Low Positions

What I Learned from Diana Fu

This Saturday, I had the pleasure of listening to Crossfit rockstar, Diana Fu, teach the principles of olympic weightlifting. If you are not familiar with Diana check out her website and blog at fubarbell.com.

Before attending the workshop I thought I had a decent understanding of the positions and transitions necessary for performing an efficient barbell snatch and clean and jerk. However, as I would discover in the seven hours spent in Diana’s presence, I still had a lot to learn.

Below are three vital concepts I learned from this olympic lifting goddess:

1) Don't forget your anterior chain

Performing movements to strengthen the posterior chain (back of the body) has become all the rage in the strength and conditioning world, and for good reason. In our culture, we are often in positions (sitting, leaning forward) that shorten the front of our bodies; therefore, logically it makes sense to try to strengthen the opposite muscles. Moreover, many of the exercises performed to accomplish this, such as, deadlifts and kettlebell swings promote functional strength and explosiveness. As a physical therapist, I have found these kind of exercises to be therapeutic for treatment of low back, hip and knee pain.

Strengthening the posterior chain can be very valuable, but when when performing vertical movements the anterior chain cannot be neglected.

Understanding the many reasons that posterior chain strengthening can be beneficial, it -- like most things -- can be overemphasized at the expense of functional efficiency.

In regards to this workshop, many participants (myself being one of the biggest offenders) were attempting to take the action of the anterior chain (mainly the quadriceps) out of the equation by setting up their cleans and snatches with weight shifted back through the heels. The "through the heels" cue can be very beneficial for decreasing stress to the anterior structures of the body in the presence of pain during exercises like squats and deadlifts, but in the case of olympic lifting, this can be counterproductive to the vertical path the bar must take. Diana reminded us that vertical jumping, in which the body is moving in a similar direction, must involve strong engagement of the anterior chain if any proficiency in performance is expected.

Setting up for a vertical jump will tend to load the middle to front of the foot, activating the anterior core, anterior thigh, and posterior lower leg muscles necessary to perform vertical motion.

2) Stack your combined center of mass

Further exemplifying the erroneous nature of the excessive posteriorly directed setup, was the concept of stacking the body’s combined center of mass over the bar. This was described with elegant simplicity as setting up with the navel over the bar and the shoulders over the navel. This setup cue again brought many participants more forward on the feet than we were accustomed. Despite the initial awkwardness, it was quite evident -- at least to me -- that the balance achieved while receiving the bar in either the power or squat position was much greater. Moreover, the amount of effort to create power and speed under the bar was substantially decreased, making the full movement much more efficient. Diana explained to the participants that once a proper setup is attained, all one needs to do is “stand up”. Initially I was skeptical that she may be over simplifying things due to her vast amount of experience, but I came to understand exactly what she meant by the end of the seminar.

A traditional deadlift setup where the bar is substantially out in front of the navel

Diana herself, setting up for a snatch with her navel stacked over the bar and her shoulders over the navel

3) Stability has an inverse relationship to speed

This concept made so much sense once it was said, but can so easily be underestimated in training movement. Often coaches are so focused on creating tension in the body through strength and stability training that it can be forgotten that in movements requiring speed and power, our athletes need to learn the skill of relinquishing and regaining tension depending on the component of the movement.

In my personal experience with olympic lifting, I often prepared to clean and snatch by creating near maximal tension on the bar and throughout my body. Upon heeding Diana’s cues to relax my starting tension, I found that the bar moved with much less effort. Moreover, I felt improved range of motion in my shoulders during both the pulling and receiving of the bar.

See the video below for my cleans and snatches pre- and post- Diana’s teachings. Can you tell the difference? I could certainly feel it.

Many other tidbits of information were shared by this olympic lifting icon, but those were the three that will stick with me the most and have forever changed the way I look at these movements.

Thank you, Diana!

The Muscle Isolation Fallacy

**Initially posted at www.strengthcoach.com Reposted with permission from Mike Boyle

A mindset has emerged over the years where specific muscles are viewed as the culprits for all physical deconditioning or dysfunction.

Want a six-pack? Work those abs.

Having difficulty walking? You must need gluteus medius strengthening.

Back pain? Activate those glutes.

Shoulder pain? Must be a weak rotator cuff.

I could go on and on, but I think you get the point. When it comes to movement impairments, it’s commonplace nowadays to point to a specific muscle as either the scapegoat or the savior. This isn’t to say that the muscles identified aren’t involved in the mechanism of injury or aesthetic discontent. What it is saying is that the entire extent of the problem often doesn’t lie just within those muscles.

