Best Exercises You're not doing - the Turkish Get Up

Aside from helping you cut a steely core, the TGU increases stability and upper body control – powering you to a stronger overhead press.

Why muscle up the motivation to train if your workout doesn’t benefit your body outside the gym? Trust us, there’s little worth in size without strength. This month master the Turkish Get-Up: it’s the best multi-tasking exercise you’re not doing.

As one of the best functional movements – exercises that emulate real life tasks like lugging luggage or shifting heavy furniture – the TGU hits all the major muscle groups. In one rep you test hip and shoulder mobility, core strength, rotational control and scapular stability. Get it wrong and you risk coming face to face with heavy metal and an awkward conversation with your boss, explaining away a black eye.

However, don’t be put off by this or retro images of strongmen doing the move with 100lbs or more. This exercise is as much for the beginner as it is for those with brawn.

You can use the getup to get ahead in your training one of two ways. The first, in warmups. Add light load TGUs as a prequel to overhead lifting. They’re a nice way to build base strength and experience load in the overhead position. That’s because, rather than press the load up, you sneak the body underneath the weight – a little like building a pyramid underneath the kettlebell.

Alternatively, stop being a planker and reach for a heavy kettlebell to hammer your core at the end of the workout.

Like the deadlift, there’s few people that won’t get bang for their butt from this move. So what are you waiting for?

You need:

A kettlebell, barbell, sandbag or dumbbell all work. Training at home? Practice with bodyweight or a 2ltr water bottle.

Master the move:

1. Lying on the floor, safely move your weight of choice into a locked out position inline with your right shoulder. Slide your right foot in towards your bum until it’s next to your left knee.
2. Drive up onto the elbow of the left arm by firing the abs and pushing off the opposite leg – think of punching the weight to the ceiling or ‘crunch and punch’.
3. Drive your hips to the ceiling while engaging the glutes and abs to create enough space to slide your leg beneath you into a half kneel position.
4. Step up from half kneel to standing keeping the weight above your head and core tight. Breathe.
5. You’re not done yet. Reverse steps 1 to 4 to get back to the floor.

Exhale......

Pro athletes around the globe have been paying a lot of attention to a muscle they can't see or touch: the diaphragm.  Having studied under the US based Postural Restoration Institute, I set about trying to understand why....

We are pre programmed to survive.  Our brains will do everything they can to make sure we don't die today.  Ensuring our hearts pump blood around our bodies and that we breathe air in and out.  Although we don't consciously control our hearts, we can control our breathing - and thats why positional breathing techniques can be so powerful and effective.

Our diaphragm is a respiratory muscle - it is 'designed' to draw air into our chest, however,  much the same way as changing the angle of a bench can make a chest press more or less difficult, changing the position of our hips, ribcage, or indeed any other part of our bodies can put the diaphragm in a position of weakness.  If and when this happens, our brains have to figure out how to get air in and out another way...

Not breathing is not an option, so with the diaphragm out of play we will have to breathe from the top of our lungs which involves trying to 'shrug up' the shoulders to create space.  This shrugging up, or over extension,  can cause tension and trigger points on the shoulder and neck, tension in the jaw, headaches, and even debilitating migraines.  Working down the chain there will be a tendency to hyperextend the lower back - causing a cascade of compensatory patterns in the hips, knees and even feet!

Our bodies are not designed to live the way we do.  We spend far too much time in one position, whether sat at desks, or exercising always in the same way.  Essentially we are forcing our bodies to live a 2D symmetrical life when we should be living in a more asymmetric, or 3D kind of way.

If you were to draw a line down the middle of your body, we would not be the same on both sides.  And yet if you think bout the activities we partake in to move our bodies - especially in gym settings - we are expected to do everything symmetrically:  run in a straight line on a treadmill, sit on a spin bike, perform a squat or a deadlift in a neat parallel stance....  These activities all fit into a world we have created around us, but it is not how we are meant to be.  We need and thrive on reciprocal rotation in order for our bodies to work correctly.

