Tagged: injury

The Downers of the Downward Dog

This was inspired by a client of mine who wanted to restart yoga after a bad back injury.

What if, as a trainer I told you that we were going to do an exercise that did the following:

I want you to lengthen out your posterior chain as much as you can, throw both of your shoulders into extreme extension, put yourself into spinal flexion (even if you can’t properly tilt your pelvis) and stretch out your hamstrings and calves as far as they can go (thereby also yanking hard on your sciatic nerves) – oh, and do it while loaded with up to 70% of your body weight, and the load increases the further you get into the exercise.  So for a 150 pound female that would mean their shoulders and knees are loaded in extension with up to 105 pounds on their spine and other joints.

Does that sound like a good idea for anyone, let alone people recovering from injury?

The funny thing is, people in yoga classes do this almost every day.  It’s called a downward dog.

downward-dog-technique1

Now, before the yoga community absolutely freaks out and starts thinking I’m bashing the movement, I’m not.  All I’m doing is providing a practical analysis of what people are required to perform to get into this position.  I’ve had a client recently with severe back issues try to get back into yoga and the one movement she had immense trouble with (not surprisingly) was this one.   I’ve also attended yoga courses where thankfully the instructors were aware of the limitations of this movement and realized that not everyone should perform a downward dog – in fact several of my most respected colleagues actively discourage it since they have realized what it does.

On the flipside I’ve also been to yoga classes where the instructors did absolutely NOTHING except for sun salutations over and over again.  You can guess which class I didn’t go back to.

BKS Iyengar, one of the foremost yoga teachers in the world asserts that this asana stretches the shoulders, legs, spine and whole body; builds |strength throughout the body, particularly the arms, legs, and feet; relieves |fatigue and rejuvenates the body; improves the immune system, digestion and blood flow to the sinuses, and calms the mind and lifts the spirits.”  (ripped from Wikipedia) – and it does all of these things.

But what people need to realize as a whole is that some movements that you perform in a typical yoga class are very hard forceful strength movements.  Simply because it is packaged as something healthy and therapeutic doesn’t mean that it is.  Just like any other type of exercise, it needs to be tailored to the person participating in it.  A 200 pound deconditioned person has absolutely no business getting into this position and here’s why:

Here’s what people need to be able to do into order to successfully perform this movement:

Put your arms overhead fully or even behind the torso while internally rotated.  This requires a healthy rotator cuff complex, the rib cage to be able to move and the shoulder blade to be able to move with proper rhythm.  One loaded movement I often have clients do to test this area is a loaded shoulder extension (think a front raise but over the head with a cable) at various angles in order to engage the entire shoulder complex.

Hinge the hips with proper pelvic movement so that the lower spine isn’t flexed forward putting strain on the lower spine with load – while it’s flexed.  Think loaded Romanian deadlifts, and even things like good mornings (I have a bias against these because of where the load is placed but whatever).  Just because your hands and feet are on the floor doesn’t mean there isn’t a ton of pressure going through the lower spine in this position.

Fully extend the knees and dorsiflex the ankles as much as possible – general limits here are thought to be 30 degrees but most people have much, much less than that.  Generally here in a squatting position I look for the ability of the knee to travel forward properly and therefore dorsiflex the ankle.  Can you squat low?  Or does your person have longer legs relative to their torso?  Are they recovering from a knee issue that might be contraindicated to full knee extension (like a meniscus injury?).

There can be many restrictions in this area and it also has the highest risk of issue due to the excessive load people will put on their knees in order to force themselves into a straight legged position.  The restriction might also come from hamstrings, calves or somewhere else, not even the ankle.

So here’s my question:  Can or should you do all of these things and hold them for time?  No?  Maybe this movement isn’t for you.

What people need to realize is that even though it is relaxation based and supposedly “stretching”, yoga is still force on joints.  Sometimes a lot of it.  Another common flaw of the downward dog is that people will generally run away from weakness.  This means that if they are weaker in the shoulders and have trouble there they will dump more load into their lower body in this position.  If they are weaker in the lower half they may dump more load into their upper body.  I have seen this often in classes.  And it can cause a serious problem if suddenly the load shifts by 20-30% into the wrong area suddenly due to a weakness somewhere else.  However, due to the nature of the position there isn’t any way to get out of it.  Except for compromising by say, lifting your heels or bending the knees or even elbows to put load elsewhere.

