Injury Prevention

Why Some People Hurt Their Backs With Certain Ab Exercises

On April 22nd, 2014, posted in: Injury Prevention, Low Back by 0 Comment

I gave a presentation for a group of personal trainers and was asked “Why do some people hurt their backs doing certain abdominal exercises?” Here was my answer:

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How to Instruct Transverse Abdominis Contraction

During a presentation on injury prevention, I taught a group of personal trainers how to instruct transverse abdominis contraction. Check out the video:

Video transcription:

If you palpate your anterior iliac spine and just go with your fingers to the soft tissue right inside of it, you bring your belly button toward your spine. If you’re doing it right you’ll feel your transverse abdominis, your deepest abdominal muscle, great stabilizer of the spine. It’ll firm up and push out into your fingers and that’s before I’d have them doing back extensions. I’d make sure that they have a really solid contraction of that, that they can do it without holding their breath and hold it for twenty seconds at a time. I’d make sure those baseline things are there before I have them doing that but it’s a good exercise as well, just when they’re ready for it.

Planks: Are You Using Abs or Glutes?

On March 25th, 2014, posted in: General, Injury Prevention by 0 Comment

 Planks: Are you using abs or glutes?

I was asked this question by a personal trainer after a presentation I gave on injury prevention. And here was my answer…

Video transcription:

With planks I wrote on the thing using abs or glutes–I see a lot of people using planks, a lot of good trainers making sure that the spine stays neutral and all that but what I don’t see is a lot of them checking — are they counteracting the hip flexor pull and keeping a neutral spine because their glutes are doing that or because their abs are doing that?  If you want the glutes involved of course it doesn’t matter but if you want to really be a solid ab exercise and specifically for the abs what I do is I’m right down on the ground with them and I’ll palpate on the glutes themselves right and I’ll say you know I really want you to relax these and use your abs to keep your back flat and I kind of draw in like this. I’ll say as I’m drawing in on the abs here kind of give that so go ahead and flatten out the back, lift up a little bit and keep these as relaxed as you can, and she does pretty well with that. It’s a little bit more of an arch than I’d like, but I really wanted to show that if you really want the plank to be as solidly about the abs as possible make sure they’re not getting too involved with the glutes.

How to Mobilize Your Thoracic Spine

On March 11th, 2014, posted in: General, Injury Prevention by 0 Comment

How do you have patients loosen their thoracic spine?

I was asked this question by a personal trainer after a presentation I gave on injury prevention. And here was my answer…

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How P90X Can Create Back Injuries

On February 25th, 2014, posted in: Injury Prevention, Low Back by 0 Comment

Some exercise programs can be dangerous. Here’s why I think P90X isn’t for everyone:

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Gym Equipment & Exercises You Should Avoid!

On February 11th, 2014, posted in: Injury Prevention, Low Back by 0 Comment

Are there any commonly used exercises or equipment you warn people/personal trainers to avoid?

I was asked this question by a personal trainer after a presentation I gave on injury prevention. And here was my answer…

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Common Golf Related Injuries

On January 28th, 2014, posted in: Hip, Injury Prevention, Low Back, Neck/Shoulder by 0 Comment

What’s the most common golf-related injury you see in the clinic?

I was asked this question by a personal trainer after a presentation I gave on injury prevention. And here was my answer…


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Common Cycling Injuries and How to Treat Them

On January 6th, 2014, posted in: General, Hip, Injury Prevention by 0 Comment

What are some of the common issues you see in cyclists in your clinic?

I was asked this question by a personal trainer after a presentation I gave on injury prevention. And here was my answer…


Video Transcription:
With true cyclists, they’re clipped in and they’re pulling up as much as they’re pushing down, so I see a lot of, not just the psoas/hip flexor stuff with them but a lot of TFL (tensor fasciae latae) and that usually is involved with really high IT bands. Rarely I’ll have a cyclist, and I see a number of them, come in without a pretty tight IT band/TFL and I touch it and they’re like UGH! They feel great when you’re done but it’s kind of torture to get through it. Definitely teaching them to get on a lacrosse ball or foam roller and really get into these areas here. I know some people say lay on a ball to get the psoas. I’m not a big fan of having people do that. There’s just a lot of stuff going on in there and I feel like you should have skilled hands weaving through viscera to get down to that and not just laying on the ball in the abdomen. There’s a lot of complex things there. If they have any kind of impingement of the hip, it’s going to cause them on that side to kind of rotate and lift up especially in aero position. If you’re riding up top it’s usually not an issue, but I’ll have them bring in their trainer and bike. I’ll watch them and first of all say how symmetrical are we looking here, one hip versus the other that’s usually going to identify the issue, and if they feel that pinch there or it can be a number of different tightnesses or weaknesses.

Injury Prevention Screen Part 5: Squat/Ankle Mobility

On December 24th, 2013, posted in: Ankle, Hip, Injury Prevention by 0 Comment

The video below demonstrates the Squat/Ankle Mobility Test, which is part 5 of a 5 step Functional Movement Screen I taught to a group of personal trainers. This set of movement tests is designed to identify predispositions to injury so they can be addressed before a problem occurs.

