Low Back Myth’s with Stuart McGill

Here is a great video from Stuart McGill.  Those of you that have read the blog over the last two years will note that I’m a huge Stuart McGill advocate and believe in his spine principles wholeheartedly.  In this video he goes over some of the common myths associated with the back and training. 

Myth #2 may be my favorite.  This is one of the worst problems I see in sports.  When an athlete has a tight back, or possibly injures his back the first thing many physical therapist, or athletic trainers want to prescribe is “we need to stretch it.”  There’s always an underlying cause to why an injury occurs.  Generally in the low back its the hips that are giving us the real trouble.  The lumbar spine will always compensate for movement limitations, and/or activation issues  about the hips and thoracic spine.  I cringe when I hear people advocating stretches for the back and spine when their is an injury.

Training the Rotator Cuff to Failure

I found a couple of interesting studies done on the effect of fatigue on shoulder proprioception.  The rotator cuff has essentially two functions: to stabilize and depress the head of the humerus in the glenoid fossa.  The following studies show how fatigue can create dysfunction in the shoulder. 

Effects of Muscle Fatigue on and the Relationship of Arm Dominance to Shoulder Proprioception

The first study displays how the proprioceptive ability of the shoulder decreases with muscular fatigue.  This should really come as no surprise to most coaches out there.  The authors state that muscular endurance without overly fatigue should be the priority in training. 

 

Rotator Cuff Fatigue and Glenohumeral Kinematics in Participants Without Shoulder Dysfunction

In the second study the authors demonstrated that fatigue in the rotator cuff caused superior head migration.  In other words the ability of the rotator cuff to depress the humerus was compromised.  Allowing the humerus to move upwards decreases the sub-acromial space which isn’t a good thing.   This space was decreased by up to 40% which is hugely significant. 

The most interesting thing in this study is the authors had subjects perform one set of prone T’s with the thumbs up to failure.  Failure was noted after the subject couldn’t raise the weight past 45 deg. and at least 40% decrease in strength was noted.  Overall, the average degree of fatigue was indicated by a 54% reduction in prone horizontal abduction.  The average weight used for the protocol was 3.94 kg and the average time to fatigue was 84 seconds. 

The second study should open eyes as after one set of 90 seconds, the cuff can be fatigued enough to create sub-acromial impingement.  Now think of all the athletes with shoulder problems that get blasted with 40 sets of RTC exercises everyday in an effort to strengthen their shoulder. 

The problems are not only in a single workout but can carry over to outside of the weight room.  If the cuff is constantly fatigued stability fades and we don’t want to lose its strength and stability when a pitcher is throwing 94 mph off the mound in the 7th inning.

The problems with training the cuff to failure is that you create instability, which is something we’re trying to eliminate.  Allowing the head of the humerus to move in a joint that is already having dysfunction may eliminate all the positives that are created with actually training the RTC.

Movement Screening

I got a question this past weekend from an athletic trainer on my article he saw in the December 2010 Training and Conditioning Magazine. 

Special Delivery

I read the article that you wrote in December of 2010 about the screening process and conditioning routines that you put your pitchers through throughout the year. We utilize a similar process that I started this past year. I also utilize Gray Cook’s FM screening, but I read that you have modified it and changed the order to fit more specific needs of a pitcher. Is there anyway that you can send me a basic outline of your program so I can compare it to what I have come up with and share more information with our pitching coach to try to improve our performance and technique. Thanks for your time and help. Good luck for the rest of your season.

Thanks for your question.  I include tests for lat length, pec minor length, scapular stability, ankle mobilty, and the Thomas test for psoas and rectus length.  We measure internal and external rotation at the hips and shoulders.  On top of this I do breakout sessions which are dependent upon score.   Often times a perfect score on certain parts of the screen will negate the need to search for more issues.  If an athlete scores poor we will go deeper with a breakout seession, as Gray Cook calls them I believe, and look for a more specific issue.  All in all it depends on the athlete as to how much we look at and how deep we probe.  

Remember we’re always looking for dysfunction in movement patterns.  If there isn’t a gross dysfunction don’t go searching for problems.  I get asked often as to why I measured one athletes ankle mobility but didn’t measure another.  Its most likely due to the fact that the other athlete didn’t have a dysfunctional movement pattern that could be caused by an ankle restriction.  They may in fact have a restriction or limitation if we dug deep enough but since it doesn’t affect their movement, we really have no reason. 

A lot of the shoulder portion of the screening is determined by the athlete’s injury history, and / or pain.  We do a fairly thorough evaluation for internal and primary impingement is there is has been or was a recent problem. 

