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….

PRI Postural respiration - Cliff notes

PRI stands for Postural Restoration Insitute - a group of very clever folks led by Ron Hruska, working out of the Hruska Clinic in Lincoln Nebraska.  Anyone scanning the internet for training / rehab information will have undoubtably come across writing either by them, quoting them, or at least heavily influenced by them.

I was introduced to the PRI school of thought whilst spending some time at Cressey Performance in December 2013.  I was, quite frankly, pretty taken aback at the dramatic impact some simple breathing drills could have on my hip and shoulder range of motion, and that some niggly SI joint pain I'd had for years had 'magically' vanished. Needless to say - after getting back to the UK I was very keen to get into a bit more detail as to the hows and whys of PRI methodology and signed up for their certification program.

 

Now PRI courses are very anatomy heavy - and very technical in their descriptions of internal kinematics.  Bit my attempt at a cliff note summary is below:

 

Human beings are hard wired to not die.  When we talk about primal patterning - nothing is more 'functional' than staying alive.  This is a key concept of how PRI methodologies work.

[caption id="attachment_90" align="aligncenter" width="300"] Staying alive is important.
And JT opening up his right chest wall helps him do this.[/caption]

The PRI thought process is that we as humans will adopt some postural changes as a result of both internal and external influences.  Internal being the internal anatomical asymmetry we are all born with - larger chest cavity on the right side, thicker diaphragm leaflet on the right, heart and vena cava on the left - making it easier for us to collapse the right chest cavity than the left.  Throw on top of that the right sided world we have created around us - where even the southpaws will generally have to reach for most things with their right hand and you can see why what PRI term the Left AIC Right BC pattern is so frequently adopted

 

[caption id="attachment_91" align="aligncenter" width="194"] Left AIC Pattern.
Credit: Postural Restoration Institute.[/caption]

So if we have settled into a posture like the one above - we have closed down the right mediastinum and created a less than optimal mechanism for respiration.  However - respiration is a pre requisite for life - and we are hard wired to ensure that we can continue to exchange gas no matter what.

Now there lies the rub - a less than optimal respiratory mechanism will require greater assistance from the accessory respiratory muscles (lats, upper traps, legator ecap, scaliness, SCM) and start to create all kinds of associated problems relating to over activity or hyper tonicity in these areas - this list is seemingly endless and ranges from upper trap trigger points through to thoracic outlet syndrome, migraines and anxiety.  But... as we need to breathe...we will use whatever means necessary to do so - and if that means recruiting all these other muscles to do it then so be it - it may screw us up - but at least we're not dead....  However, thats not the while story - now that we have figured out a new way to breathe, our in built survival mechanism will not actually permit movements that it sees as a threat to this new pattern.  So if you are using your neck to breathe - your neck is 'on'  - and don't expect it to be 'off' until you have fixed the pattern - all the stretching in the world won't solve that problem as the neural tension created is (as far as your nervous system is concerned) what is keeping you alive.

Now we know what the problem is then how do we fix it?

PRI non manual techniques are essentially taking the subject to the opposite posture of the one s/he is in (so typically externally rotating the right shoulder and ribcage and internally rotating the left hip) and carrying out controlled, forceful, diaphragmatic breathing in that new posture.  The purpose of this is to 'trick' your nervous system into allowing inhibition of the overactive accessory muscles.  In simple terms convincing yourself that coming out of the adopted posture is no longer a threat....

The list of PRI positional breathing drills is immense and way too long to go into here - but they are all built on that underlying principle of reversing the acquired posture - and learning to breathe there.  Only when you can breathe there can you 'own' the new pattern you are trying to create.

So there it is  - 20+ hours of lectures down to a few paragraphs and a John Travolta picture.  Hope this summary is useful - and I highly recommend checking out the full PRI resources.

 

 

PRI Postural Respiration - Cliff Notes

How Functional is the Overhead Squat?

I am well aware that this post may upset a few people – and whilst upsetting people is not its main aim – I do like to encourage people to challenge ideas, ask questions, and formulate their own opinions rather than blindly follow

 



 

Over the past decade there has been a shift away from the single joint machine based training popularized by Joe Weider in the 80s, and towards ‘functional’ exercise.  I am all for this – preparing people for life outside of the gym  - whether its on the sports field or simply being able to climb the stairs at home without any pain – that is what I’m all about.  However, there is a case to be made for the pendulum having swung too far…

 

[caption id="attachment_81" align="aligncenter" width="224"] Awesome bosu leap brah, let me high five myself in the face[/caption]

A functional exercise by definition must have a function.  As simplistically stupid as that may sound.

