This is a very interesting topic and we invite an open discussion.  Please join in and share your thoughts.

A recent paper (2/09) by Matthew Dritz, MSc, John Cronin, PhD, and Patria Hume, PhD, entitled The Bodyweight Squat: A Movement Screen for the Squat Pattern, evaluated the research on the squat and devised the ‘proper’ position for this exercise. They looked at Baechle’s, Bloomfield’s, and Kinakin’s work on the subject to devise their methodology.  I, for one, really embrace this paper.  As a sports rehabilitation specialist, I very much appreciate the concern for proper form and certainly for a neutral spine.

So, what do we do a two-legged squat for?  It is to train our back?  Do we squat to affect our gluteus maximus (butt)?  Does squatting train our hamstrings?  Well, the truth of the matter is that when we perform a two-legged squat, we are primarily activating the quadriceps musculature…Research by Stuart McGill, PhD has shown this and he writes about this in his studies/books.  Although we might use many muscles in the squat as we have to be stable, the primary movers are the quads.  So, this begs the question of why so many ‘train’ other muscles when they squat?

For example, many bend at the waist when they squat (either during the initial phase of the squat or when coming back up).  Many stick their butts out when they squat.  Many look ‘up’ when they squat? Are these positions part of the proper squat?  The answer is a resounding ‘NO’.

There are some basic rules of squatting and if you follow them, you’ll greatly reduce your risk for injury.  If you don’t follow them, injury will occur.  It is usually not a question of ‘if’ so much as it is a question of ‘when’.  Simply put, you cannot load your body with weight in a fashion that the body is not able to handle such a load.

The basic rules are as follows:
1.  The back stays straight…period…if you stick your butt out while you squat, you shouldn’t be squatting…there is no way around this.  We do not want to compress our facet joints with extension while we have weight on our shoulders.  This is very dangerous.  Our spinal erectors are already facilitated…no need to facilitate them more! Straight back means straight back…it doesn’t mean we cannot bend at the hips a little to get a comfortable squat position.  Bending at the hips is regarded as being safe.  Bending the spine is dangerous!
2.  We look forward.  Looking up will force us to compensate and go into extension.  Very bad!
3.  The knees stay aligned over the feet.  If our knees move in or out when we squat, we are enforcing faulty tracking knee patterns and this could lead to significant knee damage. We bend the hips and knees to squat.  We don’t want the knees to go in front of the feet as this will injure the patellar ligament.
4.  The feet are positioned about shoulder-width apart.  They do NOT come off the floor.

When we go into the downward phase of the squat, we keep our position.  If we are tempted to stick our butt out, lean forward, look up, move our feet, etc…, this is a good time to evaluate if we are mechanically sound to perform a squat.

How do we know if we can squat or not? According to McGill, there are a few assessments to perform before squatting.  McGill recommends starting with something called a Potty Squat.  This teaches our body the form of the squat.  We then progress to the ‘Short Stop’ squat (unassisted squat), which takes away the support we get from the Potty Squat and creates a free-form exercise.  From this training position, we can start to move a standard squat with weight.  The key is to develop the proper stability so the squat motion will train the muscles it’s supposed to train, not create injury.

Along the way, we have to be certain that we have proper biomechanical integrity.  If we lack proper hip internal rotation, if we have iliotibial tract syndrome, if we have a lack of ankle dorsiflexion due to a history of ankle sprains (without needed rehabilition following), we might need these issues corrected by a chiropractor (with sports training) or a sports physical therapist.

Without proper joint function, many times we cannot achieve the movement we’d like. Stretching will increase range of motion but it will NOT reduce stiffness (McGill)…in other words, it won’t improve joint function.  Joint dysfunction inhibits adjacent muscular activity (this is one of the favorite sayings of Kevin Hearon, D.C.).  Think of it this way…if a joint is fixated, or not moving properly, the muscles will work harder to get the joint to move in its ‘normal’ ranges of motion.  Being the muscles cannot reset the circuitry of the joint, muscle injury will occur as the muscles work harder and harder.  I won’t get into articular neurology here, but we need a different type of neurological stimulus to get joints to work better.

So, there you have it.  Do you know how to squat and do you know what you are squatting for?  Now you should have some answers.  Please feel free to ask away on this topic as it is a great one for an open discussion.

For those who have never been rock climbing / steep hiking, it’s a very aggressive exercise and is very demanding and tiring.  It is a lot of fun though!  I am in very good shape, and to be honest, this type of exercise kicks my butt.