If you do a lot with movement screening, Gray Cook has a new book out titled Movement: Functional Movement Systems: Screening, Assessment, and Corrective Strategies.   It deals a lot with his breakout sessions and where to go when a certain pattern produces a dysfuction.  I’m still working on it but I’ve heard great things about the material within.

Year in Review

It’s been over a year since I started this site.  Since then I’ve met a lot of people and had a lot of good things come from it.  There’s been over 85,000 views, I’ve posted several articles, and even had an article published in Training and Conditioning magazine on the annual training of the TCU pitchers.  

Special Delivery

This site has also seen a lot of big things happen for TCU athletics and the teams I work with.  The baseball program made it to their 1st ever College World Series, the football team made it to their 1st ever BCS game with the Fiesta Bowl, then won the Rose Bowl this past January.

I’ve posted over 150 times and in the last year and one thing I’ve been wanting to do was to review some of the most popular posts in the past year.  These posts have been in the top few as far as traffic goes. 

Feel like a million bucks today!

Soccer and Energy Systems 

Internal Impingement of the Shoulder – Part IV

The Pushup, Interns, and Friday

Lower Crossed Syndrome II

Pull-ups, or Chin-ups

I read this article a while back in the NSCA Journal and forgot about it until I saw a post by Mike Reinold earlier this week. 

Surface Electromyographic Activation Patterns and Elbow Joint Motion During a Pull-Up, Chin-Up, or Perfect-Pullup™ Rotational Exercise

If you haven’t read the article its pretty evident that it compares muscle activation during the three variations of a pull-up.  The chart below details activation of external oblique, erector spinae, pec major, lower trap, infraspinatus, bicep, and lat.
The lats are all highly active in all three variations which is no surprise but  one of the most interesting points is that the pull-up actually has the highest activation within the lower trapezius, 56% for the pullup vs. 45% for the chin-up.  The lower trap was also the first muscle active within the exercises as the scapula is in an upwardly rotated position at the bottom position. 

I have talked at length about how important the lower trap is in athletes for proper shoulder function, especially overhead athletes.   The lower trap is an often overlooked muscle that will shut down during times of shoulder trouble much like its partner the serratus anterior.  Anything we can do to get more out of the lower trap is good.  Conversely, the chin-up has the highest activation within the biceps as well as pectoralis major, but the lowest in the lower trap. 

LOWER TRAP

Something I would like to see is the activation of the pec minor, and lower during the pull-up and chin-up with retraction and depression vs. rounding over at the top, as well as the differences with the neutral grip pull-up. 

All too often I see athletes that round over at the top of any pull-up / chin-up movement.  They end up doing the chin poke at the top with their back rounded over like the hunchback of N0tre Dame.  Essentially this is the upper crossed syndrome position and I am in full belief that you are eliminating the positive benefits of pull-ups for the scaps and reinforcing the negative ones that already persist in many athletes.   

Mike Reinold, trainer for the Boston Red Sox, mentions that the pull-up may be a better option for a baseball player due to the fact that the lower trap is more active and the bicep and chest is less active vs. the chin-up. 

I agree with Mike in that the pull-up may present be a better option because of activation.  At the same time my concern is that when we look at the externally rotated position of the pull-up, this is a position of vulnerability when it comes to SLAP tears.  High bicep activity in an externally rotated position can be a recipe for disaster.  This is how orthopaedic surgeons generally diagnose SLAP lesions. 

Just food for thought.

The Superdog

Recently, I found a video from Nick Tumminello that puts a new twist on the birddog. 

This is a great glute activation exercise.  Like we talked about before the whole concept of the birddog is to stabilize the spine while the joints around it are mobilized.  By placing flexing the opposite hip you put the pelvis into posterior tilt eliminating lumbar spine compensation and forcing the glutes to do the work. 

The Birddog

An erercise like this fits well into the warmup to get the glutes firing before other lower body activities.

Activation Circuit

Ya, it’s been a while since my last post.  Life has been super busy lately.  Between fall ball officially ending and our true off-season training for baseball starting up, attending the ALDS, and World Series, as well as a few articles that you’ll see in the coming months, October was busy.  So with that behind me I can hopefully get back to it. 

This is a short video of an activation / recovery circuit that we did today.  This circuit had 4 exercises that were performed 3 times through with no rest.   We also perform some form of rotator cuff / scapula training that I didn’t include in the video as a part of this circuit. 