Nothing Works in Isolation

We talk a lot about muscles, as they’re the tissues of the body over which we have voluntary control when training. However, it’s important to recognize that humans are a “system of systems,” and nothing – and I mean nothing – works in isolation.

For instance, our nervous, circulatory, lymphatic, endocrine, and immune systems are all affected by how we move – not by arbitrary quantitative assessment of specific muscle capacity.

Thus, when it comes to physical performance, our muscular system is just one of many systems working in synchrony. With all this being said, one can see how oversimplifying specific musculature as the sole problem can be shortsighted and ineffective. In fact, it can even be downright harmful at times.

We live in a culture in which most of us sit all day, every day. Then in the gym, instead of exploring the natural extent of our movement capabilities, we isolate muscles,which only further feeds this negative culture.

You see, muscle training is more of a movement prescription than a movement education. Oftentimes, the exercises that are prescribed to isolate certain “muscle problems” actually lead to further imbalances that originated from our chronic static positioning.

Take, for example, any machine that promotes isolated muscle strengthening in a seated position. When we’re doing a seated leg extension, we are indeed strengthening the quadriceps. But we must ask ourselves the following questions:

Do our quads really need training in the seated position? Do we ever really use these muscles in this way? If we sit all day, why would we want to sit when we’re exercising?

Doesn’t seem too logical to me.

Clearly, machine training rarely promotes muscular use in a functional context. Instead, it merely amplifies the muscle imbalances caused by chronic sitting.

Another common example is training crunches excessively to try to “work your abs.” This movement promotes a high volume of trunk flexion – the very position we find ourselves slumped over into while in front of the computer or leaning over a counter. Again, not too smart.

Training the abs via crunches can actually increase muscle imbalances caused by long durations of sitting and standing in trunk flexion. The upshot? Increased risk of injury and decreased ability to generate force during functional and athletic movements.

In response, you might say, “Okay, so we just need to work our lats, back extensors, and rhomboids to counterbalance all that forward motion.”

The trouble with this line of thinking is that the concept of balance goes far beyond muscles. No real world movement calls for isolated muscular effort. When we train specific muscles in a controlled gym environment, we’re making an assumption that these muscles will then activate when we go to perform athletic activities or activities of daily living.

What this method grossly underestimates is that human movement is a learning process, not a strengthening process. Therefore, strengthening muscles in isolation does nothing to improve our ability to move better – and can ultimately make the process more difficult.

The Art and Science of Movement Training

On the other end of the spectrum is movement training, which utilizes a deconstruction of functional or athletic movement as a guide for assessment and programming. Here, the movement professional helps the client develop strategies to move as efficiently as possible by developing task-specific qualities like mobility, stability, strength, power, and endurance.

This educational process is a combination of both art and science and incorporates all body systems together. Better movement can’t simply be prescribed; instead, it is an ongoing path that we all must travel.

Working a static hollow body position while lying on your back can be progressed to static hollow body vertical hanging, which can then be utilized to perform a variety of dynamic movements that incorporate hanging from the bar while maintaining midline stabilization.

On this path, the movement professional is responsible for teaching, coaching, motivating, and supporting the client. This process must be highly specific based on each individual client’s movement needs – not their muscle deficiencies.

Progressions and regressions are chosen in order to put the client in a better position to control and kinesthetically understand the optimal movement technique. Training movements are selected based on their transfer to each client’s unique movement goals. Likewise, exercise volume and load are added to well-controlled and well-comprehended movement patterns, not to specific muscles.

The entire approach will, of course, be guided by an understanding of the underlying science of movement. Having a firm grasp on the anatomy, physiology, geometry, physics, and even the biochemistry of movement allows for the creation of highly individualized programming.

The Turkish Get-Up is perhaps the best example of true movement training. At its core, the get-up is simply training the common human skill of getting up and down from the ground efficiently. Yet it’s also a highly complex movement that must be progressed slowly and methodically for true mastery. Clearly, the get-up is not is an attempt to isolate specific muscles, but rather an effort to integrate the entire body to work as one functional unit.

On the Path to Better Movement

With the transition from muscle training to movement training, the biggest difference I’ve noticed in my clients has not been their strength, power, endurance, mobility, and stability – all of which have improved dramatically. Rather, the biggest difference has been their ability to carry over the knowledge they’ve gained in our supervised training sessions to their independent sessions and, ultimately, their daily lives.

Human movement is a significant factor in how we interact with the world and should be treated as an inherent part of being alive. When we train in isolation, we’re treating ourselves more as science experiments (think a hamster on a wheel) than full-functioning human beings.

