When an athlete suffers a burner or stinger, it is usually due to the nerve being traumatized in some way. If there is disk involvement in the cervical spine, then this program will not be beneficial and could even be detrimental to the athlete. Make sure that the integrity of the cervical spine is good via communication with the athletic trainer and/or a physician.
The exercises are simple to implement, but it is crucial to err on the side of caution. When this program was first implemented back in the mid- 80’s for college level football athletes, the information we were given from the medical staff was that the damaged nerve only recovers at 2-5 mm per week. In severe cases there was tingling, numbness and weakness to the hand, meaning the athlete could be out several months. The second caution the medical staff advised us to be cognizant of was that the nerve would tire rather quickly. So many exercises were done to the limit of the damaged side with dumbbells that were unequal in weight so that the nerve was allowed to progress in recovery and regeneration. Neural tiredness is characterized by a heavy, tired, dull, dead and/or weak feeling. When this happens it can actually slow or even harm the recovery process of the nerve.
The exercises are as follows:
Manual Neck –
This drill is done four ways emphasizing both the concentric and eccentric resistance range of motion. The anterior version wraps the towel over the forehead and on the chin for grip and for sanitary purposes. The athlete will lie on their back and concentrically go from almost full extension to almost full flexion with resistance. Then the partner will provide the force to eccentrically push the head back to almost full extension. Do not get to full extension as this may trigger the nerve and cause the burner/stinger symptoms again.
The prone version requires the athlete to roll over onto their stomach. The towel is placed upon their posterior skull and the athlete will go from almost full flexion with resistance to almost full extension. The partner will again provide resistance for the eccentric portion of the range of motion. Again, the purpose behind going from almost full extension to almost full flexion is that no additional stinger event will be caused by the exercise program, as this would set the recovery process back.
Lateral is accomplished by having the athlete sit upright at the end of a bench and grab the front of the bench so there is no lateral flexion of the upper body. The towel goes over the head and the resistor places one hand on the outside of the head and the other will support the outside of the opposite shoulder. The athlete will attempt to go from ear on the shoulder to ear on the shoulder with concentric and eccentric resistance just as in the anterior and posterior versions of the exercise.
Shrug Series –
There are four versions of shrugs that are incorporated into the burner/stinger program. The first is the overhead shrug. This is not a strength exercise as much as a motor learning exercise. In contact sports the upper shoulder complex must brace and support the neck upon contact. This is accomplished by elevation or “bowing the neck” and many athletes are unable to do this movement with the arms in an overhead, extended position. Holding a bar overhead in a fully extended, locked out snatch grip, have the athlete attempt to press the bar using shoulder elevation. As the athlete does this, the spotter should place each of his index fingers on either side of the neck under the ears. The athlete should attempt to pinch the spotter’s fingers between the traps and neck muscles. The load is a bar only. Full ROM is important, especially at the top end or fully contracted part of the movement.
The second shrug to learn is the hang shrug. This shrug is done from the hang clean position with dumbbells in order to force the athlete to shrug up and back to increase the strength of the upper and mid trap in order to support the elevation/bowing action. This is also a motor learning drill that once learned, can be moderately loaded. Full ROM is important, especially at the top end or fully contracted part of the movement.
The next version is the bent over shrug. Just as the name implies, the athlete is bent over so that the back is parallel to the ground and the dumbbells are hanging from the shoulders in the hands. Varying of the grips by rotating the dumbbells will challenge the motor learning part of the exercise. Emphasis should be put on contracting the traps/shoulder blades down and back for full contraction. This drill can be moderately loaded. Full ROM is important, especially at the top end or fully contracted part of the movement. The dumbbells will go from the hang position in front of the thigh to the outer hip, almost to the back pocket.
The final version is the upright row, again with dumbbells in order to allow each side to be appropriately challenged without over stimulus of the nervous system. This version can be loaded the most in relation to the other drills. The spotter technique of placing the fingers on the traps is again recommended here so that full ROM contraction of the traps is accomplished.
