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Thoughts and Review of Postural Respiration Part Deux

5/22/2014

If you haven't already read part one, then check that out first. Aside from the overview in part one, here are some other key points I took away from PRI's Postural Respiration.

*The diaphragm often gets stuck acting as a postural muscle instead of a respiratory muscle when things are out of whack/position. Position needs to be restored and diaphragm needs to restore its respiratory function.

*Right hemidiaphragm pushes air into the left lung and left into the right lung. Since we favor our right hip and have our liver on the right, we have an easier time getting air into the front of our left chest wall and a harder time getting it into our right anterolateral chest wall (mentioned this in part one). We need to get air into our left posterior mediastinum (posterior thorax) and right chest wall better. An important component of making this happen is developing our left abs (obliques) to help balance out the stronger right diaphragm.

*We often need to hypoinflate left ribs and hyperinflate right ribs; maximize exhalation on left and inhalation on the right and alternate.

*Neutrality is found when the diaphragm is contracting without the expense of extension and there are smooth transitions between left and right during gait. (Someone with an anterior tilted pelvis and hyperlordosis in the low back will tend to extend excessively to breathe, leading to unwanted back stress).

*Underneath every symmetrical movement is an asymmetrical challenge. I.e even if you are doing barbell squats bilaterally, there is still a war going on between left and right underneath that double leg squat. This supports my belief that bilateral and unilateral training should have a good balance in a program to keep things in check as doing only bilateral work will ultimately lead to an overpowering side (can you guess which one).

*Positions proceed patterns. To change a pattern, we need to reposition first. For example, if a muscle is not firing correctly or a muscle is inhibiting another muscle, we need to check position first because without proper positioning, neuromuscular patterning/firing will be off. If we restore position and THEN there is a neuromuscular problem, we can deal with it. Same story with movement in general. Until we get control of our pelvis and ribs, movement won't be ideal.

*The sphenoid, sacrum and sternum are the base points that all positioning branches off of.

*Modern day ergonomics lock us into the patterns mentioned earlier. We need to get out of them.

*Since the left brain has more responsibilities for speech and language and controls the opposite side of the body, the right upper extremity becomes dominant with communication, development and growth. This pattern needs to be balanced with neurologic and muscular activity on the left.

*The normal imbalances mentioned need to be regulated by reciprocal function with walking, breathing and turning. When they are not, weakness, instability and musculoskeletal pain often results. “Balancing muscle activity around the sacrum (pelvis), the sternum (thorax) and the sphenoid (middle of the head) through a PRI approach best positions multiple systems of the human body for appropriate integrated asymmetrical function.” This quote is taken from the PRI manual and sums up a real good point. It is a matter of being positioned well enough to work effectively in our normal asymmetrical state. This is what neutral means. Many people (including myself at first) get confused when they talk about neutral. Neutral does not mean symmetrical. It means being able to control and function optimally with the normal asymmetries that our body has and is supposed to have while avoiding overcompensations, pain and performance detriments.

*Being out of position can often stem from neurological reasons. For example, if you experience some kind of trauma whether it be an injury, an event such as a car accident or abuse, your body will generally go into sympathetic fight or flight mode. When you go sympathetic, your body has a good chance of falling deeper into these positional patterns mentioned earlier. So, you might be out of position (i.e. left AIC pattern or PEC pattern) as a result of your fight or flight response. I actually have a client who was doing well improving her left AIC/right BC pattern (shifted right, pelvis rotated left side forward, poor apical expansion on the right, left rib flare, etc.) and getting rid of pain nicely. She then got into a car accident and she went backwards, getting back into her old habits again. This was most likely a sympathetic response from the accident. A month after the accident doing the appropriate exercises and drills, she is better than ever. It is a very fascinating phenomena.

*Everything from vision to in uterine position can influence asymmetrical habits and patterns. Take someone who has had Lasik eye surgery and you will probably see some changes in muscle tone in their back, balance and certain patterns since their brain now has a changed sensory input with the improved vision and depth perception.

*A flat thoracic spine will result in an unstable scapula. Until flexion is restored, many scap exercises will not be as effective. In my experience and past learning, its usually been about improving thoracic extension. Many people actually do need better thoracic flexion.

