rehab

Continuing Education for anyone who trains or rehabs clients, patients or athletes with Robb Rogers

Space is limited so sign up today for an early bird special!

AUGUST 6th & 7th – Download Seminar Info and Schedule Click Here

ONE DAY SEMINAR:

On or before JULY 29th$299.99
After JULY 29TH – $349

TWO DAY SEMINAR:

On or before JULY 29th$449.99
After JULY 29th$499.00

Continuing Education Credits offered for NSCA, ACE, APTA

Call or email to sign up/ 307-413-1621/ info@t2bb.com

 

Pattern Quality: The Impact of Exercise Prescription Variables on Overuse Injuries

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.

Neutral or Natural Spine? Which is Optimal for Health and Performance?

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.