Recommended Training Program –
The sets and reps are determined by the ability of the athlete and the traumatized nerve(s) to withstand the level of stimulus with out being over trained. Manual neck sets and reps are 1 set of 8-10 reps. As the athlete progresses, this becomes a max effort drill in which the athlete can only do 10 reps each direction. For each of the shrugs, begin with 1 set of 8-10 reps. As the athlete becomes accustomed to the training prescription, the volume can be progressed up to 3 sets of 8-10 reps. Remember that quality is much more important than quantity as the rehabilitation program progresses.
In injury prevention programs, emphasize ROM, optimal patterning and quality movements. The loads can be moderately heavy as long as full ROM is performed. Prescriptions can be 3 x 8-10 down to 4 x 5-6 or even 10-8-6-4.
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The core is an area of the body roughly defined as the region from the armpits to the knees. Most of our movements occur through the core after beginning somewhere else. For instance, in jumping the area of the core will move toward the ground as the arms reach back or up and the legs flex. Upon forceful extension of the arms and legs the body is propelled upward with the force moving through the core to the blocked arms. When sprinting, the arms and legs are dynamically moved through out the range of motion in order to develop the velocity of the body, moving the core forward. These ballistic arm and leg movements occur around a generally stable, strong core. If the core lacks proprioceptive strength, (strength with balance and stability) then energy leakage can occur upon force production or force absorption and the power generated by the limbs and transferred through the core can be lost, resulting in less speed or height generated for an event, routine or technique. During force reduction, the compensation pattern to accommodate these weaknesses can lead to injury.
In training the core it is important that the many vectors of stress and planes of motion be addressed as the demands of sport occur at high speeds and a variety of angles. Training the core in the variety of angles needed is similar to the angles of attack in the combative arts. The attack vectors of martial arts are up and down; diagonal up and down right and left; across the body from right to left and vice versa: and finally straight in, which is unnecessary for core development.
If the core can be trained in these various angles with a variety of implements then it will better be able to withstand as well as transfer the forces needed in preparation and competition. The labels for the various vectors are as follows:
Straight Down – Slams
Straight Up – Scoops
Side to Side – Twists
Diagonal Up – Lift
Diagonal Down – Chop
The stances are relatively simple to master as there are 4 basic stances with three levels of difficulty. There is the lunge stance (kneeling or standing), the squat stance (kneeling or standing), diagonal variations off of each of these and the single leg stance. To vary the level of difficulty for each all you do is shorten the stance from wide to narrow. The lunge stance starts out with the foot about 1-2 foot widths wider than or away from the opposite knee. The next level of difficulty is the foot/knee is on one side of a line and the opposite foot/knee is on the other side of the same line. The most difficult lunge stance is the one in which the foot/knee and opposite foot/knee are on the same line, as if on a balance beam. In the squat stance start out wider than hip width, move to hip width and the most difficult stance in order to maintain core stability during a strength movement is with the feet less than hip width. Needless to say, the single leg stance is the most difficult of all to maintain balance and execute pillar core training.
As for modalities used to implement core training the Keiser Functional Trainer is excellent for the constant variety of speeds and loads at any angle and it has a power output reading. Most of us are not so fortunate to be able to afford a Keiser, so substitute some light to medium resistance tubing in order to give resistance in the proper ranges of motion. Medicine balls are excellent in order to mimic the movements in the various vectors and stress the ability to maintain a tall pillar core without arching or collapsing with rotation. The medicine ball can also be thrown to the floor or off of a wall in the various vectors in order to increase the power developed and force transfer through the core. The most stressful implement to use in core vector training is the water ball. The water ball is simply a small stability ball with about a gallon or 8.8 pounds of water. Just get a small piece of tubing and fill the sink with water. Take the smaller stability ball that is about ¾’s full of air and insert the tubing into the sink, under the water and suck start it in order to start the flow of water. Insert the tube into the ball in order to siphon the water from the higher sink into the lower ball on the floor. Keep adding water until about a gallon of water is added into the ball. During the movements the added water will move about inside the stability ball and cause the core to react and proprioceptively stabilize in order to execute the movements.