So what are some good modifications?  Well, like in any other loaded position if you can take the load off a bit, then the person can attempt the range of motion without the excessive joint force.  For example, a person with good shoulder mobility but poor posterior chain range and pelvic movement might want to perform a simple hip hinge with their shoulders extended and brace their upper body against something.  Prenatal classes often recommend this.

modified_downdog-600x396

Another option might be to intentionally elevate the heels and bend the knees as I expressed earlier.  You can also bend only one knee or alternate sides.  For less force on the arms and shoulders, lower the body and rest the forearms on the ground.  These are all modifications that can easily be suggested in a class but often aren’t.  During a busy class most instructors just don’t have the chance to go around and suggest individual modifications to people.

Or here’s a thought – don’t do it.  There are ways to work up to this movement, just like any other yoga movements but so many people make the mistake of jumping in and following along, and then wonder why they are sore the next day and never want to go back.

The good news is that with my modifications to her positions and telling her to skip downward dogs my client successfully navigated two yoga classes and has been able to get back in touch with something she previously enjoyed but couldn’t do.

Don’t get me wrong, I’m a fan of yoga.  I’m a fan of anything that keeps people moving, enjoying loaded positions to develop strength and will over time develop additional range of motion.  I’m also a big fan of the relaxation side of the practice and allowing people to be in a parasympathetic state, even if it is only for five minutes at the end of class in savasana.  It’s something most people should do a lot more of.  The reason I’m writing this is to make sure that if you are about to jump back into yoga because you think it is a good way to ease into exercise again – it might not be depending on the class.

As always, if you have comments feel free to comment here or email me at paradigmfitnessottawa@gmail.com.  Good luck with your future practices!

The Best Coaches Teach Fundamentals

As a trainer and coach I tend to read a lot of stuff written by other successful trainers and coaches in order to try to make me better at my job.  Throughout the years there has been one main theme I have seen that I thought I’d point out to the rest of you, trainers and potential clients alike.

Newer trainers and coaches tend to think they need to reinvent the wheel in order to make themselves more marketable or stand out among the crowd.  They try whatever the latest fad trend is with the hopes that it will cause the client to be impressed.  Eventually (with any luck) they realize that a coach is only as good as their results.  Doing something showy and flashy in order to create a temporary response is usually a sales tactic – anyone can push someone really hard, as I wrote about previously HERE.

This means whatever the client goal is they need to be working towards it and making constant improvement.  For my strength clients, this is being able to generate more force or move more weight.  For my running clients it is being able to run greater distances, faster or both.  If you coach a sports team, then they should be increasing their skill levels at whatever position they are performing in and also hopefully using that to win games.

So what is the key?  Throughout history of successful coaching, it really comes down to one word:  fundamentals.

Successful coaches can make people better at things that they should already be doing well.  For a strength coach, this can mean the basic lifts like squatting, deadlifting, pulling and pressing.  For an athletic coach this can mean things like power, agility and coordination.  For my runners, it means being more efficient with every foot strike, which in some cases means starting over again at the beginning.

Throughout the sports world, high level athletes will tell you that they spend hours upon hours practicing fundamentals.  Basketball players practice foul shots.  Cyclists ride their bikes for hours a day.  Swimmers swim lots of laps.  Baseball players take batting practice daily for hours.  Often this has no major goal beyond building the fundamental mechanics or strength they need in order to improve.

weighlifting meme

Just two months ago I started working with a post surgery client who had recovered but had shin splints daily.  When her basic walking gait was corrected and she started to use the proper muscles again the shin splints disappeared.  The same thing tends to happen for back issues when the person learns how to deadlift and squat properly.  Some trainers would call this “correcting an imbalance”.  I’d rather call re-educating the client (and their tissue) on something they already know how to do.

