Course Notes

Building the Ultimate Back:

From Rehabilitation to Performance

Stuart M. McGill, PhD.

University of Waterloo, and
www.backfitpro.com

Sponsored By:
COURSE OBJECTIVES

Global Objectives:

 To update delegates on the most recent developments in clinical biomechanics of the lumbar
spine - specifically how it works and how it becomes injured.
 To provide guidance in the application of this knowledge to the clinic, workplace,
rehabilitation centre, and sports field to reduce the risk of injury, optimize healing of the
patient, and build ultimate back performance in the athlete.
 To give practice and technique development with workshops throughout the day.

COURSE OUTLINE
Brief Description of Topics:

Building the foundation: Dispel the myths about how the spine works and becomes injured.
Anatomical, biomechanical and motor control perspectives are provided to setup the clinical
approaches. Determine the variables that both cause and exacerbate back troubles, together with
some characteristics that facilitate rehabilitation and performance training.

Interpreting patient/athlete presentation: Understand aberrant motion and motor patterns and
possibilities for corrective exercise. Provocative tests and their mechanical basis provide
guidance for optimal exercise design. Specific markers will predict who will progress. These must
be addressed at the outset of a program to optimize success.

Reducing the Risk of Injury: No clinician can be successful without removing the cause of back
troubles in patients. This section teaches delegates how to identify the causes and how to
remove them. This approach to prevention goes beyond Ergonomics.

Rehabilitation Exercise: Biomechanics and Clinical Practices - Many exercises prescribed to

low back patients have not been subjected to scientific examination. This component of the
course attempts to quantify and rank exercises for their spine loading, muscle usage and
stabilizing potential. Algorithms for choosing the best exercise approach for each individual are
provided. Specific perturbed motion and motor patterns are shown together with some
appropriate corrective exercise. Nuances of form and technique are discussed that either
enhance or inhibit clinical objectives.

Training for performance – Training the back for performance (either athletic or occupational)
requires different approaches and objectives than training to fulfil rehabilitation objectives. Some
of the techniques developed in our work with world class athletes will be introduced and
discussed within the context of valid mechanisms and evidence. These include the progressions
from establishing motor control patterns with corrective exercises, through to stability, endurance,
strength, power, speed and agility. The concept of Superstiffness and how world class athletes
create performance beyond expectation will be explained with data-based examples.
 SUGGESTED READINGS

This presentation synthesizes many research articles. Rather than provide an exhaustive list, the
interested delegate is encouraged to see them at:
http://www.ahs.uwaterloo.ca/~mcgill/

However, the information has been synthesized into two books. The first book describes the science of
back function, prevention of back troubles and stabilization exercise:

McGill, S.M. (2007) Low Back Disorders: Evidence based prevention and rehabilitation - Second
Edition, Human Kinetics Publishers, Champaign USA, 2007

The second book describes the science of back function as it pertains to training for higher performance
function (either occupational or athletic), provides algorithms for examining the critical components of
different activities to identify what needs training, and the full exercise spectrum and progression from
corrective exercise to stabilization exercise, endurance training, true strength development and speed,
power and agility enhancement. Techniques used by some of the top athletes in the world are quantified
and described.

McGill, S.M. (2014) Ultimate back fitness and performance, Fifth Edition, Backfitpro Inc, 2014
Available at: www.backfitpro.com

Two DVD’s illustrating the Assessment and Therapeutic exercise techniques and Performance
enhancing techniques used in the clinical portion of the course are also available:

McGill, S.M. (2012) The Ultimate back: Assessment and therapeutic exercise, Second Edition
McGill, S.M. (2010) Enhancing Performance, www.backfitpro.com

BRIEF BIOGRAPHY - Stuart M. McGill

Professor Stuart McGill has authored over 300 scientific publications that address the issues of lumbar
function, low back injury mechanisms, investigation of the mechanisms involved in rehabilitation programs,
injury avoidance strategies, and performance training of the back. He is a consultant to many medical
management groups, elite sports teams and athletes, governments, corporations and legal firms around
the world.
Brand New, now available:
A book written for the lay public with back pain:

And the DVD: The New Science of Golf

Available from www.backfitpro.com

Use the following pages for making notes – some critical slides have been provided.

The Foundation
Injury Tutorial:
Role of cumulative trauma, rest, adaptation, interval training

Normal Mechanics:

Myths and Fallacies:

Spine function and dispelling the myths.

Are painful backs a life sentence?
Do psychosocial variables affect function?
Isolation approaches vs integrated approaches
Pain and motion/motor compensations
Strengthening vs rehabilitation vs performance
Stretching?

Anatomical features of the spine and associated tissues.

- The passive tissues
- Functional significance of vascular and neural structures
- The structure of the abdominal muscles, their function, and optimal
training
- The special architecture of the extensors and their role for buttressing
damaging shear force
- the hip musculature and why you must do more than squat

Spine biomechanics – function and loads.

- How the “system” functions
- the foundation for designing exercise progressions based on spine
load and muscle activation level – optimize risk/reward

Stability Tutorial:
What is stability?
How is it quantified?
What constitutes a stabilization exercise?
How do they “work”?

Low Back Injury Mechanics:

Cumulative trauma model
Aberrant Motion/motor patterns
Results of tissue damage: short and long term
 Volume 1:  Anatomy trains, connective tissue, elastic recoil
Building the foundation  Good form
 Assessment: Precision of technique, expert
interpretation, reliability not so important
Stuart McGill  Train with speed to achieve 100% neural drive
www.backfitpro.com  Superstiffness
 Risk / Reward

The Foundation:
Relevant anatomy and normal mechanics
Injury mechanics and resultant instability
 Epidemiological studies
Perturbed motion/motor patterns
 Assessment
Prevention of back troubles:

Rehabilitation of the painful back:  Rehab plan design

Assessment
Corrective and therapeutic exercise
Translation to daily living

Performance training:
Enhancing endurance, strength, power and performance

Applied Tissue
> Tolerance
Load

Page 1
 Injury

Tolerance

Modified therapy

Training Poor therapy

Appropriate
load
therapy

Time

Productive work

Capacity

Unproductive work

Page 2
Page 3
 McGill et al
2013

 Special spine extensor and

stabilizer

 Lumbar nerve Roots:

 Large excursions

Page 4
 In Vitro Lab In Vivo
Lab

CT, X ray, loading machines,

Micro dissection

Building the Virtual Spine ...

Muscle Force

Potential energy stored in linear springs (muscles)

Muscle Stiffness 90
UL  F
m 1
m ( l p m  l o m )  1 / 2 K m (l p m  l om ) 2

Muscle
Length

Potential energy
of the spine
system 18X18
Second DETERMINANT
Hessian Diagonalized
Lumbar Potential energy stored in torsion springs Derivative
V  UL  UT  W Matrix (STABILITY INDEX)

Sagittal View Diaphragm spine

geometry (passive tissues) (UT )

Serratus Post. d 2V  0
Multifidus
Erector Spinae QL External Load Work performed on external load (W) d 2
Thoracolumbar Psoas Major
Fascia
Interspinous Lig’s d 2V  0
Intertranversarii d 2
Supraspinous Lig’s

Page 5
 Moment Comp. Shear

(Nm) (N) (N)

Straight Leg 64 3234 257

Bent Knee 66 3413 302

 Moment = 50 Nm

Compression (N)

Extension 1340

Lateral Bend 2170

Axial Twist 5400

(McGill, 2002)

 Speed ‐ mall
strolling vs. fast
walking

(McGill, 2002)

Page 6
 Haylings

Max Shear Tolerance

UW AL for Shear (500 N)

Page 7
 60  1. Proximal stiffness/stability for distal athleticism
50
Post rest
Pretest
Pre-test

Post Bench-Sit
2. Guy wire system facilitated successful load
40


Torque (Nm)

30 Post exercise

20
Post Warm-Up bearing
10

0
0 10 20
Angle (degrees)
30 40
 3. Stiffness eliminates micromovements in the
joints that lead to pain and tissue degeneration
(Green, Grenier, McGill, 2001)

 4. Build armour

Muscle activation/force/stiffness

100%
Force
Magnitude

50%

Stiffness

L. Spine buckles with 90N (20 lbs)! Stability depends on geometry,

stiffnesses, balanced ”cable
tensions” and column 0 100
“imperfections” Activation

Page 8
1. Muscle stiffness is always stabilizing
 Typical Rapid shoulder flexion
2. Muscle force may stabilize or  Control group: feedforward in Erector Sp, Ext Obl,
compromize stability…… too much or  LBP Group: no feedforward (on average)
too little
Subclassify
Thus risk is at very low levels and high levels
of activation LBP
Unstable group
Stable Group
ES delayed
Erector Sp. No delay

1
Figure 6.9
3500.00% 1.000E+02
10
Percent Difference in stability from changing each muscle activation

91.000E+01
3000.00%

81.000E+00

2500.00% Rectus Abdominis

71.000E-01
External Obliques
Internal Obliques
61.000E-02 Latissumus Dorsi

Stability Index
2000.00%
Pars Lumborum
51.000E-03 Iliocostalis Lumborum
Longisimus Thoracis
1500.00%
41.000E-04 Quadratus Lumborum
Multifidus
Transverse Abdominis
1000.00% 31.000E-05
Determinant

21.000E-06
500.00%
11.000E-07

0.00% 1.000E-08
Four Point Kneeling with Right Bridging Right Side Bridge
Leg Lift

Kavcic and McGill 2007,

Same findings by Stokes et al, 2011

 Example of another aberrant motor pattern

 Evidence:
 McGill et al 2003, former LBP used hams and back
extensors to lift, normal used less but more hip extensors
 Cholewicki and McGill 1992, Better ones use less back
torque and higher hip torque
 Re‐Train gluteals!

