Sooner or later, you’re going to tweak your back, and there’s nothing you’ll ever experience, perhaps shy of limb dismemberment, that’ll put a stop to your training as cruelly or effectively. Of course, if you’ve already had some back problems, you know what we’re talking about. Either way we recommend you bone up on the back. It’s one complex little beastie.
This time around, we’ve got fewer bullet points and plenty of videos.
15 – Reevaluate Use of Unstable Surfaces
I’ve spent a good chunk of the last five years studying unstable surface training (UST). In fact, the results of my master’s thesis were published in the Journal of Strength and Conditioning Research in 2007, and I’ve written an entire e-book about the topic.
My main impression that’s come about from all this research and experimentation is that UST is like the food guide pyramid of the exercise world. There are certain people in certain scenarios (e.g., ankle sprain rehabilitation, upper extremity proprioception drills) who need to use it, whereas it’s remarkably inappropriate for others. Standing on an unstable surface is different than sitting on an unstable surface, which is also different than doing a push-up on an unstable surface.
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I could go in a hundred different directions with this, but for the sake of brevity — and to avoid the guaranteed Internet pissing match that would ensue — I’ll simply highlight one obvious perspective and back it up with a bit of research. Classic “core” work on unstable surfaces doesn’t really carry over to anything.
Stability balls might increase fiber recruitment on these exercises (and double the spine load, according to Dr. McGill, but that’s another story). The bigger issue is that the core stability improvements may not carry over to functional tasks.
A 2004 study from Stanton et al. is a great example of the divide between testing proficiency and performance. Researchers found that six weeks of stability ball training improved core stability in young athletes — as it was measured (in a manner consistent with the training itself).(1)
In other words, this is like saying that bench press training will make you better at bench pressing. Well, duh! The more important question, though, is whether or not that bench press performance will carry over to athletic performance.
While their measure of “core stability” improved, it did not effect favorable changes in running economy or running posture, or modify EMG activity of the abdominal or erector spinae muscles. In other words, it didn’t carry over.
A comparable result was seen in a 2005 study from Tse et al. After eight weeks of stability ball training in collegiate rowers, while “core stability” (as they tested it) improved, the experimental (core training) group showed no performance improvements over those who did ZERO core training during this time.
And, the researchers tested several measures: “vertical jump, broad jump, shuttle run, 40-m sprint, overhead medicine ball throw, 2,000-m maximal rowing ergometer test.”(2)
So, I guess the question is why bother doing this stuff if there really isn’t any evidence to suggest that it directly improves performance? I could take the “it may lead to injury” perspective, but I think that the “why waste your time?” mindset is far superior.
Of course, if you’re training with unstable surfaces just for comedic value, carry on.
16 – Appreciate the Role Thoracic Erectors in Protecting the Lumbar Spine
Take a look at any high-level Olympic lifter or powerlifter, and you’ll see some monster thoracic erectors. Why? They subconsciously know to avoid motion in those segments most predisposed to injury, and the extra meat a bit higher up works to buttress the shearing stress that may come from any flexion that might occur higher up on the spine.
Novice lifters, on the other hand, tend to get flexion at those segments — L5-S1, L4-L5, L3-L4, L2-L3 — where you want to avoid flexion at all costs. Show me a lifter with crazy hypertrophy in the lumbar erectors, and I’ll show you a guy who probably has a history of back pain. Our body is great at adapting to protect itself — especially as we become better athletes and can impose that much more loading on our bodies.
Here’s the issue, though: you’ve got to take care of your thoracic erectors or else they won’t perform up to par. Tissue quality is incredibly important, and since regular massages aren’t always feasible, we utilize two “home versions” with our athletes.
First, you’ve got the more diffuse approach with the foam roller.
Second, you can get more focal with a doubled tennis ball (held together by masking tape) by working with a ball on each side of the thoracic spine.
17 – Consider Different Classes of “Core Training”
There’s been a pretty solid back-and-forth jabbing here at T Nation over the past few years about whether or not specific “core” work is overrated. Some say that squats and deadlifts are enough, while others insist that you’ve got to train the core directly. Who’s right? As usual, my answer is “it depends.”