Your body is a very smart thing.  It learns based on the input it is given.  As I always say, crappy information IN means that you will generally get crappy information OUT.  If you overwhelm your nervous system from the get go it doesn’t have a chance to adapt and make improvement.  This means spending weeks (for some people) practicing simple things until they have them down.

So what are the fundamentals?  Well, it really depends on the person.  For some people, walking properly is hard enough.  Throw in a few activities of daily living like sitting down, picking things up and climbing stairs and they might be done.  I’ve had to reteach these things to hundreds of people over the years, and more often than not when they are practiced and put into place little painful issues tend to resolve very quickly.  Same with high level performers.  Often with my athletes they simply need to be coached on how to perform a movement they have forgotten how to do properly.  This can be as simple as a squat (for a powerlifter) or as complex as an ankle mobility movement for a soccer or football player.

Most movements can be broken down into basic primal movement patterns, which is echoed by both movement gurus and athletic trainers alike.  Deadlifting.  Pushing and pulling.  Spinal flexion, extension and rotation.  This is generally what 95% of my clients start with, even if it is completely de-progressed like a basic box squat within a range of motion their hips, knees and ankles can perform at without deviation.

In fact if you’re a reader of fitness magazines, you can see this plain as day.  Any program that tells you how to get a BIG LEGS has a squat in it.  BIG CHEST means lots of bench pressing.  Not a one armed dumbbell press on a Swiss Ball.  Stick to fundamentals and you are guaranteed to see progress.  Another of my mantras is that you EARN THE RIGHT TO DO MORE.  This means if you can’t do something basic you have no business doing a progressed version of it.  Most high level coaches adhere to this.

If you have run into a coach or trainer who tells you that you need to perform some sort of elaborate system in order to improve a simple movement, maybe you should think twice.  There’s a time and a place for breaking down movements to isolate weak points, but it should not be the primary focus of any workout.  There always needs to be a goal, and in my opinion that goal should be centered around the fundamentals.

So the next time you read about some amazing NEW system that is going to explode your gainz please put down whatever article you’re reading (unless it’s mine) and go deadlift.  Or do some pullups.  It’s probably what any decent coach would tell you to go and do anyway.

Case Study: Chris D

Often I have cases come into my practice where they stand out as a good example of what appropriate progression can accomplish.  Also, frequently I get people asking me: what do you do with people?  What is your secret to helping people get pain free and strong?  I thought this case might be a good example of both and allow me to share some of the principles that have brought me success with people like Chris D.  While this is an extreme example of a case, it might help give you insight as to what proper progression and intention can accomplish.

Chris started working with me ten weeks ago.  He came to me through a referral described as a “back problem”, which I quickly found out was a bit of a loose description.  I can’t obviously share what his scans MRI revealed but needless to say they were detailed and he had a lot of spinal issues stemming from a long career as a contractor.  The biggest problem with our initial assessment was a pretty glaring one:

Chris couldn’t sit down.  He couldn’t sleep for more than about an hour without waking.  He couldn’t work without constant pain in his neck and shoulders and legs.  Even driving his car was an exercise in pain management.  Due to the pain in his neck, upper back, shoulders, lower back and legs after just sitting in my office for five minutes he was uncomfortable enough to have to stand up.  No matter what I tried to do in order to check movements through his upper and lower body he was in pain, and it would flare up at the slightest bit of movement or force.  Even isometrics, which is usually the most minimally irritating to most people was really irritating to Chris.  I’ll share later what we have found out during the course of his treatment but needless to say it was a very daunting task.

For only the second time in my training career (and you can read about the first HERE) I was faced with a situation where I wasn’t 100% sure if I could help.  Chris expressed that his previous physio experience left him feeling better, but of course things came back once he stopped because he didn’t have strategies to keep helping himself after he was done.  This is all too common – physio can help to an extent, but then it takes getting stronger to really complete the rehabilitation process.