*We need to get serratus anterior, low trap and tricep functioning optimally so that we can reach without excessive spinal/trunk rotation and maintain a stable position of our ribs and spine

*After digging into this stuff, I am amazed at how many people I see out in public standing on their right hips, with their left legs crossed into external rotation and/or right legs crossed into adduction/internal rotation, right shoulders lower and so forth. These patterns start to emerge right in front of your eyes. The assessments I have been doing (didn't cover this specifically in this article) continue to follow suit with much that the base courses cover as well.

In conclusion, it was a great course and on top of the things mentioned here, I picked up some great manual techniques and exercises to help facilitate better breathing function in people. I look forward to exploring the rest of their courses and deepening my understanding of the complex and asymmetrical body that we as humans live with. There is always so much to learn.

If you'd like to dig deeper, I'd highly recommend looking up stuff by Bill Hartman, Zac Cupples, Patrick Ward and Eric Oetter to name a few. They all have some brilliant insight with this material and have been studying it longer than I. Of course, you can also go to the source at posturalrestoration.com Thanks for reading.

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Thoughts and Review of Postural Respiration Part Numero Ono

5/20/2014

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(This picture will make sense later)

I recently took a great course put on by the Postural Restoration Institute (PRI) called Postural Respiration (actually a few months ago; its just taken me forever to get to this article with my oh so crazy schedule). PRI holds multiple courses that deal with analyzing, treating and dealing with imbalance in systems of the body. The main idea behind their practices is the fact that the human body is asymmetrical by nature. No human being is meant to be perfectly identical side to side. Some main facts about our static design show this: We have a liver in our right abdominal cavity, a larger hemi-diaphragm on the left, a pericardium and heart that is on the left and three lobes on our right lung versus two on our left. Because of these major static asymmetrical design components, we develop dynamic asymmetries that come about with our everyday functions.

We tend to favor and stand on our right hip with our left pelvis rotated forward (right hip becomes adducted/internally rotated and left becomes abducted/externally rotated), crunch down on our right trunk/ab wall, and rotate our upper thorax to the left to counteract the pelvic rotation to the right, creating left anterior rib flare and right posterior rib hump. They classify specific patterns that we fall into as Left AIC (anterior interior chain), PEC (posterior exterior chain), BC (brachial chain, usually right bc) and other patterns up into the head/neck/face and vision. I'm not going to get into details of these for the purposes of this article but they basically specify certain chains of muscles that are overactive or inhibited with different positions we get stuck in, in most cases right being different than left.

Continuing on, with our liver on the lower right and heart on the upper left, we tend to get air into our left chest wall better than our right. We have more lymphatic drainage on the left. Left and right parts of the brain control different sides and areas of the body. The list goes on. We are asymmetrical animals. This is normal.

Ok so what is the purpose of analyzing and treating people then if this is normal?

With these asymmetries present, we still need to have the ability keep things “in check” and function effectively for activities of daily living and sport. Looking at gait (they base everything off of this), we need to reciprocally get into and out of our left and right hip with adequate rotation and movement of our thorax, ribs and extremities. Right hip and left arm move/work together, left hip and right arm together, etc. etc. Problems come about when we lose the ability to keep things in check and can no longer get out of that right hip and fully into the left as we move. We get stuck on the right and in a half assed attempt to make the left work, we jack the left hip out of place and activate stabilizers on the right side excessively to try and stay upright and functional. This carries up to multiple compensations in the abdominals, thorax, shoulders, head, neck, face and eyes and down to the knees, ankles and feet.

At the root of all of this is our breathing; our diaphragm function. Breathing is what controls everything else in the body. If our breathing is off, something else is pretty much guaranteed to suck. If something else sucks, then you better believe that even something else is going to start sucking. You get the idea. When our pelvis is out of position (left side forward, shifted right) our thorax rotates the opposite way in an attempt to get ourself somewhat centered. When this happens, our right ribs tend to get stuck in a state of exhalation and our left ribs in a state of inhalation (look at rib flare). When we don't get air into our right chest wall due to this occurence, our right shoulder gets out of position and compensations, pain and injuries can then occur there, such as losing internal rotation on the right shoulder and losing horizontal abduction on the left shoulder. This is not a situation where “stretching” would be needed to gain internal rotation. Simply repositioning the ribs and sternum and restoring airflow into the right chest wall will allow IR to return on its own. I have gotten multiple clients back to full IR without touching their shoulder since I've started experimenting with this stuff.