Page 9
 Muscle B
Muscle A

Ultrasound measures do not

indicate activation levels in Position 2

the abdominal wall Position 1

Page 10
A 18 Subject A: stability decreases with
natural brace
16 10% brace
abdominal brace
14 40
35
12

Stability (Nm/rad/rad)
30
% MVC

10
25
8 20
6 15
4
2
10
5
 Grooves motor patterns to ensure sufficient
0 0
natural brace 10 % brace
stability
RRA

RTES
RLES

LRA

LTES
LLES
RLD

LLD
REO
RIO

RMUL

LEO
LIO

LMUL
B 50
 Considers:
natural brace Subject B: stability increases with
45 10% brace abdominal brace  Spine loading
40
35
30
45
40
 Muscle activation levels
% MVC

Stability (Nm/rad/rad)

35
25
20
30  Endurance training
25
15 20
10 15
5 10

0 5
0
RRA

RTES
RLES

LRA

LTES
LLES
RLD

LLD
REO
RIO

RMUL

LEO
LIO

LMUL

natural brace 10 % brace

Brown, Vera-Garcia & McGill (2006), Spine

Index
700 Inspire 4
Expire
600 3.5

3
500
Stability Index

2.5
Volume (L)

400
2
300
1.5
200
1

100 0.5

0 0
6 7 8 9 10 11 12
Time (s)

Page 11
  Trabeculae:
 Vertical
 Horizontal

Build Capacity
- Stand/annulus stretch
- Use Lumbair/Embraceair

Prevention/Treatment

schmorles nodes

Mechanism: Compression

“crabmeat”?

Immune modulated
Inflammatory response?
Dave Fyhrie, HFH

Page 12
  Full flexion: 23 ‐ 43% loss in strength (dependant upon hydration level)

Dave Fyhrie, HFH

 When in neutral posture:

 Superhydrated (after rising from bed)
▪ 18% loss in strength
 More prone to central endplate fractures

Page 13
 Courtesy Dr J. Fryer

 Adolescents: 6 deg
deflection
 Adults: 1 deg
 From Mike Adams

Page 14
 Negative findings do not rule out massive bony Radiology Report:
injury. “Unremarkable Findings with limbus vertebra.”

Radiology case study – Dr Carstensen

SPECT: RT L3/4 facet

 Load‐Rate Dependency

Bone scan: Rt L3/4 facet

Issue: where is pain coming from?

CT: Rt L5/S1 facet

Noyes and colleagues

Michael Adams, Bristol

Page 15
 Focal disc bulge

Herniation Process
The endplate and underlaying
trabecular bone also appears
damaged

A dissection of the posterior annulus revealed where a small cleft had connected two adjacent lamellar
layers and nuclear material that had passed through the bundles. The cleft is covered by a couple of
lamellae (A). The adjacent lamellae were removed (B), and the cleft appears to have separated the
lamellae bundles(C). The cleft and annular material in a lateral view (D). (Tampier and McGill, 2007)

Results: End plate loss of connectivity •Injury mechanism

Pre Post •Spine load
•function motion/motor patterns

Carstensen, Balkovec, McGill, 2013

Page 16

(A) Directionally diffuse
partial herniation with
volume contained at an
angle of > 45°.
Yates and McGill 2010
 Prevention implications… potentially NB
 Rehab implications:
 McKenzie with lateral bend?
 Facets problematic
Herniation initiated
 Cause: Modest compression with cyclic flexion
motion (torque)
 Comp (N) with 61Nm:
 260 No herniation up to 86,400 cycles
 867 Herniation at 22‐28 K‐cycles
 1472 Herniation at 5‐9.5 K‐cycles
(B) Directionally
concentrated partial Repeated flexion with compression
herniation with volume
contained at an angle of • <30 % of comp tolerance = herniation
< 45°. • >30 % of comp tolerance = End plate damage
Aultman and McGill
Courtesy: Professor Bill Marras
“Vacuumed in” with prolonged
extension
Scannell and McGill, 2009
Page 17
 Too much of any one thing!
Or
That which does not kill you makes you stronger
Twisting only: No Repeated flexion only:
Herniation Posterolateral Herniation (Conan the Barbarian)
Or
Don’t tell me we don’t know what causes tissues damage or
that loading does not cause specific damage

Twist and flexion: Herniation and Radial

Delamination

What results from Injury?

 The spine needs to move – but is limited in the number of bends. The
more the load while bending, the fewer the tolerable bends. Choose
best way to use these.
 Loading and work causes adaptation but also temporary weakening.
Muscle, bone, connective tissue will adapt. Discs do not. Repeated
bending will eventually tip the balance to cumulative damage
outstripping the pace of repair.
 Sparing the spine while training will lead to higher tolerable volume
of training. Hundreds of situps will limit training volume.
 Qualitative Observation: the greatest Fighters have little lordosis
while the fastest sprinters have lots of lordosis!!!!????!!!!????

Additional reading

Farfan – Mechanical Low Back Pain

Adams, Bogduk, Burton, Dolan, – Biomechanics of Low Back Pain
Kirkaldy Willis and Burton – Managing Low Back Pain
Waddell – The Backpain Revolution
Bogduk and Twomey – Clinical anatomy of the lumbar spine
Porterfield and Derosa –Mechanical Low back Pain

www.backfitpro.com

Page 18
Use the following pages for making notes – some critical slides have been provided.

Low Back Injury Rehabilitation:

Assessment: Posture, movement, pain provocation

Unstable or too stiff?

Algorithms for designing the progression

Corrective exercise technique

 • Assess to determine pain triggers, and flaws that
cause stress concentrations.
Volume 2:
Rehabilitation • Remove the triggers and flaws.

Stuart McGill • Design corrective and therapeutic exercises to

remove pain, build foundation to train.
www.backfitpro.com
• Begin a training program.

Probing and provoking the painful back

Assessment: to render a precise diagnosis that directs
What Would We Assess? both treatment and prevention
strategies

Solution (ensure that this does not happen):

First Clinician-Patient Meeting
“Hypothesis Driven” 1. Identify the rehab objectives (specific health or performance
objectives)
History (suspected mechanism of injury) 2. Do they have better/worse days
Observation – noticeable perturbed patterns 3. Consider patient age and general condition
Provocative testing – identify motion and motor patterns 4. Identify occupation and lifestyle details
that exacerbate 5. Consider the mechanism of injury
Functional screens and tests
6. Have the patient describe perceived exacerbators of pain and
symptoms, and tolerances
7. Have patient describe type of pain, its location, whether it is
Remove the cause of the troubles radiating, and specific dermatomes and myotomes
Design therapeutic exercise 8. Assess movement
9. Perform provocative tests …… form hypotheses
Evaluate progress (continual) 10. Perform screening tests

Page 1
 Specific Tests - examples Movement screens:
(matched appropriately to the person)
1. Testing Muscle Endurance
2. Testing for aberrant gross lumbar motion
3. Testing for lumbar joint shear stability Examples: Rising from a chair (squat)
4. A note on motion palpation
5. Testing for aberrant motor patterns during challenged breathing
Getting up off the floor (lunge)
6. Determining suitability for ROM training and stretching
7. McKenzie posture test Basic capabilities to performance
8. Distinguishing between lumbar and hip problems
9. Sitting slump test – neural tension & nerve mobility?
10. Fajersztain test
11. Hip flexion and rotation Squat with Bar, Jump, etc
12. Spondylolisthesis vs retrolisthesis

Just because they can doesn’t mean they will

What happens when Speed and Load

is added to the movement?

N=52, Age = 37
Firefighter tasks

FF Specific tasks General Tasks

Page 2
 Summary:
Movement patterns change with speed and load – sometimes better and Can Faulty movement be changed?
sometimes worse – a function of training approach. (Frost, Callaghan, And
McGill, in press).
Both adding speed and load to the task change movement patterns, tissue Can an exercise/training approach change
stress, injury risk and performance patterns in other tasks?

