On average 80% of Americans will experience low back pain at some point in their lives and more than a quarter of the population currently deals with low back pain on any given day.
Not only do most people have some form of back pain, but it many cases it is the result of poor movement patterns that have been abused for years causing the root of their problem to be both incredibly complex and multifactorial.
An exercise once thought to be dangerous (something that has been debunked by a multitude of recent studies), there is arguably no other lift that is more functional than the deadlift. The deadlift is a hinge type movement pattern, which is used every single time you bend over to pick something up off the floor, so you better be efficient with this movement. This article is Part I of a two-part series covering the common mistakes I see in the clinic and will teach you how to prevent low back pain while deadlifting.
This exercise can be moderately complex to perform correctly and the number one mistake that I see most in the clinic is a poor set up. There is a lot that goes on to get into this position but by bringing your shoelaces to the bar and remembering the “3 B’s” (Bow, Bend, Blades), most people will be able to get into a solid starting position.
So in review, to be in a good set-up position you need to “bring your shoelaces under the bar," bow until you feel tension in your posterior chain, bend your knees until you can grip the bar, and engage your shoulder blades. Doing this will get you into a good set-up position, which will protect your low back and allow you to lift bigger weight.
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Strength and flexibility training along with skill practice are usual as we train for marathons, weightlifting competitions, tennis matches and golf tournaments. But have you ever thought about training your diaphragm? What about your pelvic floor?
What if I told you there is one major key to training that many folks skip right over? Would you try it? Here is your chance. The diaphragm is a large muscle in the body with direct connections to the lumbar and thoracic spine and ribs. The pelvic floor mirrors the diaphragm- like the younger sibling that mimics the older- and has connections to the pelvis, sacrum and hip rotator musculature. What are the most common injuries and dysfunctions that WE see? Low back, SI joint and hip!
“Core strength” is definitely a buzz word in the fitness industry these days. And if you ask 5 people what it means, you are likely to get 5 different answers. So first, let’s talk about the “core.”
What is the core?
Your core, or the “soda can," is made up of your deep abdominals in the front, back muscles in the back, pelvic floor on the bottom of diaphragm on the top. These muscles work on concert to create pressure on your midline- think a full can of soda that has not been opened. If there is weakness or dysfunction in one of these muscles, then the midline is depressurized- the can has been opened.
So as you run, lift weights, swing a tennis racket or play with your kids, this pressurized can is helping you create torque and move through space with both dynamic stability and mobility. To learn more about this system, check out my blog about pelvic floor anatomy and leaking with exercise.
How can I train it?
No doubt your diaphragm works; you’re sitting here breathing right? But you can train it to be strong and more effective with your training. A great place to start is the diaphragmatic breath. Not only does this help us work towards full excursion of the diaphragm with a deep breath but it also help relax the pelvic floor. Relaxation of the pelvic floor is just as important and being able to contract it!
Try the 90/90 breathing drill and see if you are able to focus on the moving the ribs cage out and up rather than shallow chest breathing. This is essential for control. To add more strength work, try blowing up a balloon in the same position and breathing pattern!
As far as the pelvic floor goes, I am definitely a proponent of seeking assistance from a women’s health PT before starting specific strengthening programs. They can give you a better idea of what YOUR body needs- strength, endurance, relaxation. But a great place to start is imaging creating controlled amounts of tension through your pelvic floor. This can be cued for most folks as avoiding passing gas or gently stopping a stream of urine. (Don’t ever actually stop your stream of urine, this is just a cue for a gentle contraction.)
So this contraction should be as intense as the activity that you are performing. Lifting a pencil would be perhaps a 2% contraction, where lifting a heavy couch might be closer to 100%. This sliding scale applies to both pelvic floor and abdominal contractions. Only as much tension as needed for the task!
How does posture relate?
