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….

Stretch What's Tight.....?

That’s what we’re all taught in PT school right?  Strengthen what is weak and stretch what is tight…  Or in todays parlance – mobilize and stabilize.

 

Is it that simple though?  How many clients do you work with who had a tight hamstring, you stretched it and fixed the problem…  Not just got some transient improvement for a couple of hours, but genuinely addressed the tightness?



We should be a bit smarter than that by now.  The question what is tight is not enough – we need to be asking why its tight.

 

There are a number of reasons a muscle can ‘feel tight’ – ranging from genuine tissue length restrictions through to protective tension and alignment issues.

 

So how do we know what it is? We do assessments!

As ‘The Injury Whisperer’  Dean Somerset says: “If you aren’t assessing you’re just guessing.”

Try this simple assessment and correction for the any of your male general fitness clients who are suffering from the ‘tight hamstring’ epidemic:

 

Take a look at the line of their shorts from the side.  If you note a significant downslope on the waistband from back to front they are likely to be sitting in an anterior pelvic tilt (a very common posture for a desk-bound male).

 

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

Have them perform an active straight leg raise – take a note of where they get to.

 

[caption id="attachment_76" align="alignnone" width="300"] Active straight leg raise to assess hip flexion[/caption]

Then have them perform a maximal effort front plank with a neutral pelvis keep in mind if they are starting from a position of anterior tilt they will need to aggressively fire their glutes to back to neutral – in fact it would do no harm for these folks to be cued slightly into a posterior tilt (flat back).  Have them take 6-8 deep diaphragmatic breaths with a forceful exhalation – if it’s a genuine max effort plank this will be enough to have most people shaking like the proverbial dog on a comfort break.

Next  - re test the active straight leg raise and see if they perform any better…

 

Now if they perform better on the re-test you have given the person increased range through hip flexion.

 

But hang on -  you haven’t stretched their tight hamstring!

 

If we get a positive result with this correction – then the restriction was as a result of protective tension – and we have simply given the client a platform allowing the hamstring to ‘switch off’ and permit a movement that was previously considered as threatening.