Initially Chris decided to give me a two week period to see if what I was doing would help a bit.  Here’s a layout of how our first movement session worked (I keep notes on everything I do with every client so this is directly out of my notes):

  • Priorities:  Mobilize upper neck C5/6/7, upper trap, R side shoulder blade, strengthen L side upper quadrant.  Standing mobility in L side hip com/glute com/lower back, strength in R side glute/hip coms and ankle on R side. (this was all based on what I could assess)

Release therapy was done on his upper trap areas on both sides to bring blood flow into the area and expose him to self myofascial release that we could do on his own with a ball.  There are varying sizes of these and we used the largest one in order to have the largest surface area and the least access to deep tissue.  Chris could not stretch conventionally  because any movement would cause his pain to flare.

We started with a manual two legged hip hinging movement with about 20-30 degrees of hip and knee flexion (with a base for support that was 30 inches high as a guide) for control and teaching how to use his pelvis.  My initial goal was to work on getting him sitting down (to help with work and being at home), then lying down (to help with sleep).  We did some R side isometric engagement (while standing) for his glute and hamstring.  We did some standing brace work to teach his inner unit how to engage properly and worked on his walking gait.  One major discovery we did right away was that if he flexed his L shoulder 20 degrees forward while walking his pain diminished significantly through his neck and upper back.

After 35 minutes we had to stop because Chris was getting major irritation in his shoulders and neck.

Using proper microprogression and trial and error Chris was able to sit down in his car so that he could drive to his father’s place 1 hour away for Father’s Day in June, about five weeks after we started.  His sleep was still an issue and his shoulders and neck would still get irritated quite easily, but through constant self therapy and working on movement patterns we had established on his own, things started to improve.  Chris started to experience periods of time without neck/shoulder pain.  Through more trial and error we found that if Chris rotated his shoulder blades a certain way he experienced relief.  Being mindful of all of these things kept him encouraged and improving.

His lower back and legs started to improve significantly and we introduced compound movements.  After the eight week point we discovered that his thoracic spine was likely twisted and began to work on that aspect, which helped quite a bit.  Chris discovered that when driving (which he could do at all previously and now could do for extended periods) if he consciously kept his shoulder blades even he could eliminate pain in his neck.  By now Chris could squat (with load), split squat, flex his shoulders almost to 90 degrees and even hold his spine against rotational torque.

After ten weeks Chris could deadlift 60 pounds with perfect form.  I have a video of it but Chris asked that he remain relatively anonymous.

He has been getting proper nights’ sleep and been able to do more driving for work.  He has been able to do work around his home that would have caused serious problems three months ago.  Here’s a layout of our most recent workout:

  • Alpha Ball warmup – mobility in rotator cuffs (both sides), one legged balance and thoracic spine mobility.  Blood flow increase to VL/IT Band fascial line on R side (since doing more with his legs he started to experience some weakness through this area on his R side).
  • Dead Lifts starting at 50 lbs and increasing to 60 (he holds the bar in external rotation because his shoulder is able to maintain in that position) for up to 9 repetitions.
  • Lying position shoulder flexion with 3 lbs load on both sides maintaining position above 20 degrees from floor (through various positions we found that he is able to use front delt/pec/serratus in this position)
  • Single Legged Leg press at 90 lbs of load (does not affect his lower back or hip complex any more)
  • Eccentric loaded row in an incline position (I would have to take a picture of this for you to understand but think about lowering through a chest press focusing on the negative portion only)

Chris had made phenomenal progress over his time so far seeing me for only two hours per week.  He also does a lot of work on his own, which is what I expect from my clients.  He is aware of what he needs to do (and not do) and every time he comes in we have some new insight into a movement pattern that he experienced and we are able to build on that.  One thing I constantly express to him is how I love the fact that he wants to understand what is going on and focuses constantly on moving properly.  Chris has invested in his recovery, which is vital to any progress you want to make physically.  It doesn’t happen slowly, it happens with careful application and time.

So here’s a good example of how a properly progressed strength program can help someone that has been in chronic pain for a long period of time.  Many people walk around in situations that can easily be diminished or resolved through a properly progressed program with lots of intention and appropriateness.  I’m hoping that Chris will continue to improve.  One of our major goals was achieved last week when he actually slept properly, something he couldn’t remember doing for a very long time.  These little things can make a huge difference to someone’s quality of life.