Implications:
Speed and load are required to assess movement competency and predict Frost, Beach, Callaghan, McGill (in press)
injury risk and performance. (Frost, Callaghan and McGill, in press).
N=75, Pensacola FD
Others: 3 training groups:
Flanagan and Salem (2008) The range of squat strategies converge with load control
(25‐100% 3 RM).
“Fitness” Training
Movement Matters Training

• Placing an emphasis on how each exercise was performed (movement‐

oriented fitness) altered the firefighters’ habitual movement patterns And these general tasks (with speed and load)
• They exhibited less spine and frontal plane knee motion post‐training while performing five
transfer tasks not included in their exercise program. predicted competency in the FF specific tasks
• The adaptations observed were consistent across loads and speeds.

• Emphasizing “fitness” alone may have increased the firefighters’ risk of

injury.
• The individuals in the “fitness” oriented group showed a propensity to adopt more spine and
frontal plane knee motion post‐training.

Methods Methods
• Group 1: stretching only • Group 2: stretching and stabilizing
– Not isolated to the hip joint (hip disassociation from spine)
– Sustained and ballistic

ISB, Brussels. July 2011 ISB, Brussels. July 2011

Page 3
Methods Results: ROM
• Group 3: Core strengthening, • Group 1, 2
stabilizing; NO hip stretching
*
• Group 4: Control Paired t‐tests with
* * Bonferroni
adjustments
*

• Ext:  from 7th to 75th percentile

• Total Rot:  from 20th to 90th percentile
ISB, Brussels. July 2011 ISB, Brussels. July 2011

Can coaching/feedback change the FMS

Results: functional hip motion
score immediately?
• NO evidence of increased hip extension or rotation
utilized post‐stretching (groups 1 & 2)

ISB, Brussels. July 2011

A B C

Can movement quality predict future

injuries?

Injury Mechanism?

Figure 3. The individual depicted received FMS scores of 16 and 20 on the pre and post screens, respectively (subject 18 in Figure 1). As
part of a larger project the firefighter was also asked to perform a simulated hose advance (C) while his movement patterns were
Studies of Firefighters and
quantified. The animations above illustrate the movement behavior employed to perform this task. Despite receiving threes (a perfect
score) on his post‐feedback deep squat (A) and in‐line lunge (B), the individual exhibited substantial frontal plane knee motion when
asked to perform a task that simulated the demands of his occupation.
athlete groups

Page 4
 Predicting injuries Endurance, strength, hip mobility and movement competency of collegiate basketball players
Reported back
injury
No reported back
injury
Reported back injury
No reported back
injury
Category Exercise/Task Category Exercise/Task
Mean SD Mean SD Mean SD Mean SD
Sit‐up Posture (s) 134.2 99.5 142.5 75.8 1. Standing Posture 2.6 0.5 2.5 0.5

Endurance Tests
Front Bridge (s) 117.2 78.0 83.8 20.6 2. Seated Posture (sit to stand) 2.2 0.4 2.1 0.3
Biering‐Sorenson (s) 107.2 32.3 106.4 21.8 3. Gait 2.6 0.5 2.7 0.5
College basketball Team (N=15), followed for 2 years, 5 back injuries. R 86.4 23.4 82.7 25.9 4. Segmental Flexion 2.6 0.5 2.5 0.7
Side Bridge (s)
No link or trend to FMS score (see graph) L 90.4 33.4 73.4 27.3 5. Segmental Extension Bend 2.0 1.0 1.6 1.2

R 46.4 6.7 55.0 9.6 6. Segmental Lateral Bend 2.4 0.9 2.4 0.7

Strength Tests
Grip Strength (kg)
L 47.4 2.2 51.0 8.0 7. Segmental Twist w/o Hips 1.6 0.5 2.4 1.1
Firefighters (N=135), followed for 3 years, 24 lost time injuries( 10 of the back, 14 Pullup (repetitions) 11.0 2.5 7.4 3.2
8. Overhead Squat 1.4 0.5 1.3 0.7
others). Bench Press repetitions (185lbs) 14.6 6.6 8.5 5.2

Movement Assessment
9. In Line Lunge (right leg
R 3.8 9.2 1.8 9.5 1.8 0.8 1.2 0.4
No link to any score except Biering Sorensen extensor test (p=0.06) (non‐injured 86 knee flexed
forward)

Thomas Test (degrees) L 3.4 10.8 2.9 10.4 10. Hurdle Step (right leg lift) 2.0 0.0 1.8 0.6
seconds, back injured 76 seconds)
knee R 3.0 6.7 0.3 10.5 11. Box Lift 2.4 0.5 2.6 0.5
Injured had slightly better in‐line lunge, slightly better single leg squat, slightly better extended L 2.2 7.1 1.1 8.6 12. Coin Lift
13. Single Leg Deadlift (right leg
2.6 0.9 2.7 0.7
R 119.8 17.4 125.5 9.7 2.0 0.0 2.2 0.4
torsional control

Hip Mobility
knee flexed on floor)
Unilateral Hip Flexion L 120.0 17.6 124.2 10.2 14. Single Leg Squat 1.8 0.4 1.4 0.8
(degrees) R 91.0 18.4 89.1 14.2 15. Straight Leg Raise 2.4 0.5 2.3 0.5
knee
16. Shoulder Mobility
extended L 87.2 17.8 87.2 16.8 2.2 0.8 2.3 0.9
There are other variables but we are having difficulty honing in on them! (impingement test)

R 36.6 11.6 45.7 6.7 17. Pushup (spine extension) 1.4 1.5 2.3 0.9
Prone Internal Rotation (degrees)
L 42.4 15.2 40.8 7.9 18. Torsion Control 1.8 0.8 2.0 0.8
19. Rotatary Stability (Spine
R 43.6 5.9 44.2 9.1 2.2 0.4 1.8 0.6
Prone External Rotation (degrees) Flexion)
L 46.2 7.3 44.2 8.6 20. Pelvis Rock 2.2 0.4 1.5 0.8
Overall 42.2 6.8 41.6 5.5
FMS Score 13.4 2.3 13.0 2.4

Pearson product moment correlation of performance variables with measures of agility

Annual performance statistics of collegiate basketball players with and without back injury Long Jump Three Bound Shark Time Get‐Up time Vertical Jump Lane Agility Court Sprint Celtic Run
Right Grip
Strength
Left Grip
Bench Press
Repetitions
(cm) Jump (cm) (s) (s) (cm) Time (s) time (s) (repetitions) Strength (kg)
(kg) (185lbs)
Reported back injury No reported back injury
Exercise/Task R 0.49 ‐0.14 ‐0.01 0.23 0.26 ‐0.43 ‐0.03 0.19 ‐0.29 ‐0.42 0.05
Mean SD Mean SD Games
Played
alpha 0.08 0.63 0.97 0.42 0.37 0.13 0.93 0.51 0.32 0.13 0.86
Games Played 28.6 9.3 21.9 10.6 R .567* 0.15 0.01 0.07 0.39 ‐.594* ‐0.06 0.29 ‐0.26 ‐.565
*
0.02
Minutes Per
Game
alpha 0.03 0.61 0.98 0.82 0.17 0.03 0.83 0.32 0.37 0.04 0.94
Average Minutes per Game 21.7 11.6 12.8 13.3
R 0.2 0.15 ‐0.05 ‐0.09 0.15 ‐.598* ‐0.04 0.34 ‐0.39 ‐0.03 ‐0.35
Points per
Game
alpha 0.5 0.6 0.87 0.76 0.61 0.02 0.9 0.23 0.17 0.93 0.22
Points per Game 6.0 4.2 6.2 7.5
R 0.34 0.04 ‐0.1 ‐0.26 0.36 ‐.741** ‐0.19 0.50 ‐0.14 ‐0.49 ‐0.37
Assists per
Game
alpha 0.23 0.89 0.72 0.38 0.2 <0.01 0.50 0.07 0.64 0.07 0.20
Assists per Game 0.8 0.5 0.9 1.4
*
R .625* 0.25 0.03 0.11 0.28 ‐0.44 0.07 0.18 ‐0.24 ‐.550 0.23
Rebounds
per Game
Rebounds per Game 3.2 2.6 1.7 1.6 alpha 0.02 0.4 0.92 0.72 0.33 0.12 0.8 0.55 0.41 0.04 0.43
*
R 0.52 0.06 ‐0.04 ‐0.12 0.51 ‐.690** ‐0.25 0.34 ‐0.22 ‐.607 ‐0.22
Steals per
Steals per Game 0.7 0.3 0.5 0.6 Game
alpha 0.06 0.85 0.88 0.69 0.06 0.01 0.38 0.23 0.45 0.02 0.45
*
R .553* 0.37 ‐0.17 0.27 0.1 ‐0.07 0.23 0.04 ‐0.08 ‐0.26 .589
Blocks per
Blocks per Game 0.6 1.0 0.1 0.1 Game
alpha 0.04 0.2 0.56 0.35 0.73 0.8 0.42 0.89 0.79 0.37 0.03

Dark gray shaded cells are statistically significant (**p<0.01, *p<0.05)

Light gray shaded cells are approaching statistical significance (p<0.10)

High level Summary (Our work)