Are you a hamster or a human? I, for one, choose to embrace my humanity.

Special thanks to Travis Pollen (www.fitnesspollenator.com) for editing my incoherent gibberish into something readable and hopefully valuable.

Mobility for Breathing

Positional Mobility Part 2: Sidelying with Rotation

Positional Mobility

Core Misconceptions

You can almost guarantee that when dealing with fitness or rehabilitation professionals, you will hear a reference to core training. Another near certainty is that very few people will agree on what it is. In my opinion, there is no aspect of training more important yet more misunderstood. Below, I have laid out the top 3 misconceptions I have encountered in my experience as both a physical therapist and strength and conditioning professional (or movement professional to combine the two). My hope in writing this post is to develop a healthy discussion among other movement professionals regarding your experiences. So please read below, and fire back:

Please FIRE BACK with comments regarding your experiences.

1. Your core is your abs:
It has been well established in scientific literature1,2 that there is no single muscle or group of muscles (as your abdominals are) that make up the core. The core is not a specific anatomical structure at all, but instead, a theoretical functional unit that is task-specific. Research has demonstrated that up to 29 muscles are involved in stabilizing the lumbar spine during isometric exertions alone2. Moreover, current movement theories indicate that core stability is to be broken down into two separate muscular factions: the superficial (global) and deep (local) core. The division of responsibilities of the muscles involved in these two categories are nearly opposite but often need to work together when one performs functional movement. In short, your superficial/global muscles are the muscles farther from the skeleton and those built for short duration/high tension activities such as heavy lifting and carrying. Your deep/local muscles are closest to your spine and responsible for balanced postural positioning during longer duration/low intensity bouts of work, such as sitting, standing, walking, running, etc. Cooperation of these two core systems occur by the deep muscles activating prior to the superficial muscles, during limb or trunk movements.

The muscles of the body work in a chain in order to allow for the pelvis to be held in a neutral position. The idea of the abdominals being the primary core stabilizer is extremely short-sighted

2. There are core-specific exercises:
Initially, this may sound like blasphemy to the movement professional, but let me explain. What I am indicating is that while I don’t believe that there are core-specific exercises, I do believe that nearly all exercises can be considered core training opportunities depending on the quality of the movement performed. Often exercises that are labeled core-specific are simply positional holds of more complex movements or movements that have been simplified to the point where pelvic orientation can be the primary focus. This can be a very skillful practice in the continuum of progressions for more complex movements, but has very little benefit outside of a functional movement context. Using a common example, the prone plank is no more of a core exercise than a push-up. The plank is simply a static hold of the full push-up movement. The push-up itself, when performed properly, is a beautiful display of dynamic core stability. The same idea can be carried over to your favorite movement whether it be pull-ups, deadlifts, or Olympic lifts.

Am I holding a plank or stopping at the top of a push-up? 

3. Your core needs strengthening:
As we have identified that the anatomy of the core really isn’t that anatomical but more task-specific, it is helpful to look at core stability as a concept that needs to be taught more than a structure that needs to be built up. When heavy things need to be lifted and carried, tension needs to be created in all muscles involved to better stabilize all the joints involved in the movements executed. To build optimal tension in the muscles a balanced joint orientation needs to be maintained by the deeper stability muscles, and these muscles need to be activated before the onset of superficial muscle activity. In this way, timing and coordination are more important to train than strength. What is often mistaken for core strengthening is simply isometric co-contraction of superficial muscles to generate more force during a particular high-intensity movement.

Coordinated tension is needed between deep and superficial muscles, to stabilize the spine during heavy carrying.

When dealing with low-intensity activities, the idea of building tension and strength is actually in opposition to efficient core training. As the activity will need to either be sustained for a long period of time (i.e. sitting in an upright torso position for two hours), or be easily controlled in order to progress to a more challenging activity (i.e. own a single leg stance before throwing a kick), creating the least amount of tension in the body necessary to maintain a balanced posture should be the primary focus. This ability to effortlessly maintain a balanced posture, requires joint and soft tissue mobility to also be balanced throughout the body, making mobility and stability training inseparable. It should be noted that when referring to mobility training, I am not referring to the idea of getting as flexible as possible in as many joints as possible. Mobility, like core stability, is task-specific and must be trained as such. But that is a topic for another post.

A child's ability to easily maintain a squat is an example of the interdependent nature of mobility and stability with longer duration/low-intensity activities.