Again, breathing function and mechanics are at the root of all of this. Many people, in our society especially, tend to get stuck in a hyper inflated state of constant tension, never fully exhaling and never fully relaxing. Their brains get stuck in sympathetic fight or flight mode, leading to excess tension in muscles, nerves and organs throughout the body; hello back and neck pain. Instead of having a zone of apposition (ideal alignment between ribs, pelvis and diaphragm to get optimal airflow with inhalation and exhalation), many develop a “zone of anxiety" where hyperventilation and panic lives. Without proper breathing, our brains freak out and start causing chaos in our muscles, nerves, joints and movement. Restoring full exhalation allows us to get back towards parasympathetic, rest and relax mode or at least somewhere closer to the middle.

Parasympathetic (Rest & Relax)----------Sympathetic (Fight or Flight)

Some people just need to breathe, period. Some need to get air into their right chest wall better. Some need to stop using their neck muscles to breathe. Some need to stop breathing with all belly and get their sides and back involved. Some need a combination of all of these things. Bottom line is: breathing is the key to many, many things that are kind of a big deal. You know, like brain function, blood ph levels, emotional stress, organ function, movement, joint alignment and position, walking, fatigue, sports performance, pain, relationships, sex, crushing heavy weights. Cool things like that!

So, if your pelvis and ribs are out of position, breathing will be off and if your breathing is off, pelvis and ribs will probably have an easy time being out of position, and if all of this is happening, other things are going to suck. Restore position, restore breathing and you will be golden (and less things will suck).

This is just the surface of a nutshell of what is all covered with these courses and their research and study. Specific assessments, treatments and exercises are used to identify exactly what issues someone is having (that is usually causing pain) and to improve the problem at hand and get people back to neutral. (Neutral meaning we can function effectively without excessive compensation; there will still be some natural, normal asymmetries no matter what). In my next post, I will go over some other key points that I took away from the course.

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Sometimes You Need to Hurt Your Back

9/13/2012

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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.

Building steel across their backs

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Movement, Massage and Low Back Pain

6/10/2011

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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.

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The Concept of Relative Flexibility

3/26/2011

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Relative flexibility is a very important phenomenon that most people do not even begin to understand. Shirley Sahrmann details this concept beautifully. In her book "Diagnosis and Treatment of Movement Impairment Syndromes," she sums up the concept like this: "Because of the intersegmental variations in the springlike behavior of muscles, a reasonable hypothesis is that increased stiffness of one muscle group can cause compensatory movement at an adjoining joint that is controlled by muscles or joints with less stiffness." Basically what this means is that a particular muscle may not actually truly be stiff; it is just stiffer than a neighboring muscle or muscles. Here's a couple of good examples that I see all of the time and that Sahrmann discusses.

Lats are stiffer than the lumbar spine
I see this all of the time when I take new clients through assessments. Someone flexes their shoulder (raises their arm overhead) and their low back extends (most likely hyperextends) rather than their shoulder reaching through to its end range. Since their lumbar spine is more flexible than their lat, this compensation occurs. Chances are, if we can get their trunk muscles to stabilize their lumbar spine and get the stiffness in the low back up to par with the stiffness in the lats, the range of motion in shoulder flexion will improve. It could also be a situation where you may need to decrease some of the stiffness in the lats AND increase the stiffness in the lumbar spine. This is a great example of why assessments are so important.

Rectus Femoris is stiffer than the abdominals and supporting structures of the lumbar spine
In this situation, the rectus femoris (big quad muscle that crosses the hip and knee) is stiffer than the supporting trunk muscles. When the knee is flexed, there will be excessive anterior tilt of the pelvis and the low back will extend. At the same time, the knee will not flex to its ideal range. In this situation, if we increase the ability of the trunk muscles to stabilize and stiffen, we might get better range of motion in knee flexion and less pelvic tilt and lumbar extension. In another light, it could be a situation that rectus is so stiff, that the body has to compensate by extending the low back and tilting the pelvis when the knee is flexed. There are various implications that could be present and Sahrmann gets into great detail on them all. But hopefully, this gives you a decent idea of what I am talking about. In my experience, it is most often a combination of stiffness in the talked about muscle and lack of stiffness/weakness in the supporting muscles. Both would be addressed to make the situation better. Again, everyone has specific things going on so not every condition will be taken care of in the same way.