Comparison of anthropometrics, movement competency, endurance and strength between firefighters who reported
back injury and those who did not
1. There is a threshold where compensations occur (load, speed, reps, fatigue, time)
No history of back injury Back injury
Category
Assessment/
Exercise
P‐value Implication: Training should be viewed to elevate the load, speed where compensations occur
Mean Std. Deviation Mean Std. Deviation
Age 36.5 9.5 35.4 8.3 0.58
Height (cm) 179.2 8.6 180.7 5.1 0.28 2. Superior strength, endurance etc provides capacity for more intense demands – how the
Anthropometrics

Weight (kg)
BMI
88.8
28.0
10.8
7.8
87.2
26.7
8.4
2.0
0.46
0.07
individual adapts determines risk of injury and performance. Implication: Successful tests will
Waist Circumference (cm) 92.7 10.1 92.9 6.6 0.91
need to be sensitive to adaptations
Hip Circumference (cm) 103.5 8.0 107.2 10.6 0.20
3. Coaching and form matters
Coin Lift 1.3 0.6 1.5 0.6 0.10
Box Lift 2.2 0.5 2.2 0.6 0.79 Implication: Enhanced training capacity and enhanced transference to other activities
Torsion Control 1.4 0.6 1.4 0.5 0.76
Movement Assessment

Single Leg Squat (Right) 1.8 0.6 2.1 0.6 0.07

4. Movement competency is movement/task specific. However, some key features are common
Single Leg Squat (Left) 1.7 0.6 1.6 1.0 0.85
Seated Posture 2.2 0.5 2.2 0.7 0.94
(buckling knees, lumbar flexion).
Stand‐Drop‐Stand 2.2 0.7 2.5 0.6 0.14 Implication: Movement assessment needs sufficient challenge to capture these.
Lunge (Right) 1.8 0.9 2.1 0.8 0.17
Lunge (Left) 1.9 0.9 1.9 0.8 0.58 Others work
Total Movement Score (out of 27) 16.2 3.6 17.6 3.1 0.10 1. FMS score did not predict performance: a) Firefighters and Basketballers (McGill et al, 2011) Several fitness tests (Okada et al 2010), Golfers (Parchmann
And McBride, 2011)
Biering‐Sorensen (s) 74.8 45.2 54.9 43.0 0.10 2. FMS score did not predict injury rates in firefighters, police officers, Basketballers (McGill et al, in press). Contrast footballers (Kiesel et al, 2011) showed
orso Endurance and

Side Bridge (Right) (s) 54.6 21.2 54.8 18.5 0.96 lower injury rates for FMS>14 (But sensitivity rating was 0.54 meaning approx 50% chance of false positive injury prediction). Teyhan showed noise level
Side Bridge (Left) (s) 54.4 21.5 55.5 13.0 0.77 in FMS score needed change of >3 to be meaningful. O’Connor et al, 2011 N=874 police candidates showed FMS did not predict injury.
Strength

Front Bridge (s) 127.5 53.5 138.5 53.6 0.43

Grip Strength (Right) (kg) 59.5 13.4 61.4 22.4 0.73

Grip Strength (Left) (kg) 57 6 12 4 59 5 22 9 0 75

Page 5
Opinion: Movement assessment should……..
Example: Junior Weightlifter Development
 Screen for injury mechanisms – how do they break form? program design
 Account for body type
• Start with 10 points
 Assess with appropriate speed, load and repetition (specific) • Subtract for flaws
and see how a person chooses to move (document them)
The goal being……..
• Criterion changes with
development
 Predict choice of movement patterns in other tasks • Need to score 9 or 10 to
(transference) add weight
 Predict injury patterns and accommodations with fatigue,
change in risk etc

Assessment
 Tiger, Ali, (Best compensators) • Real world is chaotic
– Tests need to be conducive to an element of chaos
• Unpredictability
 Compensation: • Fatigue
 Enhanced Tactical ability • Danger
• Can’t control so what is reaction?
 Peak/Taper, Intervals
 Restoration
Simple movement matters. But change speed and
load, danger, fatigue and movement changes

WA Training Performance and Injury resilience

Assessment

Sufficiently
Robust Screen
Training
“Criteria”  Understand the challenges. Use data on players and the team. Injury data together with performance
data need to be mined for patterns and relationships. These will reveal mechanisms that can be
addressed. The more detail the better. For injuries we would like to know their diagnosis, time of the
day/season etc, their training regimen, training/recovery, peak and taper, etc. Performance statistics
Unfit but Fit & should include injury resilience (games without injury), baskets inside and outside of the 3 point zone,
Moves well Moves well 
assists, rebounds, minutes played etc.
Devise a player assessment protocol. Using the information obtained from the procedure above, we
will have a clear idea of suspected injury mechanisms and imbalances thwarting performance. (Sport,
Movement Position and player specific). This will also create the baseline characterization of each player.
Competency  Create a monitoring program. Each player will be assessed on a schedule – one for in‐season and
another for out of season. The most successful clubs are on a 3 week schedule for in‐season. The testing
is minimally invasive and obtrusive but has elements that are biomechanical, physiological,
Unfit and
Fit but neurological and psychological in nature. This will catch fatigue that leads to injury, player distress
moves poorly causing detriments in play, etc. This is to keep the machine “well tuned”.
Moves poorly  Follow‐up to assess program efficacy. Here the team/player results are compared to those from
previous years.

Fitness

Page 6
 Provocative testing: Be aware of “reversed” perceptions
(matched appropriately to the person)

Postures For some reason, some patients have “reversed”

Loads perceptions

Motions
Non-specific back pain  Muscle activation is perceived as needing stretching

What is tolerable?
 End range stretch as perceived as relieving
What is exacerbating?
What is relieving? Results in excessive stretching and self manipulation

Muscle Endurance:
Muscle Endurance
Flexor Test
Absolute values and relative muscle ratios:
1. Flexor muscles
2. Lateral muscles
3. Extensor muscles

Muscle Endurance: Muscle Endurance:

Lateral Musculature Test Extensor Test

Page 7
 Muscle Endurance Muscle Endurance
 The following discrepancies suggest endurance
Men Women All
“imbalance”:
Task x SD Ratio x SD Ratio x SD Ratio
RSB/LSB endurance > 0.05
Extension 161 61 1.0 185 60 1.0 173 62 1.0 Flexion/Extension endurance > 1.0
(R or L)SB/Extension endurance > 0.75
Flexion 136 66 0.84 134 81 .72 134 76 0.77
Extensor strength (Nm)/extensor Endurance (s) > 4.0
RSB 95 32 0.59 75 32 .40 83 33 0.48
LSB 99 37 0.61 78 32 .42 86 36 0.50
Ratios  Absolute magnitudes:
Flexion/Extension .84 .72 .77  Side Bridge > 70 sec linked to less injury in hockey players
 Poorer side bridge score identified who developed standing pain first
RSB/LSB .96 .96 .96
 <60 seconds in side bridge predicts all sorts of future problems
RSB/Extension .58 .40 .48

Dejanovic and McGill, 2013 Dejanovic and McGill, 2013

Stability in the Lab/Clinic Joint Instability

Dr Stan Gertzbein

Normal locus during

flexion/extension
Abnormal locii
confirming joint
instability

Page 8
 Instability “Clunk”

Disappeared with exercise therapy

Coupled Motion During a Twist

Very flexible spine

Disappeared with 5 minutes of motor training

Unstable spine with catches

4 months post – spine stable, no pain

140

Lumbar Movement Muscle Activity

120

30
100
100

90
20 80
% SMVC

80
60
10
70
40
EMG (unitless)

0 60
10.906 11.906 12.906 13.906
20
50
Degrees

-10
0
40
5

15

-20
30 10

5
20
-30 0

10 -5
% SMVC

-40 -10
0
-15
Substantial
10.906 11.906 12.906 13.906
bracing
-50 Time (s) -20
Time (s)
Lumbar Flexion Lateral Bend Twist R IO R LD R UES R LES L UES L LES -25

-30
5.8 3

5.9 5
8

6.5 5
8

7.0 3
5

7.6 3

7.8 5
8

8.3 3

8.4 5
8

8.9 3

9.0 5
8

9.7 5
8

10 1
88

44

10 6
13

69

11 5
81
6.9 5

9.4 5

.5
5.5

25

75

8.1 8

25

75

No Clunk after 3 days – no pain after 4 months of minimal tissue irritation

6.7

9.2
56

12

68

81

37

93

06

62

18

31

87

43

56

12

68

81

37

93

06

62

18

2
10
.0

.1

.3

.6

.8

.9

.1

.2
6.1

7.3

8.6

9.8
5.6

6.2

6.4

7.2

7.5

8.7

9.5

10

10

10

10

11

Tim e (s)

Page 9
But not everyone has instability – some are Twist hinge
too stiff:

Unstable spine with catches

Twist hinge

Kayaker - ROM Lumbar curve reversal

20

10
Haven’t found one who could lift!

-10
Degrees

-20

-30

-40

-50

-60
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 11.0 12.0 13.0 14.0
Time (s)

Spine Flexion Spine Bend Spine Twist

Scoliosis – is it correctable?

