Is our body really made up of ‘Separate’ parts?

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Last week I was in New York and in the hotel where I was staying, as well as all over town, I noticed some marketing material for ‘Bodies….The Exhibition’ which happened to be appearing at the South Street Seaport Museum in downtown Manhattan whilst I was there.

You may or may not be aware but only last year, there was a very similar exhibit being hosted in London, which I unfortunately never got round to seeing. I think that sometimes when something’s on your doorstep its easily taken for granted, and before I knew it the opportunity had passed me by. Realising that I’d been given a second chance I decided to make the most of this opportunity whilst I was there and even dragged my family along.

I’ve been to a couple of post mortems in the past, during both my undergraduate and master’s degrees, one of which we were even allowed to handle the body parts, but this exhibit was a different experience completely.

The exhibit was divided into different rooms, each devoted to a different sub system in the body including the skeletal system, muscular system, respiratory system, nervous system, circulatory system, digestive system and the reproductive system with the relevant information and display in for each section.

As I left I couldn’t help but reflect on how, in our quest to understand the human body further, we have divided body into different sub systems, then divided each system into different parts and how medical professionals even specialise along these lines. And although by doing this we may have a better understanding of how each specific part works, we often overlook how each part interacts with one another in order to contribute to how the body functions as a whole.

Generally speaking, I think that everybody appreciates that the heart is only part of the cardiovascular system, the lungs are only part the respiratory system and the spinal cord is only part of the nervous system and more importantly they understand that none of these parts function in isolation.

However, for some reason this fundamental principle is often over looked when teaching students about the muscular system. In the very first year of my degree I had a module called ‘functional anatomy and biomechanics’ where amongst other things I had to learn the origin and insertion of each muscle in addition to what action each muscle able to do.

For example, here is an image which shows which shows the origins and insertions of the hamstring group that you typically find in an anatomy book

According to the majority of anatomy text books, this group of muscles contract to flex the knee and extend the hip. In reality, the hamstrings do far more than that, but that’s a topic for another time. The point I’m trying to make is that we are taught what each muscle does in an isolated role but we often overlook how they work as part an integrated system.

“the ‘biceps brachii’ can only exist as a separate structure with a knife’s intervention to divide its ends from various attachments, its connections with surrounding myofascial units such as the brachialis, as well as its nerve and blood supply, without which it simply could not function”
Thomas Myers – ANATOMY TRAINS

What we must realise is that looking at the isolated function of any muscle tells us NOTHING about movement, as all movement requires integration of the whole musclular system!!!

In fact, the more I think about it the more there is to think about (are you still with me?), with regards to movement the muscular system is still only a very small part of a very big picture. Bear with me for a second, but aren’t bones just as necessary for movement? So the muscular system and the skeletal systems are only a part of the musculoskeletal system.

And the fact is, if we are talking about muscles and bones, we CAN NOT ignore fascia. Afterall, the fascial net is one single connected unity in which all the bones and muscles ‘float’. We also know that compared to muscle, fascia is proprioceptively rich and therefore is constantly communicates with the nervous system and these two systems collectively form the neuromyofascial web.

“The muscle-bone concept presented in standard anatomical description gives a purely mechanical model of movement. It separates movement into discrete functions, failing to give a picture of the seamless integration seen in a living body. When one part moves, the body as a whole responds. Functionally, the only tissue that can mediate such responsiveness is the connective tissue.”
Feitis Schultz – THE ENDLESS WEB

The fact is that MOVEMENT REQUIRES INTERGRATION BETWEEN FASCIA, MUSCLES, BONES AND NERVES. And this is only from a pure biomechanical viewpoint and doesn’t even take into account the importance of energy to movement, which means we mustn’t underestimate the importance of nutrition (digestive system) and hormones (endocrine system) for movement.

So before I get carried away, let me rephrase what I said earlier, What we must realise is that looking at the muscular system still tells us ABSOLUTELY NOTHING about movement, as all movement requires integration of the whole musclular system with other systems!!! And I for one believe that it’s about time that we, as health professionals, start thinking across systems!

Barefoot training

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This post is a little more random than usual but I recently had a conversation with another PT on the topic of barefoot training which has been playing on my mind ever since so I’m hoping that putting my point across in a post like this I might finally be able to lay the ghost to rest once and for all.

It seems that almost every time my friends and I meet up with this particular PT he tries to sell us these ‘Vivobarefoot’ running shoes. He also seems to believe quite strongly that a mixture of corrective exercise and barefoot running can solve ANY foot problem. Over the last year so I’ve done a little of reading on barefoot training so I was very interested to hear what he thought, in the hope that I might learn something new. Unfortunately this wasn’t the case, so I thought I’d share my opinion with you as it’s something that I feel quite passionate about.

Now it’s just my opinion, and I fully acknowledge that I’m still learning, but whilst I am aware of the many benefits of barefoot training I think that to say that all foot problems can be solved by teaching you to run barefoot is a pretty bold statement.

As we continued our discussion he also made another interesting comment suggesting that orthotics are completely unnecessary. Admittedly, there was time when I thought that everything could be fixed through exercise. In fact, here is an extract from a previous article I wrote in 2010:

‘In recent times our understanding of functional applied science has come a long way. We are learning to develop neural control and strength of our core musculature rather than rely on weight lifting belts and resistance machines with fixed paths of motion to provide external stabilisation.
Can we apply the same functional principles to our feet? Of course we can….If you have a ‘fallen’ or ‘collapsed’ arch, why can’t we train your feet to develop the neural control and strength required to hold the foot in a neutral position instead of relying on orthotics or supportive trainers to provide external stabilisation (just as you would with a weightlifting belt)?
You could argue that to recommend orthotics yet scoff at wearing a weight lifting belt is quite hypocritical as you failing to apply the same sound functional principles to the foot as you applying to the spine’

To this day, I still do believe that exercise can help people overcome a lot functional limitations (which are less osseous and more soft tissue related). However, since learning more about structural foot deformities with Cor-Kinetic, I’m now aware that in some cases structure will always dictate function and in this scenario othortics may provide an alternative solution.

