Posts Tagged ‘lumbar hyperextension’

Overhead Work and Shoulder Flexion Limitation

Tuesday, June 12th, 2012

Here’s a breaking news: you need good shoulder flexion to be able to perform overhead work safely.

All sarcasm aside, if you don’t have appropriate shoulder flexion range of motion, you’re setting yourself up for injury when performing overhead exercises.

Many different things can be the cause of a lack of shoulder flexion.  Here are some of the causes of limited shoulder flexion.

A lack of upward rotation at the scapula can be limiting shoulder flexion. This can happen for a couple different reason.  One of them is the lack of activation or the lack of strength in the serratus anterior and the lower trap.

The upper trap is usually the strong player of all 3 muscles that contribute to upward rotation, so it rarely needs more activation.

The lack of shoulder flexion can also be caused by shortness or stiffness of the pec minor, latissimus dorsi or the long head of the triceps.

As you can see in this picture, the long head of the triceps could limit overhead range of motion because of its attachment on the scapula.

Another factor that could limit shoulder flexion is the structural variation of the acromion.

There are structurally 3 different types of acromion, and depending on what type you have you might be limited in shoulder flexion.  The type 3 acromion is usually one with which we want to stay away from overhead exercises.

I didn’t go into too much details about the causes of shoulder flexion limitation, but the message I want to get across is that although some of these limitations are modifiable, and some of them aren’t, there is significant damage that can be put on the shoulder if you try to grind through overhead work, especially exercises involving approximation (think pressing movements) of the humeral head in the glenoid fossa when your mobility is limited.

The other important thing to know is that if you force overhead exercises on someone who doesn’t have the shoulder flexion range of motion, he’ll definitely try and compensate in some way to get the weight overhead.  One of the most common compensation patterns you’ll see is lumbar hyperextension.

The picture above is not even taken from the side and you can still see how hyperextended she is at the lumbar spine.  Overhead presses, carries or other overhead exercises that involves approximation of the humeral head in the glenoid fossa should be avoided, at least in the short term while you fix the problem (if it’s not structural).

There are plenty of alternatives to overhead pressing that can yield similar benefits, depending what the goals are.  Be smart about it, and make sure you assess your clients and athletes before throwing them under the bus with overhead exercises if their body is not ready for it.

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Paying Attention to Details

Tuesday, March 20th, 2012

Being a strength and conditioning coach or a personal trainer requires many qualities.  One of them is the ability to pay attention to details.  When coaching exercises, there are many different body positions and subtleties in movements that one needs to be aware of.  Just demoing the exercises and throwing a couple coaching cues up in the air is usually not enough to get the result we want from our athletes and clients.

A coach (or trainer) needs to be able to identify and understand the subtleties in the different movement patterns to be able to coach the exercises in the most optimal way possible.  Here are some of the subtleties that a coach needs to be able to distinguish and correct (in no specific order):

1. Thoracic Spine Extension vs Thoraco-Lumbar (T-L) Junction Extension

I covered that in a previous blog post, but the “chest up” cue is not always interpreted the right way by the athlete or client.  Basically what we want to see when calling “chest up” is an extension at the thoracic spine so that the athlete maintains a more neutral spine.  Often times, the extension will come from the T-L junction which will put more stress on the lower back, will cause the anterior lower ribs to flare out and put the diaphragm in a less than optimal position.  That pretty subtle substitution will too often go unnoticed if the athlete is wearing a loose shirt.

Barely noticeable T-L junction hyperextension because of a loose shirt

2. Hip Flexion Compensation

In most athletes the psoas ends up being the weakest hip flexor.  The reason being that it is the only hip flexor effective above 90 degrees of hip flexion.  In most athletic endeavors the hip ends up being flexed above 90 degrees rarely, if ever; that in turn causes a higher recruitment of the 2 other main hip flexors, the TFL and the rectus femoris, and the psoas ends up weak.  It is a good idea to include psoas activation exercises in a training program to re-establish hip flexor strength in the end range of motion.  When doing these drills, athletes will be tempted to compensate because they are pretty weak in that position.  The seated psoas lift is one of my favorite psoas activation drill, but can be cheated pretty easily if not coached properly.

Often times, athletes will either lean back or hunch over to try to get the knee up as high as possible.  But in both situations, you’re really avoiding the above 90 degrees end range of motion; the angle of the hip flexion will be less than 90, and therefore you’re not getting that psoas activation you’re going after.

Bad Form- Leaning back will prevent your hip flexion to be above 90 degrees

Bad Form- Rounding of the lower back will also avoid that end range of motion

The same problem can occur if you perform a standing psoas hold, or any other type of exercise of that nature.