Provocation Tests
A few have been shown…
Here are a few more

Page 10
 Compression Test Compression
Seated posture modulated pain – Hern/bulging active disc
 Unfortunately this is regarded as a test for malingering Standing drop – Hern disc or endplate damage
by some!
 Discrimination: Herniation vs. EPF

Test for A-P Instability Adjust posture for pain control

Poor setup
Reduce ES
compression
and cramp

Trialed by Hicks, U. Pitt.,2005 - most effective predictor of who

will do well with stabilization exercise

What takes the pain away? Disc vs facet

80% specific discrimination

Depalma and McGill, 2010

Presence of lumbar midline pain increases probability of disc pain & reduces probability of FJ & SIJ pain
(Depalma)
Para midline pain increases probability of FJ and SIJ pain but only mildly reduces probability of disc pain
(Depalma)
Static hip flexion pain increases probability of disc pain and reduces probability of FJ or SIJ pain.
(Depalma)

Page 11
 Hip joint vs neural tension vs pelvic ring vs spine Finding neural tension levels

Prone traction, traction extension Extension with shear/traction , lat bend/compression

Pain upon extension – spondylolisthesis test? Retrolisthesis?

Relief upon traction, traction with extension – posterior disc?

Facet joint protocol (Laslett)
(exclusionary for Facet pain)
Treatment: restoration of lordosis?

Extension Tests: specificity vs exclusionary SI Joint provocation

Pulse fist and adjust lordosis

Stork – claimed to id. pars fracture. Quadrant – claimed to
narrow foramen
But also stiffens pelvis/spine

Page 12
 Testing Sciatic Tension

Clinical impression first then view images

Breathe 10% CO2 Flossing Candidate?
1. Locate L.level: Dermatome/Myotome
2. Locate central or side: sciatic leg plus well
leg
Assess motor patterns 3. Distinguish muscle tension from neural
tension
4. Nerve irritated or pinched? Tension from
head vs. leg

Slump test is limited

Poor technique!

Testing Neural/Muscle Tension and dynamics

The lumbar root “underhook”
 Patient presents with spine flexion and a disc bulge
 Neural tensioning from above relieves pain! But this
causes flexion and more disc bulge!!!!!!

 Deal with the disc bulge, then try and free the nerve
root.

More neural tension tests: Low Back Exercise Prescription

 Notes on extension programs
(McKenzie)
 Very effective for some acute
discs
 Some posterior annulus’
increase stress while others
decrease (Adams et al, 2000)
 May be over-prescribed
following acute episode

Martial Arts School - China

Taking pain from Gluts – Not piriformis?
Note L4, L5 roots are relieved, L1 and L2 are tensioned

Page 13
 McKenzie Tests Evidence and Interpretation:
 Facet joint protocol (Laslett)
 Centralization with McKenzie positive for Discogenic pain
(Laslett) and discriminate SI and FJ from Disc
 Presence of lumbar midline pain increases probability of disc
pain & reduces probability of FJ & SIJ pain (Depalma)
 Stand  McKenzie  Better? Worse? Same?  Para midline pain increases probability of FJ and SIJ pain but
 Follow up with provocative tests only mildly reduces probability of disc pain (Depalma)
 Quadrant extns, pars integrity
 Tolerate compression, bending, twisting  Static hip flexion pain increases probability of disc pain and
 Associated deficits: endurance, strength, balance, etc reduces probability of FJ or SIJ pain. (Depalma)
 Centralization with McKenzie positive for Discogenic pain (Laslett) and
discriminate SI and FJ from Disc

In Practice…. Clinic Workshop

 Have a team of players – your responsibility • Position of strength  Evaluation
•Fatigue pushup then  Aberrant patterns:
fascial rake  Standing, sitting, sit-to-
 Assess each individual stand, walking, stooping
 Provocative Tests and squatting, breathing
 Compression  Eliminate hip problems
 Devise corrective exercises to address movement flaws,  Shear  Neural tension? Leg raise
imbalances (some work on mobility, others strength or  Extension (standing, laying, – cervical flexion, better
endurance, others movement patterns etc) prone with traction) posture to enhance reflex?
 Torsion  Floss candidate?
 These are performed prior to team conditioning and/or  Twisting (also pelvic rock)  Optimal posture?
on their own schedule  Spinal Hinges, standing,
Quadruped rock
 Pelvic ring, SI

“active flexibility” Clinic Workshop

1. Stretching inhibits muscle  Stretching
Combat sitting stresses
eg vertical jump pre/post stretch demo 
 (standing, standing swirl)
 Psoas stretch, lunge walk
 Spine sparing hams and quads, full 3d fascial stretch
2. Active flexibility under load – facilitates muscle  Hip mobility
Sitting/standing flexion and abduction
eg arm flexor strength demo 
 Hip transverse plane airplanes
 Wall squats
3. Transference: Adding ROM with stretching does  Deep squat with complex spine-hip-shoulder motion
Thoracic mobility stretches
not always change movement – need to change 
 Warm-up
movement. Active flexibility encodes new engrams.  cat-camel – then 3D

Page 14
 Clinic Workshop Clinic Workshop
“Basic Motion/Motor Patterns” “Basic Motion/Motor Patterns”
 Abdominal Brace  Squat patterning
 neutral spine  glut (med, max) patterning, Back bridge progression (to
one leg)
 Basic Motion
 squat (simple, potty, one legged, 3D reach, bowlers, diff
 hip vs. lumbar motion (use back stick too)
speeds, combo movements, OH hand press, labile, 2x4)
 3 movement tools: Hip hinge (kneeling, shortstop pose), lunge
to floor, torsional buttress  dynamic correspondence squat
 glut airplane
 Rib-Pelvis control  One legged “good morning” (push heel)
 wall pattern, floor roll patterns, athletic floor roll and stand
 squat demo (poor form, vs. hollow, vs. brace)
 turkish getup (workshop)
 soft hands (workshop)
 Japanese stick (1 & 2 leg, eyes close)
 Mini band Hip/Core evaluation (workshop)

Bern, 1994

Types of Pain
 Skin
 Bone
 Nerve
 Ligament
 Muscle
 Fascia
 Peritoneum

Page 15
Page 16
 Designing the Program Overview
Neural patterns
 Agree on rehab goals/objectives
 Begin motion/motor patterns,
corrective exercise
 Develop spine position awareness
 Joint stability/whole body stability
 Endurance
 And for athletes:
 Strength
Rt. foot clockwise
 Power
 Motion
 Agility Rt. hand draw “6”

3 MOVEMENT PATTERNS SS Squat

 Squat – lift, sit
 Torsional Buttress – push, pull
 Lunge – transition to floor

Observe!!!! Posture: Simple correction

Lost opportunities:

Sitting
Standing
Sit to stand
Walking
Bending
Lifting

Page 17
 Posture: Simple correction
Walking break for stenosis patient
Prescribing muscle relaxants?

Posture: Simple correction using the

hands to “steer”

Establishing the “hip hinge”: Establishing the “hip hinge”:

Page 18
 Identifying The Critical Patterns Gluteal Activation?
 Squat/lift
 Push/pull
 Lunge
 Gait
 Twist
 Balance
 Very little activation when quantified
eg throw
 Back to the drawing board…

Squat – Gym Ball Between Knees Squat – Correction via Stu

Right Gluts
20
Right ABs Right ABs
20 18 25

Muscle Activation (%MVC)

Muscle Activation (%MVC)

18
20
16

Muscle Activation (%MVC)

16
14
15
12
10 10
8
6 5
4
2
0
14 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RRA REO RIO

12 RRA REO RIO

Left Abs
Left Abs
10 60

Muscle Activation (%MVC)

40
Muscle Activation (%MVC)

50
35
30 40
25
20
8 30

20
15

6
10 10

5 0
0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

LRA LEO LIO 4 LRA LEO LIO

Right Back
Right Back
2 50

Muscle Activation (%MVC)

40 45
Muscle Activation (%MVC)

40
35
35

0
30 30
25 25
20
20
15
15

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
10
10 5
5 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RGMED RGMAX
RLD RUES RLES

RLD RUES RLES

Left Back
Left Back 60

Muscle Activation (%MVC)

35 50
Muscle Activation (%MVC)

30 40
25 30
20
20
15
10
10
0
5
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 LLD LUES LLES

LLD LUES LLES

Right Gluts
Right Gluts 20

Muscle Activation (%MVC)

18
10 16
Muscle Activation (%MVC)

9 14
8 12
7 10
8
6
5 6
4
4
2
3
0
2
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
1
0
RGMED RGMAX
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RGMED RGMAX RRF SOLE

120
RRF SOLE

Muscle Activation (%MVC)

100
60
Muscle Activation (%MVC)

80
50
60
40
40
30
20
20
0
10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

