In this podcast I interview my friend Rob Andrade, a doctor of physical therapy. Rob does a good job of straddling the coaching/training world and the physical therapy world. His bias is obviously on optimal movement and a healthy client, but tapping into his hard science knowledge of things like motor control, muscle physiology, etc. is interesting and helpful to a coach. I’d like to have more interviews and makes ome videos with Rob in the future, so feel free to send questions.
Knee pain is common in lifting, and it’s nearly 100% caused from a) poor mechanics and b) some sort of hip dysfunction. This Chalk Talk doesn’t get into lifting or movement mechanics, but instead addresses some palliative treatment and soft tissue work you can do to alleviate some of the pain.
Generally speaking, knee pain should tell you to work on hip mobility, especially with the rectus femoris. This muscle crosses both the hip and the knee, so if it’s tight, it’ll tug on it’s lower attachment near the knee (i.e. all of the quadriceps flow into a common tendon that attaches to the patella, which then attaches to the tibial tuberosity) and cause pain in the center of the knee, usually under the knee cap.
One thing we can do to try and alleviate tension is soft tissue work on the rectus femoris itself, and then on some of the other quad muscles.
Note that this precision soft tissue work works well when it occurs before stretching; it’s difficult to stretch a muscle that hasn’t had tension worked out of it. I like to follow this soft tissue work with the couch stretch, like in this video.
Dr. Stuart McGill is a professor of spine biomechanics in the kinesiology department at the University of Waterloo and is renown as being an expert on back health. According to his academic profile, his department is concerned with (my paraphrasing) a) understand how the low back functions, b) understand how it gets injured, and c) create prehab and rehab methods based on their findings.
McGill is an expert with a variety of textbooks used in academia as well as folks in the fitness or strength and conditioning fields. This .pdf titled “Designing Back Exercise: from Rehabilitation to Enhancing Performance” from his website provides a collection of useful information. Points of emphasis in the article include:
- A proper history taking of a client
- Analyzing a client’s movement and determining faults (pg 4-5)
- A sequence of events for rehab (pg 6)
- The “big 3″ stabilization exercises (pg 7)
- And developing athletic ability (pg 9)
McGill’s work is logical, easy, and effective. It has made me consider the importance of proper spinal function and positioning in lifting and athletics, and I’ve implemented them in my coaching in barbell mechanics. You’ve probably seen recent videos where I keep referring to a “strong, stable trunk” with an emphasis on “contracting the lower abs”, and I now teach it as a fundamental concept for barbell training.
Proper spinal mechanics in all movements is vital in order to prevent unnecessary injuries. I pay close attention to how trainees and athletes move, sit, stand, and lift, but in the past I have not put as much of a focus on “active spinal awareness”, which is basically making a concerted effort to align the trunk properly.
What does this mean for lifters? CrossFitters? Strength and conditioning athletes? It means that by utilizing contraction in the lower abs during lifts, we can maintain a neutral relationship between the trunk and the pelvis. If that relationship changes via too much lumbar extension or flexion, anterior or posterior pelvic tilt, or other instability, then it can at best not transmit force effectively and at worst result in an injury. It also means using spinal stabilization exercises in order to create endurance and habit for good spinal position.
Dr. McGill’s “big three” exercises can train help train this endurance and habit. In this video, he talks about four total exercises — the curl up variation, the bird dog, the side plank, and a moving plank on a ball. I know what you’re thinking: it looks like silly conventional fitness crap. These exercises aren’t supposed to build back strength, but instead they increase endurance in the back’s postural muscles so they can maintain a good, neutral position. The key to these movements is proper position, then endurance. They also teach the “skill”, or motor program, of what a correct spinal position is. Most people are in a perpetual state of instability with their spine; sitting in flexion or standing in hyperlordosis, for example. Ideally the trainee would work on their posture throughout the day in congruence with these prehab/rehab exercises, and they would improve their spine’s default position.