A good real time example would be with the squat. Someone with an overly stiff rectus femoris in comparison to their low back will generally stand with their pelvis tilted forward and their low back extended past neutral. With this stiffness imbalance, there will be compensations within their squat pattern. As they descend into a squat, they will get to a certain depth and when their hips run out of room to move, they will move where their relative flexibility allows them to, which in this case is their low back. With someone like this, in most cases, the rectus will need some lengthening and their abdominals (usually the external obliques) will need some strengthening. The glutes and hamstrings usually will need some work as well. When you increase the ability of the muscles that posteriorly tilt the pelvis (abdominals, glutes, hamstrings, etc.) and improve the length in the muscles that anteriorly tilt the pelvis (in this case rectus femoris), the relative flexibility will be better and the squat will be a lot prettier with a stable trunk and mobile, nice moving hips.

As I said earlier, it could be a condition where all you need to do is stretch rectus and your fine. Could also be a condition where all you need to do is stiffen up the lumbar spine and your good. From my experience, it is often some form of combination. Whichever way it is, taking care of problems with relative flexibility can relieve a multitude of back, knee and shoulder pain and problems.

Hamstrings stiffer than the low back
Here is one more good example. If you lay on your back and raise your leg straight up, how high can you go without your low back flattening into the ground? If your hamstring is stiffer than your low back, your back will try to compensate by flattening in order to gain more movement. A little trick to get your leg higher is to brace your abdominals as if someone is going to punch you in your stomach. The added stability for your lumbar spine will allow your leg to raise farther without loss of a neutral spine. This example is tricky though because if it is truly hip flexor muscles that are stiff, the pelvis may be anteriorly tilted to start; thus, giving the illusion of the hamstrings being the issue when in reality it is the hip flexors that are the issue. See my past write up on misconceptions about hamstring stiffness to read more on this. Either way, bracing the abdominals will help your cause with the leg raise. Being sure that the pelvis is in a neutral position to start can clear things up.

Notice how all of these examples feature an issue with the lumbar spine being unstable and too mobile? Stability and the ability to stiffen when needed needs to be developed around the abdominal wall and lumbar spine. The inability to do this is one of the biggest and most repeated causes of back issues, knee issues and performance detriments that you will find. Yet, tons of people continue to promote more movement here with blind stretches and exercises. I've touched on this multiple times as have some of the best strength coaches, therapists and specialists in the world. Rationalize what you do. If you really do need more movement here, than by all means you better work on it. In my experience, this is a rare case.

Randomly and blindly training for flexibility does many people more harm than good. If you took the person from either of the last two example and stretched his low back and trunk muscles, his problem would become worse. Both strength training and flexibility training need to be individualized and specific. Relative flexibility is a great and proven concept. Contrary to conventional wisdom, sometimes stretching might not even be needed to improve flexibility at a certain joint. Simply balancing out the relative flexibility by increasing the stiffness at a supporting or neighboring joint will take care of the movement at the area in question. Think about how this could revolutionize what you do in the gym or in your sport. Pretty powerful stuff!

Where do you think his flexibility/stiffness imbalance is?

Franco surely had better relative flexibility for the deadlift than the guy in the last picture

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The Importance of Movement

11/26/2010

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Don't think this guy understands the importance of proper movement and his back isn't going to like him for it

Proper movement is the base point of exercise and performance. I don't care how great of shape you think you are in or how many times a week you go and workout; if you are not moving the right way, you are wasting a large amount of your time.

