The Twists and Turns of your Rotary Core

The final chapter in our exploration of core function is my personal favorite, the rotary core.  It’s my favorite piece to the puzzle because there are so many wonderful variations of rotary exercises out there with fantastic risk-reward ratios.

We’ve already covered:
The Anterior Core
-The Posterior Core
The Lateral Core

Through our discussion, we have already come to conclusion that your core musculature is capable of producing trunk motion, but it’s most essential role is PREVENT motion of the trunk.  The anterior core resists trunk extension.  The posterior core resists forward flexion, and the lateral core resists lateral flexion of the spine.  The more often we take our lumbar spine outside of neutral, the more we are asking for problems in the discs and surrounding structures close to the spine.  This point is not debatable and might be even more important in the case of rotation.

As world-renowned physical therapist Shirley Sahrmann states, “during most daily activities, the primary role of the abdominal muscles is to provide isometric support and limit the degree of rotation of the trunk…A large percentage of low back problems occur because the abdominal muscles are not maintaining tight control over the rotation between the pelvis and the spine at the L5- S1 level.”

So, the job of the core is to prevent lumbar (lower back) rotation in order to keep the spine neutral.  Why?  Well, remember back when we looked the anatomy of our spinal column.

We learned that the area of the neck is referred to as the cervical spine, the area of your spine from about the top of the shoulders to the bottom of the ribs is known as the thoracic spine, and the area from the bottom of the ribs to the top of the sacrum is known as the lumbar spine, as shown below:

Gray_111_-_Vertebral_column-coloured

As you can see, each vertebra is named (C for Cervical, T for Thoracic, etc.) and numbered starting with C1 in reference to the proximity to the skull.  C1 is the closest vertebra to the skull, T1 is the uppermost thoracic L5 is the lowest lumbar vertebra, etc.

How does this play into our discussion about rotation?  Each segment of your spine is capable of a certain degree of rotation range of motion.  Attempting to surpass this range of motion can and will result in serious injury, such as a tearing of the annulus of the disk, if performed repetitively over time.  This annulus tear, if left untreated can eventually lead to a disk herniation.

The lumbar spine, or lower back, is the most common site of back pain, and lumbar rotation is one of the most common causes.  The reason for this is pretty simple.  Each segment of the lumbar spine is capable of only 2 degrees of rotation.  Rotating just 1.5 degrees further than this range of motion, repetitively over time, has been shown to create the annulus tear that I just mentioned.  That is an incredibly small window with which to work and because of this, using exercises which create lumbar rotation are almost always forbidden when you see a PT for back pain, and should be completely removed from all exercise programming as a preventative measure.  There are SO MANY wonderful exercises that we can use to challenge your rotary core without creating lumbar rotation, that the use of lumbar-rotating exercises make zero sense.  Remember, people with sedentary jobs sit, often with a flexed lumbar spine, all day long and add rotation for things like answering the phone, opening drawers, etc.  This is an extremely common mechanism for back pain, and adding more rotation at the gym is a bad idea.

On the other hand, the hips and the thoracic spine are capable of wonderful amounts of rotation, and are both highly mobile joints.  Rotation of the upper body should occur almost entirely through the thoracic spine, and people should learn how move with their chest.

Stop Doing This:

Russian twists, scorpion stretch, seated trunk rotation, full range of motion window wipers, or any other motion which produces repeated rotation of the lumbar spine.  The russian twist is an incredibly common exercise meant to strengthen the rotary abdominal muscles in which you are seated, essentially balancing on your tailbone, taking a medicine ball or other object side to side.  I’ve even seen this exercise advertised online as a way to “reduce your waist.”  Since we already know that spot reduction is a myth, I’m not going to go too far into that detail. What happens with the russian twist is essentially the same thing that happens when people sit in their chair and rotate for something at work, except they don’t do that at work for 3 sets of 40.  The hips and lumbar spine flexes and excess rotation is seen at the area of the lumbar spine.  This, again, is a primary cause for annulus tearing in the disk.

The Scorpion involves lying face down and then bringing both legs over one side of the body, then the other, without moving the upper body.  So here, we prevent thoracic spine movement (the place we actually want to move) and create it in the lumbar spine (the place we want to keep still).  Same goes for the seated trunk rotation and full range of motion window wipers.  Partial range of motion window wipers, when executed slowly and properly, can be safe and effective.  The knees should move only 15 degrees or less to each side of a vertical line, as this is the summation of the range of motion that each lumbar segment can go through.  These must be done with great care, but can be an effective trunk stabilization technique.

Start Doing This:

Birddog, Palloff exercises, chops and lifts.  The birddog is a great starting place for rotational stability training.  Get down on all 4’s, keep a neutral spine, and start moving things around.  Kick a leg, reach an arm, go slow, go fast, etc.  This is an exercise that a HUGE range of people are capable of doing, and can be made extremely challenging for the more advanced exerciser/athlete.  As you create range of motion in your extremities, your core musculature is working to resist rotation in your lumbar spine.

A Palloff Press or Palloff hold is simply attaching a band, tube, or cable pulley to an anchor point which is set to be about chest height, holding that implement in front of your chest, and extending the arms directly in front of the chest to create a rotary challenge.  The band, tube or cable is trying to pull you into rotation, while your core muscles work to resist it.  This can be done in a hold for a certain amount of time or for repetitions (pressing in and out).  This is another exercise which can be done by almost anyone, and can be made brutally hard.  You can do this standing, on your knees and even lying on your back.

Chops and lifts create a diagonal pattern of movement, either going from one shoulder down towards your opposite hip (a chop), or going from one hip up towards your opposite shoulder (a lift).  This can be done using a cable, band, med ball, rope, etc. and can be done standing, kneeling, or lying on your back, again making this a very useful exercise for many populations.  The key with these exercises, as with the birddog and palloff press, is that the movement comes from the arms and shoulders, NOT the lumbar spine.  From the bottom of your rib cage to the top of your pelvis, zero motion should occur.

This concludes our exploration of core function, so let’s sum up:

Stop Doing: russian twist, scorpion, seated trunk rotation, full range window wiper, sit-ups, curl-ups, crunches, side bends or side crunches, superman, or traditional hyperextension.

Start Doing: Birddog, Palloffs, Chops/Lifts, Loaded Carries, Side Planks, Planks, Front-Loaded movements such as squats, deadlifts, rows.

As always, thanks for reading!