We summited the peak at a little over 4150 ft. (I did not take a reading at the bottom but I figure we had about a 2500 foot ascent).  I did the hike with a friend of mine who is a triathlete and runner.  He has great aerobic fitness and even he was spent by the time we were done.  Please note that we had ample fluid and snacks, and we replenished electrolytes with Sports Connexin each hour.

I think the nature of rock climbing / steep hiking makes it an inherently tough activity.  Take the hot Vegas sun (it was 85-90 degrees when we were there), the slight altitude, the adrenal rush of the danger element, and the actual physical exertion.  All these together make for a very challenging activity.

We have to look at the activity itself to determine why an anaerobic-type athlete like myself and my aerobic-type athlete  buddy were both really tired at the end.

Rock climbing with steep hiking would fall into the category of what is called an Acyclic Combined activity (as defined by Bompa and Haff).  This means that there are parts that are aerobic, or repetitive, and parts that are anaerobic.  For example, you might be walking for a little while on a steep incline (cyclic) before getting to rocks where you have to push off with your feet while pulling yourself up with your hands (acyclic).  In effect, this activity requires both aerobic and anaerobic fitness.

It is a very tiring activity and it burns a TON of calories.  Don’t forget that once you get up to the top, you have to get back down again…and sometimes the downward trek is more dangerous and difficult than the way up.  Caution is required for both directions.  As a side note, you have to be certain to wear proper footwear…sticky rubber shoes/boots are really a must.

So, you ask, how many calories can you burn with steep hiking coupled with rock climbing?  I’m about 230 pounds and I was carrying a 20 pack.  We were active for over 3.5 hours, so let’s safely say 210 minutes (really it was closer to 4 hours).  Depending on what sources you look at, I burned between 2700 and 3700 calories…not too bad for half a day’s work.

Why are so many calories burnt with this activity versus many others?  This is not too difficult to figure out.  First of all, hiking with a 20 pound bag on your back is never easy!  Add a steep incline, the need to use your arms and legs, add in slippery surfaces, and it’s easy to see that a lot of concentration and stability is required.  This means that the brain is working hard along with your body to maintain stability and good footing.  Rock climbing uses all available limbs.  Unlike running or biking, which are predominately two limb activities, rock climbing requires use of upper and lower body strength and stability, with the dynamics of the activity always changing.  Bracing your low back and core as you throw your legs around onto rocks while at the same time stabilizing and holding your upper body with your shoulders and arms (while still having that 20 pound pack on your back) require a lot of muscle activivation.  I find that rock climbing really taxes all parts of the body.

If you ever get the chance to go rock climbing and steep hiking, you should.  It is exhilerating, fun, and very demanding.  It also usually gives you great scenic views and a sense of accomplisment when you are done.  If you are ever out in Vegas, I highly, highly recommend the drive out to Red Rock…we parked at the first scenic area.  We walked down sharply and off to the right and simply started our ascent (about 2/10 of a mile from the parking lot area).  Make sure to pick your line for ascent before you get going or you can spend hours just figuring out how to get up the rock mountain.

How does this information relate to working out and training clients?  Think about the activities/sports your clients partake in…are they cyclic in nature, acyclic, or combined? How does this knowledge affect how you train them and what you train?  Do you know how to break down workouts to help athletes in all categories of sports?

Getting close to the top! Quite the ascent!

A picture looking down...

A picture of the beautiful scenery...

Easy to see why this activity is such a caloric burn!

Taking a break from the sun!

Always having an interest in biomechanics and working out, I quickly developed a fond appreciation of Dr. Walther’s take on Cross Crawl patterning.  This topic really piqued my interest!  I distinctly recall one conversation I had with him when he discussed Tonic Labyrinthine Reflexes (TLR)  (an expanded understanding of such) and the association with Cross Crawl patterning.

So, what the heck is a TLR?  By strict definition, the Tonic Labyrinthine Reflex (TLR) is a primitive one and it is usually paired with following pattern:  a newborn, while on its back, will have arching of the back when it tilts its head back, will also have straightening of the legs, adduction of the lower extremity, pointing toes, an arm bend at at the elbows and wrists, and clenched hands.  This reflex is considered pathological when found as one gets older.  We can see from this reflex that even at a very early age, our body is patterned, and as we age, we are always learning new patterns.

So, how does this relate to the Cross Crawl?  The Cross Crawl pattern is a developmental milestone.  Once an infant begins to slither across the floor (and even much earlier than this), the right hand/left leg (and vice versa) pattern begins to develop.  Proper development of this pattern is necessary for coordination of activity.  This pattern eventually develops and tunes our gait.  Individuals with neurological disorganization (learned and disease state) may not exhibit this patterning.