Another way to execute core vector training is by using dumbbells and ankle weights and moving the limbs through a variety of movement vectors while beginning with a pillar core in extension on the floor for front side or on a stability ball for back side core. A 2 – 5 pound dumbbell and 2 – 5 pound set of ankle weights are sufficient for most any athlete. While on the back, the dumbbell is extended above the head and the opposite leg is extended while the same side leg is flexed at the knee. The athlete will bring the dumbbell and ankle weight up in a long arm and leg movement and meet in the middle for a sit – up type movement. As the dumbbell and ankle weight are returned to the ground it is imperative the athlete get long through the core but does on arch the back. The second vector is to move the arm out to “2 o’clock” position and the opposite leg out to the “8 o’clock” position and now execute the same sit – up type movement in a diagonal type vector. The final movement starts from a totally different position. The arm is extended above the shoulder straight up at the ceiling while the opposite leg is extended up above the hip in a similar fashion. The arm moves away from the body toward the “3 o’clock” position and the leg moves away from the center of the body toward the “9 o’clock” position. Neither the arm nor leg will touch the floor as the core of the body fights to keep the belly button facing straight up to the ceiling. Do not let the belly button follow the long, straight leg away from center is one cue, the other being to maintain ground contact with both hips throughout the movement.
The same concept can be utilized on a stability ball for the “super man” type of exercise. However, we will change the vectors and emphasis of motion. Just about everyone is familiar with the “superman” exercise. However, we will add a dumbbell in one arm and ankle weights as well as provide a different aiming point and cue for technique execution. Most people will coach and execute the movement by reaching up for the ceiling with the arm and leg. The optimal execution is to reach the foot and hand for the meeting point between the wall and floor and let the long stable core support the shoulder extension at the deltoid and hip extension at the glute. The foot should not get higher than the glute and the hand should not get higher than the deltoid. The cue is to “reach” and get “longer” through the back side core. The vectors are the normal superman with either the same arm or opposite arm involved. The second vector is the arm at “2 o’clock” and the leg at “8 o’clock” and the final vector is with the arm at either 3 or 9 o’clock and the opposite leg at either 6 or the opposing 8 or 4 o’clock angles.
What emphasis do you put on core training and when and where does it fit in your program?
Core training is done at the beginning, middle and end of all of our strength workouts performed in the weight room. At the beginning of our workouts we may do chronic abs which are a series of on the floor sit –ups done either coach directed or at the athletes direction targeting all areas of the abs. We may also do hanging abs, where we hang from the racks and lift our legs, knees or feet up to our stomach, chest or hands in a variety of exercises. We may also do some swiss ball exercises, some mediball drills or some rubber band or tubing exercises for our core. I always assign some type of core training prior to the work out in order to awaken and stimulate the core in order to foster correct neural recruitment to protect the core as the heavier exercises are executed. Years ago it was recommended that no core work be done prior to heavy weight training in order to prevent core fatigue and possible injury. I have found over the years that some core work at the beginning actually seems to help foster better mechanics during the lifting workouts.
At the end of our workouts we assign more ab/core work and a lot of this is of the weighted or heavier variety. We repeat our pre workout chronic abs but add ankle weights and a plate or mediball in our hands for extra resistance. We do burnout sets with the mediball. We prescribe swiss ball exercises for stability and strength when the athlete is already fatigued. We do more rubber band or tubing ab drills. I also have found that if I break up the ab work I can get better compliance from my athletes, especially when it is not coach directed.
Many of the exercises our athletes perform call the core into play. When an athlete cleans, snatches, squats or does combination lifts, the core is being called upon in order to support and stabilize the load. Many of our circuit workouts with dumbbells have an extreme core component in the execution of the individual exercises. In essence, any time our athletes are standing and lifting loads that are in their hands or on their shoulders, their core is involved to some degree. The higher the load is over their shoulders and the lower the hips are in the movement, the greater the core is being called into play. Going from bilateral support to unilateral support increases core involvement. Decreasing the stability of the athlete or increasing the instability of the surface the athlete is on increases the demand on the core.
In summary, the more ways we can target the core, the better we get at just about everything we do.
Is warm-up that important?
