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I cant believe the amazing amount feedback we had on my last post displaying Mark’s videos! It just goes to show how important this Low back pain stuff is.
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Today, (as promised in my last post) I’m going to discuss the negative side of looking at the spine the way displayed in Mark Young’s videos. But, before I do so – I would like to first congratulated Mark for his fantastic video idea.
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Secondly, I’d like to apologize for the delay in this Blog response. Last week was very hectic as I traveled to Arlington Va, to present at the 2010 IDEA Personal Trainer Institute convention. This was a sold out event and I was honored to be a part of it along with such names a Gary Gray, Todd Durkin and Bill Sonnemaker.
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Both of my classes, Secrets of Joint Mobility and Dynamic Warm Up – New Concepts & Techniques, were filled to capacity with best and brightest fitness professionals in the area. I had a blast teaching at this event and I wanted to thank IDEA for again, having me as a presenter and THANK YOU to everyone who attended – You ALL made this event a fun and memorable part of my life!
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Now, lets talk more about the Spine and Spinal research!
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In Mark’s videos, he used Pig spines to show us an inside look at what commonly used exercises may be risky for the back. Using pig spines for research is fairly standard at Universities as is by world renowned back specialist, Stuart McGill who also uses pig spines in his research which can found all over the internet and his two amazing books – Low Back Disorders and Ultimate Back Fitness and Performance.
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Now, the problem with looking at pig spines is that sometimes we end up hitting the bullseye of the wrong target. As my good friend, mentor and world famous PT, Mark Comerford says “Pig spines are great to look at physiology, but not biomechanics – Pigs don’t have upright spines”
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What Comerford says is an obvious truth that I’m still astounded has been missed by some incredibly smart people! With no disrespect to Stuart McGill – who cares how many flexion cycles it takes to buckle a dead pig spine!
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First off, upright flexion is not normal pig function. The only time a pig stands upright (on two legs) is when it’s trying to hump another pig.
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Secondly, pigs don’t have any functional movement similarities to humans what so ever. This goes back to what Comerford said above.
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And, third – this is dead spine with no muscles to control force and no regenerative qualities that a living creature would have. I could get into all the science here. But, instead I’ll give you this analogy:
You take a frog out of the swamp and place it into a glass box with a few plants, some water and artificial light. You still will never find out how it lives in the swamp. All you will know is what a frog does in a glass box. And in this case, we are placing a spider in a glass case to find out what a frog does in the wild. It makes no sense! – This is why I said that we’ve gotten good at hitting the bullseye of the wrong target!
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So, in short – it’s important that we do not confuse physiology with movement biomechanics. Animal spines are great for looking at general structure, some animals over others as explained in this scientific comparison. But, when it comes to human biomechanics – Well, thats a whole different animal – Pun intended!
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Coming Soon!
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Many folks were also upset about what Mark said in this post about the dangers of squatting. I have some thoughts in regards to that as well. I will talk about these thoughts in an upcoming post.
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Meanwhile, lets here your comments on today’s post!
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Coach Tumminello,
Bodybuilders often get mocked/chastised for using too many dynamic abdominal exercises, but for someone whose main goals are oriented toward a long career of healthy lifting and creating the best appearance on the competitive stage, do the implications of this post mean that these trainees are often (somewhat) unjustly bashed for their ab training?
Obviously level of leanness matters, but I know that many competitors will contend that a championship, stage-worthy midsection requires at least some dynamic ab work to complement anti-side bend, anti-rotation, and anti-extension work.
Even with today’s hyper-awareness of training spinal stabilization over spinal flexion, side bending, and rotation, I’ve still made a point to include at least 2 days of dynamic ab work where I will focus on 1-2 movements for the different movement patterns for training the abs dynamically (sometimes 3, but no more than that) and then hit them for 2-3 sets each with reps in the 6-12 range (weight or other methods of increasing the intensity being added as I progress).
I’ve been catching a lot of flak from trainers at my gym, but my spine feels better than ever, my goals are health and aesthetic-based (so how truly “functional” these added movements are considered by the fitness cognoscenti is less of a concern for me), and I see no reason to delete this conservative volume of dynamic work (flexion, reverse crunch-type movements, side bending movements, and rotational work) despite everyone regularly contending that I am just itching for a herniated disc.
In regards to Stuart McGill’s research on low back disorders, I have read his book “Low Back Disorders” and I have purchased his DVD on treating back disorders. I’m sure he’s a smart guy (a little arrogant however) and has earned his PhD. However, I have searched for other studies on low back pain and I can’t find anyone else that supports his studies. If I were to look up the benefits of Creatine, or HIIT studies, I’ll find hundreds of other studies to support findings. But I can’t find anyone else that has done similar studies. All I find are other trainers that are quoting Stuart McGill not to do crunches because pig spines herniated after they did “crunches”. I would add that Tami-Lee Webb (“Abs of Steel”) has done more crunches than McGill’s pigs and she doesn’t have back problems.