Let’s take someone who has a rearfoot varus coupled with a forefoot varus, for example. A forefoot varus is where the forefoot is inverted relative to the rearfoot. And a rearfoot varus is where the rearfoot is inverted relative to the lower leg.

A common problem with someone with a this type of structural defortimy is that the STJ has to go through excessive pronation (i.e. not a problem with pronation itself but a problem with the AMOUNT of pronation, more on this in a future post) in order to get the forefoot to the ground to load it during gait.

This may cause the foot to supinate later in the gait cycle than it should, or even worse it may not even supinate at all meaning that the client ends up pushing off of a flat foot, which could have repercussions at the foot as well as be detrimental to the rest of the kinetic chain (knee, hip, lower back).

Now I’m not entirely sure, but you could argue training barefoot may magnify any symptoms/problems in a client with this type of structural foot deformity. I personally would argue that a more tailored approach is necessary, and perhaps the use of a custom made orthotic may be useful in this particular scenario.

Here’s another point, what about people with leg length discrepancies? I haven’t personally come across any literature which has shown that barefoot training can alter the length of your bones. Have you?

Let me make it clear that I’m not disputing the many benefits of barefoot training, in fact, most of the time I actually train barefoot myself. I’m just saying that I do not believe that it is for everyone!

One of the most significant things that I have taken away from my mentorship with Cor-Kinetic so far is that there will never be a set solution for any particular problem. What works with one person with a specific problem will not necessarily work for another person with the exact same dysfunction or as Ben Cormack puts it A+B doesn’t always equal C.

If I go back to my personal principles of function for a second, one of my most fundamental principles, not just of function but of training in general, is the Principle of Individuality or ‘individual differences’. I don’t believe that any one technique or method of training claim to be the solution for everybody and I’m more than a little cautious of any person who believes that there is.

If there is one thing I am sure of, it’s that there is no ‘one size fits all’ solution to training, otherwise every trainer would be doing it. I think this is a classic example of a fitness professional trying to define a client’s function. A better approach is learning to understand our clients function rather than trying to define it, so that we can adapt our training methods or techniques to suit THEM not the other way around. Put simply, our clients function should be defined by THEM not by us.

And in order to do this we need to learn more about the body rather than specific techniques or methods of training. And once we fully understand how our client functions (and a lot of the time, more about their dysfunction), we can then make an informed decision with regards to which technique to try with them. And most importantly, it is THEIR RESPONSE to our chosen technique that will tell us whether we have chosen correctly.

Density Training: A Different Approach

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As I’ve mentioned in previous posts, one of the most fundamental principles of training is THE PRINCIPLE OF PROGRESSIVE OVERLOAD. This principle basically states that in order for our body to adapt you need to apply a stress or load which is greater than it is normally used to.

It also states that the level of improvement will also plateau over time (sometimes referred to as ‘Repeated Bout Effect’) as the body adapts to the imposed physical stress. So in order to continue getting your results, you must provide progressively more overload than you did before.

There are so many ways to overload the body during training, most common include lifting heavier weights, doing more reps during each set, doing more sets in total, or by increasing the length of working intervals, just to name a few.

But without question, one of the most overlooked way of progressively overloading the body is to increase the ‘density’ of your workout. Put simply, increasing the density of your workout just means doing more work with the same amount of time.

For example, if during your last workout you did 12 press ups in 30 seconds, you can increase the density one of two ways, either by doing 15 press ups within 30 seconds, or by doing 12 reps within 25 seconds.

In a previous article I introduced you to Charles Staley’s Escalating Density Training (EDT), which as the name suggests requires you to increase the density of each workout.

Personally, I’m a big fan of Staley’ EDT. However, having used it with several clients in addition to my own training I have to admit that at times I’ve found that it can be a little unpractical.

In my gym we only have one pair of each dumbbells so hogging two pairs for a whole 20 minutes has caused more than a little friction on more than one occasion, especially during peak times when there’s already way too much testosterone floating around the free weights room.

Let me make this clear, there is nothing wrong with the training system itself. If my client and I were the only two people in the gym, charles staleys EDT routine would definitely be a viable option. Unfortunately, I don’t have this luxury, especially when I’m training an evening client. Between 6pm and 9pm I’m lucky to find a set of dumbbells to use, let alone two pairs or god forbid a bench. And even if you are lucky enough to find a bench you can bet your arse that the second you turn your back to do your second exercise you will lose that bench to some meat head.

The final straw for me came during my last phase of EDT, I was 3 weeks into my program and really looking forward to beating my previous scores but I had to ‘work in’ with another gym member which resulted in me being unable to beat my score, because I had to keep waiting for him to finish his set in between mine. Needless to say, I was not a happy bunny!

It was because of this incident that I went back to the drawing board and created my own density training system. Now I’ve not exactly reinvented the wheel here, I’ve just adapted an already fantastic system into something I can do with my clients regardless of how busy the gym is.