Our first exercise of the video is our Marching Man on a Stability Ball (Feet on Box) w/ WT.  This is 100% for torso stability.  We don’t utilize crunches, situps, Russian twists, etc.   All of our core work is in the form of stabilizing the lumbar spine.  This is how the body functions in sport.   Something stabilizes while other joints around it are mobilized, or moving.  The torso should be trained to aid in stability and transfer power to the linkages.  If you are in question about any of my philosophy on the spine, then look to any of Dr. McGills works. 

The second movement on the video is the Scap Pushup on the P.P.  w/ Feet Elevated.  In a study by Lear and Gross it was determined that the feet elevated pushup plus (scap pushup) produced much higher activation levels in the serratus anterior than with the feet on the ground. 

An electromyographical analysis of the scapular stabilizing synergists during a push-up progression.

Some form of glute activation is the final movement.  Today, this was the Outside Leg Raise w/ Resistance.  In a study presented a year ago in the Journal of Orthopaedic and Sports Physical Therapy the side lying abduction is far and away the best exercise, by over 20%, for stimulating the glute medius.

Gluteal Muscle Activation During Common Therapeutic Exercises

This small circuit usually takes right at 12 minutes to complete and goes a long way to developing some of the often over looked areas in an athlete.

The Deload – Part I

It is the last week of fall practice for the baseball team and consequently this is a deload week for us at the same time. 

We will begin our main off-season training program next week.  It’s my favorite time of the year for obvious reasons. 

With it being a deload I thought I’d share a few comments on the stresses of training and how to keep them in check. 

Training is a major stressor on the body.  Exercise itself can be a good stressor but intense, dedicated training can be damaging to the body.  This is one of the reasons its important to have recovery and rest built into a program.  Everyone wants to program in the “good stuff” as far as training goes but we must remember that the body needs time to re-build and repair itself.  Continually breaking down the body causes proper adaptation to cease.  In turn this causes the body to break down and can become susceptible to sicknesses, and injury.  If you want to know more about the human body’s reaction to stressors pick up Why Zebras Don’t Get Ulcers.  It’s a great book and one that actually keeps you interested about things you probably aren’t interested in like gluccocorticoids and such.  Awesome read though. 

An interesting note is that Zach Galifianakis’ stunt double actually wrote the book.    

The Author!

Not the author!!!

The body doesn’t differentiate stressors.  It can’t tell that the accumulated fatigue on the body is from training, or only sleeping for 2 hours a night because you have a new member of the family.  One thing that has stuck with me was something Buddy Morris has talked about.  He stated that the stress response for training is greater than that of a broken bone.  Stress is either realized as local or general and a broken bone becomes a local stressor where as training takes on a large general response. 

Rest and down weeks are just as important to the training process as the actual training itself.  Eastern bloc training principles were based on the deloading periods as this is when all supercompensation occurred provided it was done correctly.  This was the chance for the body to recover and adapt to higher level.  Often times, the body was put into a state of overreaching for long periods of time on purpose followed by 4-6 weeks of what was essentially an unloading period at which point supercompensation was at its highest. 

Most coaches probably recommend a deloading week every 3-4 weeks of training.  I think this all depends on the overall plan.   We will only have 6 weeks of hard training left following our fall ball period.  This doesn’t leave a whole lot of time for deloading.  We will utilize a deload prior to our final week of testing to allow for recovery.  You can see the deload has to always come down to the overall training plan. 

I’m a big fan of deloading every 4th week during the off-season and every 3rd week during the in-season.  One thing coaches should always remember is the more advanced the athlete is, the more stress the body incurs.  High level athletes require much more in the way of recovery and restoration than your average 9th grader.  Central nervous system fatigue is always higher the more advanced an athlete.  With kids just starting out in sports performance training they aren’t able to tap into the CNS enough to cause fatigue.  Younger kids could quite possibly train for 6 months in a row without a deload week and still make gains every week. 

One rule of thumb that has always helped me was the 60% rule.  I believe it was Zatsiorsky that suggested this.  I could be wrong on author but on theory remains the same.  During unloading weeks the volume should be approximately 60% of the largest volume of the previous cycle. 

There are several different methods of deloading whether its decreasing volume, intensity, or both.  Each one has a different effect on the recovery of the body.  Generally I prefer to deload both volume and intensity.  However, volume will take the majority of the deload.  We will back down our percentages for a deload week often times but not an extreme amount, maybe 5-15%.  Again this depends on the overall plan, where we are in that plan, needs and goals, etc.