In my experience as a Personal Trainer, I find that men that are out of shape (beer bellies) and have poor eating habits are prone to back pain. I find women that have gone through a few pregnancies and have a habit of carrying a kid on one hip while doing household chores sometimes have lower back pain. I find as a client gets older they exhibit disc degeneration as a natural part of aging or have a family history of the same problem. But in my experience I haven’t found anyone that has low back pain that has done too many crunches or too heavy of squats. I’m sure there are some out there that will disagree, but this is my opinion.
Jim
At first glance that video of the pig spine seems horrific. But it seems to me that as humans we perform spine flexion and extension all the time as part of our normal movement patterns. To suggest that these movements are unnatural and poorly supported by human physiology seems a little strange. Witnessing the wide range of human performance and the potentially extreme loads that athletes can tolerate in various situations, it is hard to imagine that the strength of healthy tissue is limiting most of us.
Love this piece, Nick. When using science to back up our claims (especially ‘wow me’ science where spines are exploding) it must be utilized with the appropriate context. Transfer depends on relatability, and you did a fantastic job of pointing out the obvious that was missed by so many. Keep up the great work and I look forward to more of your critical arguments.
Hey. This is very interesting subject and informations. I have injured my back few years ago and due to t-nation articles stopped most flexion based movements in my training. I really can’t get back on truck. I used to be a well conditioned athlete and now I can’t do my favorite sports nor train in the gym.
One day I hope I find simple program for lower back treatment and core training that works and doesn’t hurt my back.
Those were my thoughts as well Nick. I must admit, being a trainer and S & C coach, I jumped on board the no flexion/rotation bandwagon right away because to be honest, I listen to people who are smarter than I am. I am still leaning towards the safety of avoiding those movements still, but I’m open to some flexion (i.e. rev. crunch, thoracic crunch). I do think that rotation should originate at the hips always. Thanks for pushing the envelope and getting me to think outside the box.
Several years back I ruptured multiple discs because of many stupid reasons (overtraining with the O-lifts while not even activating my core, doing weighted russian twists off of a hyper bench while not really activating my core, and overtraining in judo with people that were 100 pounds heavier than me, etc. etc.) Regardless, after recovering, I made it my mission to strengthen my back and core so I wouldn’t be miserable again. I purchased a commercial reverse-hyper from Louie Simmons and used this, along with other exercises, to rehab and gain strength in my posterior chain. Everything dramatically improved. Then I read Stuart McGill’s book, which showed how rev hypers exerted potentially damaging loads on the spine, as well as other exercises that I did, including “supermans” (the kind where you are prone and lift your legs and arms upwards). Dr. McGill also pointed out the dangers of working out in the early AM because your discs were fully hydrated and more prone to shear and rupture with any kind of lumbar flexion. Well, jeez. It sure was a thick, complicated, serious, scientific book and Dr. McGill sure did sound impressive-so I obviously had to stop doing all these DANGEROUS things to my back. Flash forward and what do you think happened? My back and core got weaker and I reinjured my back. And what did I do to improve? Of course, going back to what I was doing, including rev hypers, supermans, and working out in the morning. I realize this is anecdotal, but I will forever remain skeptical of people like Dr. Mcgill with all their pseudo-scientific studies. As a matter of fact, Coach Sommer of gymnasticbodies.com has more or less said the same thing in response to a question about Dr. McGill’s work.
This is certainly an interesting topic. Personally I stopped my clients doing ab crunches about 10 years ago when I completed my a low back pain intervention for my Masters degree. It is not just Stuart McGills opinion that flexion increases the risk of disc herniation – all the orthopeadic surgeons I worked with during my intervention agreed that flexion coupled with rotation played a significant role in disc herniations. There is a lot of research out there discussing this, check out Nik Bogduk and de Rosa and Portersfield to start with.
I also studied the populations who had significant back problems and amongst the nurses and shearers were Yoga instructors and dancers. I find it interesting that most of the Pilates instructors I know suffer back pain – anecdotal evidence I know, but interesting.
I think just because one athlete or person says I have done ab crunches all my life and don’t have problems is not a reason to dismiss how the exercise may affect the population in general.
Aside from the back issues, the negative side of crunches is the mind set that goes with it. I believe it contributes to postural issues that are aggravated by those who insist on training all the mirror muscles. I work in a gym based in an international hotel and find the quality of workouts by most guests to be shocking, with many variations of ab crunches as the basis. These people walk around with forward heads, caved in chests and rounded shoulders. They look terrible and perform terribly. My clients only do ab crunches when they are strong enough and if it is necessary for their sporting or working situation – which is not very often. We do a range of other ab exercises including dynamic and static.
