Brian Schiff’s Blog

Please click on the link below below for a video message from me.  I must openly admit I am still trying to master this whole video thing. As such, you will need to turn your volume all the way up to hear me as my facility has high ceilings and the acoustics are not ideal. But hey, it is the content that matters most, right? I look forward to sharing many great tips, exeercises and strategies with you in 2009!

First off, Happy New Year to you.  I hope 2009 is a great year for you.  In today’s post I wanted to share some recent research on rehab exercises for low back pain with you.  I think most people have had or will have some form of back pain in their life.  With the introduction of computers, more people sit all day long and this alone has increased back pain due to prolonged static positioning in poor postures leading to daily “not so good” mechanical loading of the disc.

I suffer from sciatica myself at times, so I personally care a great deal about maintaining a healthy back.  A recent research article I read in The Journal of Orhopedic and Sports Physical Therapy looked at surface EMG readings of certain back muscles with different exercises.  These exercise included extensions, side bending, bridging, lifting opposite hands and legs in the air and many others.

The key points I want to share are:

1. Exercises where the trunk was maximally extended to end range against gravity (picture a 45 degree back extension machine at the gym) with resistance produced the greatest muscle contraction
2. The ideal prescription for muscle development was 15-18 reps with a 5 second isometric hold at the end of each contraction

So, the take home message here is to strengthen and create a healthy back, lower loads and higher reps with targeted extension exercises are best for maximal strength development.  One controversial point was the suggestion that despite high compressive loads with full hyperextension, some clinicians may need to choose that motion anyway to achieve desired results.  Personally, I am never a big fan of end range hyperextension on a repetitive basis, so I am not sure I would advocate that end range extension unless I were working with a gymnast or athlete who would be utilizing that motion in sport.

So, if you suffer from back pain you will want to add in some extension work at home.  You can do prone (laying on the stomach) opposite arm and leg lifts, superman lifts or even extensions on a stability ball.  I have included pictures of the prone superman and a weighted mediciane ball stability ball back extension exercise I recommend in my new golf conditioning book below. 

Prone Superman

Prone Unstable Medcine Ball Back Extension

Well, you might imagine the look of surprise and relief on the face of a client I saw this week when I told him what was finally causing his hip/leg pain.  This particular client trains with one of my staff members.  He has a longstanding history of pain in the upper posterior thigh and groin area.  It flared up recently and he finally went to see a physician.

He was diagnosed with an adductor strain and given a prescription for physical therapy.  My trainer wanted asked for guidance in working with him as not to aggravate the situation yet continue his fitness program.  As I spoke with him, he mentioned his worst pain occurred with sitting.  In fact, he can’t tolerate more than 5 minutes of sitting due to pain.  This struck me as very odd and not typical with adductor strains.

I began to probe further.  Next, I had him do some specific movements and I took a closer look.  My brief exam yielded limited hamstring flexibility and pain/weakness with hamstring resistance.  It was clear that his groin pain was more likely related to a medial proximal hamstring strain and not an adductor strain.  Because the medial hamstring controls hip rotation, his symptoms would easily be provoked in certain movements and positions much like an adductor strain.   

The take away message here is simply to listen carefully and closely examine the affected tissue to determine the true source of pain/dysfunction.  Treating the adductor will NOT cure his hamstring problem.  I am sure his physician is very competent, but often MD’s do not listen closely enough or perform inadequate testing, which leads to an incomplete or inaccurate diagnosis.  Any intervention I offer to clients should yield positive results or improvement within 4 weeks.

If you have an injury or physical goal and are not seeing forward progress in this time period, it is time to take a closer second look at the plan of attack.  It may take a different set of eyes and ears to get you back on track.  The little things really do matter!

In my last post, I spoke of lunging and the stress on the knee joint.  Today, I thought I would speak about muscle strains.  Keep in mind you strain muscles and sprain ligaments.  The most common muscle strains I see are hamstring, quadriceps and groin injuries.

They typically occur with a deceleration movement in sport or recreational activity.  In my experience, I notice that some athletes tend to be more prone to these than others.  This particular group of athletes seems to be those with a predominance of fast twitch fibers (more of your sprinters) and those lacking good flexibility and mobility (no surprise there).

Proper warm-up, strengthening, plyometrics and acceleration/deceleration training all play a role in preventing these injuries.  Recovering from such an injury is often a tricky thing.  Athletes often are fearful of pushing the injured tissue 100% (they fear re-injury) and coaches may not sufficiently gauge how long to hold the athlete out of full participation.  More importantly, the athlete often under reports the pain associated with the injury.  I have included a great recovery article HERE that gives you 3 R’s to go by. 

I also included a picture of one of my favorite rehab exercises for rehabbing high hamstring strains below.  It is the single leg Romanian dead lift and provides n excellent way to elongate the hamstrings functionally.  Pain or the absence thereof during full range of motion will indicate the relative healing of the injured tissue to date.  One should be able to do this equal to the non involved side without pain.

RDL - Descent

Ever have knee pain in the gym with lunges?  I work with so many clients who find their strength program limited by knee pain.  It is very common for women to suffer from Patello-femoral Pain Syndrome (PFPS) as they get older.  It commonly begins affecting them around age 30.

Essentially, the cartilage behind the kneecap may soften (often referred to as chondromalacia) or break down exposing the subchondral bone (below the cartilage) to excessive stress.  There are many pain receptors in the subchondral bone region that let you know quickly when the knee is unhappy.

Activities like stair climbing, kneeling, squatting and impact exercise often bring this pain on.  Therapists and trainers have long debated whether one should lunge or squat with the foot beyond the toes.  To date, little research has been done to support the notion that allowing the knee to extend beyond the toes dramatically increases PF joint stress.

That is until now.  In a recent study in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT November 2008), researchers compared a short and long step lunge both with and without a stride (stepping out and back).  The results in a nutshell confirmed that indeed a short lunge (allowing the knee to extend beyond the toes) produced more force and stress on the PF joint than a long step lunge (knee remains over the foot).  The stride with a short step and long step also produced more force than it did with a stationary lunge indicating a stationary lunge is less stressful, especially at lower knee flexion (bending) angles.

The angles where the forces really increased on descent were from 60-90 degrees.  This research would suggest that people with anterior knee pain would be better served to lunge less than 50 degrees with a  longer step length in a stationary position while rehabbing or until they build enough strength to move safely into a deeper lunge without pain.  The big takeaway here is to find the range of motion that works for you, but ultimately lengthen the step length to avoid increasing PF joint stress with lunges.

With all that said, I still believe we were designed to move in ways that the knee does extend beyond the toes.  It happens with step-over-step stair descension and sprinting/acclerating for sure.  Yet, doing 2-3 sets of weighted lunges 1-2x/week on a regular basis for strengthening in this fashion may lead to problems long term.  For those with documented PF problems, the safer route is to side with the research and listen to the body.  I hope this info serves you well in the gym moving forward!