"Oh my knee hurts!" Well, if you had any idea how to squat and use your hips and glutes the correct way, your knee probably wouldn't hurt so much. When you squat with your weight on your toes, heels off the ground and your knees are coming forward so far it hurts to watch, you're probably giving yourself knee pain. If you do this throughout the day with work activities, etc. you can only imagine the issues you are creating. "Oh but I went to physical therapy and they said I shouldn't squat." Well sorry to tell you, but if you ever want to get better, you're going to have to learn how to use your hips and guess what, squatting is pretty much the best way to do that. If your therapist was any good, they would have shown you how to move the right way and fix this problem but since they probably have no idea how to move correctly themselves, they screwed you. Sorry. "Oh well I've worked with another trainer before and they gave me a workout plan." Really!? Well that workout plan and that trainer must've really sucked because they sure didn't teach you the most important aspect of any exercise program: HOW TO MOVE!!!

"My back hurts" Well, lets see you pick this ball up. Well since you just picked that up with a flexed lumbar spine, and you do repetitive motion like that at work all day, five days a week, you are probably causing problems. Let me show you how to deadlift properly and that should begin to help you. "Well, my friend works out like all the time and he said that deadlifts can hurt my back." Well, your friend just proved that he has no right to an opinion on the matter. Picking feathers up off of the ground with the form you just showed me is bad for your back. Deadlifting respectable weights with proper form will help you like you wouldn't believe.

(These were just generalizations, not directed towards any individual)

If you are trying to exercise and you are not performing free motion, multi joint movements either because you are scared to or don't think you need to, you have two options. A- Just stay home and eat chips because you are wasting your time and probably creating future problems for yourself B-Get help from an expert who can actually teach you proper movement patterns with effective exercises for yourself.

If you are performing multi joint, free motion movements but have terrible neuromuscular coordination and movement patterns then props to you for at least trying to do something worthwhile. However, you still should refer to option B from above. Get help from an expert who can actually teach you proper movement patterns and effective exercises for yourself.

Movement is so important guys. You need to learn to move through your hips with a stable trunk. You need to learn how to squat both bilaterally and unilaterally while utilizing proper hip, knee and trunk position. You need to learn how to pull and push with proper thoracic mechanics. You need to learn how to rotate correctly. You need to learn how to perform locomotion effectively. You need to understand how to fire the correct muscles at the right times to do all of these things our bodies are meant to do the right way. Its not as simple as going to the gym and guessing your way through random useless things. A home video can't teach you if you have no idea how to feel things. A magazine is even worse. A lot of health professionals that deal with the body can't even help you (also a lot who can). I know this because I constantly see people who have been to other health professionals and still have absolutely atrocious movement skills. It blows my mind.

It all comes down to movement. There are many great exercises that can do a lot for you, regardless of what your goals may be; however, the fact of the matter is that no matter how great the potential of an exercise, if your movement pattern is less than optimal, the exercise is not going to do what it should for you.

You owe it to yourself. If you are going to invest your time in exercise and bettering your body and life, you owe it to yourself to invest some time in learning how to do things the right way. I have talked about and could get into all of the trillion other things that go into proper and effective training and programming but no matter what topic or aspect I talk about, it still comes back to proper movement. It is the essential base point for everything else and has to be mastered first. So give yourself a great gift this holiday season and learn how to move!!

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The Mobility-Stability Continuum- Lumbar Spine

7/8/2010

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After hearing some good lectures at the seminar last weekend, seeing some horrific stretches and exercises in the gym and doing what I do with people everyday, I was motivated to write more about this topic. I wrote a large part of this in the newsletter for Southridge but go into some more detail here. The concept of having stability versus mobility at different joints is something that is not understood by enough people.

The body has what is known as the stability-mobility continuum. If you look along the kinetic chain of the body, joints that need to be mobile and joints that need to be stable pretty much alternate. To sum it up, the ankles need mobility, the knees need stability, the hips need mobility, the lumbar spine needs stability, the thoracic spine needs mobility, the scapula needs stability, the shoulder needs mobility along with appropriate stability, and so on.

Most people move at all of the wrong places and do not have the mobility and stability needed to stay healthy and pain free. In this post, we will focus on the lumbar spine.

I work with a lot of people who have back pain and have successfully helped a lot of people get rid of it. I have also been around people and have studied work of people who are really really good at fixing back issues. One of the major causes of back issues is too much movement in the lumbar spine (low back area) with too much stress going through it. It is not designed to produce a lot of movement and doing so leads to lots of problems. Why does this happen?