If you have any comments or questions about what I have been doing/have done with Chris please simply ask and I will share it (with his permission of course).  Also, if you have any people who you think could benefit from the type of treatment Chris has gone through feel free to let me know.

Until next time – keep moving!

A Tale of Three Runners

It was the best of times, it was the worst of times…if you understand that reference then you’re probably my age or older (or just enjoy reading).  Actually, this weekend it was the best of times for three of my athletes.

Recently in my city of Ottawa we had our annual Ottawa Race Weekend.  It is a fantastic weekend for runners where they hold a marathon, half marathon and a 10k and 5k and all events are well attended with over 30,000 people participating.  Every year it is run flawlessly for the most part (although they had a bit of a screw up on the ½ marathon course this year) and attracts runners from all over the world.  Since runner coaching is a part of my business I wanted to share a story about three of my athletes who all come from different aspects of fitness, but all achieved a level of success this weekend, even though they started in very different places.

RP is a gentleman who has been working with me for over two years, who although he just turned 40 still has the athletic ability of a gazelle and the sparkling wit to match.  When he started working with me he had acute Achilles tendonitis and he had 8 weeks to his first marathon.  He couldn’t run for more than about 10k without pain.  I distinctly remember the look on his face when I told him his mileage was getting cut in half 8 weeks before a marathon, but he went with it and successfully ran his first marathon.  Since then he has done several other races including two more full marathons, a half marathon PB and a 500 kilometer bike ride from London to Paris.  Last weekend he beat his personal best on the marathon by over 30 minutes by staying consistent and running 4 times per week with a gradual buildup to 65-75k per week over time.

TW is a woman who came to me only a few months ago with another problem – this time ITBS, or iliotibial band syndrome and she couldn’t run at all, but still wanted to compete in the 10k with a restriction of only running 3 times per week (with a holiday mixed in for good measure).  She had previously done marathon training so was used to volume, but had to have some adjustments to her speed (I actually sped her UP to give her a proper gait) and work on her IT band issues, which resolved fairly quickly.  Her initial goal was to complete the 10k, but then a few weeks out we changed that to doing it in under an hour, which she had never done.  She finished in 58:30 with a smile on her face and no IT band issues.

CM is a woman who I have been working with for about a year who came to me because she liked to walk long distances with a goal of completing another ½ marathon walk in another short time line.  She is obese and has some other health issues that make it difficult for her to move.  We got her through that race, however she continued to suffer from calf and ankle issues and had to restrict her volume so that she could stay consistent with her workouts.  She completed another ½ marathon walk last weekend only about 10 minutes slower than the year previous – having never walked for more than an hour in training.  For her a ½ marathon walk takes four hours but she got through it, even on a brutally hot day.

These three people all made significant accomplishments last weekend.  The point I’m trying to make is that different people accomplish things differently.  All three of these athletes came at their respective events from different places, skill levels and levels of progression.  However, all had a successful result following a plan – and in CM’s case that plan was simply to get it done even though we both knew she was going to have a hard time.  With all the athletes they did what they could to make consistent progress towards the goal they had set – and then those got modified when progress was either better or worse than expected.

Anyone can be successful given the right tools and progression, no matter what you want to do.  Want to bench press 300 pounds?  Want to run a marathon?  Want to climb a mountain?  Great.  The idea is to set the goal and then work towards it carefully, mindfully towards what your body is capable of at that time and then just keeping moving forward.  And you’re never going to get anywhere by trying to not listening and respecting your body when you try to push it too far too soon.  The great thing is, it will tell you when you’re pushing too hard and try to stop you – you just have to listen.

Getting hurt doesn’t mean you have to stop – it means you have to learn what caused you to get hurt, and either stop doing it or modify what you’re doing in order to let it recover and not have it happen again down the road.  Attack the problem, not the symptom.  With a couple of these athletes it was a simple form adjustment and being mindful of what they were doing, which you should be doing anyway.

So today, tomorrow, whenever you start working towards something be smart, progress yourself within your tolerance limits and above all, listen to your body.  Oh, and hire a good coach.  I happen to know one, and he trains runners virtually as well if you’re interested.  Maybe next year you can have the same success that all of these people did, even though they started from completely different places.

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