My Density Training System

No machine exercises

There are so many reasons why I decided to ban machine based exercises from this program but for the sake of keeping this post short and not going into one of my rants I’ll tell you three reasons why I decidced to ban all machine exercises. To start, I’ve never been a big fan of fixed resistance machines because they limit the natural movement of the body by forcing a fixed path of resistance, which can lead to pattern overload. Secondly, we know that isolating or emphasising one particular muscle using machines can cause muscle imbalances. My third and final reason is that it’s almost impossible to have a machine to yourself in a gym without someone else asking to work in with you, especially during peak hours, and trust me, there is nothing more frustrating than someone messing up your rest time when they work in with you.

Train movements not muscles

My first reason is that the body recognises movements, not muscles. So instead of a chest press, why not use a horizontal rowing movement. When more muscles contribute to a movement, we can use a heavier loads, meaning we can build more muscle and burn more calories. Also, due to the fact that you are only required to do 4 exercises each session my intention was to choose 4 exercises which I felt worked the most muscle and therefore provided the most effective full body workout.

Whilst on this subject, I onlyuse full body workouts or an upper/lower body split with my clients. Dedicating a whole workout to just one muscle only works if you are on steroids. You can try a pull/pull split, however, I haven’t tried it yet on myself or with clients
The following is an upper body density workout that I like to use with my paying clients:

Pair 1
Horizontal Pushing Exercise
Horizontal Pulling Exercise

Pair 2
Vertical Pushing Exercise
Vertical Pulling Exercise

The aim is to have two different upper body workouts based around the same movements. For example Workout A may have a bent over barbell row and Workout B may have a single arm dumbbell row as their horizontal pulling movements. By doing this each muscle is hit every workout and therefore has a repeated exposure to hypertrophic stimulus but from a slightly different angle to avoid pattern overload and overtraining.

No longer the need to train against the clock

Admittedly, I was pretty gutted that i had to change this aspect of the system. There’s nothing I enjoy more than competing against myself whilst working against the clock. However, there is nothing as frustrating as somebody else eating into your time by sharing equipment.

So I decided to base this system on doing 60 reps. I know what you’re thinking but I can assure you that my system is not another high volume training system like Charles Poliquins German Volume Training (GVT) or Vince Gironda’s 8×8, which are two fantastic muscle building systems.

Remember, our aim is to progressively overload the body by increasing the density of each workout. And in order to do this we need to do more work in less time. Here’s the program

• week 1 – 20 sets of 3
• week 2 – 15 sets of 4
• week 3 – 12 sets of 5
• week 4 – 10 sets of 6

So although you are performing 60 reps each time you workout, you should aim to do it in less time each week as you do less sets with more reps. Admittedly, I don’t always start with 20 sets of 3. Most of the time I start with 15 sets of 4, and once my client can do 10 sets of 6, I increase the weight by 5% for their next workout and aim for 15 sets of 4.

I know what you’re gonna ask next so I’ll put you out of your misery….you should aim to complete each workout with you 8 rep max. And please note that your 8RM is NOT the weight you normally do 3-4 sets of 8 with. It’s the weight that you cannot do a 9th rep of even when fresh!

If you’d like to try density training but find it impossible to do in your gym give this system a go and let me know how you get on.

Functional Assessments

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I haven’t put anything up in a while, I’ve had quite a manic start to the year, with work, family and with the mentorship program I’ve started with Cor-Kinetic there just doesn’t seem to be enough hours in the day.

One of the very first things that I learnt on the mentorship program is that every strategy and technique I use with my clients should be based on my principles of function. Ever since then I’ve been analysing everything I do in the gym both with my clients and my own training.

That got me on the trail of thinking about the assessments I have used in the past with clients in the sports injury clinic as well as the gym. Surely if techniques and strategies I use for treating these injuries are based on these principles, so to should my assessments, right?

However, when I really think about it, I think that the vast majority of assessments I’ve been taught so far completely fail to take into account what the body does in function.

20120217-143359.jpgAt the risk of being a little controversial I’ll use the Trendelenburg Test as my example.

To perform the Trendelenburg test, you start in a standing position with your feet shoulder width apart and slowly lift one foot off the ground, whilst balancing on one foot.

A positive test or Trendelenburg’s sign is when the hip of your non weight-bearing leg drops or is lower than the other side. Apparently this indicates that the glute med on the weight bearing leg is ‘weak’ or ‘underactive’ as it is unable to stabilise your pelvis.

To be honest, there is so much about this test that doesn’t reflect my principles of function, that I really don’t know where to start.

First of all, by saying that a positive Trendelenburg Test indicates ‘weakness of the glute med’ goes against two of my most important principles of function; that the body recognises movement, not muscles and that all movement is integrated.

So thinking in terms of movement, would it be more accurate to say that the Trendelenburg Test is testing the ability of the body to abduct the hip? However, when we consider the principle of specificity, can a positive test really indicate that your hip abductors are ‘weak’ and unable to abduct the hips, or just that they just can’t abduct the hips whilst in this specific position?

It’s important to note that because a joint might not be able to go through a certain motion whilst in a particular position, it doesn’t mean that it will not be able to go through that same motion from another position. Taking this into account, can this test tell us anything about dysfunction in any other position than that being used in this assessment, I personally don’t think so!

Maybe it would be more accurate to say that the Trendelenburg Test is testing the ability of the body to abduct the hip whilst balancing on one leg?

Now I don’t know if I’m over thinking this a little, but the more I think about this assessment the more I ask myself whether this assessment even tests hip Abduction, or just the ability to hold your pelvis horizontal or parallel to the floor. Just think about it for a second, this test has absolutely nothing to do with the POSITION or the MOTION of abduction. I’m not saying that your abductors aren’t working, just pointing out that the test doesn’t require you to go through the motion of abduction, or hold the position of abduction, as a negative test would require you to keep your pelvis in a pretty neutral position in the frontal plane(as in neither adduction or abduction).