Stiff Hips and Thoracic Spine

Many people have really stiff hips and terrible mobility in their thoracic spine (upper part of back). If you can’t move in either of these places where the body really should be moving at, you compensate by moving through the lumbar spine. This is a problem. If you are not around someone who can help with this, I suggest checking out any of Mike Robertson, Bill Hartman or Eric Cressey's products.

Poor Movement Patterns

Many people flat out do not know how to move the right way. Once someone learns how to move through their hips and thoracic spine while maintaining a stable lumbar spine, their problems usually subside.

Poor Exercise Programs

Probably about 95% of the population has absolutely no clue why they do what they do with their workouts and are doing more harm than good for themselves. We know that we need stability in the lumbar spine yet tons of people continue to train it to move. Crunches, stretches into extreme ranges of spinal flexion and extension, twisting through the lumbar spine, rounding the back and the list goes on. We need to stop training this area to move and teach it be stable. This has been proved time and again in the research. One problem is the fact that media and misinformed health
professionals give people the wrong information and they don’t know any better. Stop stretching and moving through your lower back!!

Weak and Improperly Trained Abdominal Muscles

Many people have terrible endurance and stability in their abdominals. The abs need to be trained to stabilize a neutral spine and properly control pelvic movement, not to flex the low back and round the shoulders forward as is done with crunches and poorly performed situps so often (ties in with poor movement patterns.) If you take anything away from this article, please do yourself a favor and stop wasting your time and making yourself worse off with crunches (at least the way most do them). Learn to train all different sections of your abs with effective exercises that train them to stabilize and work in conjunction with other muscles such as plank variations, side bridge variations, jackknifes, cable chop variations, rollout variations and neutral spine leg raises/leg lowering. Any kind of multi joint movement such as squats, deadlifts, chinups, etc. train the abs to a great degree and should always come first and foremost. The obliques are often very weak and neglected by many people (will go into more detail later). They are the most important part of the abs to bring up for many (no, crunches do not train the obliques effectively).

There also has to be a progression with the exercises you use. You can't just put a beginner with poor function on the floor and tell them to do an ab wheel rollout (I've seen someone do this recently and it wasn't pretty). You have to start with specific exercises that you can handle and progress from there. Otherwise, the back will take up unwanted stress and bad things will happen.

According to Sahrmann (a goddess among physical therapists and a top expert in movement impairments and corrective exercise), the most important outcomes of abdominal exercises are obtaining the control that is needed to do the following.
1. Appropriately stabilize the spine
2. Maintain optimal alignment and movement relationships between the pelvis and spine
3. Prevent excessive stress and compensatory motions of the pelvis during movements of the extremities.
(Taken from "Diagonosis and Treatment of Movement Impairment Syndromes")

She says that a primary role of the abdominals is to "provide isometric support and limit the degree of rotation of the trunk" during daily activities. This point is huge because many people practice terrible movement patterns and posture throughout the day, even with light tasks. In her book, she also states that "a large percentage of low back problems occur because the abdominal muscles are not maintaining tight control over the rotation between the pelvis and the spine at the L5-S1 segment." She also goes on to say that "they are not preventing excessive anterior tilt of the pelvis or spine during activities that involve lower extremity musculature. In contrast, excessive abominal muscle activity, shortness, or stiffness contributes to posterior pelvic tilt and lumbar flexion." (Also taken from "Diagnosis and Treatment of Movement Impairment Syndromes")

Since the external oblique controls or prevents anterior pelvic tilt and pelvic rotation, effective exercise for this muscle should involve moving the legs to train its influence during this kind of movement. In his presentation at Perform Better, Mike Boyle also made a nice point in saying to think of the obliques as "anti rotators" instead of rotators. So, we must train them to control pelvic and leg movement, stabilize against rotation or at least control rotation and to effectively stabilize the spine.

Too many people overwork the rectus abdominis (6pack muscle) and make it short and contribute to a rounded kyphotic shoulder posture in addition. They do nothing to bring up the supporting cast and develop optimal back health and performance. This is not to say that rectus is not important because it is. Often times it is just overworked in people. I am not just talking about average joes with some back issues; a lot of athletes also train with a complete backward approach. Training the trunk correctly has a huge impact on performance as well. As an example, take a look at throwing a punch. Ideally, you generate the power with your hips, transfer the force through a stable trunk, and carry it out through the shoulder and arm. If their is any kind of leak through the trunk during the movement, the outcome will suffer.