The founder and godfather of PRI - physical therapist Ron Hruska - discovered that common problems such as shoulder or back pain are caused by improper posture and therefore improper breathing.  By fixing the posture and optimising breathing patterns we can cause the most extraordinary changes to almost every aspect of human performance.  All we do is train your brain to breathe efficiently in a more optimal position.  A little like pressing the reset button on a mobile phone!

Staying in Your Lane

Having worked in sports, health, and fitness since starting my undergrad sports science degree in 1997, (when I remember not picking up my new University email address for a whole term thinking this interweb thing would never catch on...) its fair to say I've been around the block a few times when it comes to exercise and seen a fair few fads come and go

OK I wasn't around for this one, and also: WFT?

It has also given me plenty of time and experience to figure out what my 'niche' is.  For me that has been looking to bridge the gap between clinical rehab and performance.

Building a niche is, in my opinion, one of the most important things a health and fitness professional can do in ensuring longevity in an industry renowned for chewing up and spitting out willing and enthusiastic newbies.  Those have been led to believe that a world of instagram selfies is the key to the 'four hour working week' and being a 'six figure trainer' (spoiler alert, its not).

Which brings me on to the point of this post.






Staying in your lane, or rather, within your scope of practise is often overlooked as being one of the most effective ways to build credibility, integrity and a full client book.   Conversely many people feel the need to try to cover all bases for their clients.  No one, I repeat, no one is an expert at everything - to truly become an expert Malcolm Gladwell would have us believe that 10,000 hours of practise is required.  In coaching terms thats 100 sessions a month, every month, for over 8 years - and that would just make us an expert at 'coaching'  when you have found your niche, be that nutrition, hypertrophy, S&C, or in my case biomechanics, you're looking at 10,000 hours of practise in that field  to consider yourself an expert.


Keeping all of that in mind we can hopefully start to see the importance of building an effective referral network of other experts that compliment your own skill set.

This collaboration continuum illustration was borrowed from a Postural Restoration Insitute seminar, and is one I have incorporated into internal training at the facility in which I am based.
Unfortunately, due to either a lack of understanding, or just plain and simple egotism, the health and fitness industry tends to exist towards the left hand side of this diagram.  if we wish to encourage movement towards the right hand side - we need to have an appreciation (and therefore an understanding!) of our scopes of practise....

Now I will caveat this somewhat by clarifying that a 'greying of the edges' of an individuals scope of practise is in many ways inevitable when considering a long career of a lifelong learner - and that particular areas of focus and emphasis can tend to change over time.  However, even with such individuals, there must still be a commitment to actually learning their new skill!

Once we understand our own scope of practise - and where it ends - we can and should begin to build a professional network of individuals who excel in areas that we do not.  That way we can continue to do the right thing by our clients and refer them to people we know and trust to best help them - trust me on this one, if your client has an issue outside of your scope, and you refer them to someone who is better positioned to help - you have a client for life.

The flip side of the 'if in doubt refer it out' mantra - is of course 'if you are not trained, qualified, or insured to do it - find someone who is!'.

In my own area of dealing with a majority of post rehab clients,  both athletes and general population, I consider myself highly fortunate to have a solid working relationship with arguably the top sports physiotherapist in Europe.  The reason that it works well is because of mutual trust, and an understanding that we have skill sets that are complimentary, but different.  I do not put my hands on any clients or patients, I do not stretch or force range, I make no attempt to change any physical structure.  My job is to coach people to move well, and to get them stronger - and to select the most appropriate movement for that individual at that time.  In short, we stay out of each others lanes.

One thing I cannot stand is the trainer who thinks he's a physiotherapist because he's watched a few videos on youtube, or sat in on a treatment session or two.  Just as someone wouldn't trust me to fly a plane they were in because I've watched Top Gun a few times,  they shouldn't trust a person with their physical health who is not educated, qualified, and insured to look after it!