The merging of the primitive TLR  and the developmental Cross Crawl is quite evident when we are in the gym.  When you are in the gym, look around and see the body positions of people as they work out.  When they are doing a one armed biceps curl, which foot is forward?  When they do a triceps kickback, which leg is forward?  When doing a standing leg exercise of any form, which arm is forward?  Does it really matter how we stand when we work out?  You bet it does!  I’ve taught it this way for years!

All one has to do is muscle test a particular muscle while in a gait stance to see how Cross Crawl patterning works.  For example, when our right leg swings forward when we walk, the left arm is going forward.  The left leg is obviously going backward and the right arm is going backward as well.  Ever see anyone walk differently than this?  If so, they have serious neurological impairment.  Even slight deviations from this indicate neurological confusion.

When we pick up a weight or do any activity, we have to keep in mind how the brain is processing the information.  Do we want to create neurological confusion, or do we want to enhance brain processes?  Working out with Cross Crawl patterning in mind will enhance our functioning whereas working in a homolateral pattern (there are a few exceptions to this but not many) will create neurological disorganization.

Let’s take for example an elliptical machine that is commonly found in the gym.  Do you notice that most of them are built so that the right arm goes forward as the left leg goes forward?  Have you seen a machine where the right leg and arm are tied in together, thus creating a homolateral pattern?  If you can find such an improper machine, try getting on it and moving very quickly for 5-10 minutes.  Hop off and see how ‘out of sync’ you feel. For the time you are on that machine, you are literally confusing your brain as you are not wired for a homolateral pattern but for a Cross Crawl pattern.  Do you think that if we train without thought of proper patterning that over time, we can create not only musculoskeletal issues, but also neurological issues?

The answer is an emphatic ‘YES’!!  Why confuse the brain?

So, where do we go from here?  Each of us could learn the entire musculoskeletal system and how each muscle works with the Cross Crawl pattern.  That, however, can take a lot of time and should not be necessary if we work with fitness professionals.  Your trainer should have a functional knowledge of anatomy, biomechanics, kinesiology, etc… to go along with a strong understanding of Cross Crawl patterning as it is vital to the proper positioning of clients.  If you have a trainer who is not well-versed in this area, you might want to consider finding one who does as training against these principles will do more harm than good.

So, does anyone have any experiences with the material presented in this blog?  Please share your thoughts on this interesting and important topic.

Allen Manison, DC, DACBSP, CCEP, CSCS

All too often, clients spend a small amount of their time with their trainer actually working out. I’m sometimes amazed at how much conversation goes on and how many minutes pass between sets. I seldom think that the client’s hard-earned money is going to good use.

Let’s take a look at a simple way to figure out how much time you are actually working out. By following this format, you can get a ‘sense’ of the intensity of your workout…and intensity is very, very important. The proper term for this assessment is Relative Density (as adapted from Bompa). So, you have a 60 minute session slated with your trainer. You should be warmed up and ready to go before your session. (Your trainer should not be standing beside you as you walk on a treadmill, thereby wasting true workout time). Every time you are actively participating in an exercise, have someone click their handy stopwatch and keep time of this…when you rest, the stopwatch stops. In the course of 60 minutes, you will get a number that will tell you how much of the time you are actually exercising (and how much of the time your trainer is doing something other than training you). Now we can insert this number into a simple formula. For the record, there is a specific way of assessing workout intensity, but for our sake here, the relative density should be good enough.

Let’s say you worked out 25 minutes out of the 60 minute period. (Don’t be surprised, I’ve timed trainers that have clients that only were active 15 minutes during the hour!). We can take the time the client was working out (25) and divide it by the total time of the workout period…in this case, 60 minutes…so, we end up with:

25/60=.4167
Now simply multiply this number by 100 to get 41.67%.

This means that during your workout, you worked out 41.67% of the time..this doesn’t look too good! So even though you’re with a trainer, you’re really not doing much benefit for yourself. We cannot determine the true intensity of the workout unless we establish the Absolute Density of the workout, but we can save that for another time.  It’s clear enough from the Relative Density that this particular workout is really a workout at all.

So, for those who workout with a trainer, how much time do you spend actually exercising?  Can you really get the heart rate up enough if you’re only working out for 41% of your workout?

For example, a trainer takes a class on how to use a BOSU ball or Swiss (rehab.) ball and comes back into the gym on Monday and has all of his/her clients using such apparatuses. The trainer does not do a stability assessment and really doesn’t know what the client is capable of, but the trainer feels the need to try out what was just learned so everyone gets on a BOSU or Swiss ball.  This is a HUGE mistake as the trainer might be doing more harm than good.