So, perhaps it’d be more accurate to say that the Trendelenburg Test is testing the ability of the body to keep the pelvis parallel to the floor whilst balancing on one leg.

Let me ask you this, can you think of a single functional activity which would requires you to hold this particular position? Which brings me to my final and probably most important point, what can this assessment tell us about movement? During all movement muscles are constantly going through a cycle of loading and unloading. The simple fact that the Trendelenburg Test requires you to hold an isometric contraction means that this test doesn’t tell us anything that can be related to movement.

Things like NASM’s ‘Overhead Squat’ and ‘Single Leg Squat’ assessments and Gray Cooks ‘Functional Movement Screens’ are a definitely step in the right direction in that at least they analyse movement. I still use them from time to time with my clients, but when we take into consideration the principle of specificity, it’s important to recognise that these movement screens also provide limited information very specific to the positions and planes being assessed. I recently read a great post by Ben Cormack on this topic which sums it up better than I ever could, it’s definitely worth a read, check it out here

Before I end this post, I want to make it clear that I’m not saying we shouldn’t use them with our clients. I just think that before we perform any assessment we need to ask ourselves, what are we actually assessing? What position do we want to test them in?

Personally, I think that there are far better ways of testing the body’s ability to abduct at the hip which may be a little more functional. However, if we are truly sticking to our principles of function, I think that there shouldn’t be just one test to test the hips ability to abduct or for any other movement for that matter.

What we should be doing is trying to understand our client’s functional needs and designing tests specific for them which will give us more information about how well they function. This is something I’m very keen to learn from my mentorship program.

My Confession

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I have a confession, i’ve been really really lazy! I filmed a bunch of videos videos nearly 2 years ago now and to this day I still haven’t done anything with them.

I originally wanted to make a video of a workout based around exercises using the freemotion cable machine in my gym but unfortunately I never got round to finishing off the rest of the videos.

I had a little play around with what little footage I was able to get and even managed to pop a couple of them up on my YouTube channel. But to this day I still hadn’t put them up on my site or wrote any articles with any relevance to them…that is until now!

So for todays post I thought I’d share some of my personal favourite exercises using the freemotion machine. For the sake of my clients who, for whatever reason, like to know the name of these exercises i generally refer to them as

1. Integrated Cable Pull
2. Integrated cable Push
3. Single arm squat to row

Here is a short video of each exercise:

1. Integrated Cable Pull

2. Integrated cable Push

3. Single arm squat to row

I like them include that they address the following principles:

INTEGRATION

The human body was designed to move in a variety of directions at a variety of speeds. In order to move effectively your muscles need to work in synergy with one another. Opting for Integrated exercises such as these over traditional ‘isolated’ exercises will reinforce and enhance functional synergystic movement patterns.

Remember, the body is stroger as a whole than the sum of its parts. Taking this into account, by using integrated movements such as these your clients will be able to move bigger loads, meaning that they will burn more calories! And as you can see from the above videos the freemotion cable machine provides us with a great tool for training intgrated dynamic movement patterns.

RHYTHM

In order to dissipate forces generated from ground reaction and gravity we need to
to move in a rhythmic motion. In doing so we are able to train within our ‘zone of transformation’. The zone of transformation is a zone that occurs during movement where the muscles switch from a loading to an unloading phase.

The loading phase is where muscles decelerate momentem through eccentric loading in all three planes of motion. The unloading phase is where the muscles contract concwntrically to accelerate momentem in all thrre planes of motion. The moment that occurs between these two reactions where the body changes from a loading to unloading phase is known as the ‘zone of transformation’.

Training the transformational zone will teach your body to load and unload more effectively and enhance proper joint function.

The final reason I love these exercises is that they provide a great workout!!!

One final word….in my gym I usually see people using this machine to do ‘cable crossovers’, ‘tricep pushdowns’ and ‘bicep curls’. However, there are so many exercises that you can do on this machine, you are only limited by your imagination. so to start you off here are a couple more videos with a few ideas for you to try out in the gym next time….

Try one of the exercises in this video instead of sitting at a lat pulldown machine or doing any vertical pulling exercises for that matter…

Try one of the exercises in this video instead of doing a seated cable row or doing any Horizontal pulling exercises for that matter…

Before I end this post, let me just say that this is miles from a definitive guide of exercises that you can do on this machine but hopefully it should give you a few ideas to to start you off. Remember, our bodies were designed to move in a variety of directions at different speeds, and this machine provides us with a great tool for training integrated dynamic movements, all you need is a little imagination.

Is the TRX Bicep Curl a Functional Exercise?

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I was at a course recently where two trainers were debating whether or not the TRX is a functional exercise. I thought it was quite interesting so I’ve decided to share it with you on this site. One was arguing that it WAS NOT functional as it doesn’t replicate a movement that you would do in the ‘real world’, whilst the other was saying that it WAS functional because it challenged stability and required the body to work more synergistically as integrated unit. Who do you think is right? Although they both made good points and spoke total sense, in my opinion I don’t think either of them were right.

Let me explain my reason behind my view point. Earlier in that very same course the tutor defined functional exercise as ‘Movement with Purpose’. I quite liked this definition. And if we take this into account is seems that the two trainers had completely missed the point…How can we call an exercise functional if we haven’t defined the purpose of the exercise?

Some of you may recall in a previous post I stated that you can’t define an exercise as ‘functional’ just because it requires you to move in different planes of motion, involves a large number of joints, challenges stability, requires you to overcome the forces of gravity and ground reaction or trains a movement instead of specific muscles.