0 RRF SOLE
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RRF SOLE Spine Motion

Right Gluts
5

Spine Motion 0

Angle (deg)
10 ‐5
5
‐10
0

10
Angle (deg)

‐5 ‐15
‐10
‐20
‐15
‐20 ‐25

9 ‐25
‐30
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Cflex Cbend Ctwist

‐35
Muscle Activation (%MVC)

8 0 1 2 3 4 5 6

Cflex
7

Cbend Ctwist
8 9 10 11 12 13 14
Force Plate 3 (right foot)
500
450
Force Plate 3 (right foot)
7 400
350

Force (N)
400 300
350 250
200

6
300
150
250
Force (N)

100
200 50
150 0
‐50

5 100
50
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Fx Fy Fz Mx My Mz
‐50

4 0 1 2 3 4 5 6

Fx Fy
7

Fz Mx My
8

Mz
9 10 11 12 13 14
Force plate 4 (Left Foot)
500

3 Force plate 4 (Left Foot)

400

300
Force (N)

400
200

2
300
100
200
Force (N)

0
100

1
‐100
0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
‐100
Fx Fy Fz Mx My Mz

0
‐200
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Fx Fy Fz Mx My Mz

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14
RGMED RGMAX

Manual Abdominal activation – Fascial

Manual Abdominal activation- Fascial Raking
Raking

Page 19
 Remove the cause!!
Designing the Program Overview
 Agree on rehab goals/objectives
 Begin motion/motor patterns
 Develop spine position awareness
 Joint stability/whole body stability
 Endurance
 And for athletes:
 Strength
 Power
 Motion
 Agility

Spine Position Awareness

Balance is an Essential Pre-Condition For

Designing the Program Overview
Performance
 Agree on rehab goals/objectives  Static balance
 Begin motion/motor patterns
 Develop spine position awareness
 Dynamic balance
 Joint stability/whole body stability  Low volume of work, but perform daily
 Endurance
(Gary Gray, 2002)
 And for athletes:
 Strength
 Power
 Motion
 Agility

Page 20
 Balance Training Examples
 Leaning Tower - ant/post, medial/lateral sway.
 Hurdle walk - step over object then pause in balance, then next


step.
Scramble up - start prone then scramble up (fast), then repeat
Quantification of

with eyes closed
90 degree jumps - Jump and turn 90 deg and land. Then jump
Appropriate Exercises
back to start. Then close eyes.
 Red light/Green light - hold balance each time.
 Rhythmic balance exercises - use music to govern rate of
balance activity.
(Gary Gray, 2002)
BUT SPARE BACK – ONLY FOR CAREFULLY SELECTED PATIENTS

Abdominal Exercises Extensor Exercises

(McGill, 2002)
(McGill, 2002)

Frail Robust

 Get results
 Stay out of court

Wang et al 2012

Page 21
 16,000
Deadlift 200kg 24,000N plus

12,000

(N)
8,000

4,000

Walking 1400 N
0

Wang et al 2012 McGill, multiple studies

Minimum aBMD (g/cm^3) Activity

0.7
0.8 add
Walking (swing arms)
Curl-up, 1 leg quadruped A Sample Program
0.9
1.0 add pushups
1.1 add situp, k.b. swings with <16kg
1.2 add superman, suspended pushups All exercises must be performed pain free
1.3 add rowing (in boat)
1.4
1.6 add golf, 1 arm pushup, box lift 50 lbs
(knee to waist)

To be published 2013

Cat-Camel Cat-Camel Motion

 Don’t press end range
 Reduce viscosity
 ”Floss” tissues
 Used to reduce the risk of post trauma, or
surgery, scarring. Efficacy ????????

Page 22
 Flexion - Cobra

Big 3 Curl-up
 Curl-Up
 Side Bridge
 Birddog
 Conserves spine, endurance,
stability & motor control

The “Levit” Side Bridge

Page 23
 Side Bridge With Roll

5 - 6 kN Compression!

 For stability with varying torque

Birddog Birddog:
 Half the spine load
 PNF pattern to better:
 Activates all extensors and obliques
 Activation:
Birddog Roman Chair
Lumbar ES 30% 53%
Thoracic ES 47% 45%
Lat Dorsi 12% 7%
Ext. Oblique 16% 4%

Page 24
Using a Gym Ball Increases Spine Load
Good Form
Poor Form
 Low Load

 Much higher co-

contraction and load
 There is a time and
place!

Clinic Workshop:
Birddog Tricks
Big 3 for Stability
 Curl-up progression – dead bug – lower ab
breathing – RKC Plank - stir the pot – the Levit
& crawl
 Side bridge progression – breathing – plyo elbows
 Birddog progression - squares

Beginner – intermediate – high challenge – plyo’s

Twitch and power breathe

Boo Schexnayder "Soft tissue injuries result

from excessive tension, so excessive tension in Getting Patients Better
the rehabilitation situation is
counterproductive...stretching of ...chronically
tight tissue is counterproductive. It may give an
initial sensation of relief because the muscle 1. Remove exacerbators
spindles have been deadened, but this 2. Commence exercise therapy
practice...weakens the tissue further because of
the weakened proprioceptive response.“ 3. Establish a positive slope
4. Add one new challenge at a time

McGill “Stop trying to stretch and mobilize, let

5. Go back to big 3 if positive slope is lost
tissues settle and regain their proproceptive
abilities so they tell the truth.”

Page 25
 A note for surgical candidates Now the Patient is Ready For
 Always precede with staged and progressive
Functional/Occupational Training
exercise
 Patients may get better
 Surgery is forced rest…….. Try this first!

Think: Push, Pull, Lift, Carry, Torsional tasks

A few thoughts for handling patient

challenges: Additional reading

 Many are used to getting a pill – “here is your “movement pill”.

 To those who don’t want to exercise – “its your choice – You
can exercise 20 minutes a day or be painful for 24 hours a day”.
 To those who don’t have time to exercise – “What better suits
your busy schedule? Exercise for half an hour a day or be dead
for 24 hours a day?”.
 To those who are overtrained – “you will never regain your
health until you build tolerable capacity”, Hitting your thumb
with a hammer will not take pain away. More exercise is the
same as getting a bigger hammer.
Magee – Orthopaedic Physical Assessment 4th ed, 2002
Sahrmann – Diagnosis and treatment of movement impairment
syndromes, 2002
Richardson, Jull, Hodges and Hides – Therapeutic exercise for
spinal segmental stabilization in LBP, Second edition
Butler – Mobilization of the nervous system
Shacklock - Neurodynamics

Page 26
Use the following pages for making notes – some critical slides have been provided.

Training for Performance:

Too much mythology? What are the true determinants of ultimate performance?

The right exercise for the right person for the right reason.

Designing the progression

Superstiffness

Q and A Session:

Clinic Workshops:

Provocative Tests…

Qualifying the patient/client/athlete:

o Consider results of provocative tests
o e.g. Squat (clean, snatch) “breaking the back”
o Twisting progression
o Pushup with hand motion
o Rolling side bridge
o Cable progression (variable m.a. and twist)

Stretching and active flexibility:

o Combat sitting stress (standing, standing swirl)
o Psoas stretch
o Spine sparing piriformis, hamstrings and quadriceps
o Hip mobility
o Sitting/standing flexion and abduction
o Hip transverse airplanes
o Warm-up: Walking lunges, lateral walking lunges, dragon walk, cat-camel, wall
squats

Basic motion/motor patterns:

o Abdominal brace (neutral spine)
o Basic motion – hip vs. lumbar motion (use back stick too)
 o Rib-pelvis control – wall pattern, floor roll patterns, soft hands, japanese stick (1
& 2 legs, eyes closed)
o Squat patterning
o Gluts (med/max) patterning
o Squat (simple, potty, one legged, 3D reach, different speeds, combination
movements, labile, 2 x 4)
o Dynamic correspondence squat
o Squat demo (poor form vs. hollow vs. brace)

Big 3 for Stability:

1. Curl up progression
2. Side bridge progression
3. Bird dog progression
4. Correctives for mobility, thoracic flexion and extension

Performance progressions:
o Push, pull, lift, torsion, carry, plus special individual requirements
o Twisting vs. twisting torque
o Twisting progressions
o Standing one-arm pull
o Rolling side bridge
o Cable high/low chops with arm straight
o Speed/Power
o Medicine ball tosses up, into wall, “hot potato” hanging clean
o Power lunge/strides sagittal/frontal plane
o Muscle activation/deactivation drills
o Agility
o Plyometric jump progressions – 9 square, jump up and stick, over and
land, land and spring
o Workshops
o Postural strength
o The squat (and plyometric progressions)
o The bench press (transitioning to standing postures and plyometrics)
o The jump
o The pull
 What do these athletes have in common?

Volume 4:
Enhancing Performance

Stuart McGill
www.backfitpro.com

The “Old way” OR “The gym of the future”?
Fitness: Every variable is a trade-off
 Vo2 Max - higher means less explosive
athlete (Ft vs ST)
 Flexibility – is more or less better?
 Strength or speed (force vs stiffness)
(force vs relaxation)
 Stability vs mobility

What is the most athletic vehicle?