Warm – up is a critical component of the training and conditioning process in my philosophy as a coach. Warm – up will set the tone, tempo and attitude of the individual, group or team for the entire workout. If the warm – up is slow, methodical, sloppy, half – hearted, mechanical, or non – existent, then the workout, practice or competition will reflect that type of warm – up. However, if the warm – up is up tempo, crisp and possesses variety, then the following session will begin will reflect those same attributes.
I try to accomplish several things during warm – up. I want to warm the athletes up. But, I also want to create suppleness throughout the body, turn the neuromuscular system on, properly prepare the athletes for the workout to follow and progress the warm – up to the point the athlete is ready to handle the stressors of the upcoming workout. I call this sequence warm – up, loosen – up, turn – on, build – up and workout.
Warm – up consists of a variety of exercises and drills I implement in order to create an athlete that is prepared for the workout. When I was coming up, warm – up used to consist of “run around the goalpost” or “3 times around the gym” or “give me a lap around the track” and that was it. Today, warm – up is utilized for pre – hab injury prevention exercises, neural innervation to “turn on” the proper musculature, agility, mobility, core strengthening, joint loosening, balance enhancement, spatial awareness training, as well as building up to the speed, power and strength in the ranges of motion needed in the workout itself. In other words, as Vern Gambetta queried many times,
“Where does warm – up end and the work out begin?”
The warm – up is crafted based upon several parameters. The type of workout that will follow the warm – up, the sequence of the previous workout, the warm – up menu for the training period, the demands of the sport and the needs of the athlete. If the workout is a horizontal speed session, then the warm – up is more like a “track” warm – up, with lots of sprint technique drills. If the workout is a lateral speed and agility session, the warm –up is designed to prepare the athlete for hip, knee, ankle flexion, rotation and extension at the proper speed and depth. If the work out is a strength, plyometric, conditioning or work capacity session, then the warm – up will again reflect those differences.
During warm – up I prescribe lots of pre – hab drills in order to foster injury prevention. Things such as neck for football, multi – planer balance single leg squats and single leg good mornings as well as rubber band walks for ACL protection. Slide board drills for groin development/protection, hamstring slow speed strengtheners on glute hams, physioballs and with partners to name a few. Loosen – up consists of dynamic movements to prepare the joints and the body for the full range of motion demands of the workout. I do not do a lot of “stretching” prior to a training session. Old timey stretching/flexibility is saved for post workout time.
Turn – on is a reference to incorporating the neural component of the neuromuscular system. Many of my athletes have been in bed sleeping or sitting in class just prior to the training session. Many of the muscles have been somewhat dormant and need to be awakened or “jazzed up” for the workout. The core needs to be addressed, the glutes need to be made to function and on some specific athletes, the abductors and adductors of the hip need remedial work. I assign specific drills and exercises in order to get these areas fired up and functioning as they were designed.
Build – up refers to the athlete continuing the warm – up to the point in which they are prepared to move at the speed needed for the session and in the manner required for the drills assigned. If the athlete is doing an agility workout, they need to be prepared to bend, rotate, extend and explode in and out of cuts. If the training session is a horizontal conditioning session, then the athlete needs to be prepared to run at the tempo required for the sprints assigned. If the athlete is going from warm – up to the platform, then they need to be ready to pull and rack quality weight with posture, power and technique.
My warm – ups are generally 10 – 20 minutes in length and consist of a variety of drills, modalities, techniques, planes, tempos and ranges of motion. It is imperative the athlete be prepared for the upcoming session. I look at it this way. If the upcoming training session were a competition, would I want my athletes prepared to start fast, with great focus, function and fundamentals? I think we all would respond with a resounding “Yes!”