The TRX Bicep Curl does fill the above criteria, but does that mean it’s more functional? No, it just means that it is more of a ‘functionally integrated’ exercise than a typical traditional bicep curl which emphasises the biceps. (notice that I used the word ‘emphasise’ and not ‘isolate’, for the sake of keeping this post short I won’t even get into the whole ‘single muscle theory’)

For an exercise to be considered functional I think that it needs to have a DESIRED OUTCOME or as the course tutor put it a PURPOSE.
However, if you are looking for an exercise to emphasise the biceps to improve the way they function, you need to first understand the functional anatomy of the biceps.

In most PT courses you are taught that the biceps has two heads. The Long head of the brachii originates on the supraglenoid tubercle of the scapula and the short head originates on the coracoid process of the scapula. Both then come together and insert into the radial turberosity and bicipital aponeurosis into deep fascia on the medial part of the forearm. You are then taught that both heads work synergistically to flex at the elbow (and flex weakly at the shoulder).

However, functionally your biceps work to eccentrically decelerate of elbow extension, pronation of the radioulnar joint and shoulder extension as well as assist in concentric acceleration of elbow flexion, supination of the radioulnar joint and shoulder flexion. You biceps dynamically stabilise the humeral head during movement. Taking this into account, you could suggest that the ‘TRX Horizontal Row’ is just as good an exercise than the TRX Biceps curl and traditional bicep curl for improving the function of the biceps. What do you think?

As always I can’t stress enough that this is just my opinion and it only reflects my current understanding as I am still learning. So feel free to leave a comment to let me know your opinions or even to challenge mine.

Clienst needs Vs Clients Wants

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Let me begin this post by asking you ONE simple question…As a Personal Trainer, Should you give your clients what they WANT, or what they NEED?

Although, this may sound like a simple question I find that it can raise a little controversy amongst trainers. Now before I go on any further, let me make it clear that everything I’m saying in this post is just my opinion, I’m not claiming to be right and you are more than welcome to leave a comment or send an email if you think differently, or the same for that matter.

A typical example, let’s say you have a client who WANTS to lose weight but from a quick visual assessment you notice that they have some form of postural dysfunction. As their trainer do you give the client what they want by helping them burn fat whilst turning a blind eye to their postural dysfunction? Or do you attempt to fix their problem? Can you do both? And if you attempt to do both will you be compromising what they want to achieve?

Personally, I’m a strong believer that it is your responsibility as a trainer to do both. And even if you don’t attempt to address or ‘fix’ the problem at the very least, as a trainer, you need to be aware of the dysfunction in order to know to how to avoid making problems worse. Unfortunately most PT qualifications don’t cover how to do this in their courses meaning that a large number of courses are not only leaving trainers unprepared but also putting gym members at risk.

Here’s your scenario….

For the sake of this post I’ll try to be a little more specific. That same client who wants to lose weight also has a history of non specific, muscular/mechanical lower back pain (for those of you whole like a label) and from a quick assessment they present with an anteriorly tilted pelvis, poor core control and a difficulty activating their gluteal muscles. (For those of you who read my last post should know that I’m describing some of the postural changes associated with Lower Crossed Syndrome (LCS).)

They’ve also been told the following by their doctor:

1. If they lose weight, this will take a little pressure off of their back, and may reduce pain

2. They need to strengthen their core

So they join a gym, start hitting the treadmill hard, and doing some crunches, and maybe even a few planks because they read in a recent issue of Mens Health that these exercises are good for the core. Needless to say, they aren’t losing much weight and their back pain is still the same if not worse, so they quit the gym. However, they are still tied into a 12 month contract, so eventually they do whayt they should’ve done at the beginning and hire a Personal Trainer. This is a pretty common scenario that you will come across.

Option 1 – Give them what they want

You decide to focus on what your client WANTS and overlook their postural dysfunction. After all, they’re paying you to lose weight, not to fix their back, and you’re pretty sure that by losing some weight their symptoms will improve a little.

The best case scenario here is that you’ve had a little training on corrective exercise and you are aware of the structures which may be contributing to the problem so you avoid exercises which may make your client worse. At the end of the day, they won’t lose any weight and you won’t get paid a penny if your client is in too much pain to train.

Unfortunately, in my experience there are far too many trainers out there who completely ignore the problem and just ‘beast’ their clients into losing weight. These are trainers like the ones who you see on TV on shows like the biggest loser who pay very little attention, if any, to technique. And whilst these clients can and very often do lose weight in the short term, it’s only a matter of time before their pain becomes unbearable and they cease training with you, eventually putting all the weight back on again.

NOBODY WINS

Option 2- Give them what they need

Let’s say you have some form of corrective exercise qualification such as NASMs Corrective Exercise Certification (CEC) and you attempt to correct the postural dysfunction during your sessions. I’ll be brutally honest with you, the majority of your clients only care about how much weight they use and how good or bad they look in front of a mirror. They certainly don’t want to pay you £X amount an hour to spend 10-15 minutes doing SMR on a foam roller and then another 20 odd minutes on the mats doing boring static stretches and isolated strengthening exercises that don’t even make them sweat. In this scenario, it’s only a matter of time before they stop turning up for sessions, meaning that they don’t get results and you don’t get paid.

Once again, NOBODY WINS!

Sure you can set them corrective exercises for homework, but in my experience clients very rarely follow these instructions.