A great way to train endurance in the obliques, quadratus lumborum, back extensors, lats, hips and the entire family is with side bridge variations. Stuart McGill has done some great work and research on the best ways to train these muscles the right way while sparing the back.

So basically, to sum this section up. The abs (and most muscles for that matter) need to be trained to do specific tasks (stabilize the lumbar spine), not just trained to be trained. So lets say that you do a few sets of 20 reps of crunches. Great, but when you get into a real time daily or sporting activity, those crunches will have no carryover to what you are doing. There are very few situations in which it would be beneficial for someone to do the movement of a typical crunch. On the other hand, if you train effective stabilization patterns with, lets say, a side bridge variation or an anti rotation cable hold, those obliques will kick in next time you are doing something in real time and your lumbar spine and lower back will be fine. There are actually some effective ways to perform crunch or curl-up variations if that is an area you are weak, but most do nothing close to them.

Finally, having optimal control in the abs has a huge effect on achieving optimal hip mobility. As I stated before, having good hip movement is also a huge factor in having a healthy back.

Poor Endurance in the Low Back Extensors

Some people have poor endurance in their low back muscles in addition to their abdominals. This provides very poor stability for their lumbar spines, allows more movement there and leads to even more issues. Bird Dog progressions are a great starting point here.

I also feel that it is important to have a strong back (I'm a powerlifter, come on now); however, without these other qualities that I have discussed, having a strong back will not always prevent injury and will not always equate to optimal performance and health. The first four sections in this post don't even deal with the back directly; thus, as you can see, it is usually not the back itself that is the problem. It is the areas surrounding it.

In conclusion, the lumbar spine should be a stable area, not a mobile one. Start treating it this way and watch your performance soar and your pain go away. I highly encourage you to check out any of Stuart McGill's work and research if you are interested in more on lumbar stability and the negative effects of repeated lumbar flexion. (Repeated lumbar flexion is the number one mechanism of herniated discs). I have also covered lumbar stability, back pain and ranted about crunches and misguided stretching in previous posts so go ahead and go through the archives and check em out.

To appreciate the proper training of the abdominals even further, in one of my next posts, we will take a brief look at the deeper anatomy of the abdominals, their true function and more on how they specifically tie into maintaining a healthy back. Its already in the works so stay tuned!

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Are Your Hamstrings ACTUALLY Stiff?

4/18/2010

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Are your hamstrings actually stiff in reality? There are many people who "feel" that there hamstrings are stiff and then go about stretching them day in and out to try to relieve back pain, move better, etc. Well I have some news for you. Just because they feel stiff does not necessarily mean that they are. Stiff hamstrings is a very commonly misdiagonosed case.

A client I began with last week had this exact problem. He had been to a physical therapist for a couple of years who misdiagnosed the problem and he himself also "felt" that his hamstrings were stiff. However, when I checked the other joints around his hips and simply looked at him stand, it was easy to see that this couldn't be farther from the real issue at hand. He had an anteriorly tilted pelvis.

When your pelvis is in anterior tilt, your hip flexors become stiff/short and your glutes shut off and become weak/inhibited. Your hamstrings are ALREADY in a constant state of stretch and since your glutes are not doing their job, your hamstrings take up all of the slack. Since they are in a constant state of stretch and constantly overworked, they will FEEL stiff. So, as sad as it is, many people just like the client I saw, go on for years stretching their already overly stretched hamstrings and make their problem worse than it already is.
I should point out that an anteriorly tilted pelvis also increases the curve in the lower back, which overstresses this region also and often causes back issues. Guess what, stretching those hamstrings makes the issues worse.

So what do you need to do to fix the problem? First of all, stop stretching your hamstrings, which are already on stretch. What you need to do is stretch your hip flexors (primarily rectus femoris, psoas, tfl) or for the simple minded the front of your hips, and activate/strengthen your glutes. Doing this will tilt your pelvis back in the direction of neutral, take the stress off of your hamstrings and back, and make you feel like a million bucks again. The hip flexor stretch, glute activation work and soft tissue work that I covered in previous posts are great ways to begin doing this.