Adam Reeder

acr30@zips.uakron.edu

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Carries and Love Handles- The Lateral Core

Today we pick up our core training series with the lateral core system.  We’ve already talked about the anterior and posterior aspects of core training, and after today we will be left with only the rotational aspects.  The muscles of the lateral core are involved with a ton of movements, including many found in the anterior and rotary systems, but they are really isolated by a movement called lateral flexion.  This is the action of side-bending the spine, bringing one arm pit closer to the pelvis.  As we’ve talked about in previous posts, the name of the game in core training is to resist movement, so today’s post will be all about anti-lateral flexion.  When trained properly, the lateral core musculature acts to keep the spine neutral when there is a force (gravity, a weight) trying to create lateral flexion of the spine.

What muscles are involved with anti-lateral flexion?

transverse absQuadratuslumborum

Several muscles are involved in the act of resisting lateral flexion.  The two most noticeable are the internal (IO) and external oblique (EO) muscles, but also involved in the process are the transverse abdominis (TVA) and quadratus lumborum (QL).  The IO, TVA, and QL muscles are all deep muscles which lie underneath the more superficial rectus abdominis (RA) and the EO.

The External Oblique (EO)

The external oblique runs from ribs 5-12 down to the crest of the hip bone.  The EO is innervated by the thoracoabdominal nerves as well as the subcostal nerve. One extremely common complaint among women exercisers is the desire to get of their “love handles.”  This area of abdominal fat, found above the hip and under the ribcage, lies right ontop of the external obliques.  Because of this, many people attempt to side-crunch their love handles away, thinking that by working their external oblique, they will be reducing their abdominal fat.  Unfortunately, there is no amount of side crunches or ball twists that will reduce the body fat ontop of the muscle.  If you want to lose your love handles, the vast majority of your work must come from cleaning up your diet.  This is obviously a topic which can and will be it’s own post, but you will absolutely never out-exercise your nutrition.

The Internal Oblique (IO)

The Internal Oblique muscle lies below the EO and just ontop of the TVA.  As you can see with the picture above, the EO must be removed in order to see all of the IO.  The IO originates on the Inguinal ligament, Iliac crest and the Lumbodorsal fascia and inserts into the linea alba and ribs 10-12.  Like the EO, the IO is innervated by the thoracoabdominal and subcostal nerve, as well as the iliohypogastric and ilioinguinal nerves.  This is important to note because things that are wired together tend to fire together– meaning that when two muscles share common nerves, they tend to work together.  In this case, the IO and the EO work together to stabilze the spine.  The IO also plays a very important role in breathing, which is a topic that we will also cover in a separate post.

The Transverse Abdominis (TVA)

I spoke at length about the TVA in my post about anti-extension stability.  Check that post out for a more thorough explanation of the job of the TVA, and also know that it helps support the spine laterally as well.

The Quadratus Lumborum (QL) 

Ah, the poor QL muscle.  It gets some really bad press for a lot of things that just aren’t the QL’s fault.  One of my favorite therapists, Dr. Kathy Dooley, has a great write up on the QL here: http://www.drdooleynoted.com/anatomy-angel-quadratus-lumborum/

The QL is a muscle that is meant to help other, larger muscles stabilize the spine.  It’s meant to help the erector spinae and multifidii support the spine and keep it from flexing forward.  It’s meant to help the obliques support the spine from side to side.  When erectors, obliques, or rectus abdominis aren’t doing their job, the QL is your body’s last resort to maintaining an upright spine, and as such, the QL gets over-worked…a lot.  If you sit a lot with poor posture or if you don’t strengthen the other hip and core muscles around the QL, your QL will have to do a job it’s not designed to do.  An over-worked muscle often becomes a painful muscle, and this one of the very common reasons for lower back pain.  Since the QL plays such an important role in spinal stabilization, we certainly need to strengthen this muscle.  However, we also must make sure to strengthen the muscles of the hip and the core around it, to make sure it does not become over-worked.

Stop doing this:

side bend

Side bends, side crunches, or anything where you’re repetitively taking your spine out of neutral as you try to isolate your obliques.  I don’t care how many side crunches you do, your love handles are only going away if you change your nutrition.  Similar to the traditional crunch or sit-up, a side crunch or side bend takes the spine out of neutral and repetitively doing so can lead to back pain, disc damage, etc.

Start doing this:

side plank musclessuitcase carry

Side planks and loaded carries.  The side plank is simply holding a plank position, except on your side.  You balance between your elbow and your feet and you maintain a neutral spine with gravity attempting to pull your hips down towards the floor.  Holding this static position is the very definition of lateral core stability.  Once you can hold this position for roughly 30 seconds per side, you can start to add various movements to the side plank, or move into loaded carries.

Loaded carries are a group of tremendously beneficial exercises that just about anybody can do.  One of the most basic forms of a loaded carry is called a suitcase carry.  Simply hold a weight at your side and take a walk.  We usually carry for 50-100 feet per side set.  The weight on one side of your body attempts to pull you into lateral flexion, while the core musculature of your opposite side works to keep you upright.  The great thing about loaded carries is that they have the added benefit of improving grip and shoulder strength, while also getting the exerciser onto their feet.  This is an exercise that almost anyone can do in some capacity and has a great tendency to improve multiple areas of fitness.

Thanks for reading!

Adam

Baby Got Back- The Posterior Core and Anti-Flexion

As we move through our journey exploring core function and training, we come to another misunderstood topic- the muscles of the lower back.  We’ve already delved into the basics of core function and we’ve explored anti-extension, one of the 4 main components of core stability. Today we will look at the muscles that directly oppose the muscles of anti-extension.  Your anti-extension muscles are found almost entirely on the front side of your body and consist mainly of the Rectus Abdominis (RA), Transverse abdominis (TVA) and the Internal and External Obliques.  These muscles resist trunk extension, and we saw an example of them in use when we performed the partner drill where you and a partner face each other with extended arms and try to push each other over.

Anti-Flexion is the functional opposite of Anti-Extension.  The muscles involved with anti-flexion work to keep the spine neutral when there is a force- such as gravity, a barbell, or somebody pushing you from behind- acting to round your spine forward.  As you will see in the picture below, anti-extension and anti-flexion muscles cooperate to keep your body as close to neutral as possible as often as possible.

What muscles are involved with Anti-Flexion?

Lumbar-Extension-Muscles muscles-of-the-core-diagram

We will talk about the powerful muscles of the hip such as the gluteus maximus in a later post, and will focus on the oblique muscles when we cover our lateral core anatomy.  To get a basic understanding of the anti-flexors, we will narrow our focus down to the Erector Spinae and the multifundus.