Option 3 – Do Both

That’s right, there is a third option. Here’s how you can give your client what they need AND what they want, thus justifying the money they pay you.
Pick 3-4 integrated exercises that will correct their dysfunction, and perform the back to back in a circuit manner seconds each. In this scenario I would personally choose the following 4 exercises

• Reverse Lunge with bilateral overhead reach in the sagittal plane
• KB Deadlifts
• Sagittal Plane Hip Drivers
• Double Hand Kettlebell Swings

Here is a quick rationale of why I would pick these particular exercises:

KB Deadlifts

I’m sure that I don’t need to spell out the benefits of the deadlift. However, I will say really quickly that the deadlift (or at least some variation of a deadlift) is an exercise that I perform with almost all of my clients with a body composition related goal. The only time I don’t include a deadlift in a program like this is if a client can’t perform a deadlift with safe technique.

On that note, let me tell you why I would use a deadlft with this particular client. One of the main reasons would be because it’s a great exercise to teach lumbo-pelvic dissociation. Initially a lot of clients with LCS find it very difficult to separate lumbar extension from hip extension, I find that once they learn to perform a deadlift with good technique lumbo-pelvic dissociation becomes second nature.

The Deadlift is also a very functionally integrated exercises which requires lots of muscles to work synergistically. This means that they can lift heavier weights and therefore burn more calories.

Reverse Lunge with bilateral overhead reach in the sagital plane

My main reasons for choosing this exercise is that this movement can improve glute activation, hip extension and dynamic core stability of the Lumbo-Pelvic-Hip Complex (LPHC) as well as teaching lumbo-pelvic and lumbo-thoracic dissociation.

First of all, as your client steps back to extend their hip and knee joints together, their glutes activate to prevent your lumbar spine from hyper-extending. This movement will also eccentrically load their hip flexors and the connective tissues surrounding them in the sagital plane.

This exercise will also improve your client’s ability to control movement and maintain their alignment of their body during movement due to the fact that they are slightly off-balance for a second as they step back.

By instructing your clients to reach both hands overhead in the sagital plane you are also creating a reaction in both their thoracic spine and a little further away in their hips. As their hands pass shoulder height, thoracic extension will occur and the hips will also be driven further into extension. Please note that that the key word here is REACTION as opposed to a conscious muscular contraction

Finally, by controlling the movement and not allowing lumbar extension to occur, this serves as a great dissociation exercise to dissociate lumbar extension from both thoracic extension and hip extension.

Kettlebell Swings

There are many reasons why I would choose this exercise for this client. But before I tell you about them I want to make it clear that I would only select this exercise if the client has already demonstrated good lumbo-pelvic dissociation in the previous exercises and are able to successfully hinge at their hip without any movement at their lumbar spine.

As mentioned previously, clients with LCS typically present with a weak posterior chain and tightness through their anterior chain. If performed correctly, the Kettlebell swing is a one of the best exercises for developing strength in the posterior chain whilst improving the range across the hip joint in the sagittal plane of motion.

In addition to this, the KB swing is an exercise which if done for long enough will get your clients heart pumping and stimulate a decent metabolic effect.

Sagital Plane Hip Drivers

I love using sagital plane hip drivers with my LCS clients. I was first introduced to them by Gavin Attore when I attended a 2 day AFT Skills course back in 2010. Here’s a short video of one of my clients performing the exercise for their first time. If done correctly this exercise will teach you client to load and unload their hip flexors in the sagittal plane.

As you can see, it’s vital that you instruct your client to drive from their hips and not their lumbar spine. It has pretty much all of the benefits of the downward dog exercise used in yoga. But by being performed dynamically in a rhythmic motion your clients will learn to dissipate forces through the system in a way which is more constant with the way human bodies are designed to function. The fact is muscles need to turn on and off (or load and unload). This exercise will teach help them to learn proper muscle timing and sequencing which will enhance function of their hip joint.

Then I would spend some time teaching them the proper technique of each exercise and get them to do a 10 reps of each exercise back to back. Only once I am confident that they can perform these movements safely I progress them to a circuit where I get them to perform each exercise for 45-60 seconds, with a 15-30 second rest between each exercise (obviously times will vary according to the individual but as a guideline, I start most of these types clients off with a 45:30 work to rest ratio and try to manipulate both their ‘work’ and ‘rest’ times in systematic way over a few weeks until they are working at a 60:15 work to rest ratio.

This is a pretty decent ‘metabolic circuit’ that will challenge your client, take them out of their comfort zone, burn lots of calories during the session, boost metabolism for hours after the workout has finished, and make their abs sore for a day or two, serving as a great reminder of what a fantastic trainer they have ;-) However, as I explained earlier these exercises also have the added benefit of giving your client what they NEED. The best thing about doing this is that you will be able to work your clients at a pretty high intensity, which is needed to burn fat, whist helping to correct their dysfunction simultaneously.

In this scenario, Everybody Wins!!!!

Whilst I accept the fact most PT courses don’t teach you how to do this in their syllabus because as a level 3 personal trainer you are only qualified to train so called ‘normal’ clients. Let’s not forget that we live in a society where an awful lot of people sit behind a desk, at a computer, or behind the wheel in a car all day meaning that postural dysfunctions are so prevalent.

Although, not all everybody who suffers from these common postural dysfunctions may currently be in any pain or discomfort, I’m a strong believer that Personal trainers have a responsibility to continue to learn once they have qualified in order to do the best by their clients or at the very least so that they know which exercises to avoid which may eventually cause discomfort.

Put simply, the fact is that these are the people who will make up a large portion of any trainers client base, which is why I think that training providers have an even bigger obligation to give personal trainers the skills they need to do their jobs properly.

I’ll finish this post by asking another question… Are you able to give your clients what they want AND need?

Common Muscle Imbalances

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Don’t get me wrong, although it has happened, it’s very rare that a gym member approaches me and asking me to help them with their posture or to correct their muscle imbalances. Although the majority of you clients NEED to address their posture, it may not be what your clients WANT from training with you.