It is important in prescribing exercise programs to be aware of several variables and the impact the exercise prescription can have on a person that is not ready to execute certain drills, movements, loads and intensities due to lack of training age, poor general fitness and/or inadequate movement patterns due to lack of mobility and/or stability. Some popular exercise programs assign exceedingly large loads of volume and/or intensities (resistance, speed and/or range of motion) with little regard to the ability and state of preparation of the end user. The human body is a superb machine, able to compensate for many inadequacies and still execute some form of the movement, even though the pattern is less than ideal. Over time, especially with increasingly larger loads/volumes, the body will begin to exhibit symptoms that relate back to these less than ideal patterns of movements. Poor compensation patterns of movement may ask muscles to do jobs they were not designed to do, in a sequence and order that is not optimal for the pattern, or put joints in poor positions in terms of their designed function. These symptoms include low back tightness; hamstring tightness and pulls; tendonitis and bursitis in various areas; stiffness in joints; and over time, the inability to execute certain movements due to pain and restrictions in muscles and/or immobility in the joints themselves.
Let me explain. If a person is unable to squat in a normal squat pattern because they tend to load the front side by bending the knees first (rather than hinging at the hip), collapse forward at the trunk due a weak core or tend to shift onto one leg due to a lack of flexibility in a muscle group or lack of mobility in a joint, is it wise to load them with 40-50 reps, added resistance, speed as in jumps or large range of motion movements? They may be able to execute the prescribed workload (4-5 x 10 with a 20 pound vest and squat below parallel) and not immediately have any noticeable ill effects. However, over time, the cumulative effect of repeated poor movement patterns will cause training adaptations that may not be ideal and could contribute to muscle, tendon, ligament, joint and disc problems.
If the professional tasked with prescribing exercise programming is aware of some simple parameters when implementing the exercise prescription, then the program designed for the athlete will not only prepare them for the rigors of their occupation and hobbies, but can also enhance the athlete’s ability to stay fit, healthy and active at an exceedingly high level for as long as they choose.
Observing the athlete moving in any skill or pattern begs the question, is the pattern optimal and clean in its execution. If the answer is yes, it is ok to execute that pattern. However, if load is added in terms of speed, additional ROM, volume, TUT (Time the muscle is Under Tension – i.e. heavy and slow, light and fast or medium loads with pauses or stops in the range of motion) or some other variation and the pattern changes for the worse, then the athlete is not prepared adequately. This compensation is due to a weakness, imbalance, lack of mobility or stability and negatively impacts the ability to execute that exercise prescribed. At this point, a decision must be made to either restrict the load/intensity or regress in the progression and periodization of the exercise prescription.
However, in some instances, the movement improves, providing a clue as to the cause of the poor pattern. If the athlete is unable to perform a decent squat pattern, i.e. collapses forward in the trunk region, but when load is added in the form of a medicine ball or weight held at bent arms length which subsequently improves the movement pattern, this tell us something. The front of the core (abs) is a spring built for resistance to collapse. With the addition of external load at bent arm’s length, many times the body will compensate by engaging the core and resisting the collapse, thus causing improvement in the squat pattern in terms of the anterior core no longer collapsing.
As a professional tasked with assigning exercise, if optimal pattern awareness is made a part of the exercise prescription process, then managing the physical ailments by our athletes as they age will be made easier by the type and quality of training the end user does in their younger years. No pain – no gain is no way to prepare the people we are entrusted with improving their fitness abilities. No train – no gain combined with train for stability/mobility for enhanced physical ability to bend, rotate and extend with strength, power and fitness is a way to approach program design and exercise prescription for the diverse population that presents itself each and every day. Pattern, progression and periodization pave the way to optimal movements, continued progress and few injuries.
There has been great controversy over the past several years about the position of the spine (specifically the low back) as it relates to optimal performance and long term health. Is the Lordotic spine healthy? It seems to function quite nicely for a great many athletes. What about the Kyphotic spine? This back position seems to produce the greatest amount of symptoms and problems. But what about the concept of “neutral” spine, how do we define it, what is it? Is it braced, drawn in, tail tucked, flat back bowed, arched or what? How do we attain it? Why are we so worried about it? What happens if I don’t have it? How do I get it? Where do I find it? Who invented it?
Let’s look at some definitions.