The Erector Spinae (ES)

The erector spinae is aptly named as it is one of the primary muscles responsible for maintaining an erect spine.  It is a long, thin muscle which has attachments from the back of the head all the way down to the top of the hips.  The ES is composed largely of Type 1 muscle fibers.  Who cares?  Well, Type 1 muscle fibers are known to be very good at maintaining long duration, low force, and slow muscle contractions while not being very good at producing large amounts of force over a short period of time.  This means that Type 1 muscle fibers are made to work often, pretty much all day long, but are not meant to be creating a bunch of movement on their own.  We’ll see why this matters when we get to the exercise portion of this post.

The Multifundus

The multifundus is another muscle of the lower back which provides support and stability to the spine.  It is similar to the ES in that it is made up largely of Type 1 muscle fibers and is a long, thin muscle which spans most of the length of the spine.  Both the ES and the Multifundus have a very strong connection to the Central Nervous System and are therefore readily available for activation without much thought.

Stop Doing This:

superman

Superman, traditional hyperextensions, or any other movement which prioritizes LUMBAR extension over HIP extension. When people ask me whether or not I think they should do a particular popular exercise,  the reasoning behind my answer usually comes down to whether or not I think that exercise gives the individual an appropriate amount of bang for their buck or if there is another, safer, exercise which more completely accomplishes what they’re trying to do.  Because of this reasoning, there are not many exercises that I feel are totally worthless or that I completely discourage people from doing.  The superman is a rare exception.  None of my clients do this exercise and while I am always open to a reasonable argument, I don’t forsee my opinion on this one changing.  McGill’s research shows that the superman exercise imposes somewhere around 1350 pounds of compression force on the spine, all while performing an action that the muscles of the lower back are NOT MEANT TO PERFORM.  This exercise asks the ES, Multifundus and others to repeatedly contract/relax and take the lumbar spine well past a neutral alignment.  Remember earlier when we talked about their appropriate function?  To resist flexion?  Yeah, the superman isn’t doing that.

Traditional hyperextensions performed with the feet and legs locked and the trunk and upper body free are dangerous for similar reasons- excessive compression forces and very little bang for the buck.  I do not completely discourage this one simply because I know people who are strong enough and body-aware-enough to actually do this movement without extending their lumbar spine…but when I say “I know people” I really mean I know one or two people who are good enough to do this for reps and sets.  For most people, this is not even a remote possibility and as such the exercise becomes dangerous and rather ineffective.  That’s why it falls onto this list, though I will not go as far as I did with Supermans and say nobody should ever try it.  I view reverse hyperextensions, performed with the legs free and the trunk and upper body supported to be a completely different exercise from the traditional hyper.  They are much easier to do safely, and target the large muscles of the hips, which are meant to create a great deal of force, rather than the spinal erectors, which are not.

Start Doing This:

goblet

Goblet squats. Front Squats. Deadlifts.  You’re going to find these exercises in just about every good training program because they’re awesome for developing strength and power of the lower body.  What often gets missed though is their ability to strengthen the lower back muscles.  Taking the Goblet Squat (pictured above) as an example, the weight is trying to pull the lifter forward, into flexion.  As long as the weight is appropriate for the individual, the lower back muscles reflexively activate to MAINTAIN a neutral spine.  They don’t extend the spine, they don’t jack the spine into positions it doesn’t like.  They simply keep it upright, just like they’re supposed to.

This “anti-flexion” force is not limited just to goblet squats.  How about a bent over row, as pictured below:

bent row

You can replace the dumbbells with a bar, a cable, a band, or whatever you want.  The resistance is trying to pull him into flexion, and the muscles of his lower back are acting to resist that flexion.

Just about any exercise which is front-loaded, meaning the weight is set out in front of the individual trying to lift it, exerts a flexion force which the body must react to in order to keep the spine neutral.  And the interesting thing with a lot of these exercises is that heavier loads tend to be better than lighter loads.  When a goblet squat, front squat, or deadlift is excessively light, the body really does not have to react to much and therefore technique gets sloppy.  When the load is heavy enough, your body is forced to counteract the load pulling forward to keep the spine neutral.  This is exactly what we’re looking for.  That’s the beauty of a well-designed training program.  If you’re doing the exercises you should be (deadlifts, front-loaded squats, etc.), then you don’t actually need to spend extra time training the posterior core.

Bottom line: Keep your spine neutral and lift weights that are heavy enough to create a reflexive stabilization technique in your core musculature…oh, and stop doing the superman.

Thanks for reading!

Adam

Back Health and “Six Pack” Abs: Anti-Extension at it Finest

My previous post outlined the various movements that your spine is capable of going through.  I also talked at length about how core function ultimately comes down to “anti-movement” rather than creating movement.  This means that the most basic function of your core musculature is to stabilize the spine and resist excessive movement outside of neutral.  This point can not be understated, and it is one of the most misunderstood topics in fitness today.  My most recent post broke core function down into 4 main components of anti-movement- Anti-Extension, Anti-Flexion, Anti-Lateral Flexion, and Anti-Rotation.  Today’s post will more closely examine the commonly-used component: Anti-Extension.

What is “Anti-Extension?”

Anti-Extension is your ability to resist the lumbar (lower back) spine’s tendency to move into an excessively extended position.  In my introduction to core anatomy, I mentioned that most people live with a slightly extended lumbar spine position, and this is completely normal.  Those of us who spend much of our day on our feet- construction workers, personal trainers, professional athletes, etc. live in slightly more extension than normal, while those who spend much of their day sitting at a desk live in a slightly less-extended position.  Regardless of where you start though, the idea with core training is to get as close to neutral as possible and to stay there while you train.

To get an idea of what anti-extension feels like, get a partner and face each other.  Extend your arms straight out in front of you with your hands about shoulder height while your partner does the same and put your palms against theirs.  Have your partner gently push into your hands and don’t let them knock you backwards.  If successful, have them push a little harder, a little harder, etc. until you’re unable to maintain a nice tall posture.  Your partner was exerting an extension force on your lumbar spine and your core musculature (along with your arms, shoulders, etc.) was creating an anti-extension force to keep you upright.  Notice, you didn’t have to think about this too much.  It just happened.  That’s the beauty of normal abdominal function– when core muscle function is working properly, it happens at a subconscious level that does not require much thought.  There is a fantastic internal feedback mechanism at work where you sense a force placed on your body, and your body simply reacts to it.  You don’t crunch, you don’t hollow your belly, you don’t “activate” your transverse abdominis.  You just don’t let yourself get knocked over.