There are several levels to stability and balance and a proper assessment is necessary to determine where to begin. Before I go any further, I’ll digress just a little about the use of stability tools and weight training.

A trainer needs to make a determination as to what needs to be done with the client so that the workouts match the goals.  Is stability the primary objective, or is weight training for muscle strength, power, hypertrophy, etc… the main goal?

The reason I discuss this is because too many trainers try to work on stability while at the same time work on strength.  Case in point: standing on a BOSU while doing biceps curls.  What is the point of this? Is the objective stability or muscle hypertrophy? Sadly, in most instances, the trainer may be having the client do these sorts of activities without really knowing what is being done.

If you are trying to work on muscle strength, you cannot do so when on stability equipment as you cannot use the same weight due to stability issues.  This means the particular muscles you are trying to focus on will only get a fraction of the resistance they need to respond.  If you do these exercises to work on stability, the client needs to be functionally assessed to know where to start. Think of it this way…if you want to improve your stability/balance and you are doing biceps curls, are you really able to focus on the stability 100%, like you need to?

So, that biceps curl on the BOSU begins to look like an exercise in futility…it is really not achieving anything in particular…it’s neither working on stability as the person is usually ‘cheating’ immensely to just stay on the thing and it’s not working the muscles fully as they are not utilized correctly due to the body trying to maintain stability and the resistance needed is not provided.

Okay, sorry to digress there…there are 5 or 6 levels of stability. Before you begin working with a fitness professional, you should go over with them the levels to see if they are familiar.  Are they able to progress you properly through the levels so that you can maximize your benefits?  If they are not, you should find someone who can.  It’s safe to say that stability work begins on a flat surface, then progresses to a 2″x4″, and then goes from there.  Perturbations (think of this as disturbances) can be added at each level to help demonstrate mastery before progressing.  Once proficient at the higher levels, plyometric, multi-plane movements and like activities can be added to ‘lock in’ the gains made during the earlier sessions of stability.

The goal of stability exercises is to essentially teach your body a new pattern, or habit, if you will.  When stability is increased, the ‘core’ functions more efficiently, reducing pressure on the back and distributing that energy more evenly to other structures so as to reduce injury.

Proper training of the core will lead to more stability.  However, if you skip steps and/or start at a level that is too advanced, your body will compensate and you will likely increase your risk for more injury.  It is your fitness professionals’ responsibility to make sure that you are starting at the right level.  Therefore, make sure you get an assessment from a qualified professional to help determine how stable you are before you ‘jump’ into stability exercises.

Anatomy and kinesiology dictate that in order to contract the rectus abdominis, one must approximate the thoracic cage to the pelvis or vice versa (and no, I’m not including isometric contractions here).  This is not occurring with the aforementioned exercises, and even with a sit-up, it only occurs during the first 30 degrees of body flexion…the rest of the motion is very, very bad for you!

So, when we see someone hanging or on a Gravitron and bringing their legs up to 90 degrees, or lay on their back bringing their legs up several inches off the floor… or for that matter, doing a sit-up, what is really being done?  Well, two things are certain: the abdominal muscles are certainly not being trained and the low back facet joints are getting pounded!

In fact, these exercises target the hip flexor musculature, and this is something most of us do not want to do.  We have four hip flexor muscles: Psoas (Minor and Major), Sartorius, Rectus Femoris, and the Iliacus.  The Psoas is clinically significant as it partly originates from the anterior discs in the lumbar spine…this means it exerts a force, bringing the lumbar spine into extension.  It is a major component of the lower cross fix pattern and it is many times responsible for lumbar damage.  The Psoas is also the strongest of the hip flexor muscles and is already a facilitated muscle on most people…training will only lead to back injuries!

It is a shame that people, mistakenly thinking that they are training their abdominal region, are actually training the hip flexors…and this is very pervasive in all gyms!  We even seen personal trainers instruct people with these exercises!  You can go into a gym at almost any time and see someone hanging and bringing their legs up to 90 degrees. You can usually also see someone on a sit-up bench with the legs locked in (creating a nice anchor for the hip flexors to work) pulling their body all the way up…again, these exercises are DANGEROUS!!  Considering most people sit all day long and already have facilitated hip flexor musculature, going into the gym and further shortening these muscles at the expense of the lumbar spine certainly doesn’t make much sense!

So, to open up this discussion, what are some better ways to address the abdominal musculature?  Now, I’m not talking about core stability here, I’m only talking about actually addressing the rectus abdominis, along with the internal and external obliques. How can we best go about addressing this area without compromising other parts of our anatomy?  What would we want to tell people when we see them doing these dangerous exercises?