Performance

???

Injury Rate

Strength

Page 1
 Performance Programming
???
•Gearing
•Limb leverage
Injury Rate
•Neurology
•Optimal strength, not more strength,
etc
Strength
ROM
Vo2 max

Can you change an NFL linebacker into a golfer?

Corrective Exercise
Can you change an MMA fighter into a sprinter?

Bogduk and Twomey

WA Training Performance and Injury resilience

Assessment

Sufficiently Assessment of unfit and poor movers:

Robust Screen
Training
“Criteria” Interview
Movement Assessment
Unfit but Fit & Stability/Mobility
Moves well Moves well Pain provocation
Movement Also: personality, co‐morbidities
Competency
Unfit and
Fit but
moves poorly
Moves poorly This takes me about 3 hours!

Fitness

Page 2
 Testing for Sport:
Qualifying: e.g. Dead Lift
Qualifying an Athlete for Training
 Where do you start?
 Demands of Sport/Performance?
 What are their current capabilities?
Deficits?
 Special risk of injury?
 Some examples, More later……………….

Speed and mobility: Test and train

Torsional control qualifier

Mobility: Test and train

Page 3
 Failed Tests Rehabilitating the Athletes Back
 Generally, don’t train the failed tests 1. Groove motion patterns, motor patterns,
Encode Engrams with corrective exercise
 Train the activity that they are working
towards 2. Build whole body and joint stability/mobility
 Eg train runner with running specific
3. Increase endurance
approaches and drills
4. Build strength
5. Develop speed, power, agility
 Overlay: The position of performance

Training Athletes:
Get into Their Motor Control Scheme
 Have athletes draw the movement:
 Joint motion
 Centre of mass, Base of support

 Bar trajectory etc

How to find and “tune” the patterns
 Then draw the muscles involved:
 Focus on co-contraction, synergists etc
 Lots of surprises!

Finding Movement Errors: Some Principles Strength from Posture

 Optimizing Performance:  Safety:
 Summation of joint forces  Minimization of tissue stress
 Continuity of joint moments  Optimal joint positioning
 Production of linear impulse  Minimization of fatigue
 Direction of force application
 Stability
 Summation of segment velocities
 Production of angular impulse
 Conservation of momentum
 Manipulation of moment of inertia

 Look for Energy Leaks (eg pelvis

leaves ribcage during sprinting)

Page 4
Within the 5 stages think of patterns of
movement:

An example:
Push
Pull
Lift
Squat Developing the squat pattern
Lunge
Carry
Torsional buttress

Gluteus Medius Patterns Back Bridge and Gluteus Maximus Patterns

Thumb on ASIS
Pre-activate gluteals

Back Bridge and Gluteus Maximus Patterns Advanced Back Bridge Motor Patterns

Allow gluteals to extend hip if hamstrings dominate

- push with quads
- spares the knees

Page 5
 More Squat Patterns: Potty Squat Hip external rotation and abduction
Ab brace
Neutral spine
Hip hinge

Hip external rotation and abduction with

Hip width for depth of squat
extensor activation and control

Corrective thoracic mobility

Page 6
 Motion/Motor Patterning: Golf

Spine position awareness

Motion/Motor Patterning: The “Sweet Spot” Assessment: Stability & Spine Awareness

Training: Stability & Spine Awareness

On Patterns,
Stretching,
Active flexibility

Page 7
 Psoas targeting Tools for training movement

Soft Hands Japanese Stick

Stabilize what needs to be stabilized

Standard…one leg…close eyes
Mobilize what needs to be mobilized
Recognize the symbiosis

Rehabilitating the Athletes Back

First:
1. Groove motion patterns, motor patterns
2. Build whole body and joint stability
Whole body stability

3. Increase endurance
4. Build strength
Second:
5. Develop power, agility
Joint (spine) stability

Page 8
 Big 3: Advanced for Athletes “Dead Bug” the Spine Conserving Way

Front Side Back

Transitioning from static to speed to plyometrics

One-Armed Dumbell Ball Balance

Abdominal Work with Spine Position & Back Extensor Work With Spine Position
Bracing Awareness and Bracing Awareness

Page 9
Back Extensor Work With Spine Position Cable Chop
and Bracing Awareness

Focus on spine posture and abdominal brace

Cable Pull Cable Abdominal Work

Focus on spine posture and abdominal brace Focus on hip rotation with abdominal brace

Functional Stability Functional Stabilization: Basketball “Posting”

Page 10
 Functional Stabilization: Basketball Rehabilitating the Athletes Back
1. Groove motion patterns, motor patterns
2. Build whole body and joint stability
3. Increase endurance
4. Build strength
5. Develop power, agility

Endurance Philosophy Functional Stabilization: Swimming

1. Build with sets, not Right Left
by prolonging
holding times 4 4 / rest
2. Hold 6-10 seconds
(two breaths) 3 3 / rest

2 2
Longer holding times for some athletes
Train endurance without fatiguing

And elliptical trainers?

handles bar free

Moreside and McGill, 2010

Page 11
 Rehabilitating the Athletes Back
1. Groove motion patterns, motor patterns
Volume 5:
Enhancing Performance 2 2. Build whole body and joint stability
3. Increase endurance
Stuart McGill 4. Build strength
www.backfitpro.com
5. Develop speed, power, agility

Strength:
Strength
Challenging All Motor Units in the Pool
Building True functional
strength with strength
stability  Must train:
 Slow strength, fast strength
10
9  Concentric strength, eccentric strength,
8
 Multi-articular complex strength, reciprocal
RPE……….RPTechnique 7
6 inhibition strength,
1. Athlete rates technique (eg “x”/10) 5
4  “Playing position” strength
2. Exercise stops if RPT < 8
3
2
1
 Example: Bench press vs. wall cable push

Strength:
Strength: “Create capacity”
Challenging All Motor Units in the Pool

 Mental Imagery “mindful training”

 Example: Lifting
 Train heavy with traditional strength and  Cannot recruit all extensor motor units
power approaches but……..  Must use imagery to imagine movement
 Result: More EMG amplitude!

 Max effort to stimulate M.U.’s

Page 1
 Eugene Sandow in 1904: "You may
go through the list of exercises with
dumb‐bells [sic] a hundred times a
day, but unless you fix your mind
upon those muscles to which the
work is applied, such exercise will
bring but little, if any, benefit. If,
upon the other hand, you
concentrate your mind upon the
muscles in use, then immediately
development begins."
This strength is not
trained in typical B-Bldg
approaches

Extensor Training: Kazmaier Exercise Extensor Training: Kazmaier Exercise

Extensor Training: Excellent patterning with

Extensor Training: Kazmaier Exercise
lat dorsi, neutral spine.

Can obtain high

challenge with
minimal pain

Page 2
 Patterns Training the
 Pull pull-row pattern
 Push
 Lift
The Effect of Exercise on Muscle Activation Levels
 Squat and lunge 140

Carry
120

Muscle Activation (%MVC)

100

Torsional Buttress
80
* *
 60
* * * *

Specific isolationist and integrative exercises

40

 20
*
*

 Hip external rotation 0

Grip and wrist control

IO

LD

S
ES

RG S
ED

AX

BF

F
R
R
LR

UE

LE

E
LL
LE

LI
RE


R
LU

M
LL

R
R

M
R
R

G
R
Bent Over Row Inverted Row One Armed Cable Row

More pull patterns:

Handgrip and pull to chest

Rope/hose pull Lat pulldowns

- centrate scapula

Switch hip split

Page 3
 Kettlebell swing (16kg)
Lumbar range of motion: 26 deg fl. to 6 deg ext.

Lumbar compression: 3200N

Lumbar shear: 460N (posterior)
Ratio of C to S!

Ballistic Contraction
and Relaxation

Muscle activation: Gluteals ~ 80%MVC

Lumbar ES ~ 50%MVC
Thoracic ES & Lats ~ 55%

Strongman- combination patterns Strongman

More push patterns……….