Given the increasing participants we have in lifting, CrossFit, powerlifting, Olympic weightlifting, and other related activities, there will always be injuries, particularly in the lower back and sacral area. Usually these injuries can be prevented with better awareness, coaching, and physical preparedness. By using the “big three” exercises in a warm-up and/or cool-down in training, trainees can be taught what is “correct” and self-diagnose what is “wrong”. Compliment it with improved coaching of the barbell lifts and it’s possible to prevent injuries, or at least the severity.
Give these movements a try in your training. Don’t expect them to have immediate impact, but look for long-term improvement. Start being self aware of what your trunk and pelvis are doing throughout the day, especially when lifting.
The press is a fantastic exercise because it integrates the entire body and creates the largest kinetic chain exercise; everything from the feet articulating with the ground to the hands holding the bar overhead. It’s a significant trunk builder, but press mechanics and strength are better expressed when the trunk is purposely contracted and tightened.
In this video you’ll see an example of a press without trunk tightness followed by reps where an emphasis is placed on tightness.
There’s something I cued her to on a few days later that made an additional impact: I cued contraction of the quadriceps after explaining the importance of making the entire body stable. If the quadriceps have tension, it will prevent the knees from unlocking. If the knees unlock as the press rebounds out of the bottom, the lifter loses some of that force application in the soft, unstable knees. Maintaining quadriceps tension prevents that force loss, but also helps provide a very strong, stable base to press from. Contracting the quadriceps with the entire trunk (with an emphasis on the lower abs) made Aly’s reps much faster and easier, even compared to the final reps in the above video.
Note that this emphasis on trunk stability via tightness and keeping tension on all relevant joints and muscles should be applied into every lift.
Friday I put the image to the right in the PR Friday post and asked people to explain what was wrong with it. There were a variety of good points, but I wanted to focus on the thing that stuck out to me. Before we begin, let’s all agree that the fact this girl is squatting is more important than not squatting; this concept always trumps any bickering that follows. With that being said, I teach that if you’re going to spend the time doing something, do it in the most efficient manner possible.
For the sake of giving this girl credit, she’s got a decent bar positioning, is trying to apply force with the lateral part of her foot (to prevent a navicular drop AKA collapsed arch which medially rotates the knee and hip), and she is probably at an appropriate depth (this picture is a weird angle). It’s possible she’s doing this weird-ass squat on purpose, but we’re gonna talk about it anyway.
As a lifting coach you’ll see many things wrong with a given lift – feet, knees, hips, trunk, shoulders, chest, elbows, grip, neck, etc. — and you can’t and shouldn’t try and correct all of them at once. Fix the thing that will have the greatest effect on the gross movement. In this case I’d start with the stance.
A wide stance inherently does not allow significant external rotation relative to foot position. External rotation allows the following:
1. It contracts the external rotators.
2. It lengthens, and therefore creates tension on, the internal rotators.
3. Therefore it creates greater tension about the hip. Tension around ball and socket joints means more stability therefore strength.
4. It maximizes the musculature used about the hip. In this case, assuming a good foot-to-ground interaction, force is more easily distributed across the lateral portion of the thigh on both the front and the back. Valgus, or knees in, knee positioning removes this area of musculature and emphasizes the medial quadriceps. As I explained last week, external rotation also allows greater posterior chain involvement, even in the high bar.
5. Externally rotating the hip prevents impingement of the femur against the anterior portion of the acetabulum (i.e. the leg bone from impinging on the hip socket). Avoiding this impingement facilitates squat depth as well as maintaining proper trunk positioning while achieving depth; squatting with knees forward will impinge the hip and posteriorily tilt the pelvis, which makes the person look like a pooping dog. Rippetoe’s “Active Hip” (it’s a pdf) article talks more about this.
When I see poor external rotation, I see a number of ways a squat can be improved, so it’s something I want to focus on. In her case, I’d narrow her stance to about shoulder width and emphasize the external hip rotation. Chances are I would not have to change much else with her, but it would be the first thing to make a habit before worrying about anything else. The first Chalk Talk episode briefly talks about cuing external rotation, but I’ll get into in a later post.