Going back to the soda can analogy- can you picture how bad posture is equivalent to having dented and bent my soda can? Not idea for keeping that pressurized cylinder! An easy example for this is running. If you have the “grandma lean” from the hips rather than the ankles, your can is bent. These folks tend to have back issues with running, perhaps some leaking and dysfunctional breathing. Straighten up the can and breaths are less challenged and your back feels better!
If you are dealing with back, hip, pelvic pain with activity try some of these strategies. This can also improve your breathing and postures/form with fitness. This merely scratches the surface but may stimulate some ideas about what is holding your training back. After you try these, if you are still having issues or questions, come see us! We love to help people like you get back to doing what they love and living a high functioning, pain-free life.
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Youth sport participation is growing around the globe, and the increasing trend is to have youth athletes specialize in one just one sport. With the goal obviously being to maximize a kid’s potential to play in college/pros/olympics, parents are having their kids spend 20+ hours working on very specific skill sets, going to countless camps, and squeezing out every last opportunity by playing on multiple teams in a single season. On the surface, it's easy to see why parents would think this… ”to get better at basketball, play more basketball." However, let's take a deeper look as to why this may not be not be the best (nor safest) route to making your kid the next Michael Jordan.
Playing multiple sports makes you more competitive
Weather your goals are set on college or the pros, top recruiters are looking for the most competitive athletes they can find...regardless of sport.
Want to play baseball? Check in to what Scott Upp, the leader of a baseball program that has been ranked as high as number one in the country and has more than 35 IHSAA sectional baseball championships, has to say. “If there are coaches out there that are telling kids to play one sport, I think they’re crazy,” Upp said. “Because while you’re working on drills and everything else like that, he’s out competing...running from 6’2”, 280-pound linemen. He’s trying to get away and make plays. So he’s competing, and you can’t really substitute that. And basketball, with time winding down, he’s got the ball in his hands, he’s learning how to compete. And all those things that happen in other sports just make him that much better in baseball.”
What about soccer? Abby Wambach, a member of the 2015 US Women’s World Cup team, is known is the best header in sport history, and guess what she attributes her success to...basketball. “Playing basketball had a significant impact on the way I play the game of soccer," Wambach said. "I am a taller player in soccer, in basketball I was a power forward and I would go up and rebound the ball. So learning the timing of your jump, learning the trajectory of the ball coming off the rim, all those things play a massive role." In fact, when the 2015 Women’s World Cup Champions were surveyed, they had collectively competed in more than 14 different sports growing up in addition to soccer.
Dreams of playing in a College Football National Championship Game? Clemson’s Head football coach, Dabo Swinney, who continuously has his team in playoff contention and won a national championship in 2016 famously recruites multisport athletes and had this to say about them. “I just think that the cross-training, the different types of coaching, the different types of locker rooms, the different environments that you practice in, the different challenges — I think it develops a much more competitive, well-rounded type person”
Playing multiple sports makes you more athletic
This one gets a little touchy...your kid has the best hands on his middle school football team, so naturally he needs to go to every SEC camp available and work year-round to improve his route running; right? Or, your daughter is the tallest on her 7th grade volleyball team so of course she's going to play year-round club volleyball to perfect her swing; right? Sure...practicing a skill is important, but the data doesn’t lie and improving overall athletic ability trumps all.
Demarco Murray, one of the most decorated running backs in Oklahoma who also led the NFL in rushing yards in 2014, didn’t seal his fate with Oklahoma until the coach watched him dunk a basketball during a game. Sam Bradford played basketball, football, golf, and hockey all throughout his high school and then went on to be a heisman trophy winner and number 1 overall NFL draft pick. In fact, 91% of the athletes drafted in the 2018 first round of the NFL played multiple sports in high school and 96% of the players who played in last years superbowl were multi-sports athletes!