3. Full Hip Extension Compensation

The complete hip extension is definitely something important in many different exercises that are part of a training program.  An incomplete hip extension can expose some pretty serious problem going on around the hips.  Whether the problem is caused by a hip flexor restriction, a lack of glute activation or just poor coaching, this is a problem that a coach needs to be aware of to be  able to prevent injuries with his athletes.  This is another movement that can be very subtle and if you don’t pay attention to it can be missed altogether.  The incomplete hip extension can present in a wide variety of different movements, with posterior chain exercises (deadlift variations, pullthrough, slideboard hamstring curls, etc) being some of the most important ones.  An athlete not being able to finish his movement at the top with full hip extension will usually compensate with a hyperextension at the lower back.

Again, if no attention to details are paid during a deadlift (or just from coaching from different angle) this is something that can easily be missed.

4. Scapular Protraction vs Elbow Extension

This is something even more subtle.  The correct technique for pressing exercises is to keep the scapulae packed back together.  If unable to get a full elbow extension, the athlete might compensate by protracting the shoulder blades to get the end range of motion at the top.

Good Form- The shoulder blades stay packed back while getting full elbow extension

Bad Form- Protracted shoulders compensating for incomplete elbow extension

The biggest problem I see with this compensation pattern is for the following reps; if you’ve lost your packed scapulae position, when going for the next rep your shoulders are not going to be in a stable position to press a heavy weight anymore.  That can in turn have deleterious effects on the shoulders.

5. Feet Position

This is one that will go unnoticed more often than not.  One  of the main reasons is that the shoes your athletes are wearing might simply hide what’s going on at the foot and ankle.  During lower body exercises like squats, deadlifts, lunges and the like a lot can happen at the foot that might be detrimental to an athlete’s health because it will either cause problems further up the chain, or it might be in itself the result of a problem going on somewhere else.  An overpronation, or a loss of the arch of the foot are good examples.

Relatively neutral feet in the bottom of the squat

Feet overpronating at the bottom of the squat

In this last picture, it is easy to realize that it is something that be completely missed when the athlete is wearing shoes. (As a side note, I am not necessarily recommending that people squat without shoes on, but it clearly reveals a problem that might have otherwise been missed.)

This is really just a quick list of some of the most subtle body positions and compensated movement patterns you can see in athletes and clients.  Paying careful attention to details is such an important part of a coach or a trainer’s job because in the end, it plays an extremely important part of the injury prevention component of an effective training program.

What’s Wrong with Keeping Your Chest Up?

Thursday, January 12th, 2012

Strength and conditioning coaches and personal trainers use a variety of different coaching cues to guide their clients and athletes to perform various exercises the right way.  When you first start coaching or training people, you talk too much, demonstrate too many times and use too many coaching cues, and your clients end up being confused.  Rightfully so!  Just imagine trying to perform a complex movement that you have never done in your entire life and that is not even close to being similar to something you know; you have no point of reference, your body doesn’t recognize the movement pattern, and on top of that, the person teaching you the movement just keeps talking and adding the number of things you should focus on!  You end up not being able to focus on any one thing because there are too many of them.

But luckily, as you become a better trainer or coach you refine your coaching technique, simplify your explanations and use fewer coaching cues.  You also realize that the most effective coaching cues end up being 90% the same from person to person.  The “chest up” cue is definitely one that’s very common among coaches and trainers.  But it’s also an effective one for a bunch of different exercises.  You can usually use the “chest up” cue with the squat, the deadlift, all variations of horizontal pulling exercises and most posterior chain exercises, just to name a few.

I use the “chest up” cue quite a bit myself.  Combine a loud “chest up” yelled across the room with a French-Canadian accent, and you have something for athletes and fellow coaches at Endeavor to make fun of me for!  It has became a running joke around Endeavor, and our athletes will take the first opportunity to make fun of me, as you can testify yourself by listening to Colby Cohen, Boston Bruins prospect, at the beginning of the following video (I’m also famous for the “butt tight” cue as well, as you’ll notice):

Coming back to serious matters, the “chest up” cue is definitely a useful one to use, but one that you need to be careful with.  There are some unwanted results that could present with this particular coaching cue.  Let me explain…

The “chest up” cue is an effective one because it’s short, simple and hard to misinterpret.  What we are usually looking for with the “chest up” cue is for the client or athlete to prevent from rounding or slouching at the upper back and thoracic spine, and keep the spine neutral.  You might also use the “chest up” cue to help pack the shoulder blades back together when back squatting or doing a horizontal pull.  But one problem may present when an athlete or client tries to get his chest up.  What they don’t know when we say “chest up” is that we want an extension at the thoracic spine, but too often they will get that extension through their lower back or thoraco-lumbar junction.

T-L junction subsitution for thoracic extension

And if you don’t pay close attention to it, you might not even notice, especially if the client or athlete is wearing a loose shirt.

A lumbar hyperextension is not always obvious when you wear a loose shirt

 An extension at the thoraco-lumbar junction will in turn cause a lower ribs flare in the front.  I’ve mentioned in a previous post that a rib flare is also associated with faulty breathing pattern because the diaphragm is not in an efficient position to do its job.