While on the topic, I have no evidence but from my studies and experience I don’t believe in holding the planks for extended periods of time. The maximum hold in a static position I use is 10 sec. I increase the demands with limb movements rather than time. I find that during long holds clients just hold their breath and hang off the ligamentous system. I don’t know what the research will tell us in the future and I might have to change my mind about this one – but it doesn’t seem to make sense to hold these positions for 3 minutes with heads hangining and hip flexors overactivated.
Interesting topic and I look forward to learning more.
Susan
First of all, your assessment of McGill’s pig models is inaccurate. The models are used to assess herniation patterns, not much more than that. For this area of study, they are quite accurate. Just as mice and rats are used for medical research, animal models are accepted for structural considerations. Comparing a pig and a human in regards to weight bearing, stability, spine buckling, etc… is silly.
I recommend everyone read McGill’s 140+ studies…and I don’t mean only the abstracts…McGill is the top spinal biomechanist in the world…period…he has contributed incredible material…the Aussie/New Zealand researches have contributed much as well, but I side with McGill as his work is more relevant in a true clinical setting. For those who think it’s not important to know how many newtons (or pounds) of energy are slammed into your back with certain foolish activities, just keep doing what you’re doing…you’ll learn soon enough when you go beyond the threshold.
As a rehabilitation specialist, I can assure you that improper loading and lots of extension exercises will damage your back..period! People can fool themselves and do ’supermans’ and whatever other hyperextension exercises they want…sooner or later, they’ll be in trouble…why is this? It revolves around the issue of facilitation/inhibition patterns and of course, imbalances to core stability. You do not want to strengthen your long ’strap’ muscles…they are too short and tight to begin with…training and shortening muscles that are short and neurologically impaired when it comes to stretching is not a good idea. To train the intersegmental muscles, a good understanding of proper core exercises is needed.
How many here treat musculoskeletal injuries as a profession? How many teach biomechanics, kinesiology, injury prevention, etc…? How many have conducted research and have been immersed in such? I have my doctorate and over 10 years of post doctorate training and still I can never know enough…as soon as you think you’re up to date, more information comes out and you have to modify your approach…many fitness resource locations are simply out of date…they can’t keep up. My point is that many feel as though they are specialists without having the proper training and/or experience…too many trainers go out and end up hurting their clients and have no idea they’re doing so…this is really unfortunate. I teach trainers…many cannot even name the major muscles in many regions of the body…
A deep understanding of anatomy, kinesiology, physiology, etc… is needed to fully appreciate what occurs when you work out in the gym.
From my own observations, I’d say that about 75% of people in a gym setting ‘work out’ improperly. From things as simple as knowing where your energy comes from (do you do anaerobic or aerobic exercise first?) to proper biomechanics with particular exercises, and more…most people in a gym setting are not properly educated about the body and how it works. Just as you wouldn’t work on a car without a good knowledge of mechanics, people shouldn’t exercise unless they have been instructed by well-trained individuals.
In regards to core stability, I could go on forever here…I’ll just say this…you do not want to make tight muscles tighter and weak muscles weaker…this should be obvious but most people end up furthering imbalances. The idea is to create balance and take pressure off of the spine. The core is composed of your diaphragm to the pelvic floor and the abdominal wall to the paraspinal musculature…and everything in-between. Any spinal weakness due to disc, ligament, or other tissue is going to affect your brain’s perception of function…and you will end up with pain and dysfunction. You can’t just push through a back problem…you have to know what problem you have and the proper way to address it. I’ve seen too many people in my practice who have tried fix their own problems or have sought care from the wrong type of provider.
Unfortunately, most individuals truly do not know what they are doing and this is why there are so many spine injuries. Most are easy to rehabilitate, thank goodness, but sometimes surgery is required. Most all back injuries can be prevented if the focus of exercise is on proper form and proper muscle balance…hence the need for core stabilization in a functional capacity.
[...] with the “anti-flexion” camps arguments. Please head over and check it out what Nick Tumminello had to [...]
One thing that I see being missed here is that a lot of the times (and I’d bet in 99% of the cases) back pain is caused by many conditions combined. Not ALL the back pain is aggravated or caused by crunches, hyper extensions or supermans. Nor will leaving them out ultimately make your spine invulnerable. The human spine is an extremely complex system and we actually now very little of it. We actually know very little on back pain as well, which is proven by the researches of the frequency of “unspecified back pain”. A lot of times we do not even know what is wrong, so for someone to say that this is right and this is wrong in EVERY case is just a little short sighted in my opinion.