However, the impact on athletic development goes well beyond the NFL and football. For example, a study in the American Journal of Sports Medicine looked at first found draft picks from 2008-2015 and found that athletes who played multiple sports in high school played in more NBA games, had a lower significant injury rate, and had more longevity in the spoty. The exposure to different athletic and movement demands, especially as an adolescent has been well documented in countless studies to have a strong carry over effect into your primary sport. The reason is simple, when you limit yourself to a single sport at a young age, the lack of diversified activity may stunt neuromuscular control development, leading decreased overall athletic ability.
Playing multiple sports decreases your risk of injury.
I’m a doctor of physical therapy, so I may be a little biased, but I’ve saved the best for last as a reason for playing multiple sports as a youth athlete. I don’t care how skilled your kid is, how physically gifted they are, they will never reach their full athletic potential if they can’t stay healthy and on the field and specializing into one sport has been shown time and time again to increase your risk of injury.
Think about this, only 65% of athletes report returning to their previous level of play 1 year after an injury and up to 20% of elite athletes say an injury is what caused them to stop playing their sports. When you specialize into a single sport at an early age you’re risking increased exposure to repetitive technical skills and high risk mechanics, Over-scheduling leads to decreased time to recover from competition and early psychological burnout, all of which have demonstrated to statistically increase your risk of injury.
So in review, let kids be kids. Don’t force their hands by specializing at an early age. Let them become a more competitive, athletic, and healthy athlete by playing in multiple sports.
Thanks for reading,
First things first, let’s clear up the pronunciation of the name. It’s kegel- as in “bagel” with a K. Kegels were named after Dr. Arnold Kegel who performed research on the pelvic floor after child birth. Just a fun fact—Thanks, Tracy Sher! Kegels are contractions and relaxations of your pelvic floor with the goal of strengthening those muscles.
Ok, now that we cleared that up, the true debate is: To Kegel or Not To Kegel?
Many post-partum patients have told me that after the birth of their child, they are never given instruction or care past “perform kegels daily” to address their pelvic floor. They are never taught or checked to be sure they are performing them correctly! You can only imagine the frustration when they learn there is more to the puzzle. Especially after years of leaking with exercise, painful sex or other related symptoms. Others, who may or may not have given birth, read in magazines that the best way to “stay healthy down there” and “please your partner” is by performing kegels daily.
The full spectrum of pelvic floor movement is contraction, relaxation, and bulging. It is important that we maintain all of these functions for optimal strength, control, and length of the pelvic floor. The popularity around kegels emphasizes the contraction and strength part. It seems that women think they tighter and harder they can squeeze, the better. This is true for certain situations- think sneezing. But it is also important to be able to relax the pelvic floor fully.
Re-lengthen before we strengthen
For much of the active population, pelvic floor over-tension is a problem. For these women, we want to focus less on the contraction and more on the relaxation and lengthening. Once full relaxation and length is achieved, THEN kegels are needed to strengthen in the new range of motion achieved. Strength comes in many forms- quick bursts, endurance, holds, etc. These are exercises specific to YOUR needs and deficits that a pelvic floor PT will prescribe to you. There is also a piece to the puzzle of timing of the pelvic floor contraction.
Look back to a blog I wrote about 7 Habits That May Be Stressing Your Pelvic Floor to start addressing these issues now.
How are you performing a kegel?
Remember how we said a kegel is a pelvic floor contraction? Well, all of these muscles are deep so if I can SEE you performing a pelvic floor contraction, you’re doing too much. Sometimes it is hard to know what you are squeezing in the nether regions. Is it pelvic floor? Is it my glutes? Am I just squishing my legs together?
The easiest way to know if you are performing a kegel correctly—see a women’s health PT and learn!
So, to kegel or not to kegel? It depends!
The best place to start - regardless of age, sexual activity, pre or post-partum - is to see a women’s health (aka pelvic floor) physical therapist. We can help you with a plan to decrease pain, improve function, and stay active without you having to guess what is right for you and if you are performing contractions correctly.
Thanks for reading,
Dr. Danny and Dr. Jackie's views on performance improvement, injury prevention and sometimes other random thoughts.