What muscles are involved with anti-extension?

There were several muscle groups involved with the example above and the total muscle groups involved will depend on the exact task at hand, but let’s narrow this down to the muscle groups that are most directly involved with anti-extension forces:

The Rectus Abdominis (RA)
Rectus_abdominis
The beautiful, wonderful rectus abdominis.  When this muscle is strong and doesn’t have a bunch of fat laying over top of it, this is the “six pack” muscle that everyone desires.  The RA runs from the xiphoid process (tip of the sternum) and 5th, 6th, and 7th ribs all the way down to the crest of the pubic bone.  It is innervated by the inferior intercostal and subcostal nerves.  If you look the RA up in most texts, function of this muscle is said to be flexion of the trunk.  This is where crunches, sit-ups, curl-ups, etc. come from.  And indeed, the RA does flex the trunk.  But knowing what we now know about spine health, the trunk does not need to be flexed repeatedly during workouts.  The much more important function of this large, powerful muscle is to resist extension through the lumbar spine.

Transverse Abdominis (TVA)
transverse abs
This picture illustrates the layers present in your core musculature.  On your right side of the picture, we see the RA and external oblique muscles (more on the obliques later).  On your left, we see the RA removed, revealing two muscles that lie deeper, or closer to your internal organs.  These muscles are the Transverse Abdominis (TVA) and internal oblique.  The TVA has received a lot of attention in certain circles lately as a cure-all muscle for back pain and breathing disorders.  The problem with is that, like with the RA and crunches from years ago, people have now begun to try to isolate the TVA by practicing what is known as the draw-in method of core activation.  Basically, just suck your belly button in towards your spine and ta-da! you just “turned on” your TVA!! Congrats!  Except, wait, your back still hurts every time you stand or do anything….shoot.  The problem with this approach is that your TVA does not function by itself when you’re not thinking about it, nor does your RA, nor does any muscle for that matter.  Your muscles are constantly working together to perform every task you ask them to on a daily basis, so isolating this one particular core stabilizer is clearly the wrong approach.  Now, you should have the ABILITY to draw in your belly button, and if you don’t, further investigation is warranted, but nobody is getting strong doing draw-ins and nobody is getting out of back pain doing draw-ins.  Instead, one must learn how to properly stabilize the trunk through a process known as “bracing,” which recruits not only the TVA, but also the RA, the obliques, the spinal erectors, the paraspinals, etc. etc.  More on bracing later.

Stop Doing This:
This point should be pretty clear by now, but most people should not be doing crunches, sit-ups, curl-ups, etc. of any kind on anything close to a regular basis.  Research shows that a traditional sit-up imposes approximately 730 pounds of compression force on the spine (McGill). Common variations aren’t much better including the straight leg sit-up (788 pounds), bent leg sit-up (753 pounds) and cross-knee curl up (666 pounds).  It’s time that these exercises make their way out of regular exercise programming for good.  They treat the RA as if it ever functions in isolation outside of the gym (it doesn’t), and they put a ton of stress on the spine.  These exercises also tend to become very easy very quickly, making it necessary to constantly add repetitions or load to an already ineffective and dangerous task. Taking a risk-reward audit of any of these exercises shows a whole bunch of risk with very little reward.  Very similar or perhaps even better muscle strengthening can take place by getting rid of these exercises and all of their variations, and instead using…

Start Doing This:
Planks and the many variations of planks.  One of the most basic exercises to build anti-extension stability is known as the forearm plank.  Get into the same position you were just in for the anti-extension example above.  Standing tall, keep your eyes looking straight ahead and reach your arms straight out ahead of you.  Keep your posture perfect and now bend your elbows so that your hands are roughly in line with your head and your elbows are in line with your shoulders.  This is your plank position.  Keep that nice, tall posture and bring yourself down to the floor, supporting your weight evenly between your toes, elbows and palms, and now you’re planking.  Do not allow yourself to lose the position that you had while you were standing tall.  Some shaking and sweating is normal and to be expected, but allowing your lower back to sag towards the floor, or allowing your butt to hike up in the air is unacceptable.  If somebody took a picture of you from the side, and then turned that picture 90 degrees, you should look exactly how you did while you were standing.  It’s as simple as that.

Hold that position as long as you can, up to about 1 minute.  Once you can hold that position for a minute, it’s time to make the plank more interesting- Start by rocking your weight forward (towards your hands) and backwards (towards your heels), using your toes as a pivot point.  Again, nothing about your posture changes, just your weight distribution.  Once this becomes easy, try taking a step or two back away from your elbows without changing anything else and hold that position for long as possible.  Lengthening that lever arm makes the challenge on your core much greater.  Variations to this exercise are only limited by 2 things: 1) Your ability to maintain that neutral posture that you found while standing and 2) your creativity.

Planks and their variations are extremely effective at producing core muscle activity to enhance strength, endurance, etc., while also keeping the body where it wants to be- in a neutral spine position.  They produce significantly lower loads on the spine, resulting in a safer and more effective bang-for-your-buck workout.  The plank is far from the only exercise we’ll use to improve your extension stability, but they’re a great place to start.  Together with the other 3 components of core function, this extension stability will put you on the fast track to a healthier back, better fitness, and better performance.

A quick note about the “Six Pack:”  It doesn’t matter what exercise you choose- pick crunches, sit-ups, planks, hanging leg raise, etc.  Whatever exercises you choose to strengthen your core will only take you as far as your diet lets you go in terms of being able to see the definition in your abs.  You will NEVER out- exercise your nutrition, and no amount of sit-ups, crunches or planks will get rid of the extra belly fat that is covering the muscle.  Spot reduction does NOT work and “feeling the burn,” is NOT you burning fat.

My next several posts will take a similar approach to anti-flexion, anti-lateral flexion and anti-rotation training.

Thanks for reading,

Adam

Ultimate Back Fitness and Performance. Stuart McGill Wabuno Publishers. 2004. Waterloo, Ontario Soft Cover

What Your “Core” Does for You (Part 2)

In my last post, I went over some anatomy of the spine and what it means to have a “neutral” spine.  If you haven’t read that post yet, I encourage you to do so as it will give you a better understanding of this post and several that will follow.  Today I want to talk about what it means to maintain that neutral spine, what it means to health and performance, and how your core musculature helps that process.