Before I go, you should note that this is not the case with everybody. Some people really do have stiff hamstrings that need some length. Everything must be checked to determine what is really going on. Assumptions will get you nowhere. Hope everyone has an awesome rest of the weekend!

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Spittin in the Wind

4/7/2010

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Have you ever experienced knee pain, back pain, had an injury somewhere, etc? How many specialists, therapists and trainers did you go to only to come back to square one with no progress or results in the long run?

I have seen lots of people who come to me with problems such as these and one common problem I have seen is that most of the professionals people have been to only look at and treat the symptom(s). Well guess what, unless you find the CAUSE of the symptom and remove it, the symptomatic relief will be only temporary until the cause brings it right back. For example, if someone has knee problems, more often than not the real issue will be somewhere in a joint above or below the knee, which would be in the hips or in the ankles. Unless this real issue is taken care of, the knee issues will continue to come back.

In Low Back Disorders, Stuart McGill states the following: "Reducing pain and improving function for patients with low back pain involves two components:
*Removing the stressors that create or exacerbate damage
*Enhancing activities that build healthy supportive tissues"

Take a good look at that first point. Without getting rid of the cause, or stressors, the symptoms will never go away for good. The cause may be a mobility issue somewhere; it could be a weakness or imbalance somewhere; it might just be a certain activity or movement that causes problems. Whatever it may be, the cause must be found and eliminated if the symptoms are to fully be rid of. You can get cortisone shots 24/7 but unless you take care of the real culprit, you will never be better.

Crossing over to another spectrum, the same type of idea goes for plateaued lifts in the weight room or performance on the field. Unless you identify the weakness that is halting progress and fix it, you will be on a long road to nowhere. For example, if your squat is stuck and you keep squatting away week in and week out, you will go nowhere. Maybe you need to fix something with your technique, maybe you have weak glutes that need to be strengthened, maybe you have rotation in your hips you don't know about, or maybe your program just plain sucks; whatever it may be, you need to find the limiting factor and take care of it.

Whether you are talking about issues with pain and injury, or performance, it is absolutely imperative that you find the CAUSE of your problems and eliminate it. If you don't do this, you are just spittin in the wind, my friend.

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Gluteless society

7/13/2009

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In America today, more and more people are inactive and sit for long periods of time. Many jobs require people to sit all day. When you are sitting, your hip flexors are shortening and stiffening and your glutes become dormant. When you have overly stiff hip flexors (in this case usually psoas, rectus femoris, tensor fascia latae or a combination) and glutes that are weak, don't fire, and are virtually non-existent, your low back, knees, and/or hamstrings tend to pick up a lot of the slack.

People with back pain often have very weak glutes that don't turn on when they are needed. With no support from these hip muscles, the back absorbs much of the force that is created with various movements, which in time is bound to lead to back problems.

If hip flexors are too stiff and you can't get your hip into full extension with the glute muscles, anterior hip pain can also occur since the hamstring will try to perform the extension instead of the glutes, and cause the femur to rub against the joint capsule.

If you are talking about athletes, those with no glutes often perform movements in a strictly quad dominant fashion. With no assistance from the glutes, the knee joints end up taking extra stress and pain and injuries can result.

Glutes are one of the biggest, strongest, and most powerful muscles in the body (at least they should be) and athletes that don't use them to their full potential are not only asking for pain and injuries, but also are hindering themselves from their ultimate performance potential.

So what needs to be done to fix this problem? The hip flexors (and any other stiff areas) need to lengthened and mobilized, and the glutes need to be activated and strengthened. I will give some examples of how to accomplish this in my next post. Stay tuned!

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Thoughts and Review of Postural Respiration Part Deux

Thoughts and Review of Postural Respiration Part Numero Ono

Sometimes You Need to Hurt Your Back

Movement, Massage and Low Back Pain

The Concept of Relative Flexibility

The Importance of Movement

The Mobility-Stability Continuum- Lumbar Spine

Are Your Hamstrings ACTUALLY Stiff?

Spittin in the Wind

Gluteless society

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