Would a powerlifter and other breed of athlete — whether it’s hockey, soccer, baseball, football, or whatever — have different demands? Yep!
Now, how about an athlete who played baseball when he was younger and then took up powerlifting after a collegiate baseball career? Wouldn’t he have a unique set of a) weaknesses and b) functional demands? Of course!
Next, how about a 38-year-old guy who a) chases his two kids around, b) sits at a desk eight hours a day for work and then in the car for another hour to commute, c) lifts heavy stuff three days a week, d) does interval training twice a week, d) does yard work, and e) plays on a beer-league softball team once a week? Think his core might have different functional demands?
Different people, different needs, limited training time and energy. What do you do?
If you’re me, you categorize your core exercises in one of the following four disciplines (although there may be some overlap):
I look at both squats and deadlifts as anti-flexion. Your goal is to maintain your neutral spine in scenarios where the load is positioned in front of your center of gravity. Honestly, if you are regularly doing squats and deadlifts (and their derivatives), I don’t think you need to add in extra anti-flexion exercises.
Working with predominantly athletes, though, anti-extension and anti-rotation exercises are of paramount importance. As the majority of athletic lower back injuries involve uncontrolled extension or rotation in either an acute or chronic sense.
With anti-extension exercises, we’re generally setting up in a position where gravity makes our job tougher. Examples include regular ol’ prone bridge variations.
These can be progressed to include all sorts of push-up variations and ab wheel/bar rollout masochism (video at right).
Finally, I love to integrate this work with overhead medicine ball throwing variations, where you resist extension each time you go overhead with the ball, whether you’re getting ready to throw, or just catching.
Taking this a step further, you can appreciate that overhead pressing can serve as a great anti-extension exercise.
As you can see, several of these exercises also include a rotary stability component (the overlap to which I alluded earlier). However, it’s also important to directly train rotary stability, particularly in rotational sport athletes. A basic side bridge is an excellent start for beginners.
These can be progressed into variations with perturbations, or single-leg side bridge variations.
Next, you can toss in some Pallof press isometric holds and split-stance cable lifts.
And these are all great lead-ins to rotational medicine ball training.
Taken all together, I hope that this classification scheme makes you appreciate that “core training” isn’t just about training abs and obliques. More importantly, it’s about training motor control: maximizing hip motion and lumbar stability, and then integrating the two in more complex movement schemes.
And, since very few of the readers out there live and die exclusively by squat, bench, deadlift, it becomes increasingly valuable to dabble in all three realms of my classification scheme each week.
18 – Learn to Love Single-Leg Movements
One other realm of stability I think is important to cover is single-leg stability or, simply stated, how well you stand on one foot. It’s crucial to overall health and performance for a number of reasons.
First, we spend a good chunk of our lives standing on one foot. Lunges, split squats, 1-leg RDLs, step-ups, and other single-leg drills are specific to the real world.
Second, and more specific to back pain, in many (but not all) cases of lower back pain, you can use appreciable loading on single-leg exercises because it’s much easier to maintain the spine in a neutral position in split-stance than in the position of bilateral hip flexion that occurs with squatting and deadlifting variations.
Additionally, you can generally drop a vertical line down through the center of gravity from the load on single-leg movements (whether they’re loaded with dumbbells or a barbell). As a result, there’s less shear stress and a reduced likelihood of going into lumbar flexion under load.
Third, using single-leg exercises with correct technique elicits equal contribution of the hip abductors and adductors; the abductors have to “cancel out” the commonly dominant adductors, or else your knee falls in. Seems easy enough. However, there’s more.
Imagine how improved abductor function carries over to the standing position, including gait. If a person’s hip falls out (adducts) in weight bearing, the photo below shows what happens to your spine.
This just goes to show you that the role of the hip abductors (glute medius, if that’s your cup of tea) is as much dynamic stabilization in weight-bearing — or resisting hip adduction — as it is pure hip abduction. You can also tell that it has direct implications of increasing the likelihood of anterior and lateral knee pain (more valgus).
