A Case Study w/ [sl]Amber

Intro: A Case Study w/ [sl]Amber:

A few hours prior my friend @amberm88 was a Cranky-McCranky-Pants, mopping around the gym with a whole lotta low back pain. She had been unable to pick up a barbell without pain for the past two weeks. Want to see what went into these clips coming to be? Then PAY ATTENTION.

Amber was training hard for a competition. Amber moves a lot of weight frequently. Amber is a proficient and fluid mover. Amber is athletic and knows how to compensate really really well, almost to the point that you probs wouldn’t even notice that something is wrong. WRONG: Amber has a really stiff thoracic spine, or, upper back.

The training that goes into being an elite CrossFit athlete involves weightlifting and gymnastics. These two modalities of movement exist mostly in the sagittal (forward and backwards) plane, this is what one could refer to as a training bias. Considering her impressive athletic history, Amber used to ball on sucka’s in softball and basketball, both of which include frequent thoracic rotation. Now, not so much.

With the foundational idea of treating the athlete as a whole, I made a student-hypothesis: Make one segment move better to offload the other segment. This is what happened.

**Disclaimer**: I am a student, and this is not medical advice. If you are seeking medical advice refer yourself to a local physical therapist.

Testing, Testing; 1, 2, Rotate:

You can think of most joints that don’t move well as a stuck drawer. How do you open a drawer whenever it is stuck? There is a scientific approach to mobilizing joints, but for the sake of simplicity and wit, do you rip that beast straight out? NAH. You wiggle that thing. You wiggle it and then see what happens. More often than not that wiggle will grease the tracks and the drawer will slide right out.

Apply that to your thoracic spine. Amber had limited wiggle once you limited movement in her hips and lumbar spine (low back) on the bench. In my personal experience working extension on a foam roller is waste of time, because you can so easily compensate in other areas.

Not to mention a lack of thoracic rotation can negatively impact the relationship between our shoulder blades ribcage. And who wants their shoulder being codependent and whinny all the time? I certainly don’t. This being said, a hypomobile (doesn’t wanna move) upper back may have negative effects up and down the spine. In Amber’s case, the issue surfaced in her low back.

AAROM, Take a Breathe, Re-Test:

I once read that if you can’t breathe in a position, you don’t own that position. The statement holds true here. I apply gentle pressure opposite the direction that I want Amber to go, I use Active-Assisted Range of Motion (AAROM) to guide her in the range that is there, but dormant. I give her some assistance to hangout in her end range, and to take a few breathes (sped up here).

The same thing can be done by pressing up against a wall, or using a band to pull you in the opposite direction. Just make sure you are moving with your upper back, not your lower. Chances are you have the range of motion, but you don’t know what to do with it because it’s 2017 and everybody has a tight thoracic spine.

SPINE TIP (no, not the coccyx): if one segment is tight, another segment will reflexively “loosen.”

But do you Extend?

Ask a CrossFitter if they’ll get prone on the ground and extend. They’ll get down there, crush it, and look at you and say, “I can do this all day, I can do unbroken “Michael,” [a hero WOD: 3 rounds of 800m run, 50 back extensions on a GHR, 50 situps], duh.” But then you limit the degrees of freedom, and BOOM, #gnarwhale.

Exercisers are fantastic at global extension, but it’s really hard to extend your spine segmentally. I saw @unchainedphysio use this exercise to prevent mashed-potatoes’ing on front squats, but it’s also a great assessment.

Slow your roll, block the hips, and gain some control of how your back extends. I’d say if you can do 3x30 of these your upper back moves just fine.

Your Ribs Aren’t Moving and Your Diaphragm Hates You

The average human takes 12 breathes a minute. There are 60 minutes in an hour, 24 hours in a day…and so on and so on, you do the math. I don’t want to, that’s why I’m in physical therapy school. Did you forget that your ribs attach to your thoracic spine? Its in the name ya’ll.

Here’s a way to get the intercostals (muscles between the ribs) working double time to expand your rib cage. If you sit on one side of a seesaw, does the other side move? Yes, yes it does. This is virtually what is happening here, creating much needed movement around a bound down fulcrum.