However, in my opinion a good personal trainer knows how to give their clients both what they WANT and NEED. So for today’s post I thought I’d introduce you to two very common postural dysfunctions that you may come across with your clients and explain how different approaches to tackling them.

On a side note, I know a lot of Personal Trainers are a little reluctant to address muscle imbalances and postural dysfunctions, seeing this as more of a job for a Physiotherapist but these days the line between a Personal Trainer and Physio is becoming more and more blurred as personal trainers are increasing their skill set, and I for one think that this is a beautiful thing.

Now while I accept that everybody is different some muscle imbalances spread throughout the muscular system in a very predictable manner. In today’s Post I want to address two common postural dysfunctions first described by Vladimir Janda in 1979.

Lower Cross Syndrome

Lower Cross Syndrome is basically the name given to a group of specific postural changes. The specific postural changes associated with upper crossed syndrome include an anterior pelvic tilt, increased lumbar lordosis, lateral lumbar shift, lateral leg rotation, and knee hyperextension.

The muscle imbalances which are usually associated with these postural changes include but are not limited to tightness (or facilitation) of the hip flexors, lumbar extensors, and adductors in addition to weakness (or inhibition) of the abdominals and gluteals.

As you can see from the diagram tightness of the thoracolumbar extensors on the dorsal side crosses with tightness of the iliopsoas and rectus femoris. Weakness of the deep abdominal muscles ventrally crosses with weakness of the gluteus maximus and medius. Hence the name Lower Crossed Syndrome

Upper Cross Syndrome

Upper Cross Syndrome is basically the name given to a group of specific postural changes. The specific postural changes associated with upper crossed syndrome include a forward head posture, increased cervical lordosis and thoracic kyphosis, elevated and protracted shoulders, and rotation or abduction and winging of the scapulae.

The muscle imbalances which are usually associated with these postural changes include but are not limited to tightness (or facilitation) of the upper trapezius, levator, sternocleidomastoid, and pectoralis muscles, as well as inhibition of the deep cervical flexors, lower trapezius, and serratus anterior.

As you can see from the diagram tightness of the upper trapezius and levator scapula on the dorsal side crosses with tightness of the pectoralis major and minor. Weakness of the deep cervical flexors ventrally crosses with weakness of the middle and lower trapezius. Hence the name Upper Crossed Syndrome

For the sake of not making this post too long, I’ll leave it here for now. Keep your eyes peeled for these postural dysfunctions in the gym, you’d be surprised at how common they actually are. When I get a chance I’ll pop up another post where I will show you how I would personally treat clients with these syndromes giving them both what they WANT and NEED, sometimes without them even knowing.

Getting to the Core 2

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In my previous post in this series I gave you a little insight into how you should train your core. The days where we used to target individual muscles of the core attempting to classify their role is long gone, what we should be doing is looking at movements and classifying them as either low or high load.

In this post I’d like to introduce you to low load training for the core, letting you know WHEN you need to train this system and HOW to do it effectively.

Now, not everybody needs to train their low load system. In fact the ONLY people who need to train this system are those who are in or who have a history pain. Let me be a little more specific, those who experience pain which is not direction specific (pain which is directional specific indicates dysfunction in the global system). The following is taken directly out of the course manual that I received back in 2008:

‘Low load Training should always be recruitment specific and target slow motor units. The aim of low load training to recruit more efficiently, therefore progression ion load are not appropriate. Low load training should be progressed and regressed in term of proprioception. Movements must always be slow in order to avoid fast motor recruitment.’

There are two types of training which come under low load training; Local Stability Training and Motor Control Training. In post article I will address local stability training.

Local Stability Training

The aim of Local Stability Training is to train your local stabilisers and is only really necessary for people who are in pain. Unless you are currently in pain or have experienced pain in the past it is pointless training this system. Here are some guidelines for this type of training:

- Exercises must be unloaded
- Exercises must be physically non- fatiguing
- Exercises are non-functional
- You must keep your trunk in neutral
- You must discourage global dominance
- Core rigidity must be discouraged
- Some global stabiliser co-contraction can be tolerated
- Exercises should be TvA dominant, with minimal if any oblique activation

Two exercises which fall under this category are:
• Abdominal Hollowing (TvA Re-education)

A quick note on the old ‘adbdominal draw in vs abdominal braceing’ debate. There is no such thing as a bad exercise, each of these exercises has it’s place. Whilst abdominal bracing has been shown to increase spinal stability, the TVA has been shown to help re-educate the TVA. That’s right, both exercises have two different functions, why people find the need to compare the two or choose one over the other baffles me completely. The ‘abdominal draw in’ or ‘TVA activation’ IS a fantastic exercise for TVA re-education and justifies its place in the training of the low load system. The problem is not with the exercise itself, just where it is used in the wrong place.

• Heel Raise and Lower (Multifidus Re-education)

Research (Hides et al, 1996) has shown that after resolution of acute, first episode low back pain multifidus muscle recovery is not automatic. Therefore in order to rehabilitate your back properly it is necessary that you do this exercise in order to re educate your multifidus so that it becomes sensitive to low threshold stimuli.

Two other exercises that I feel fall into this category are Paul Cheks ‘4 point TVA Trainer’ and ‘Horse Stance Vertrical’ exercises.