Of course this argument works two ways, and we also shouldn't  see manual therapists with no coaching experience taking people through loaded strength training protocols.  However,  as the barrier to entry to become a chartered physiotherapist is very high and requires several years of study and continual further education - we do tend to see a higher level of professional integrity in this field than in the world of personal training  - where the barrier to entry is essentially non existent.

If you are one of those professionals looking to expand your scope of practise - and get more hands on involvement with clarinets (patients), there are a whole heap of further education training resources and certifications out there that are available to personal trainers and strength coaches who want to get more hands on.  Sports Massage, ART, IASTM even acupuncture and dry needling are all available to non medically qualified individuals.  Personally I have been pursuing higher education through the Academy of Applied Movement Neurology and the Postural Restoration Insitute, and found both systems provided me with a great range of tools to help get people moving better.  However, NEITHER  qualify me to manually change the structure of a persons tissue, so I don't ever do that.  I reach out to a person in my network who I trust and collaborate with him to get that done.

In short:  Don't be a Cowboy  <-- unless you are, in fact, a cowboy (which is infinitely more cool than being a PT anyway)

Assessing Control In the Sagittal Plane

Last weekend I was fortunate enough to be able to attend a superb seminar in San Francisco to further my education in the science of the Postural Restoration Institute or PRI for short. It was such a huge pleasure to be surrounded by a group of high level thinkers, and reminded me of the expression: If you're the smartest person in the room, you're in the wrong room!

PRI science manages to be both simple and complex - it is highly technical and requires an advanced understanding of biomechanics and anatomy.  However, at the same time the principles just seem so obvious once they are explained.  It is safe to say that anyone attending a PRI educational event will experience several 'ah hah' moments - if not full on face palms.

It all seems so obvious now

At this latest event, which was very much focussed on bringing Postural Restoration science out of the clinical setting it is best known for, and applying it in the space of strength and conditioning, the presenters had simplified some of the more complicated orthopaedic based PRI assessment protocols into a series of movement 'screens'.

One of these screens has been designed to assess an individual's ability to fully exhale, and successfully inhibit their Posterior Exterior Chain (one of the various poly-articular chains that PRI science is based upon).  Now whilst this sounds complicated - in essence this was a very simple assessment that would demonstrate if a client / patient / athlete has control in the sagittal plane.

Those who know me, know that I place a great deal of emphasis on an A,B,C of movement coaching that was popularised by Evan Osur in his Integrated Corrective Exercise method.  Dr Osur explains the A,B,C principles as follows  "For a movement to be 'successful' it must optimise the individuals Alignment, Breathing, and Control in that position.  If they don't have control, then they don't fully own that position."

In order to 'clear' this very simple screen the individual must be able to come out of a gross extension pattern (alignment), fully exhale and retract the ribcage (breathing) and successfully inhibit their trunk extensors (control).




So, so simple and really was one of those 'why didn't I think of that!?' moments.  Well.... I didn't, and they did - so huge thank you to James Anderson and Julie Blandin for coming up with this.

What does it mean?

Well - in PRI speak we are looking at core organisation and restricted costal mobility, and therefore airflow on one or both sides of the thorax.

For those who aren't familiar with this terminology, or who don't wish to explore PRI science - if your client can't do this, they are not ready to train outside of the sagittal plane.  Nice and simple.  They need to work on core control in this plane first, master the sagittal plane, and then  be progressed to the more 3 dimensional movements.

So there we have it - a simple simple screen technique born out of a very advanced school of thought.  And one that has an application for all.

To round off - here we have the awesome group of people who attended this latest PRI event in San Francisco.  I'll finish how I started this post - if you're the smartest person in the room - you're in the wrong room!

PRI Integration, San Francisco CA, Oct 2015

Face Pulls

One of my go-to exercises for shoulder health, correcting a number of postural imbalances, and all round ‘good hygeine’ as a client of mine calls it – is the face pull.  It's safe to say if I have been writing programs for someone, they will have become pretty familiar with face pull variations.