References:

1. Akuthota, Venu, Andrea Ferreiro, Tamara Moore, and Michael Fredericson. "Core Stability Exercise Principles." Current Sports Medicine Reports: 39-44.
2. Cholewicki, Jacek, and James J. Vanvliet Iv. "Relative Contribution of Trunk Muscles to the Stability of the Lumbar Spine during Isometric Exertions." Clinical Biomechanics: 99-105.

Safe Snow Shoveling

Dynamic Balance/The Ultimate Hip Opener

Movement of the Week: Kettlebell Swing

Mobility Warm-Up

10,000 Swings Safely

MovementProfessional.com: A Discussion About Squat Depth

If You Are Not Squatting Past Parallel, You Are Not Squatting!

I’m sure the title of this post will stir up plenty of controversy, and although that is not necessarily my intention, I do think the topic needs to be discussed, and differences of opinions need to be aired out. I am actually writing this in response to question I got from a friend that routinely squats past parallel and was recently told by a physical therapist assistant to NEVER do so as it will cause damage to the knees. At this point, it is important to define what a squat actually is. Are we talking about back squatting, front squatting, getting up and down from a chair or toilet, a transition in getting up from the ground, giving your toddler a bath, pooping (I’m not too professional to say pooping) into a hole on the ground (had to do it in Croatia), etc. Regardless, the idea is that there is a variety of ways to squat and it is important to understand that at the fundamental level squatting is a position and not an exercise. With this being said, if one cannot get to the bottom of a squat POSITION, it is probably not a good idea to be loading the movement through a partial range with any resistance. In my clinical experience, it is not the act of squatting below parallel that is harmful to the knees but the inability to obtain the bottom position of a full depth squat well that ultimately leads to dysfunction and disability from knee injuries. The ability to obtain the bottom of a squat without compensation such as forward weight shifting, foot/ankle turnout, knees translating inward, spine excessively rounding, and/or the neck overextending, is a wonderful display of mobility and stability that carries over to so many activities of daily living. Once this position is able to be controlled and maintained, why can’t one load the pattern gradually like any other movement in the strength and conditioning world? The problem that I most commonly see is that resistance is added to a squat pattern before one has learned to control the entire movement from top to bottom without resistance.

With all this being said, I am not trying to bash any one individual’s opinion, as I had the same thought process at one time in my career. I did; however, want to use this topic to bring up a bigger point and that is that general rules stating that one should NEVER do something in regards to a movement tend to be easily refuted. Training someone to move better is highly specific to that individual. As a physical therapist and being the husband of a physical therapist assistant, I have had plenty of experience listening to individuals with high levels of education prescribe general limitations to individuals’ movement practices without actually watching them move. Let’s get into the habit of assessing movement before giving advice about movement.

MovementProfessional.com: Chair-Free Office

MovementProfessional.com: Kettlebell Challenge

Published Comment in the Annals of Internal Medicine Regarding Subacromial Impingement

Comments and Responses
Management of the Unilateral Shoulder Impingement Syndrome

TO THE EDITOR: On the surface, Rhon and colleagues’ thoughtful study (1) shows the effectiveness of subacromial corticosteroid injection and manual physical therapy to treat the shoulder impingement syndrome (SIS). However, several factors complicate the comparison of manual physical therapy with medical intervention and perhaps limit this study’s otherwise valuable contribution.

First, the manual therapy approach used in this study was well-described here and elsewhere (2).  However, physical therapists in clinical practice typically assess the presence and quality of symptoms in relation to patient movement and position, not according to a pathoanatomical diagnosis such as SIS; therefore including the manual therapy intervention as a treatment for SIS may be misleading.  Emphasis should have been placed on the idea that manual therapy is a treatment for the mechanical stresses that may lead to SIS, while a corticosteroid injection has a more direct effect on the structures that have been injured.  

Second, manual physical therapists continually reassess and adjust treatment on the basis of the patient’s symptomatic changes structured as a test–retest model (establish a baseline, do an intervention, and then retest to look for change from the baseline). This model has been validated (3) and is the common thread linking many assessment approaches used by all types of physical therapists. This model differs from a physician’s typical assessment and treatment in that therapists spend more time (generally 2 to 3 sessions weekly for at least 4 weeks) observing patients move and their response to various noninvasive interventions.

Third, this study may not have sufficiently emphasized the patient education process. Many musculoskeletal conditions involving the shoulders have high recurrence rates (4), particularly when the mechanism of injury is progressive and thought to result from repetitive overuse of the injured area. In these frequent cases, resolution and recurrence of symptoms may simply be part of the natural history of the condition; short-term pain control and improved functionality would not be the ultimate goal of intervention. Physical therapists educate their patients to become their own “self-assessors” and learn how and when to use appropriate self-treatment techniques as developed through the assessment approach used when deciding on suitable manual techniques.