And, if you don’t know what the hell I’m talking about, just recognize that single-leg work is insanely important, whether you’re healthy or have back pain. Here are a few articles with some good single-leg flavor: Five Programming Strategies for Quick Results and Single-Leg Supplements
19 – Tinker with Your Foot Position on the Bench, or Change the Exercise Altogether
It may be hard to imagine if you haven’t ever had back pain before, but those who have tried to do upper body days with back pain can tell you that setting up on a bench can be a pain in the butt.
A lot of lifters with extension-based back pain will have problems with lying back on a flat bench. These individuals can get some quick symptomatic relief by simply elevating the feet on some 25-pound plates or aerobic steps. This little bit of foot-lift leads to a slight increase in hip flexion, which allows the lumbar spine to flatten out a bit, eliminating some of the extension stress.
Another option for these individuals is to simply switch to incline pressing variations. The angle between the seat and back pad on the bench ensures that same position of hip flexion. Or, they can switch to floor pressing with the knees flexed, which keeps the spine a bit flatter on the ground.
It’s also worth mentioning that if you’re trying to train upper body while dealing with back pain, it’s generally a better bet to opt for barbells as opposed to dumbbells with your pressing exercises. When a lower back is hurting, the last thing you need to be doing is bending over to pick up heavy dumbbells from a low rack and maneuvering around the gym with them.
Next up, in the last installment of this series, I’ll bring everything to a close with the introduction of some drills you may not have seen before, plus a few technique cues to optimize lower back health and performance.
- Stanton R, Reaburn PR, Humphries B. The effect of short-term Swiss ball training on core stability and running economy. J Strength Cond Res. 2004 Aug;18(3):522-8.
- Tse MA, McManus AM, Masters RS. Development and validation of a core endurance intervention program: implications for performance in college-age rowers. J Strength Cond Res. 2005 Aug;19(3):547-52.
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These canons of professional ethics are based upon fundamental principles of moral and professional behavior and recommended for all doctors of chiropractic and chiropractic assistants. The following basic principles should be guiding factors in the practice of chiropractic and upheld at all times:
Consider the well-being of the patient. The primary effort and ultimate goal is for the greatest good of our patients.
- Dr. Alexander D. Jimenez D.C., C.C.S.TChief Clinical DirectorPhone: 9155408444Email: firstname.lastname@example.org
Specializing in Severe Pain: Sciatica, Neck-Back Pain, Whiplash, Headaches, Knee Injuries, Sport Injuries, Dizziness, Poor Sleep, Arthritis. We use advanced proven therapies focused on optimal mobility, health, fitness, and structural conditioning. We use Patient Focused Diet Plans, Specialized Chiropractic Techniques, Mobility-Agility Training, Cross-Fit Protocols and the "PUSH System" to treat patients suffering from various injuries and health problems.
Message from: Dr. Alex Jimenez D.C., C.C.S.T
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My name is Dr. Alex Jimenez, I am Chiropractic Doctor specializing in advanced therapies focused on total joint health, strength training and complete fitness conditioning. We use patient Focused Diet Plans, Advanced Chiropractic Techniques, Agility Training, Cross-Fit and the PUSH System to treat patients suffering from various injuries and health problems. Our goal too is to help your body heal itself naturally. When your body is truly healthy, you will arrive at your fitness level and proper weight efforlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25+ years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs...
My goal too is to help the body heal itself naturally. When your body is truly healthy and balanced, you will move pain free and ultimatly arrive at your optimal fitness levels and proper weight effortlessly. We want to help educate you on how to live a new and improved lifestyle. Our doctors have spent over 25 years researching and testing methods with thousands of patients. We strive to create fitness and better the body through researched methods and total programs. These programs are natural, and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.
The focus on spinal and skeletal adjustments is what makes doctors of chiropractic unique in their approach to treating patients with spinal complaints. This hallmark chiropractic adjustment, however, is not the only procedure a chiropractor may employ in managing a patient's care. I am very proud to bring my patients a variety of treatment options beyond the typical scope of care. With the advances in physical therapies and modalities we bring El Paso option that better aid in the rehabilitation process. Tissue healing is a wonderful process that begins the moment an injury occurs. How the injury is managed determine the final outcome in terms of healing. It is critical we implement immediate procedures as soon as we can in order to gain optimal recovery. The old day of let it rest until it gets better is not the only option.
