 3-4 weeks and then take 2-3 weeks to do less taxing workouts and exercises with just moderate to high reps and utilize supersets/trisets etc while pretty much eliminating barbell work and allowing my CNS to recover.  When I come back to the next intense cycle, I usually hit new PR's and feel recovered and rejuvenated.  The more advanced you get with lifting and the heavier weights you squat, deadlift, press, pull, etc.  the more important adequate recovery becomes.  I am getting much better and reading my body and at the end of a hard 3-4 week cycle, I can tell that I need to drop the intensity, and it works.  Research has shown that you can maintain max strength gains for up to 4-5 weeks after a cycle, and it has proven true for me. 
In general, my schedule looks like this:  Saturday- Max effort lower+accessories, Monday Speed/Overhead Upper+accessories,  Wednesday- Speed Lower/Heavier single leg +accessories,  Thursday- Max effort upper+accessories, extra workouts/conditioning 2-3 other times.  Obviously things get a lot more detailed and specific than that.  I'll do a detailed report on that soon. Get ready for big things.

Without further ado, here are some of the videos from the state fair meet.  Enjoy!!

Last but not least, if you are around Milwaukee, come check us out at Rosencutter Ultra Fitness and Performance!!!