To review, a neutral spine posture consists of a slight arch in the lower back, a slight rounding of the upper back, a slight arch in the neck and very little side to side deviation.  This is in a normal, non-pathological spine, and of course there are varying degrees of neutral for each individual.  Why does any of this matter?  Spinal position is absolutely essential for back health, fitness, and performance.  To use a modern-day analogy, think of your back as a cell phone.  Your cell phone has a particular battery life which, with prolonged use, eventually runs out.  Every time that you take your spine outside of neutral, you are chipping away at it’s battery life.  When the battery life of your spine wears out, bad things can happen.  Back pain, disc degeneration, etc.  This is particularly true when you take your spine out of neutral repetitively under load, meaning that motion is occurring outside of a neutral spine position with load added to the exercise such as a squat or deadlift performed with a rounded lower back.

Now, every one of us takes our spine out of neutral multiple times a day, just like you chip some battery life away from your cell phone every time you dial a number or send a text.  This is not a bad thing and in fact spinal motion is an essential part of human movement.  You recharge your phone at night and the next day you’re good to go.  But when you get into the gym and add multiple sets with multiple reps and varying degrees of weight to this motion, you’re starting to chip that battery life away much more quickly.  When you perform an exercise and maintain a neutral spine you’re sparing your back and adding strength to the areas around it.  When you perform an exercise outside of neutral, you’re not helping the muscles around it much and you’re slowly taking away your spine’s capacity for work.  Doing this repetitively is akin to streaming video or playing a game on your phone– you’re stripping away the battery life in a hurry.

For these reasons, the true function of your core musculature is to RESIST movement in your spine, rather than to create it.  The definition of core musculature can be a broad one, with many muscle groups tied to the function of maintaining a neutral spine, but for this post let’s define the core as everything from your hips up to your armpits.  Whether you’re walking down the street, going up and down steps, hitting a baseball, or performing a deadlift, these muscles are responsible for keeping your spine neutral with little to motion in the lumbar area:

muscles-of-the-core-diagram

The muscles pictured above are large muscles fairly close to your skin.  If we peeled these muscles away we would also find deeper core muscles which lie closer to your internal organs.  All of these muscles combine to form the “core.”  As illustrated above, the core musculature exists in a cylindrical shape.  Your spine is capable of motion in 3 directions: Front to Back (known as flexion and extension), Side to Side (lateral flexion), and in a circular manner (rotation).  Your core muscles, then, function to resist all of these movements in order to keep your spine neutral.

The core muscles on the front of your body act to resist extension (excessive arching) in your lower back.  This is called anti-extension.  The muscles on either side of your torso resist lateral flexion of your spine, an act know  as anti-lateral flexion.  The muscles on the backside of your “core” resist forward flexion (rounding) of your lumbar spine, and many of the muscles combine to resist rotation through your lumbar spine (anti-rotation).  Notice, every function is “anti-” something.  Anti-Flexion, Anti-Extension, etc.

This is the most commonly misunderstood area of core training- the muscles of your core are not meant to CREATE motion, they are meant to RESIST it!  So why then do we still see people doing sit-ups, crunches, curl-ups, etc.?  That’s a good question, I have no idea.  Now, I am not saying you should not strengthen these muscles, quite the opposite- these muscles should be made to be incredibly strong and durable.  The stronger these muscles are, the easier it will be to maintain a neutral spine, and the more efficient you will be when you try to transfer force from your lower body to your upper body such as in athletics.  I’m saying that we need to change the way these muscles are trained and respect your spine’s need to stay as neutral as possible in a training setting.

Now that you have a good understanding of what the core is and why your body needs it, in my next few posts I will go through each movement that the core musculature performs, a common exercise for each movement we see in the gym on a daily basis, and what you should be doing instead.

Until then, thanks for reading,

Adam

What Your “Core” Does for You

I always find myself putting the word “core” into quotation marks because, like “functional,” the word Core has become one of the most over-used buzz-words in the fitness industry.  Despite it’s growing popularity among the common gym-goer, the core is still widely misunderstood and misused by fitness enthusiasts, coaches and trainers alike.  Over the course of my next few posts I’d like to clear up some common misconceptions about core training and explain how the core and the spine interact.  In the future, I’m also going to show you some exercises that I no longer have any of my clients do, why you should avoid them, and what you can replace them with to keep your back healthy and strong.

To understand core function, we must first talk about the spine.  Your spinal cord is enclosed within a series of bones called vertebrae which extend from the base of your skull to your pelvis.  Starting at the base of your skull, the top 7 vertebrae are known as their cervical vertebrae, together forming the cervical spine.   The cervical spine ends right around the top of your shoulders, where the thoracic spine begins.  The thoracic spine consists of 12 vertebrae which extend from the top of the shoulders down to the bottom of the rib cage.  Where the thoracic spine ends, the lumbar spine begins, consisting of 5 vertebrae which extend from the bottom of the rib cage to the top of the sacrum, one large flat bone which forms your “tailbone.”  The sacrum attaches the rest of the spine to the pelvis, where it sits like a wedge between your two hip bones.  Because of this relationship between the sacrum and the pelvis, pelvic function and alignment plays a vital role in what your spine is doing, so we will look at pelvic position a great deal whenever we’re talking about the core.   The areas of the spine are referred to by their location on the spine, with C1 referring to the first cervical vertebra (closest to the skull), T1 referring to the first thoracic vertebra, L5 referring to the bottom lumbar vertebra, etc.

A popular term in the fitness industry is “neutral spine.”  What does this mean?  As you grow and develop from a young age, your spine forms natural curves from front to back in a normal situation.  These curves are referred to as either “Lordotic,” meaning arched, or “Kyphotic,” meaning rounded.  The cervical spine naturally has a slight lordotic curve, the thoracic spine has a naturally kyphotic curve and the lumbar spine has a naturally lordotic curve.  None of these curves should appear to be dramatic.  This is the neutral spine posture that is so often talked-about in fitness circles.  The exact degree of curve in a neutral spine is going to vary from person to person but this is what we generally expect in the absence of pathology.  Take a look at the picture below for a visual representation of the spine with normal curves:

Gray_111_-_Vertebral_column-coloured

 

 

Our environment can have a monumental impact on our spinal position.  Those of us who spend most of the day on our feet, such as construction workers, personal trainers, and many athletes, tend to exhibit an exaggerated lordotic curve in our cervical and lumbar spine.  On the other hand, those who sit at a desk for most of the day will tend to exhibit exaggerated rounding in the cervical and lumbar spine, simply due to the posture we find ourselves in.  Imagine the position your spine is in if you find yourself in this posture for long periods of time:

badsitposture1

Because of this, it is incredibly important to change your posture as often as possible throughout the day.  If you find yourself sitting for a long period of time, simply standing up and walking around or stretching can “rest” your body’s tendency to round forward.  If you find yourself standing all day long, take a break down on one knee, keep your spine tall but not extended and let your body reset itself.  These small postural resets can have a monumental effect on lower back pain, neck pain, and movement ability.

