With the rising popularity of Dr. Stuart McGill and his work on the lumbar spine in the health and fitness community, people have started to understand that excessive lumbar motion leads to injuries.  The extent of his research (which he has been leading for years) have given all of us a better understanding of the spine, how it works, how it should move, and what leads to injuries.

This is a MUST read. Period.

Like many other things in the fitness business, it caused an overreaction.  We started avoiding movement at the lumbar spine at any cost.  We started to focus on the hips and the thoracic spine as the places to improve mobility, which I’m not going to say it’s a bad thing because that is exactly what most people need; more mobility in the t-spine and the hips.

This overreaction, though, caused us to ignore that there is a certain degree of movement that is normal to have at the lumbar spine.

As you can see in the chart, although the biggest potential for rotation is at the thoracic spine, the lumbar spine still have a couple of degrees of rotation.  The same thing applies for flexion and extension.

To better understand the reason to why we actually need range of motion at the lumbar spine I’ll refer to the pendulum theory that Charlie Weingroff introduced a little while ago.  To quote Charlie:

“So every joint has a core and it has a neutral that is decided just like a pendulum.  It has to know that the stiffness properties allows it to go all the way to the left, right, front, back, etc., so it can rest with no effort in the middle, the position of optimal force transfer.

The clinical application is that the spine’s neutral is a function of full flexion, full extension, full side bending, and full rotation. Then and only then does the core have it’s premiere chance to do as little work as possible for segmental stabilization, and the phasic lumbar muscles can pick up the bracing slack to handle huge loads and force transfers.

If you don’t have yoga-ish mobility, the middle is always off-center, and the local stabilizers (of any joint system) aren’t triggered ideally via the brain getting “wrong” feedback from the joint receptors (…)”

What this means is simply that if your body doesn’t have a proper “neutral”, everything is going to be affected, compensation takes over, and injuries eventually happen.

Even if the goal should always be to lift weights and reinforce proper movement pattern with a perfectly neutral spine, it doesn’t mean that you’re body shouldn’t “own” that range of motion at the lumbar spine.

My personal story is a pretty interesting one in this regard.  Since reading the work of Dr. McGill years ago I became a strong advocate in limiting motion at the lumbar spine.  When I say I was doing everything with a neutral spine, I mean everything: sitting, brushing my teeth, tying my shoes, and even putting socks on in the morning!  Have you ever tried putting socks on in the morning without allowing any sort of lumbar flexion? Trust me it’s not that easy!  But I was doing it!

Not quite like this, but that far off!

I was also getting pretty strong for my height and my body structure, I was deadlifting a decent amount of weight and I never allowed myself to have anything less than perfect form on every single rep I was doing.

About 2 years ago, I started to get a little less zealous about the whole neutral spine thing in my everyday life.  A couple of months later, I was brushing my teeth in the morning and as I was bending over to spit in the sink I felt a sharp pain go through my right lower back just above my right SI joint.  A couple hours later, I couldn’t bend over at all, and I mean not at all.  Even breaking at the hips slightly to grab a glass from the kitchen table was impossible.  The pain started to go away after 3-4 days, but my back bothered me for a couple of weeks.  And weirdly enough, a similar event happened about 8 months later.

It’s only when I learned about the SFMA, the pendulum theory and other philosophies along the same line that I realized that my lumbar spine wasn’t flexing at all, which was later confirmed to me by a good friend of mine who’s an enlightened physical therapist.

I’ve been working on my lumbar flexion more recently and making sure my toe touch, as per the SFMA, stays intact and turns out my back has been feeling much better.

That doesn’t mean I’m doing silly stuff like stiff-legged deadlift with a rounded back, or crunches and sit-ups, but I’m doing isolated mobility exercises that don’t involve any type of loading to make sure that my pendulum is in the right “neutral” position.

Do you ever assess for lumbar range of motion?  You might be surprised at what you’ll find.

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Sorry.

Wrestling reference.