Letting it rest may even be an irresponsible approach considering what we now know. The implementation of active and movement based treatments have clearly shown increased and improved outcomes in many instances.
As a doctors focused on the greater good for a patient, we must assess each patient individually and apply the appropriate protocols. It is also very important to denote, that El Paso has fine doctors in many specialties of healing and repair. The direct relationship we have with specialist of these disciplines is clearly what allows us to bring the highest quality of care to our patients.
My promise to my patients is clear for all to read here. I, with Gods help, will do what ever it takes to assist you in your recovery. I too will draw upon all the specialist in this town to find you the collaborative care that is required with the disorders being tended to.
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Driven by the passion of doing what is in the best interest of the patient, I wake up every morning with the drive to help those in need. The claims process for health care is full of pits, valleys and difficult obstacles designed to strike fear in those in need. My duty is to do what is within the confines of the law, "what ever it takes" to get those involved to pay attention to those who need help. That is what I am honored to do for our patients.
Personally, I have seen great injustices transpire on those that do NOT have a voice. Whether, a language barrier or just not knowing the rules. My job is to find out how I can help. If I personally can not help, I will find the right sources to open the possibilities. I get the job done.
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Daniel Alvarado is the owner and the top trainer at PUSHasRx® CrossFit Fitness Facility. Since becoming a Trainer Daniel has kept up to date on many continuing educational classes, ensuring that his clients receive the most comprehensive and advanced training. Working directly with the Doctors, he develops and collaborates on care plans that are patient specific. No patient ever gets the same clinical protocol. His expert clinical kinesiology experience spans over 2 decades. He has trained injured patients and NCAA National Champion Athletes. His technical ability to create programs that are clinically sound and second to none. He too has used his physical therapy and recovery experience to take broken top tier athletes into strict recovery protocols assisting them to achieve highly competitive national championships. He certainly will not admit it but, he is a top national champion trainer. Daniel, also develops youth programs that are sport specific to aid young athletes achieve great success. His mastery of clinical recovery is applied applied to all patients and top tier athletes alike. All patient programs are specifically designed with patient focused recovery priorities. He is happily married to beautiful Victoria Alvarado has one child. He enjoys strength training, movies, singing, conducting, writing poetry and being a CrossFit champion. Just a way cool dude. We think you will agree.Read moreRead less
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Sandra has been working at Injury Medical & Chiropractic Clinic for over 5 years. As the head Licensed Massage Therapist, she manages and directs critical aspect of clinical care. The patients love her ability to make you laugh while removing those pesky trigger points causing pain. She is able to relax and bring comfort to all she touches. There just simply is no patient that escapes her talented touch. Trained in advance myofascial techniques, she is an integral part of patient recovery. You will never see anything but a kind smile and resolute persona ready to correct your condition and aid in your recovery. She definitely enjoys helping people, has 1 dog and loves movies. She loves flowers too.Read moreRead less
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Big Mike was born and raised in El Paso and is an excellent personal trainer and CrossFit coach. Mike works hand in hand with each patient’s clinical care plan in order to achieve optimal outcomes. A trusted clinical representative of the PUSHasRx System along with his advance protocols. Mike not only trains the injured and recovering. Mike is a sincere human that has great talent of brining out the best in every individual he works with. He will never admit it, but we will share with you a secret. He with his God given talents trains the greatest athletes and champions in El Paso. Many champions in our community know of his commitment. As a youth, he also played football (wide receiver), basketball, and track at Bel Air High School. Educated in Clinical Human Kinesiology at UTEP and loves playing football and basketball with his little nephews in his free time. Mike has three sisters and one brother, most of which live nearby in El Paso. When he’s not watching the Cowboys or Spurs play, he’s usually lifting, sleeping or watching movies. We are blessed to have this soul on our team.Read moreRead less