1.  Hyperextension biceps curls
2.  Shoulder external rotation with downward resistance…such as holding a weight (did they really think they were training their rotator cuff??)
3.  Low back compression squats (stick the butt out when squatting??)
4.  Supraspinatus compression exercises (all coronal plane activity)
5.  Hip flexor situps, crunches, seated compressions, etc…
6.  Hyperexension triceps exercises
7.  Hanging psoas tighteners (did they think they were addressing their abs?)
8.  Standing bent over arm swings (what are they trying to train, rear delts?)
9.  Bent over triceps kickbacks…why compress your spine for this?  Are you really getting all the heads of the triceps?

Anyway, there are more, but you get point.  Most people lack a general knowledge of kinesiology and biomechanics.  My sentiment is that if people want to hurt themselves, so be it…but, when they are teaching others how to hurt themselves, this is a big no-no!  It amazes how many people really do think that what they are doing is correct.

Without an underlying basic knowledge of how your joints and muscles work, it should be obvious that injury can be achieved as easy as gains.  I guess I’m very sensitive to this as I treat injuries all day long and many are due to gym-related activities…many while under the ‘supervision’ of a paid personal trainer.

With that being said, what other funny things have you seen in the gym and what do you think those people were trying to do?

When Dr. Antico and I teach, we always ask:

1.  What exercise are you doing?
2.  What muscles are you trying to address?
3.  What are you really doing?
4.  How can you better address the areas you’d like to train?

Unfortunately, improper training in the norm.  We all need to do more to better educate ourselves and those we work with so that maximal gains can be achieved while minimizing injury.

Your comments?

The shoulder is a complicated joint complex that has three primary joints: the acromioclavicular joint, the sternoclavicular joint, and the glenohumeral joint.  The sternoclavicular joint helps connect the shoulder girdle to the sternum, the acromioclavicular joint connects (although not too well) the scapula bone to the clavicle, and the glenohumeral joint is the big ball and socket joint that moves the most and is what we generally think of when we discuss the shoulder.

Unlike the hip joint, the shoulder gives up stability for mobility.  This means that the soft tissues (muscles, ligaments) holding the shoulder together are relatively fragile, especially if we do things to hurt them.  Improper exercises can really lead to a lot of damage in a relatively short period of time.  As we all know, shoulder injuries are quite common and this is easy to see when you watch people work out in the gym.

The rotator cuff is a combination of 4 muscles that work as dynamic stabilizers of the shoulder.  This means that they help to keep the shoulder together while the rest of the muscles in the region actually move the shoulder.  The health of the rotator cuff is of utmost importance.  Without proper shoulder stability, injury will occur.  Unfortunately, the rotator cuff is generally not addressed properly as few have proper training to properly train the shoulders.

So, this brings us back to the discussion of why lateral raises (in the coronal plane) along with upright rows are bad.  I’ll go as far as saying that if you do these exercises, it’s not a matter of if, but when, you’ll end up damaging your rotator cuff/shoulder.  Why is this?

When we bring our arms up to the side, we enter into a range called the ‘painful arc’ when the shoulder is between 60 and 120 degrees of abduction.  By the time we have abducted 90 degrees, the humeral head has elevated about 3 mm.  This doesn’t sound like a lot, but it is more than enough to put it in close proximity with the acromion process.  Within this range, we can easily compress the structures between the acromion and the humeral head…the main structures being the sub-acromial and sub-deltoid bursa sacs as well as the supraspinatus tendon.  Repeated movement in this range, especially with weights in our hands, will eventually lead to damage to the structures listed above.  The situation gets worse the more you work in this range as the instability in the body leans to arthritic changes.  Unless you change your movements, there is really no way around this!

In regards to the upright row, I still cannot figure out why anyone does this.  I remember taking my CSCS test from the NSCA and having a practical question that asked what you should do if an upright row hurt.  The only correct answer (which was totally WRONG) was to bring the bar up less high.  What a foolish way of dealing with this.  It essentially is telling the strength coach to hurt the client just a bit less!  The upright row essentially replicates an orthopedic test called the Hawkin’s Test.  This test checks if shoulder abduction with internal rotation and compression of the glenohumeral joint creates pain.  If it does, you have supraspinatus damage.  The upright row simulates the Hawkin’s Test to a very close degree, effectively creating a torquing motion that compresses your glenohumeral joint and crushes your acromion process into the aforementioned bursa sacs and supraspinatus musculature.

This begs the question: why do people do these exercises and what are they trying to achieve?  What muscles are being trained SAFELY with the upright row?  Why do them at all?…can other exercises that are safe be implemented instead?

The discussion is open!

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