While our daily posture does have a giant effect on back health, the way we choose to exercise is just as important.  In my next post I will cover how your core functions to keep your spine in a neutral alignment and what that means for your exercise program.

Adam

Spinal Picture from:
Gray, Henry. Anatomy of the Human Body. Philadelphia: Lea & Febiger, 1918; Bartleby.com, 2000. www.bartleby.com/107/.

What to Expect during your FMS

What should you expect when you receive an FMS Screening?

My previous several posts have talked about movement: Why it’s important to assess movement, where the Functional Movement Screen (FMS) comes in handy, and some common misconceptions of the FMS. Until now, I’ve spoken mostly in generalities about movement and the FMS. Today I want to get a little more in depth about the individual tests of the FMS, so that when you get your first screening you have an idea of what to expect.

To review, each movement on the FMS is scored from 0 to 3. 0 indicates pain and 1 indicates a severe movement dysfunction, while 2’s and 3’s are passing scores. 5 of the 7 movements have left and right components, meaning that each side of your body is tested independently and receive independent scores.

Deep Squat

The first movement on the FMS is known as the Deep Squat. The deep squat tests ankle, hip, upper back, and shoulder mobility while simultaneously challenging stability of the knee, “core,” and shoulder in a symmetrical stance. The client is asked to maintain an upright torso with arms overhead while they descend into as deep of a squat as they can comfortably reach. We use this pattern on a daily basis from tasks such as picking up a basket of laundry to standing up off the toilet.

Hurdle Step

No, you’re not jumping over hurdles…fear not. The Hurdle Step movement is a test of balance in a single-leg stance while also challenging hip mobility and “core” stability. The client is asked to maintain an upright torso while stepping over a hurdle. The hurdle step pattern is used any time we stand on one leg for any period of time.

Inline Lunge

FMS Lunge

The Inline Lunge tests the client’s ability to maintain an upright torso while going through knee, hip and ankle flexion and extension in an asymmetrical stance. In these first three tests, the client is put into what is referred to as the “3 foot positions of function”: Symmetrical, Single-leg, and Asymmetrical. Every standing position that we find ourselves in throughout the day, including athletic events, can be narrowed down into one of these three foot positions and so getting assessed in each of these positions is crucial. We use the inline lunge pattern any time we go up and down stairs.

Shoulder Mobility

The shoulder mobility test is self-explanatory. We challenge the mobility of the client’s glenohumeral (shoulder socket) joint as well as their thoracic spine (upper back) mobility in a bilateral reaching pattern. Limitations or asymmetries on the shoulder mobility test will almost always show up on one or more of the previous 3 tests, showing the importance of shoulder mobility to basic fundamental movements. An asymmetry here can be a red flag for upper body strength training. Think of an overhead pressing movement: If you connect asymmetrical shoulders to a symmetrical load (such as a barbell or even a machine such as the seated shoulder press machine), and you do this consistently, the body will favor the “good” side and it’s only a matter of time before that asymmetry is exacerbated. Eventually a shoulder injury can develop from over-use of the “good” shoulder joint.

Active Straight Leg Raise

The Active Straight Leg Raise test looks like a hamstring flexibility test, and certainly the tension of the hamstrings plays a role in your score, but there is a lot more going on here. The client is asked to raise one leg as high possible while keeping the opposite leg flat on the floor. Sounds like a hamstring test to me, but we are challenging the ability to stabilize the pelvis (“core”) while one leg remains extended on the floor and the other leg goes through an excursion. We see this well…all the time. Any time you take a step whether you’re walking, jogging, sprinting, going up and down stairs, etc., your body has to subconsciously stabilize your pelvis while one leg strides and the other stops you from falling on your face. This happens naturally in the ideal situation, but as we incur injuries and age, we start to lose some of our ability to efficiently complete this basic task. An intervention which improves the Active Straight Leg Raise can have a profound effect on the rest of our basic movements.

Trunk Stability Push-Up

The Push-Up test is another deceptive movement. It looks like a test of upper body strength and certainly if we asked you to do more than 3 of these we would be getting into an area of strength and/or muscular endurance. For the purposes of this test, however, we are again looking at your ability to maintain a rigid torso- a common theme for the FMS- while producing movement in your extremities. This movement pattern shows up at various times throughout the day and is often taken for granted until the ability to perform it is taken away. Ask anyone who has been bed-ridden for a period of time or any senior citizen who has fallen. They’ll tell you how hard it can be to push yourself up out of bed or to get from the floor to a chair or couch. This test is not just for the elderly or sick though. Just about any athletic endeavor requires the individual to reflexively stabilize their spine. Think of the lineman in football who will either reflexively stabilize their spine or crumble to the ground every time they’re hit. It’s another process we don’t think about doing- until we can’t.

Rotary Stability

The final FMS test is called the Rotary Stability test.  The test takes place with the client in a quadruped or “all-fours” position on the floor.  The client is asked to maintain the natural alignment of their spine while flexing and extending their hip and shoulder simultaneously.  This is an assessment of core/spinal stability in the presence of extremity motion.  It does not look all that “functional,” but is a very good window into the function of an individual’s deep core musculature.  Our last 2 tests- Trunk Stability Push-Up and Rotary Stability- also represent important landmarks in our development as humans throughout the life cycle.  Our ability to push ourselves up from a prone position and to crawl are seen very early on in life and are two skills that tend to drastically diminish in adulthood.  Improving these two natural human movements can have a very large carry over to quality of life as we age.

There you have a very basic rundown of the tests found on the FMS.  I highly recommend getting screened before you start an exercise program, and if you’re already participating in an exercise program it’s a great idea to get screened now.  If you’ve hit a plateau in your progress, examining movement can be a complete game-changer.

Thanks for reading, and use the email address below to schedule your first screening!

Adam Reeder
acr30@zips.uakron.edu

Movement Screening Explained (part 2)- what the FMS is not

My last post outlined the basics of the Functional Movement Screen (FMS), why it’s important and what it tells us.  Today, I want to clear up some common misunderstandings that I see around the internet in regards to the FMS and explain what the FMS does not do.