Another way to look at this concept is the tilt of the pelvis. In lordosis, the pelvis is rotated forward or anteriorly. In kyphosis, the pelvis is rotated posteriorly. In neutral, the pelvis is aligned. In examining this concept as a performance practitioner rather than a researcher, athletic trainer or physical therapist has led me to some conclusions. First of all is the pelvic position and the corresponding lumbar spine position resulting in some type of symptom manifesting itself in terms of pain, discomfort, tightness or inhibition of performance. If so, then I will prescribe some corrective exercises, stretching, foam rolling in order to address the inhibited performance due to pain, discomfort and tightness. I will also refer this person to an athletic trainer for further evaluation. If there is no pain, discomfort, tightness or inhibited performance, then why fix it if it ain’t broke? Most sprinter, hurdler, jumper, power, speed athletes will have a lordotic lower spine. If they are asymptomatic and pass the intrinsic muscle tests for the pelvic floor and lower core region – then train. The kyphotic person may need some remedial work, regardless of symptom level if you plan on loading the spine with squats, cleans, deadlifts or other types or resistance exercises that place load through the core. According to Dr. Stuart McGill, one of North Americas leading experts on the spine and its ability to withstand load a flat lumbar spine will tend to exhibit symptoms or problems much more often under load stress than a lordotic spine. Extension work for the kyphotic spine will be prescribed in order to enhance the lumbar area’s ability to withstand load.
My concern is the ruckus over the “neutral” spine concept and its application to performance training. After listening to many experts argue over the efficacy of this concept (it reminds me of the back side of the “drawing in” controversy), reading about this in the various publications concerned with performance and health exercise information as well as coaching thousands of athletes performing literally millions of repetitions over the past 25+ years I have come to the conclude the following observations. In a nutshell, the “neutral” spine is a manufactured and artificial position for the lumbar region. The term I feel much more comfortable with is the “natural” spine position. Here is a practical application of the difference. Have the client/athlete reach overhead until they feel skinny. At this point, have them take a big, deep breath and lock it in as if you were going to punch them in the stomach. While maintaining this core-lumbar position, drop the arms, exhale and drop into a basic athletic position. This is a natural spine position that is ready to absorb and produce force throughout the core region. In order to convince the skeptic, have the client/athlete produce a lordotic lumbar spine while in basic athletic position and then press down on their shoulders much in the manner of a resistance squat load. Repeat this drill with a kyphotic lumbar spine and ask the client/athlete, “ which is better to absorb and produce force?”. Then, if the client/athlete or colleague is still not convinced, ask them to assume the “neutral” spine position and repeat the drill a final time. The asymptomatic, “neutral” spine is a manufactured position that is unable to be replicated during the duress of performance. It also goes against the concept of maintaining pillar core integrity in order to transmit the power generated from the legs into the shoulders, arms, hands or implement with very little flexion, extension or rotation in the lumbar spine, until the mobility of the hips and thoracic region have been exhausted.
Dr. McGill explained this concept to me at a seminar in which in a one on one conversation I had asked him why I was being instructed at a performance center to teach the tail tucked position in training performance individuals. His first response was “I would have no idea”. When he laughed and said he would expound upon his point, I knew he was teasing me and asked him to please continue. He asked me if I would humor him in a little experiment. I said “sure”. He then instructed me to assume an athletic position, “tuck my tail” and then react to his instruction for the next 30 or so seconds. At this time he commanded me to “jump, do a squat thrust, shuffle right, shuffle left, do a quarter turn right, do a quarter turn left, squat, buzz my feet, lunge right, lunge left and get back into position”. At this point, he asked me what had happened to my lumbar postural position. I responded that I had no idea. He stated that was his point – that artificial/manufactured core positions are not practical to teach for performance athletes that are asymptomatic. In rehab settings in which specific symptoms or deficiencies are being addressed then artificial spine positions are certainly a part of the rehabilitation protocol. The natural lumbar spine position with core integrity to withstand force in multiple planes as well as transmit force in a variety of angles while still maintaining the ability to respire (without holding your breath) is a huge piece of performance that allow us as coaches and trainers to unlock the power of the legs and hips and express that power in our sports. This “natural” spine position combined with hip mobility, the skill of disassociation of the hip – shoulder complex and internal coordination resulting in huge force summation creates the physical performances we all long to enhance with our expertise.