Focusing on your breathing, and if you start to cough on your exhales that OK – it just means your diaphragm is moving for the first time in awhile. If you don’t have a wallball, just stack some sturdy pillows under your ribcage and give it a go. And if you fall off like Amber, at least you’re already right next to the ground.

Crawl Before You Walk

As infants, we spend most of our time on our back. Our baby-brains instinctually desire movement and exploration, so we rolled onto our side and then on to our stomachs (in prone). You hated it, and you cried – because your little baby neck was entirely too underdeveloped to hold up your disproportionate noggin.

You began to spend to more time here, then you pressed up onto your elbows, then you began to move around. Eventually beginning to pull yourself up on furniture, getting onto your knees, eventually making your way into standing. These concepts apply to learning exercises. It's easier to learn stuff on the ground, especially if you are like me and tend to be a floppy baby. Try 3x12-15 per side of these exercises to build up rotational endurance.

Stop extending solely from your low back and just hanging out on your passive structures. Please: Use your muscles. Progress yourself with these exercises. If King Soloman were a PT he would probs say something like, “Guard your low back above all else, for from it flows the innervation for everything downstream.” PTverbs 4:23 

A Series with The Prehab Guys: The Clean

Intro:

·      The “Clean Series” will delve into this Olympic lift through the eyes of a lifter en route to becoming a scholar. We will be discussing a broad spectrum of faults and misnomers, along with tried-and-true cues and corrective exercises that can be used for yourself, or your athletes. The clean is an excellent tool for any trainer or rehab specialist alike to build explosiveness, dynamic power, jumping and landing mechanics, and fast-twitch muscle activation in athletes/patients. If you are looking to add some tools to the tool belt this series is for you!

      Video 1 – “All Things First Pull”:

·       

      When considering the concept of stability before mobility during movement, the squat clean is no exception. If a movement begins in a stable manner, more often than not the rest of the sequence will fall into place.

In the setup of the squat clean: the athlete’s gaze should be focused on a single point along the horizon with the head in neutral; the bar and athlete’s weight should begin over the midfoot; the shoulders should be above the level of the hips and slightly in front of the bar; and the back creates a stable arch – all prior to initiating the first pull of the clean (i.e. initial separation of ground and weight). Here we use slow-mo to identify a proper first pull vs. a faulty one. Once initiated, the torso and hips should raise in one accord, with the angle of the back remaining fairly constant throughout the lift.

Common faults seen in beginner and intermediate lifters set-ups include, but are not limited to: the shoulders remaining behind the bar, the athlete’s hips being set too low causing improper hamstring tension, and a kyphotic/rounded posture in the thoracic spine. All of these faults can potentiate the athlete’s hips rising first. This position will predispose a lift with the back, rather than their full posterior chain. When considering the Olympic lifts, think of your back as the lever for the weight, not the lifter.

Clean pulls are a great tool to utilize proper initiating mechanics, and should be prescribed at the latter end of a lifting session in the ball park of 1x5 (95%), 1x5 (100%), 2x5 (105%) of their max squat clean.

Now that we have established a frame of correctness for what to look out for with the full clean, parts 2-4 will break the lift down segmentally. Remember, if you or your athlete is trying to improve their clean with a poor first pull, it will be like building a house upon sand…not stable.

Video 2 – “From the Knee to the Hip”:

·        The “Second Pull” of the clean is comprised of the bar position from the knees to hip extension.  Beginners having trouble with the concept of the “hip hinge,” Olympic lifters who tend to let the bar drift away from their body, or CrossFitters who are having issues stringing together reps, this is for you.

With a properly initiated squat clean AND hang clean, there should be virtually no mechanical change in the angle of the back, with the shoulders remaining slightly over the bar and slightly higher than the hips. This arched back position creates a powerful lever that allows the bar to “whip” once the bar meets hips a.k.a. the launching position.  If you notice in the first clip, as the bar launches from the hip position, the knees are bent, this action is known as the “double knee bend.” This whip is facilitated by a transfer of energy from the posterior chain to the quads, and actuates at the launch due to the double bending of the knee.