I’ve added a picture of them here but for more info on how to do them check out ‘The Inner Unit’ by Paul Chek

Motor Control Training

The Aim of Motor Control Training is to train you global stabilisers and teach your body to dissociate limb movements from spinal movement in all 3 planes, emphasising rotational control. Here are some guidelines for this type of training:

- Exercises are predominantly unloaded movement
- Exercises must be physically non- fatiguing
- Exercises are usually non-functional
- Exercises must be performed slow, with emphasis on smooth controlled movements
- You must keep your trunk in neutral
- You must discourage global dominance
- Core rigidity must be discouraged
- Exercises should be oblique dominant, with no RA activation
- Exercises can involve bilateral and unilateral movements

Seated Leg Extension

This is a great exercise which will teach your client to control flexion and disassociate knee extension from lumbar flexion. The aim is to get your client to extend the knee without allowing them to flex at their lumbar spine. Trust me, this one is harder than it sounds, especially if your client has tight hamstrings.

Lying shoulder flexion

This exercise will teach your client to control extension and disassociate shoulder flexion from lumbar extension. The aim is to get your client to flex their shoulder without allowing them to extend at their spine. This can be very difficult for clients who lack thoracic mobility.

Bent Knee Fallout

This is one of my favourite exercises which I have used with several clients with lower back pain. The aim of this exercise is to teach your client disassociate hip rotation from lumbar lumbar rotation. The aim is to get your client to rotate at their hip without allowing any movement from their pelvis.

In order to do this exercise instruct your clinets to maintain a TvA contraction while lowering knee move slowly outwards towards the floor without any movement from your pelvis. Allow them to use their finger s to monitor the tension in their TvA. If the tension softens as they lower their leg, instruct them to stop ands start again.

Swiss Ball Leg Lift

This exercise is a little more challenging than the previous one mentioned as it requires you to control multiple directions at once. The aim is to raise your foot off othe floor without allowing ANY movement at the spine in ANY direction.

I also feel that the ‘Horse stance Horizontal’ exercise described in Paul Chek’s ‘The Inner Unit’ article fits the criteria of an exercise which can be used for motor control training as it requires you to move your limbs whilst maintaining a neutral spine. This exercise could be used teach your clients to control movement in multiple directions.

At this point I think it makes sense to take a little break. What I want you to do is go away and try some of these low load core exercises. I think that you may find them a little harder than you imagined. Remember, you should not feel pain during any of these exercises, if you do stop immediately. Also, these exercises should not make your muscles burn or feel fatigued. However, your CNS may become fatigued, in this case you may start to get a little confused, lose coordination and it will become difficult to perform the movements. If you reach this point take a little break.

Keep your eyes peeled for my next post in this series where I will delve a little deeper into the high load system.

Getting to the Core

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The words ‘Core Training’ and ‘Core Stability’ are probably the most overused words in the fitness industry. However, despite its popularity it still remains the one of most misunderstood areas of training, and with lots of conflicting information and differing opinions floating around the gym it’s easy to understand why.

In my experience, most people want to train their in order to avoid pain or to improve performance, unfortunately, the methods they use to train their core actually causes more pain and limits performance.

Luckily, in the last decade or two an awful lot of research has been done into core training. In this post I attempt to show you my current understanding of the core as well as provide you with a few exercises to help you get the best out of your core training.

Initially I always found it easiest to look at the core as two separate systems. When I first started Personal Training I read Paul Cheks articles on the Inner and outer unit and for quite a while I based the majority of my own in addition to my clients core training on this model.

However, things changed during my MSc when I was briefly exposed to a different model of muscle classification proposed by Mark Cornerford and S L Mottram. In thier paper they divivded the core into the Local and Global Muscle Systems.

The Local Muscle System is made up of the deepest layers of muscles which have spinal attachments. These muscles are responsible for segmental stiffness and translational control of the spine. The muscles in this system cannot change in length and therefore do not contribute range of motion. This local system should be activated for pretty much every task regardless of the direction of load. (note: this is pretty much the same as what Paul Cheks calls the Inner Unit)

The Global Muscle System on the other hand can be divided into two sub categories, global mobilisers (global muscles which produced movement) and global stabilisers (global muscles which provide stability). Unlike local muscles, global muscles are only activated along the line of mode. Any muscle which can produce movement is a global muscle.

And I went along with this for a while but it wasn’t long before it dawned upon me that some muscles fitted into more than one category. In fact, the more I learnt the more it became clear that pretty much every muscle in the body has the ability to perform all roles to a certain extent, it’s just that some muscles are better suited to a particular role. To illustrate my point, I’ll use the Gluteus Maximus.

At first glance, the Gluteus Maximus appears to be a global stabiliser due to the role it plays in the eccentric control of internal hip rotation. However, the Gluteus Maximus can also contract concentrically to produce hip extension, performing the role of a global mobiliser.

You can also argue that the Gluteus Maximus helps to stabilise the lumbo-pelvic-hip complex in a local role. Taking this into account it becomes pretty clear that the Gluteus Maximus can perform in all three systems (local stabiliser, global stabiliser, and global mobiliser).

So How should you train the core?

Back in 2008 I attended a course held by Steve Batchelor which completely revolutionised the way I viewed the ‘core’. What I like most is that instead of looking at individual muscles and trying to categorise their role, this system looked at movements, classifying them into either high or low load system.

Keep your eyes peeled for further articles in this series where I will go into the specifics of each system and provide you with some effective exercises to strengthen your core

References
Chek P. The Inner Unit
Chek P. The Outer Unit
Chek, P. Scientific Core Conditioning. Correspondence Course, C.H.E.K
Institute, 1998-2006
Cornerford M., and Mottram, S. L. (2001) Functional stability re-training: principles and strategies for managing mechanical dysfunction Manual Therapy (2001) 6(1), 3±14

http://www.portalsaudebrasil.com/artigospsb/ativfis210.pdf