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Alexander Isaiah Jimenez leads the power and agility education programs for the high school athletes. While still studying for his medical degree he provides physical performance testing in order to collaborate with clinicians. He is gifted in creating physical performance programs no matter what the clinical presentation is. As national fitness champion and collegiate wrestler, he too understands what performing at high levels entails. He too has had to recover from debilitating injuries only to return better then before an win national titles. He understand how the recovery process is different for clients, patients and extreme athletes. We are blessed to have his counsel.Read moreRead less
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Ethan was born and raised in El Paso and is one of our most outgoing and friendly coaches. Ethan earned his nickname “rampage Ethan” from his years at El Dorado High School, where he played inside linebacker. He has placed twice in the Strongman Competition and also recently competed in the Desert Games with his fellow PUSH Athletes as a team and placed 4th overall! Ethan is currently pursuing his Bachelor’s Degree in Kinesiology at UTEP. His focus on clients is obvious to all. Ethan is able to manage very large groups of individuals like no other. His awareness of the dangers while exercising is his greatest concern. When he’s not coaching or studying for class, he likes to spend time with his family (who are here in El Paso) or with his weimaraner puppy. Fun fact: Ethan loves any food with sprinkles (especially donuts with sprinkles) and is a diehard Seattle Seahawks fan.Read moreRead less
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Andres has been at PUSHasRx for two years. He brought his company Recovery and became the official juicer. Andy will fix you right up. Andres, will make sure that your nutritional recovery programs fits within your standards. Also, there is great care in making sure the nutritional requirement are clinically met. Patients and high performance athletes depend on high performance nutritions. Upon your completion of the physical medicine portion of therapy you will be offered specialized organic recovery drinks and supplementation to help aid in your recovery. You will be confident that from your pushing to recovery, you will be taken care of.Read moreRead less
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ylene has been working with us for over 4 years. In her spare time she enjoys working out and running. She has 2 dogs and loves movies. Iylene is extremely aware of body mechanics and mindfully watches rehabilitation movements. She is always standing ready to assist and respond to client needs. Her commanding voice is always clear to all, no matter what floor you are on. Iylene is always ready and willing to answer any question you may have regarding fitness and recovery.Read moreRead less
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Most early-rising PUSHasRx members know Rick well as a fantastic coach who focuses strongly on form and will always make you laugh. He was born and raised in El Paso and loves to train his athletes and coach CrossFit. Rick is a very diligent, kind and considerate trainer. He is always mindful of client techniques and aware of client goals. When he’s not coaching, Rick loves to work on cars, especially his ’69 Chevelle (his next car will hopefully be a ’69 Charger). He not only became a certified Automotive Mechanic at 17, but while working on his certification at EPCC, he won 1st place in a bench competition when he was 16 (approx. 56 reps at 155#). His favorite movements are clean & jerks and snatches. He loves oreos (eats them every night), loves watching the CrossFit games, and loves his three bulldogs. He spent one year full-time personal training before he started coaching CrossFit two years ago. He is CrossFit Level 1 Certified and hopes to get his Level 2 Certification soon. Rick has competed in several competitions, including WOD for Toys in 2014, where his team placed 1st.Read moreRead less
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Adam has been at Injury Medical & Chiropractic Clinic for about a year. He enjoys designing and various forms of art. A story teller by trade he can see things people don’t see until his masterpieces are revealed. Adam is a director of many medias using the top graphics, audio and video medias to tell the story of our patient. Modest to the core, you would never know what he is about to create. We are blessed to have his talents telling the world about Chiropractic using any and all medias available.Read moreRead less
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We use Specialized Chiropractic Techniques, Balanced Diet Plans, Agility Training programs, Cross-Fit techniques, the PUSH-Rx Rehabilitation System and a highly specialized program for our Veterans.
We've been blessed to use our methods with thousand of El Pasoans over the last 27 years. This has allowed us to improve health and restore true fitness through researched non-surgical methods and wellness programs. These programs are natural and use the body's own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and informed on how to maintain this way of life.
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