Finally, corticosteroid injection and manual physical therapy often work in synergy: The former decreases inflammation, and the latter decreases the mechanical stress that may have caused the symptoms in the first place. Including a third group that received both interventions might have allowed for a more clinically relevant comparison.

Christopher Leib, DPT, CSCS, Cert MDT, COMT
Pain Relief and Physical Therapy; Havertown, Pennsylvania

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L14-0450.

References
1. Rhon DI, Boyles RB, Cleland JA. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial. Ann Intern Med. 2014;161:161-9. [PMID: 25089860] doi:10.7326/M13-2199
2. Rhon DI, Boyles RE, Cleland JA, Brown DL. A manual physical therapy approach versus subacromial corticosteroid injection for treatment of shoulder impingement syndrome: a protocol for a randomised clinical trial. BMJ Open. 2011;1:e000137. [PMID: 22021870] doi:10.1136/bmjopen-2011-000137
3. Cook CE, Showalter C, Kabbaz V, O'Halloran B. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain? Man Ther. 2012;17:325-9. [PMID: 22445052] doi:10.1016/j.math.2012.02.020
4. Luime JJ, Koes BW, Miedem HS, Verhaar JA, Burdorf A. High incidence and recurrence of shoulder and neck pain in nursing home employees was demonstrated during a 2-year follow-up. J Clin Epidemiol. 2005;58:407-13. [PMID: 15862727]

MovementProfessional.com: Shoulder Impingement Syndrome

MovementProfessional.com: the Pilates Reformer for Crossfit Movements

Don’t Be an Absolutist!

When it comes to strength and conditioning, fitness and the movement arts, it is not uncommon to find individuals arguing with each other about the BEST practice to rule them all. Whether Crossfit, yoga, Pilates, Zumba, running, triathlon training, etc., it is not difficult to find loyalists that absolutely identify themselves as a practitioner of one method (a Crossfitter, a yogi, a cyclist, a runner, etc.). In my opinion, this mindset is very limiting. No matter how versatile a specific method of training may be, the human body is way too complex not be open-minded to a wide variety of training practices. The concept of finding balance in the body is vast and goes way beyond building physical capacity by training a variety of movements. I will agree that a keystone to a good movement practice should be incorporating a wide variety of movements, therefore, practices such as Crossfit, yoga, and Pilates, have an advantage for optimal movement over single activity movement practices such as running and cycling; however, the idea of variety must be discussed beyond simply what movements are being done and instead be contemplated in regards to the specific focus of the movement based on specific goals. This idea of specificity, is unlikely to be accomplished in a holistic manner with one movement practice. Factors such as intensity, speed, breathing, environment, and competition all play vital roles in how similar movements effect an individual, and many times these factors are in opposition within different practices. For example, many of the movements performed in Crossfit and yoga are very similar in their fundamentals, however, I don’t think many would argue that the environment, intensity, breath focus, and speed of motion are very different. In these instances, it is common to look at the differences in these practices and decide that one practice fits you better than another based on the identity you have created for yourself. In this instance, it may seem sensible to say that yoga is best for me because “I like a low key environment and I do not want to lift weights”, or Crossfit is up my alley because “yoga is for girls, or I thrive in a competitive environment where exercise intensity is a major focus”. My intention here is not to deny that individuals have differences and that some are more suited to certain environments than others, but simply to point out two major factors in this line of thinking:

1. Exclusively training one style of movement, inherently limits you in areas of movement that differ from that particular style. So basically, if you train one element of movement too much an opposite element suffers. In the above example, that means if you are always training at a high intensity, you may find it difficult to down regulate your system, and instead be in a constant state of physical and emotional stress. On the other end of the spectrum, if calming, lower-intensity, body weight movements are the only elements in your practice, your body will not be prepared for tasks where short-duration, high-intensity effort is necessary (i.e. sprinting across the street, lifting furniture, etc.) and injury can often result.
2. Regardless of how individuals label themselves physically, daily life creates obstacles that incorporate a versatility of movement and emotional demands that no single practice can optimally prepare you for. Our bodies work best when our systems (musculoskeletal, nervous, cardiovascular, hormonal, etc) are in balance. That means that elements that you feel most comfortable with, may be the elements that need the LEAST training.

With this in mind, I leave you with this sentiment. Be open-minded in your approach to movement, and you will find you have more potential and versatility than you once thought.

Check out this video demonstration utilizing Pilates-based training to enhance Crossfit-style movements: https://www.youtube.com/watch?v=73ytC877ggg&feature=youtu.be