In the second clip, there is minimal to no double knee bend, which will cause decreased power and more often than not, a separation of the bar from the body. This can cause a faulty catching position, which at higher loads will result in a loss of thoracic extension, and the athlete will bail the bar forward.

The concept of neuromuscular re-education in the physical therapy world involves a slow eccentric movement, followed by an isometric hold, and finishing with an explosive concentric contraction. In the third clip, I perform a hang squat clean from below the knee, with a 2-3 count eccentric descent, a 2 second pause just below the knee, and explosive extension upward. The athlete should focus on sending the hips back, and maintaining the position of their back. This is a great tool to both reinforce proper mechanics and retrain faulty movement. This position can be further expounded upon by utilizing the bent over row (w/ the shoulder blades locked down and in), where removing the movements degrees of freedom allows for the athlete/coach to build brute strength.

Video 3 – “Keep the bar close with: Hook Grip”:

·       An LSU powerlifting coach once told me to think of my arms as nothing more than a hook and lever when deadlifting the bar, and I think the same holds true when performing the clean.

For those who are somewhat inexperienced in the ways of explosively accelerating their body, the clean can cause the novice to attempt to muscle the bar to the shoulders by flexing the elbow PRIOR to completing full extension. Coach Hatch always says, “When the arms bend, the power ends.” This mantra holds true in ~98% of the population, but there are always exceptions when considering athletic adaptation (i.e. My slight jump backwards after extension).

A faulty start may cause an early arm bend in an effort to get the bar to the hip faster to make up for lost time and speed, which can also lead to the athlete completely missing the power position. Seen here is an early arm bend into a muted hip in order to rush under the bar. This can cause the athlete to bang the bar off the thighs, rather scooping/sweeping the bar into the hip with elbows extended while maintaining tension as the bar reaches the hips.

To facilitate elbow extension, we need to turn on the triceps, and relax the biceps. This is best done by using the “hook grip,” which will relax the grip and help the athlete differentiate the clean from what could potentially turn into really fast curl to upright-row. @brucebarbell’s cue for pointing the knuckles down is a fantastic way to rev-up the triceps, and inhibit the biceps.

A corrective exercise to really drive this home is a sequential clean pull from below the knee – above the knee – and ending at the hip in order to train the athlete to keep the bar close and rely on hip extension as the primary mover, NOT the arms. As with most relationships, a crushing grip will never produce the results we want, rather loosen your grip and let the rest happen. Your relationship with the clean is no different.

Video 4 – “Flex[ed] and you Shall Receive”:

·       The archetype of virtually every movement where we are either producing a force or receiving a force involves a flexed hip position. This concept most definitely holds true when catching a barbell. Many a time I’ve seen athletes’ form breakdown past 90% of their max lifts. Many I time they will cut their movement short, and rush under the bar. Cueing the athlete “think power” often remedies this problem by giving them the gusto necessary to achieve full extension, receive the weight, and THEN ride it down into the squat.

There are two common faults I see with the catch. The first being a catch with the knees forward and hips extended, which may stem from poor motor control or a weak anterior core which cause the hip to remain flexed and the thoracic to overextend in compensation. The second being the “bar dive” where the athlete will rush under the bar and begin their descent into the squat BEFORE making contact with the bar. At higher loads this can cause an unsafe bottom out, improper hand placement that can over-torque the wrist, or cause your upper back to mash-potatoes leading to a miss forward.

A classic Hatch-method that I have found to be especially effective in building both athlete confidence, power and proper bar receiving technique is the Top-to-Bottom clean. It is performed by building up to 80% of the athlete’s 1 rep max, and will reinforce that regardless of where the bar begins in space, landing with the knees bent and a slightly flexed hip will properly distribute the weight of the bar and act as a precursor-squatting position. Receive the bar, meet the bar, but do not just simply catch it. 

If you can power clean the bar from the hip, you can surely hit 80% of your 1 RM any day of the week, whether fresh or exhausted, as long as you believe in what your body knows to be true. Trust your technique, believe in what you are doing, and happy lifting.

S/o to @djhousebrother for all the help filming!