FMS Deep Squat

The FMS is NOT:

-A test of strength, endurance, body composition, cardiovascular fitness, etc. All of these qualities may or may not be important to find out depending on who you are and what your goals are, but they should come after you find out how well you move. Remember, move well first, then move often.

-A predictor of performance. Scoring high on the FMS does not mean you’re a better athlete than somebody with a lower FMS score, nor does it mean you’ll lose weight quicker, or achieve any of your other fitness goals any faster than somebody else.

-A judgement of your character. People with little to no exercise experience tend to develop all kinds of anxiety about the FMS until I explain this point to them. “I’m so out of shape, I’m going to do terribly!” is something that I hear very often prior to a movement screening. The FMS is not meant to award the high achievers and punish those who are out of shape. I explain the FMS as more of a pass-fail test than a graded exam.

  • Did you score a 2 or a 3 on all of the movements in the screen? Great, you passed. Now get to work. There are no bonus points awarded for making a 2 into a 3 and I wont spend a great deal of time trying to do so. If one of your life goals is to get a 3 on the Active Straight Leg Raise and right now all you have is a 2, by all means I’m not going to stop you from trying to improve it, but just know that there’s no reason to think that getting that 3 will make you a stronger deadlifter, make you less prone to athletic injuries, or make you less likely to slip on that patch of ice on your steps.
  • Did you score a 1? You fall under the line of passing the test, and that means that putting you into this pattern is going to exacerbate your dysfunction and perhaps lead to injury. Now let’s make an intervention to clean that movement pattern up. This intervention could come from an endless array of possibilities- mobility, motor control, soft tissue, etc. This is where your coach is invaluable. How do you get from dysfunctional to functional to training as quick as possible? And remember, passing the screen isn’t the end goal, it’s more of a starting point. We just need you to be a 2 or better to be able to safely say “okay- now let’s get to work on your goals.”
  • Did you score a 0? That’s okay. There are still things we can do to help improve your fitness, we just aren’t going to use that particular movement pattern. Let’s get you set up with a really good medical professional and see what exactly is going on. People hate this result, but it’s incredibly necessary and incredibly powerful. Going to see your doctor or physical therapist is not a death sentence to your fitness and in this case it’s actually the fastest and safest way to achieve your goals. Whenever trainers/coaches/instructors act resistant to refer a client with pain to the appropriate medical professional for fear of losing a client, my response is always: “You can’t guarantee that that lower back pain isn’t cancer.” While this may seem like an extreme reach when we’re talking about a very common complaint (back pain), the fact is that pain can often be the only present symptom for a number of very serious diseases, including cancer.

One more thing to add about the FMS: There is a total score which can be generated by adding the scores from each individual test. This total score is where much of the debate exists as to whether the FMS is an accurate predictor of future injury. Several studies have examined the correlation between total score on the FMS and future injury incidence in certain athletic populations, and I’ve cited some such studies at the end of this article. I’ve used the FMS for several years now, and have never paid any particular attention to the total score on the screen. In my opinion, the movements are so different from each other, and athletic injuries vary so widely in nature, that simply combining the scores together and running some statistical analysis of injury incident vs. total score does not seem to make much sense. Due to the way the test is scored, high scores in a few movements can overshadow dysfunctions or asymmetries on other patterns.

For example, a male football player may score as such:

Deep Squat- 2

Hurdle Step- 1 left, 2 right

Inline Lunge- 1 left , 2 right

Shoulder Mobility- 3 left, 3 right

Active Straight Leg Raise- 3 left, 3 right

Trunk Stability Push-Up- 3

Rotary Stability 2 left, 2 right

When totaling score, you take the lowest score per test so, this person with a 1 left, 2 right Hurdle Step would score a 1 for that test. The total score of this screen comes out to 15, a relatively high score and usually the cut-off point for “high” vs. “low” scores in research. This person creates their high score by nailing shoulder mobility, active straight leg raise, and the push up, but I have some serious questions about their hurdle step and inline lunge, two tests which create a functional, on-your-feet demand for both mobility and stability. I would be much more concerned about this individual from an injury standpoint than somebody who had nothing but 2’s across the board with no 3’s.

I believe that an athlete playing with movement pain or severe movement dysfunction probably puts that athlete at a higher risk of athletic injury, I just don’t think a sum total of scores in the FMS is the way we should be looking at injury risk. I focus entirely on individual movement results and look at each movement as it’s own small piece to the injury risk puzzle.

The FMS is a wonderfully simple and valuable tool that can be administered in under 15 minutes and is quite reliable from test to test (see citations 2 and 3 at the end of the article). It can and should be used as a pre-participation screening prior to engaging in sport or exercise and can also be used to monitor movement progress over time, especially if dysfunctions show up at that first visit. If your trainer doesn’t use the FMS, fire him…just kidding. If he or she doesn’t use the FMS just make sure they’re doing SOMETHING to assess your movement quality the first time you meet them. Remember, that doesn’t mean “how many push-ups can you do in a minute?” Quality, not quantity. If you’re not assessing you’re just guessing, and movement is far too important to guess on.

In my next post I’ll go into greater detail on the individual tests and what they mean.

Thanks for reading!

Adam Reeder

Scholarly articles reviewing the FMS:

1) Chorba, R. S., Chorba, D. J., Bouillon, L. E., Overmyer, C. A., & Landis, J. A. (2010). Use of a functional movement screening tool to determine injury risk in female collegiate athletes. North American journal of sports physical therapy: NAJSPT, 5(2), 47.

2) J Orthop Sports Phys Ther. 2012 Jun;42(6):530-40. doi: 10.2519/jospt.2012.3838. Epub 2012 May 14.

3) J Strength Cond Res. 2013 Apr;27(4):982-7. doi: 10.1519/JSC.0b013e3182606df2.

3) Kiesel, K., Plisky, P. J., & Voight, M. L. (2007). Can serious injury in professional football be predicted by a preseason functional movement screen?. North American journal of sports physical therapy: NAJSPT, 2(3), 147.

4) Lisman, P., O’Connor, F. G., Deuster, P. A., & Knapik, J. J. (2013). Functional movement screen and aerobic fitness predict injuries in military training. Med Sci Sports Exerc, 45(4), 636-643.

5) Parchmann, C. J., & McBride, J. M. (2011). Relationship between functional movement screen and athletic performance. The Journal of Strength & Conditioning Research, 25(12), 3378-3384.

Movement Screening Explained (part one)- What is the FMS?