That’s the first thing that came to mind when I wrote the title of this post.  Hopefully you can appreciate.

Aaaaand just so you know I didn’t write this title just to plug a wrestling reference! I promise.

In fact, I was at the BSMPG summer seminar this past weekend and I had a blast.  I got to spend some time with the smartest minds in the business including Patrick Ward, Sean Skahan, Cal Dietz (University of Minnesota), Joel Jamieson, and Jim Snider (University of Wisconsin) just to name a few.

The recurring subject that came back with a lot of these guys during conversations is that…well…you have to know your role!  What I mean is that as a strength coach you need to recognize your area of expertise, and more importantly you need to know where that area of expertise stops.

It’s really cool to learn about the SFMA, DNS, ART, Graston, Mulligans, all the rehab protocols, but we need to recognize that a lot of these things are not our job to do.  There is nothing wrong with learning from different fields, but not with the mindset of doing everything yourself!  As Patrick Ward was telling me himself: “we need to know just enough about everything to know where to refer our clients to and when”.  I couldn’t agree more with this statement.  Joel Jamieson was also telling me that coaches get too caught up sometimes trying to fix people, and their sessions turn out into an hour of corrective exercises.

Don’t get me wrong: I think it’s extremely important to be able to bridge the cap as a strength coach because there always will be some grey area, and we can’t send every one with a mild discomfort to physical therapy.  Which is why we need to understand how the body works, what is good movement, how to identify dysfunctions or imbalances, and how to use corrective strategies efficiently.  But our job is still to TRAIN ATHLETES!

I will be the first to recognize that there is a lot of incompetent health practitioners on this planet, but it doesn’t mean that you should try to fix everyone yourself.

Our job is to make athletes and clients feel better, improve their performance and lower their risk of injury.  If they’re in pain, that is not our job to take care of them and fix them.  And that’s the bottom line.

Another wrestling reference. Sorry.

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When we think about assessment, we often think about assessing range of motion at different joints and in different angles.  The Thomas test to test hip extension, the Ober test (or adduction drop test as the PRI folks would call it) to test adduction, internal and external rotation both at the hip and at the shoulder are all examples of range of motion measurements.  Although I can’t say these tests aren’t useful because they do have a purpose and they do give you valuable information about a client, do those tests should be the focus of our assessments?

I ask the question because I really don’t hold the absolute truth on the subject, but here’s something to think about with the way we approach our assessment protocols: are we more interested in isolated range of motion at different joints or how the body move as a whole?  We’ve been big proponents of multi-joint exercises and training the body as a whole for quite a bit by now.  We know that the body doesn’t work with in isolation, and with what we know about the fascial system now and with the work of brilliant people such as Thomas Myers we know that isolation pretty much doesn’t exist at all in the body.  So if anatomy and movements don’t work in isolation and we don’t train the body that way, it would only make sense to assess the body the same way, wouldn’t it?

With all this fascia do you really think you can isolate one muscle at one joint?

A lot of you are already familiar with the FMS as an assessment tool.  A couple of you might be familiar with the SFMA, which is another more advanced assessment tool geared more towards physical therapists and the medical crowd.  As simple as those assessment protocols seem, there might be more to it than just ranking a client from 0 to 3 on different tests.  I’ve been reading Gray Cook’s Movement book for the last week or so, and I just realized that an assessment like the FMS is much more than what it seems.

It assesses movements patterns and it can tell you a lot about how your clients and athletes move.  It also assesses how the body moves as a whole, not in isolation and not by measuring isolated range of motions.  Dysfunctional movement patterns are really easy to spot using that assessment and using correction strategies to fix those test might be all someone needs to move properly and stay out of the “injury risk” zone that we know can lead to bigger problems and injuries in the long run.

Again, I’m not suggesting that isolated range of motion measurements don’t have their place.  But assessing movement patterns might be even more important because it’s the way your body moves as a whole that’s going to matter in the end.

Food for thought.

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