Jim Carrey, an outstanding face puller

In my opinion the face pull is a ‘must do’ movement for pretty much everyone, in its simplest form it encourages a posterior tilt of the scapulae, increases the sub acromial space, and encourages activation of both the lower traps, and the posterior cuff – whats not to love!?

 The sub acromial space - there is rarely a lot of it...

A certain amount of 'impingement' is inevitable, however, poor shoulder mechanics, less than optimal alignment at the scapula thoracic joint, and poor centration of the glenohumeral joint can all contribute to decreased sub acromial space, increased impingement, and hurty shoulder

To set up for the standard face pull there are a couple of key cues to remember

- cable column should be set to head height

- adopt a split stance to minimise the chance of achieving the movement through excessive lumbar extension (lock this down even further with a good squeeze of the glute on the back leg)

- pull the lower ribs down and get a solid brace through the anterior core

- pull the rope grip towards your face (towards, not into - I have seen it done trust me).

- ensure the shoulders stay away from the ears, and the elbows draw up higher than the shoulders

- smile

https://youtu.be/nQXjdUNt6nw



I like to program face pulls for medium to high reps - so anywhere in the 12-25 bracket.  I'm rarely looking to develop a great deal of force production in a movement like this, its much more about creating good movement and 'feeling' the exercise.  As for where they sit in a program, this is usually a C2 and acts as a 'filler' between working sets on secondary assistance movements, I also occasionally use it as a D2 to round off an upper body lifting session thats had a lot of heavy pressing, or even as part of the dynamic warm up for those folks 'stuck' in internal rotation and with a heavy kyphosis. 



Like all the best things in life, face pulls have variations to suit different needs ,  our job as coaches is to select the most appropriate version.  I have listed a few variations that feature most often in my programs - its by no means exhaustive  - but should serve as a decent starting point:

Face Pull to External Rotation (Supinated Grip)

Most useful for those wanting to throw a bit more stress on to the posterior cuff,  easiest to cue this one as two movements - the first pull, and then the external rotation.  Clearly loads will need to be reduced vs the conventional set up otherwise there is a tendency to shrug the weight back rather than engage the cuff (yes I know I totally need a haircut)


Half kneel face pull

I like to use this variation for those with an exaggerated kyphosis, the downward moment of the pull really encourages the posterior tilt these folks can often struggle with.  I will more likely use this variation with a newer trainee to help them understand what it feels like to have the low traps work and open out the chest.

Less useful for the 'athletic meathead' posture of shoulder blades stuck in downward rotation  - with these guys this variation could actually make them worse so make sure you conduct a thorough evaluation and assessment.

Low to High Face Pull

I love this movement for encouraging upward rotation of the shoulder blades.  Ideal for those guys who have deadlifts for breakfast lunch and dinner and find the shoulder blades stuck in downward rotation.   The upward moment on the pull will cause you to initiate a shrug as the arms pass horizontal.  For those with a really aggressive down slope on the collar bone, you may want to cue some upper trap recruitment at this point (yes we need upper traps too).

As above this movement will be great for some, and less so for others - if your client or athlete presents with abducted (winging) and anteriorly tilted shoulder blades,  and upper trap 'dominance', then this one may not be for them.

Summary

The face pull, and its derivatives are an excellent way to keep your shoulders healthy and pain free, improve posture, and allow you to go heavy on the bench press more often (which is the whole point right).

However, and there is always a however, we must must must choose the most appropriate version for the situation in front of us.  As I have alluded to above, the key to designing any form of training program is the assessment - there is no way we can get from point A to point B unless we know where point A is.  And although the face pull is as close a thing as I have seen to a silver bullet for many common shoulder niggles we must choose the correct tool for the job.  To quote the genius that is Eric Cressey if you aren't assessing you're just guessing.

No massive relevance to the article, but there are probably silver bullets in this gun. And who doesn't love Hugh Jackman and Kate Beckinsale.