Video Transcription:
So if you do see that you know there’s issues with the single leg squat in terms of the hip stability, the knees going in, things to watch out for or to wait on until you’ve got them strong and showing that stability would be lower body plyometrics, like box drops, a lot of cutting agility stuff. I’d wait on that until you saw that they’re really, really stable with that test. Is there anyone here with a history of ankle sprains or ankle issues by chance? I just want you to face everybody and, with your legs apart a little bit, however you would do a squat keeping your heels on the ground. Just go ahead and do a squat for us and come on back up.

With this, what you’re looking at, what you’re going to look from all sides-from the back, side, and the front. From the front, you’re looking for: Are the knees dropping in? From the back and the front you’re looking- Are they loading each side equally? Are they you know are they overloading one side versus the other? Go ahead and do another squat for us. This is pretty classic. From what she did there, I can immediately tell it was her left ankle before she said anything because when she drops down she gets to a point where she can’t go further with her knee because she doesn’t have enough dorsal flexion in her ankle but this one you can go further. What happens is this: It’s a rotator, so I’ve had a lot of patients in the past with let’s say a right hip/right knee/right ankle or some kind of back issue and the thing that led to it was the fact that they sprain their ankle two years ago and they’ve been doing squats like this. So they’re just loading that side. So you want to look from the front and back-are they loading evenly, first of all. If they’re shifting, are they immediately shifting like it’s some some kind of a neural pattern or they just got in the habit of staying off one side versus the other. Are they real nice and symmetrical till they get low and then they tilt off? That’s usually going to be more of a hip or ankle range of motion issue. If both ankles are limited, what you’ll see is they get to there they can’t go further, so to get deeper, I see a lot of high school athletes in the clinic and it amazes me that they’re told to do box squats. You know, touch the box down here but they have no dorsal flexion. They’re stuck there so what they do is they can either fall backwards or they have to lean forward with this big load on their back and then they strain their back, so the consequences of ankle issues on one side is that you’ll usually overload the opposite side. Then if they’re both tight you’ll usually bend forward too much and then the back’s at risk.

To look at each of them individually I have them do knee drives. Put your hands here, put one foot forward. Let’s do the right foot first and this foot back and you’re just going to drive this knee forward over your toes as far as you can. Keep the heel down. Don’t worry about this, we’re just looking at the right. So as far as you can keeping the heel down. Can you tell me what stops you? Is it a pull back here? A binding in the front? Come out of that. So that’s good on her right side. She’s good. What you want to feel at the end ranges is that what you want them to feel is that they have a stretch here somewhere along the in the gastroc soleus or down in the Achilles. If they’re having a binding in the front, that’s a problem and it needs to be fixed and manual therapy, those who know how to do that, can do so really quickly.

Go ahead and try that on your left now. Keep that heel down. What keeps you from going further forward there? So it’s surprising to me that she doesn’t have that block feeling in the front even though she’s really limited. What I would do with her is probably work on the posterior side of her leg, loosen that up, and then the next time she did it, she probably would get the block feeling because that’s more of a scar tissue thing that can build up, especially from ankle sprains. So again, with this squat you’re looking at it from all sides. Are they loading evenly? Is there an issue like a pinching at the hip? Or block at the ankle that is causing them any pain? You know what you kind of have to communicate with them-why aren’t you loading symmetrically? Try to get to the bottom of that. You know if it’s something like the ankle stuff, just stretching the tight ankle. If it’s a joint this, it’s probably just going to grind the ankle. It needs to be released with some manual techniques. If it’s just a stretch in the back, foam rolling, stretching, things like that should knock it out.

Injury Prevention Screen Part 4: Single Leg Squat

On December 10th, 2013, posted in: Hip, Injury Prevention by 0 Comment

The video below demonstrates the Single Leg Squat Test, which is part 4 of a 5 step Functional Movement Screen I taught to a group of personal trainers. This set of movement tests is designed to identify predispositions to injury so they can be addressed before a problem occurs.

Video Transcription:

Going right into the next test, with the single leg squat. So the single leg stance that we just did was looking a little bit more at frontal or coronal plane stability, kind of side to side. When you add the squat in, you’re adding in the transverse plane and the rotational instability components. I like to do the one legged squat with the other leg out rather than back because it mimics going downstairs. It’s just a little more functional. You have them lower down and first of all: “does it hurt?” If it’s just mildly uncomfortable usually that’s going to probably work itself out as you get stronger, but if they have debilitating pain or can’t go very low, that’d be something to have them check out before you get deep into a leg program or something like that. The main thing with this is, “does the knee stay over the toes?” If they drop it in, it’s a really big problem because what it does, in most cases, its showing that the hip external rotators are not doing their job to stabilize the leg. I would guess that component or that injury predisposition is present in … I haven’t looked at studies on this…  but I would guess more than half of your major knee injuries (except for maybe a football player that gets swiped in the legs). If you had that person do this before the injury, they’d be dropping in like that. In those cases, there’s tons a great exercises to strengthen the hip rotators.