Breakout Assessments

Zach,
Good stuff here. About to read part two, but my question for you is whether you now perform breakout assessments (Joint ROM testing, muscle strength, etc) as part of your typical evaluation?

This is troubling for me in terms of assessment because we only look at these things currently if we see a problem in the FMS with our athletes.

Thanks for the heads up on this and I hope to get some more food for thought from your second piece.

Best,
Chris
http://modelfit1.blogspot.com/

Chris
Thanks for the comment.  When I find deficits, pain, etc. I do go into a deeper evaluation.  I can’t do this with everyone because it would take forever.  Just screening the 35-40 kids I have now with my personal screen takes me over a week to complete.  Understand that I have added quite a bit to the standard FMS screen to look at our personal needs.   To be honest when an athlete doesn’t present a problem with our initial evaluation, then we really have no basis to go much deeper.  Obviously we have exceptions with kids that have been previously injured, or have previously had issues that we will have to keep an eye on. 

An example may be an athlete with pain during some of our shoulder evaluation.  If he has pain then obviously we go deeper to see if we have a solution and/or look to finding the culprit.  On a side note, the book Muscles: Testing and Function, with Posture and Pain by Kendall is the best out there at manual muscle testing methods, evaluation, and treatment of postural imbalances. 

A quick example of the lower body may include problems with the overhead squat, or lunge patterns.  If problems are present here then we delve further into testing the hip flexors as well as ankle complex. 

However, to answer your last question, if we don’t have problems throughout our initial screening, which I feel covers the surface of virtually everything, then we for the most part we don’t delve any deeper.  If an athlete’s movement patterns are solid without deficiency, deficit, or pain, then we move on.  We could test and test and test for days and say the glute medius on the right side is 10% weaker than the left, etc., etc., etc., but at some point we have to get to the actual work of increasing sports performance.  If it isn’t present during their actual movement, then it probably isn’t presenting them with a problem.  I actually believe that more times than not a soundly structured program whether individualized or not will clean up a large part of movement issues.  

I view the shoulder a bit differently especially with baseball players, so that’s why we do a gross screen for the shoulder as well as look at a lot of specific issues.  But we still only go deeper if there presents a need.  I’m not going to test an athlete for a SLAP tear, or internal impingement if they show no reason for the test. 

Obviously, with movement the nervous system plays a vital role.  Gray Cook’s recent material talks a lot about this fact, and Vladimir Janda’s work in this area was paramount.  A reader just sent me an article last night that I will post in the next few days on Janda.  In it the author states this of Janda’s beliefs:

In the simplest terms, it all boils down to the nervous system. The coordination of afferentation, central organization of neural data, and efferentation was paramount to the quality of function. To him, joint function was dependent on muscle function, which was dependent on nervous system function, although each of these factors was at times interdependent. A reader of these words who studied with Janda could easily find fault, because he emphasized so many other aspects that could lead to dysfunction and subsequent pain.

The Birddog

No we’re not talking about Weimaraners here, we’re on the topic of a commonly used exercise that gets run through the mud when it comes to technique.

A damn good birddog!!!

This is one of Stuart McGill’s Big 3 for low back rehabilitation and performance, and one that about every athlete performs at one time or another.  Our athletes utilize this during their warm up as well as during their low back / glute activation circuit.  It never fails that we see a lot of errors in the correct performance of this exercise. 

Not what we want

In the birddog the legs are arms are being mobilized while the spine is stabilizing.  This is the reason the exercise is so important in back rehabilitation as well as performance.  The purpose is to lock in and stabilize the spine while the arm and leg are moving around it.  This is the general concept of all athletic activity for the most part.  The spine acts to stabilize and transfer power to the appendages

Athletes generally try to bring the leg and arm up too high equalling compensation by the lumbar spine to achieve this motion.  The arm and leg don’t have to be any higher than parallel to the ground.  What we want when we perform the birddog is to push the leg straight back instead of picking it up.  This helps to keep athletes from arching the back to achieve this position as well as helps teach and train the glutes to fire.  

Spine should always stay neutral

When we teach the leg movement we also train it with dorsiflexion.  This helps create the image of driving the leg straight back through the heel and aids in creating glute activation. 

Good birddog

Another problem that commonly arises is athletes keeping their head up during the exercise.   This inevitably causes the back to arch.  Always teach and train the head to stay in a neutral position with spine. 

Athletes need to be taught the real reason for doing the birddog.  Many believe the exercise is about moving the arms and legs above parallel.  I don’t care how high we move the appendages as long as we learn the proper pattern of stabilizing the torso and spine.