Is Flexion the Devil's work

I was prompted to write this article after an email exchange with a fellow professional - and it seems its a subject that provokes a great deal of emotive debate - so here is my tuppence worth:

 

[caption id="attachment_108" align="aligncenter" width="300"] Keep your back straight[/caption]

Go to any gym,  sports club S&C facility, or even watch the New Year exercise DVD of whoever most recently traded in their dignity to eat kangaroo balls in the jungle  - and you will continually hear the same 'chest up, shoulders back' instructions over and again for every movement - and more often than not its explained that this is to help prevent back injury...

[caption id="attachment_106" align="aligncenter" width="207"] Chest up, shoulders back - does this look remotely sensible to you?[/caption]

I do understand where this has come from - we live in a society where people spend far too much time sat down hunched over a keyboard or  humancentipad (yeah its a thing - google it), and the majority of folks complain of a bad back....  Well then that flexed spine must be the culprit right?

Quite possibly yes - but does that mean we take everyone to the other extreme and force them into permanent extension?

Well that would just be silly now wouldn't it...

[caption id="attachment_107" align="aligncenter" width="225"] Silliness - almost never a bad idea[/caption]

Unfortunately the world of health and fitness seems to be one of extremes and fads, we as a collective group of fitness professionals don't seem to be able to take the middle of the road on just about anything.  Again, I get it, yeah Ive been in and around this business for knocking on for 20 years, and these days don't give a monkeys' what the current trend or 'approved school of thought' is  - but I have certainly been guilty of throwing myself onto several bandwagons in the past - without necessarily applying some common sense first.

[caption id="attachment_109" align="aligncenter" width="275"] Not always the safest place to be - but at least it means you can see both sides[/caption]

The problem we have with a one size fits all approach to postural correction is that, in driving everyone into a permanent state of extension, we are creating more problems than we solve...  The dropped (or anteriorly rotated) pelvis is - in my opinion - far more likely to lead to potentially debilitating back pain than a moderate amount of spinal flexion.  After all, spines were designed to flex!  (I'll get into who designed us at a later date).

[caption id="attachment_75" align="aligncenter" width="300"] Anterior pelvic tilt - or 'lower body cross syndrome'[/caption]

Cueing and coaching people to extend all the time will, undoubtedly, worsen the alignment you can see above - termed by Janda as 'Lower Body Cross Syndrome'. This is short or over active spinal erectors and quads, weak or inhibited gluteals and anterior core.

[caption id="attachment_96" align="aligncenter" width="300"] All you need for a stable spine[/caption]

Anyone who has ever read anything vaguely health related will know that the big hitters for stabilising a lumbar spine and preventing / rehabilitating low back pain are....  GLUTES AND ANTERIOR CORE!  So why would we be constantly cueing people into a position where these guys can not do their job!?

[caption id="attachment_110" align="aligncenter" width="300"] It just seems so obvious now[/caption]

The simple myokinematics of an anterior pelvic tilt, or lower body cross - not allowing the main spinal stabilisers to adequately recruit is, however, only the start of the problem...  A position of extension is known by the clever folk at the Postural Restoration Institute in Nebraska as a state of 'permanent inhalation'.  A simple overview of respiratory biomechanics demonstrates that for adequate exhalation a ribcage must 'oppose' a pelvis.   Think of this as the bowl of the pelvis, and the arch of the lower ribcage forming a stable spherical shape....    Now why is this important?  The diaphragm is attached around the ring of the lower ribs, and down the thoraco-lumbar fascia...  what else is attached to the thoracolumbar fascia?  The iliopsoas of course!  In fact, in cadaver studies the crurar fibres of the diaphragm are almost impossible to distinguish from these major hip flexors. When one contracts the other gets pulled - think of them as George Dubya and Tony Blair.    If we elevate these lower ribs in a position of extension, the diaphragm will still contract,  but instead of pulling the ribs in, it will pull the lumbar spine forwards (extension) and pull the hip flexors even tighter.