If a person has an instable spine, works in a warehouse and has his workout routine built on extensions and sit ups, is he in danger? I’d say yeah, maybe. So would this person benefit from removing the “dangerous exercises”? My guess is yeah, maybe. We can’t do a lot to the spine instability itself, sure we can tell the person to find a new job, but how many times is that the best or easiest option? So what is left or the easiest to change? The workout routine.
Take another case: A 22-year-old student athlete, who has nothing wrong in his spine, does hypex’s and crunches along as a part of his usual workouts. Is he/she in danger? Most likely not, especially if the muscle balance is there.
Everything is dangerous if you do too much of it. Jumping is great for your cartilage, but too much jumping is not.
The bottom line with supermans and the like is that the amount of force driven into the lumbar spine cannot be tolerated. When you read x-rays and MRIs, you see subtle changes or serious degenerative changes, based on many reasons, of course. However, someone with facet hypertrophy and/or disc bulging who is performing extension exercises is really not doing the right activities…there is no way around this. Just because you don’t hurt doesn’t mean you aren’t creating a problem…on that note…
Most people have no idea what is going on with their spine until they hurt it…then they find out the damage they’ve been causing.
In regards to Newton energy into the lumbar spine, this simply cannot be discounted. I guess if someone wants to believe that a certain group of people can get away with biomechanically flawed movements, they’re going to believe that no matter what. That’s fine…it keeps the physical therapists, physiatrists, orthopedists, and chiropractors quite busy.
Simply put, you need to understand bone deformation, disc function, and the piezoelectric effect to comprehend what is going on when you put pressure on bone that isn’t meant to take the pressure.
You also cannot compare standing up and bending backward as it creates nowhere near the pressure of supermans, roman chair extensions, etc…
You can get away with poor biomechanical movements for a while, but sooner or later, you’ll feel the effects.
The more important question is why are people training their spinal erectors in the first place? If people understood cross fix patterns along with facilitation/inhibition patterns, it’d become apparent soon enough that on this basis alone, extension exercises are foolish. Bottom line: you don’t strengthen muscles that are too short/ have reduced ability to stretch. The spinal erectors fall into this category.
When you treat back injuries, you see the injuries and the patterning. Someone here wrote that he doesn’t see injuries with squats or situps…well, that’s obvious…if you’re in a gym, those people are going to disappear for a while and end up in a doctor’s office. Injured people don’t tend to continue exercising or doing the things that hurt them.
Consider this one point. When people really hurt their back, how do they present? Straight up, flexed, extended??? They present in a flexion position (sometimes to one side or not dependent on the position of the disc)….they do not present in extension…why is this?…it is because the body needs to be in a flexion state to create negative disc pressure, even when upright. This begs the question as to why so much emphasis is put on extension movements when all they really do is damage spinal structures…we can say that everything is fine in moderation, but I disagree…there is no proper extension training for those with lower cross fix patterning…all it leads to is damage.
I could go on for hours here…if you treat neuromusculoskeletal injuries, you get a much better perspective of the injuries, how they occur, and how to prevent them. When you are on the front line of fitness in a gym environment, you’re not privy to medical histories, diagnoses, and treatment protocols for back injuries.
As far as rehabilitation and stabilization goes, extension can be added into a program, but it’s the last thing to be added…this is the same whether you’re rehabilitating someone who has lumbar or cervical spine disc pathology.
Alle,
First off, many thanks for your insightful and detailed comments.
I could not agree more with what you say about supermans and other similar supine back extension exercise. I personal do not use supermans or any movements resembling them,
This is why I developed the superdog exercise shown here – http://www.youtube.com/watch?v=6p0nizbm1SI
and wrote these articles about why NOT to perform supermans -
http://www.tmuscle.com/free_online_article/sports_body_training_performance/how_not_to_warm_up&cr=
and
http://www.tmuscle.com/free_online_article/sports_body_training_performance/five_new_exercises
If you watch the video and read the above articles, you’ll find you and I agree on most things.
Best regards!
Coach N
Just throwing it out there that I’m a long-time reader of TMuscle and Nick’s, and a long-time (due to knee/shoulder issues) patient of Allen’s, and it’s absolutely hilarious to me to see these worlds collide. Allen talks the same way in real life that he writes on a blog’s comments page, which shouldn’t surprise anyone. It’s just nice to have a chiropractor here in MD who’s actually been around the gym himself.
James,
Thanks for your comments!
I’m curious – Allen who?
And what is Allen saying about the Swiss weight Stability work?
Coach N
McGill can’t show you a single well done clinical trial that his version of core stabilization or any other version of core stabilization exercise is any better than simple back exercises for either treating back pain or preventing back pain. Virtually all studies on this issue show NO difference.
This guy is just PR himself and that will help him get more research grants or sell his books on what the well done clinical trials show to be nothing but a failed paradigm (i.e. core stabilization).