The overhead squat is often billed as the ‘king of functional exercise’ and the be all and end all of programming. In many functional gyms.   I would strongly beg to differ on this point.  How many times in your every day life, or even in your sports are you required to hold a load directly overhead and squat to the ground repeatedly, whilst keeping said weight directly over your head?

The overhead squat is a derivative of the snatch – one of the most dynamic and explosive movements in competitive sport.  As well as requiring speed and power, the snatch also requires technical expertise .  The ‘catch’ position of a snatch is, essentially, the bottom of an overhead squat.  For the competitive Olympic lifter – training this movement under load makes a lot of sense – they may have all the speed in the world to get under the bar, but without adequate core stiffness and lower extremity strength they wont be able to get ‘out of the hole’.  If your goal is to perform a loaded snatch, then yes, the OHS will be an important programming concern for you.  Now whether you should be programming the snatch for either yourself or your clients is a while other conversation!

 

[caption id="attachment_82" align="aligncenter" width="236"] Olympic lifter at the bottom of a snatch. note the heels, hips, shoulders, head and the centre of the bar are all directly above one another.[/caption]

The overhead  squat, in my mind, is an excellent assessment tool – it gives an indication of ankle mobility,  hip mobility and stability, core stiffness, thoracic mobility and scapular stability – all important parts of successful and pain free movement.

However – how many people that we assess ace it on every one of those?  Not many…   So how many of those could or indeed should be loaded through this movement pattern?  Even fewer….

 

[caption id="attachment_83" align="aligncenter" width="300"] Well aligned olympic lifter on the left. The guy on the right has neither the ankle, nor hip mobility to be in this position. The bar has to be above his feet or he will fall over - he is going into an excessive lumbar extension, forward head posture and hyper extension of his neck to try to maintain some kind of balance. Note the knees collapsing in due to the excessively wide stance he has had to adopt to get down there, this is also causing inversion at his ankles. We won't even go into whats going on with his shoulders.[/caption]

Heck 90% of the clients I work with (everything from Olympians through weekend warriors, to orthopedic referrals) don’t do any form of overhead lifting. Ever!

Now lets take those small number of  the population who can safely be loaded in an OHS position.  If we remove those who are competitive O – lifters, then what training effects are we going to give to the rest?

Can the person stably support enough weight in the overhead position to get any kind of training effect in their legs and hips?  I doubt it  - not unless the you were looking at higher repetition sets, however, in a high rep set what is going to fatigue first - the upper back or the legs?  When the upper back and the posterior cuff start to give out, and you're plugging away trying to get something out of it for your legs, what takes over?  Your lumbar extensors and the passive retrains in your shoulders - so essentially you promote hyper lordosis and hang out on the ligamentous structures of your shoulders - nice.

At best you may build in some upper back hypertrophy – given the time under tension required through the thoracic extensors. But if thats really your goal there are far safer ways to achieve it.

If I want to train an average Joe or Jane to get stronger, so they can better function in the outside world – surely deadlift variations, anterior loaded squat patterns, and loaded carries have far more relevance…

I’m fairly sure that when I changed my dishwasher the other day I pulled and lifted the old one over the step with it in front of me – I did not hold it above my head and repeatedly squat up and down with it.

If we think through the activities and movement patterns in most peoples daily lives, or indeed within competitive sports, the deadlift, and its derivations are infinitely more ‘fucntional’ than the overhead squat.

This is not to say the overhead squat is an entirely redundant movement.  Far from it.  as mentioned above I find it an excellent assessment tool, a very quick and easy way to get a snapshot of an individuals gross movement patterns.  I also think it has a place as a mobility drill, and I often use it as part of my clients dynamic warm ups.  It has a nice 'feel' for the client getting in and out of the position with stability, and is a great prep for doing some loaded front squats.    However,  just because something is a useful mobility tool does not mean we stick 60% of their bodyweight on a bar and ask them to do it to failure!

As Gray Cook  - creator of the FMS system so simply put it "Train the deadlift, maintain the squat"