In my last post I explained why movement is such an important entry point for fitness, health and well-being. I gave an example of how a simple movement screen could potentially save valuable training time while making sure that you, the client, are given the most appropriate exercise program.

Today I want to discuss one simple and highly effective way to screen for movement pattern qualities: the Functional Movement Screen or FMS. Keep in mind that this is just one of the many screens available and it’s a great idea to check out as many screening procedures as possible before you decide which is best for you. The FMS is the best one that I’ve ever used, as it gives us a relatively quick, objective analysis of how well you move. I fall into the camp of people who truly believe in the value of this particular screen, and I’m not afraid to admit that. I will save a detailed explanation of each individual movement tested in the screen for a later date and instead I will give a general explanation of the FMS and why it’s an important step to take before you start an exercise program.

What is the FMS?

-A series of 7 individually-scored movement patterns designed to identify movement dysfunction or painful movement.  It was developed by Physical Therapist Gray Cook and his colleagues.  Cook is one of the top minds in rehab and performance today.

FMS-hurdle-step

-A scoring system from 0 to 3.

  • Any movement which produces pain on the FMS results in the score of 0 and is cause for further investigation. This could come from a referral to a licensed medical professional such as a physical therapist. This is the most important finding in a movement screen and makes client-coach communication essential. If a pattern is painful, it should be treated as a medical issue rather than a fitness issue, and as such it shouldn’t be part of your typical exercise program. This does not mean you have to stop working out, and doesn’t even mean that you’ll never train this pattern. It simply means that a fitness solution is not appropriate for what is a medical condition.
  • Any movement that is screened to be dysfunctional but not painful receives a score of 1. This is cause for further investigation but the solution can often be found without referring out to a medical professional. We will still avoid loading this pattern (meaning, adding resistance to it), but we don’t have to avoid it all together. If your trainer/coach is good at what they do, they can often remedy this problem fairly quickly without losing out on valuable training time.
  • Any movement that is not painful and not severely dysfunctional, but not quite perfect receives a score of 2. There may be a flaw in the movement pattern but it isn’t severe enough to raise a red flag and we can safely load this pattern. If this is the person’s lowest score on the entire screen we may spend some time addressing this pattern in warm-up or homework, but we wont spend a ton of training time on it.
  • Any perfectly executed movement receives a score of 3. There is no pain with the pattern and no dysfunction present. This pattern is good to go. Since the FMS is done “cold,” meaning the individual is not permitted to warm-up prior to the screen, we don’t even have to address this pattern in a warm-up. We can, of course, but all of the hardware and all of the software is present for this person to perform this pattern essentially right off the street.

-The FMS also includes a series of “clearance” tests which simply ask the client to report any pain with shoulder impingement, spinal flexion or spinal extension.

There you have it.  That’s the FMS.  An objective, unbiased view of movement quality which can be administered within the first 15 minutes of meeting your trainer.  It gives us valuable information about your mobility, stability and motor control and gives us an accurate baseline of your movement health.  My next post will aim to clear up some common misconceptions of the screen and explain what the screen does NOT do.  If you think you could benefit from a Functional Movement Screen and it’s resulting exercise program, contact me with the information below:

Adam Reeder
acr30@zips.uakron.edu

Why Movement?

movementThe title of this blog is Made for Motion.  I spent much of my last post talking about movement screens and movement quality.  Why?  While popular sites display articles like “6 weeks to 6-pack abs!” or “30 days to Sexy Legs!” why do I start with movement?

It comes down to one sentence: Form Follows Function.

“Functional” has quickly become one of the more over-used buzz words in the fitness industry, but that does not mean it’s not important.  When I say “functional” I’m referring to your ability to move well and with integrity, and if you don’t move well you will never reach many of the goals to which you aspire.  If you have a poor gait pattern, you may never run the marathon you want to run because over the course of training you’re going to be beating your joints up.  If you can’t balance well on both legs, you may never be able to enjoy skiing like you used to, or you may be more prone to falling.  And if you can’t stabilize your spine in certain positions, you may always be predisposed to back pain which is going to stop you from getting in that extra set at the gym, and you’ll never reach your full potential for weight loss, fat loss, muscle gain, or whatever your fitness goals may be.

For these reasons, movement is my entry point.  I assess movement the first time I meet a client, and I’m reassessing movement with every new exercise I give them.  If you’re already a gym-goer you may be reading this thinking “Assessing movement sounds like a chore, just let me do some freaking burpees and get after it.”  But in reality, using movement as an entry point is a short cut to health and fitness success.  Let’s look at two example training approaches:

Scenario 1) Fitness as the entry point- We don’t assess movement, we just put you into a fitness program, wind you up and let you go.  It’s a great program, and many people will do fine on it at least for a while.  But since we didn’t assess movement, it’s essentially a cookie-cutter program.  You do exercises that work for most people, because they work for most people.  You stay on the program for a while, and eventually your shoulder starts bothering you.  So then you skip a few workouts because your shoulder hurts and when you get back into the gym you just go lighter because if it’s lighter it can’t be dangerous right?  Maybe it feels better, or maybe a few weeks later the pain is worse and now you’re having trouble grabbing a dish from a high kitchen cabinet.  Now you have a problem and now we have to circle back and completely rework your fitness program.  In the meantime, you haven’t made progress in weeks.  Your constant state of pain has created something of a hormonal nightmare for your body to deal with and now you’re in a fat-storing state that won’t go away until you’re out of pain.

Scenario 2) We assess movement on your first visit- We find that you have awesome shoulder mobility on one side of your body, but when we test the other side you come up short.  It’s not painful, just “tight” or “stiff.”  Okay, no problem.  We throw some should mobility exercises into your warm-up routine, pick exercises that wont exacerbate your shoulder imbalances, and clean up the shoulder mobility issue over time.  In a more dysfunctional case, maybe we do some further testing and find out why the shoulder is tight in the first place and send you with some homework exercises when you leave.  In most cases, we’re able to take care of the issue within your first several sessions, and you don’t miss out on any fitness opportunities in the meantime because we’re choosing exercises that are specifically appropriate to you.

Those 2 scenarios are obviously an over-simplification and just one example, but things like this happen all of the time.  When you’re starting your exercise program you have a choice- do you want move often and then find out if you move well, or do you want to move well first and then move more often?  My experience says that you should move well first, then move more often.  The improvements are much longer lasting, and often come to the individual quicker, as we eliminate the guesswork involved with cuttie-cutter programs.

Thanks for reading!

Adam Reeder