[caption id="attachment_111" align="aligncenter" width="224"] Follow the line of the waistband. Hips are in about 15 deg of flexion[/caption]

Apologies to whoever this guy is, I pulled this pic from an article on the interweb titled 'how to deadlift correctly to avoid back pain'.  Not like this is the answer, sorry dude.

so...

An anteriorly rotated pelvis is in a position in which major spinal stabilisers and respiratory muscles can not adequately function.   What do we want people to do when they are trying to recover from a lower back injury, or brace themselves for a maximal lift?   Breathe and stabilise!

What should we be cueing people to do?  Get neutral!  Get the ribs down, brace and breathe.

Core Training

I was recently asked by Mens Health magazine to put together some information for an article about core training. As is often the case with these kind of requests they are a little unsure what shape the article will take - as such I cobbled together my current (because they do change!) thoughts on the core – what it does – and how to train it. The Mens Health piece ended up being shorter than planned and more of a sample workout – you can see the article here.

However, I thought it would be worthwhile publishing the information I had put together for them.

The core - depending on who you listen to – can include everything from your ‘6 pack’ mucle (rectus abdominus) through to your gluteals (butt) and even your diaphragm. Training it effectively will require understanding that its more than doing crunches.



 

Muscles in the body can be broadly catergorised into ‘tonic’ or ‘phasic’ muscles.

Tonic muscles have a job of maintaining tone and are also known as postural muscles or stabilisers.

Phasic muscles - as the name suggests - provide movement.

[caption id="attachment_101" align="aligncenter" width="300"] Avoid dysfunction, imbalance and injury by not mixing up your Dachshunds with your Huskies. Or just get your stabilisers to stabilise.[/caption]

 

Maintaining optimal functionality requires us to use the right muscles,  at the right time, for the right job.  When we have large global (phasic) muscles doing the job of smaller, local (tonic) muscles, the big boys become overly 'tonic' (tight) and the little guys become weak and inactive. Classic example of this is the chronically tight hamstring doing the job of stabilising a pelvis  in a person with a weak core - you can see my post on the relation between hamstrings and core strength here.

The musculature of the ‘core’ falls into the tonic category .  Tonic, or postural muscles have a role of resisting movement rather than providing it. Their job is quite simply to keep you upright, or more specifically keep your ribcage on top of your pelvis.

 

[caption id="attachment_97" align="aligncenter" width="300"] Core stability - natures version of Jenga[/caption]

Understanding the role of the core then makes training it very simple. All we do is understand how many ways our upright, neutral posture can be compromised, and train to provide strength resisting those forces.

What directions can affect or challenge our 'neutrality'?

Flexion (forward bending)

Extension (backward bending, or arching)

Lateral flexion (side bending)

Rotation

Now to effectively train the core we need exercises to provide strength and stability resisting ALL of those directional forces. The most important to consider are the flexion and extension resistant exercises – as they are the most common forces we have to deal with – which of those we bias will depend on the starting posture of the individual.

Good ‘bang for your buck’ exercises for each plane:

Anti-flexion: ‘bird dogs’, prone ‘superman’, glute bridges

Anti extension: dead bugs, roll outs, plank variations.

Anti lateral flexion: Side planks, suitcase carries

Anti-rotation: chopping variations (as a guide - start with half kneeling and progress through tall kneeling, to standing)

 

Most important point to get across with core training, or indeed training any other tonic muscle (rotator cuff etc) is that you do not train them to failure – ever!

[caption id="attachment_98" align="aligncenter" width="105"] Little, often, and always with correct form is the key to core stability[/caption]

 

Crushing a bicep / tricep workout till you can fry an egg on your arm is all well and good – but ever tried doing that and then performing a fine control task with that same arm the next day?

Muscles that we need to maintain posture and prevent injury we do not teach to fail and shut down– think of it as driving without your seatbelt on….