Just notice how differently the diaphragm is positioned between the inhaling and exhaling phases of breathing

So it’s very important to be conscious how your client or athlete will adjust when you tell him/her to get his/her chest up.  Again, the coaching cue in itself is not bad to use, you just need to be more aware of how the person in front of you will interpret it, and you can make the adjustment when necessary.  Personally, when correcting it, I like to put my finger tips on the person’s lower ribs while instructing them to get their ribs down while keeping their chest up; it usually works pretty well.

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4 Things You Should Know About the Neck

Thursday, January 13th, 2011

The neck is a very particular area on the human body. In athletic development, we pay little to no attention to neck training. Some sports like football and wrestling will sometimes devote time to neck training, but that is pretty much it. And the way they do it is usually not only far from optimal, it’s just flat out dangerous. But I digress, as this could be an entirely different blog post. The truth is, even if we don’t train it specifically, the neck muscles still receive stimuli from conventional strength training.  At the same time, I feel strength coaches and trainers alike (me included) do not know nearly enough about how the neck works, how we should deal with it and when we should refer out.  Because let’s face it: the neck is a very sensitive area (with the numerous muscles and nerves that pass through it) that should be handled with care at all time.

I watched Charlie Weingroff‘s Training = Rehab DVD set over the last week, and I must say before anything else that it is an incredible resource for any physical therapist, strength coach or trainer out there.  Throughout his presentation, Charlie highlights the importance of taking the neck into consideration in training, as well as in rehab, no matter what you are addressing.

Here are a couple of things you should know when dealing with the neck.  But before I go any further, the most important thing to remember about the neck is that if you’re a coach or trainer and are dealing with a neck dysfunction or neck pain in a client, REFER OUT! We are not qualified for this type of work by any means, we shouldn’t deal with that.

1. The neck muscles, especially the deep neck flexors are a very important, yet totally forgotten, part of the core. The deep neck flexors are part of the inner core, with the diaphragm, the pelvic floor, the TVA and the multifidus.

Deep Neck Flexors

Inner Core

If you’re not familiar with the inner core, make sure you check out my blog post I wrote a while ago (The Inner Core).  The inner core muscles are very important spine stabilizers, and so are the deep neck flexors.  A tucked chin or neutral cervical position will always make your spine more stable because it prevents unwanted cervical movement during heavy lifting.  Also, the neutral cervical position that the deep neck flexors are able to maintain are going to have a big impact further down the spine; which leads me to my next point.

2. The position of the cervical spine can influence what happens at the lumbar spine. When you create extension at the cervical spine, you have more chances to create extension at the lumbar spine, which we try to avoid when we use heavy loads because of all the shear forces that are going to be applied to the spine.  When deadlifting for example, starting with the neck extended (when your eyes are looking straight ahead) will put a lot more stress on the cervical spine, and on top of that, it will increase the extension shear forces on the lumbar spine.

Cervical Hyperextension = Big No No

This happens for 2 reasons; for one, as I mentioned earlier, the deep neck flexors are part of the inner core, and the inner core needs to be activated to optimally stabilize the spine.  If you’re looking up, the deep flexors are not activated and the inner core will not stabilize as efficiently.  Second, the cervical and lumbar segments of the spine are both inwardly curved (“lordotic”), which causes them to react similarly; if one goes into extension, more often than not, the other one will try to get into extension as well.

3. Coaching and cueing neck position during training is very important.  If you’ve read the 2 last points, this might seem pretty obvious, but we want to keep a tucked and neutral chin during everything we do in training.

This might seem a little retarded, but it really is the optimal neck position to lift with!

When you start noticing the position of your neck and the ones of your athletes during a training session, you’ll realize that the neck tends to go in a less than desirable position (read: too much extension) with many, and I mean MANY exercises: lunges, squats, deadlifts, seated rowing, chin ups, push ups and almost every core exercise possible!  You will honestly be shocked at how much people go into an extended neck position on so many exercises, and most of the time they don’t even notice it.  Notice how much more difficult a simple plank is when you force your chin to stay tucked back.

4. The tucked chin position facilitates efficient breathing.  Being aware of the importance of efficient breathing has been a topic that has grown in importance among the strength and conditioning community lately.  Breathing through your belly instead of through your chest improves diaphragm function and puts less stress on the already overactive neck muscles scalenes and sternocleidomastoid.  Many coaches try to cue breathing through different techniques and exercises to reinforce good breathing patterns.  But the truth is that when you get in a tucked chin position, with your neck packed back, you don’t even need to cue anything; it just happens.  If you’re not convinced, try it yourself: stand up, get our head in a forward position (chin protruded), put one hand on your chest, one hand on your belly and try to take a deep breath.  Now do the exact same thing, but with your chin in a tucked back position (as in the picture above) and take a deep breath.  You’ll notice that, when in a tucked back position, without even thinking about it you’ll breathe through your belly much more easily.  So instead of cueing breathing techniques, why not just cue good neck position?

For more info, make sure to check out Charlie Weingroff’s Training = Rehab DVD set.

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