Also anterior chain challenges
(with stability and stiffness/compliance)

Page 4
Pushup Variations: Abs and “Above”

5847N

2841N

2531N

Floor walkouts provide 100% Rectus Abdominis activation

Walk Outs - Average and Peak EMG

250

200

150
%MVC

100

50

0
O
S
ED

AX

ES

BF

F
EO

IO

O
A

LD

ES

ES

R
R

LE

LR

LL
LI
LE
R

R
M
U

LU

R
LL
M
R

R
R

G
G
R
R

Wall Avg Wall Peak Floor Avg Floor Peak

Perfect Spine Form

Beach et al, 2009

Page 5
 Hanging Leg Wiper Westside Bench: Chains

120 20

10
100

0
80

-10

% MVC
60
-20

40
-30

20
-40

0 -50
0 1 2 3 4 5 6 7
Time (s)

RRA REO RIO RLD RUES RLES CFlex CTwist

100% abdominal activation

Bench Press vs. Standing Press

Cable vs Bench press
70

60

50
% MVC

40

30

20

10

0
RA EO IO LD UES LES AD PM

BP 2HP 1HP

Page 6
Better ab (anterior chain) challenge

Thoughts on squat patterns

(Recall corrective patterns already introduced)

Squat pattern Preparation: The Goblet squat Squat patterns: Spine conserving/building Squat

Westside Squat: Elastics Westside External Rotation & Abduction

Squat technique and EMG

120

100

80
%MVC

squat, <50%
60
ext rot'n & aBd

40

20

0
R GMax R Gmed R Rectus Fem R Biceps Fem

Page 7
 One leg squat / goodmorning
Hip contributions (extension and external
rotation)

Spare the back

Spare the knee

Enhance performance

Training the Arabesque Following Injury … To the Bowlers Squat, to the Arabesque

The Old Way…

… And the New

Why deep squat? Deep squats

 Gluts contribute at bottom of squat – think  Qualify:
again  No flexion antalgia when sitting
 Must pass hip exam
 Build leg muscles – think again
 Thoracic mobility
 Jump performance - think again  Knee pain? – match with style

 Uses a lot of training capacity  Other tools

 Bands, sleds
 Tight pelvic ring? Then split squats

Page 8
 Beyond Squats:
Load 1 LGMD

Beyond squats:
Load
Load 21 LGMD
Load
Load 32 LGMX
Load 3 LGMX
4500 140
A

Consider more
4000
120

Joint Compression (N)

Sled drag vs

Muscle Activity (%MVC)

3500
100
3000

2500

2000
80

60
asymmetric carries
*#

bands
1500
40
1000
20
500

0 0
SLED BAND
*# #$
*
4500 140

4000 B
120

Joint Compression (N)

Muscle Activity (%MVC)

3500
100
3000

2500 80

2000 60
#
1500
*
40
1000
20
500

0 0
SLED BAND
*$
*#
4500 *# 140

4000 C
120
Joint Compression (N)

Muscle Activity (%MVC)

3500
100
3000

2500 80

2000 60
1500
*
40
1000
20
500

0 0
SLED BAND

Strongman QL training Suitcase Vs Farmers Carry

 McGill et al, 2012, J Strength and Cond

Research

More “quick” hip external rotation Add mini-band monster walks

Page 9
Lift Patterns

Torsional patterns

Cable side walkouts – Deep obliques and Gluteals

EMG - Cable Walk Outs, Arms Outstretched

90
80
70
60
% MVC

50
40
30
20
10
0
O
AX

BF

F
EO

IO

O
A

LD

ES

S
ED

D
ES

ES

R
R

LE

LR

LL
LI
LE
R

R
U

LU

R
M

LL
R

M
R

R
R

G
G
R
R

Walk Out - Max Abduction Walk Out - Max Adduction

Walk Out - Max Abduction with brace Walk Out - Max Adduction with brace
Walk In - Max Abduction Walk In - Max Adduction
Walk In - Max Abduction with brace Walk In - Max Adduction with brace

Page 10
 Twisting with 1 end of Barbell in hands Strength:
100
Right ABs
Final summary thoughts

Muscle Activation
80
60

(%MVC)
40
20
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RRA REO RIO

Left Abs
60

Muscle Activation
50
40

(%MVC)
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

LRA LEO LIO

Full activation of M.U.’s

Right Back
40

Muscle Activation
30

(%MVC)
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RLD RUES RLES

Left Back

– achieve the full “neurokinetic swirl”

80

Muscle Activation
60

(%MVC)
40
20
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

LLD LUES LLES

Right and Left Gluts

50

Muscle Activation
40

“Steer” the strength

(%MVC)
30
20
10


0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RGMED LGMED

Right Thigh
50

Muscle Activation
40

Joints must be in balance

(%MVC)
30
20
10


0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RBF RRF

Spine Motion
10

And, in balance and proportion with one another

5

Angle
0

(deg)
‐5


‐10
‐15
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Cflex Cbend Ctwist

Force Plate 3 (right foot)

1000
800
600
Force
(N)

400
200
0
‐200
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Fx Fy Fz Mx My Mz

Force plate 4 (Left Foot)

1000
800
600
Force

400
(N)

Power at hips – not back

200
0
‐200
‐400


0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Fx Fy Fz Mx My Mz

Strength: Strength:
Final summary thoughts Reps-Set-Intensity Approaches/Controversies

(remember to consider capacity)

 Spine sparing progression: Sagittal plane
torque, then frontal, then transverse
Train “heavy”, rest for days.
(twist). Eg: sagittal lift, suitcase carry,
rolling birddogs vs
1-2 max reps every day - perhaps am and pm
 Force in one muscle must be
counterbalanced elsewhere eg ext oblique
 Don’t think “Heavy” & “Light” days – think “fast”
 Usually a strong core is non-negotiable and “slow” days

Rehabilitating the Athletes Back Speed: A few general thoughts

1. Groove motion patterns, motor patterns

Warm-up (Biomechanical then physiological then motor control)
Build whole body and joint stability

2.
 Eliminate distance work
Never train in a fatigued state
Increase endurance

3.  Hip mobility (if lateral motion needed then develop range)
Perfect mechanics (arms, core etc)
Build strength

4.  Careful with resistance (don’t slow athlete)
 Vary methods to break barriers
5. Develop speed, power, agility  Train speed of activation AND ALSO also speed or relaxation
 Always prep with CORE training

Page 11
 Final transitional training - Ultimate performance with the techniques of Super
Spine Power Stiffness, and other tricks

 P = Force x Velocity Principle #1 Proximal stiffness underpins all distal mobility and athleticism

Principle #2 Rapid contraction and then relaxation of muscle

 Keep one variable at
zero Principle #3 Tuning of the muscles

Principle #4 Muscular binding and weaving

Principle #5 Directing neuronal overflow

Principle # 6 Eliminate energy leaks – Make the impossible, possible

Principle #7 Get through the “sticking points”

Principle #8 Optimize the passive connective tissue system

Principle #9 Create Shockwaves

Relaxation after Initiation of Peak of Second Relaxation after

First Burst Second Burst Burst (Impact) First Burst

World’s fastest drummer

Right ABs
250
Muscle Activation (%MVC)

200

150

100

50

0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RRA REO RIO

Left Abs
120
Muscle Activation (%MVC)

100

80

60

40

20

0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

LRA LEO LIO

Right Back
160
Muscle Activation (%MVC)

140
120
100

First Peak 80
60
40
20
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RLD RUES RLES

Left Back
160
Muscle Activation (%MVC)

140
120
100

Right Lower Erector Spinae 80

60
40

160 20
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

LLD LUES LLES

140 Right and Left Gluts

250
Muscle Activation (%MVC)

200

120 150

100
Mucle Activation (%MVC)

50

100 0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RGMED LGMED

Right Thigh
80 140
Muscle Activation (%MVC)

120
100

80

60

Fujii and Moritani, 2010

60

40

20
0

40 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

RBF RRF

Spine Motion
20 15
10
5
Angle (deg)

0
‐5
‐10
0
Initiation of First Burst
‐15
‐20
‐25
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 ‐30 2
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Time (s) Cflex Cbend Ctwist

Training relaxation rate Training Athletes: Power and Speed

 Sudden unloading or removal of external  Use:
resistance has been shown optimal  Vision
(Matveyev, 1981).  Auditory

 Tactile
 Pavel punch
 Twitch training  Tap them to explode

 Visualization  Verbal “hit” to explode

 Rhythmic cyclical swinging, shaking to

relax muscles (fat tongue) etc.

Page 12
 Rehabilitating the Athletes Back Quick Feet: Lunge Switch
1. Groove motion patterns, motor patterns
2. Build whole body and joint stability
3. Increase endurance
4. Build strength
5. Develop power…. And agility???

Plyo testing : Landing mechanics Plyometric Progressions

Are you overtraining and limiting gains in Training intervals

performance due to neural fatigue?
Training sessions

How can you tell?

Performance

Is more recovery time needed?

Notice:
Gains are less over time as is fatigue with each

Here are some tests/approaches I have seen session.

Progress asymmtotes.

– you will have to test them.

Time

Page 13
 Training intervals Training intervals

Notice:
Inadequate rest and recovery
Performance Performance

Too much rest and recovery

Time Time

Peak and taper Workshops - list

 Determine the schedule.  Qualifying tests
 Warmups
 Performance adaptation vs cumulative fatigue (physiological,
 Patterns of movement
tissue and psychological)
 Relaxation rate

 Then other factors “adrenaline dump”  Double peak

 Strength tricks
 Squat
 Bench
 Pullup
 Jump
 Turkish getup
 Sled drag
 Speed power

Train patterns (workshop) Training relaxation rate (get bells, slamball, kettlebell, bands, rope
 Posture and strength note these next 4 slides worked well at Perform Better)
 Handshake, pushup or pullup to fatigue
 Push  Sudden unloading or removal of external resistance has been
 Ab walkout, Bench press vs pushup-up (speed, staggered hands, knees to chest), shown optimal (Matveyev, 1981).
coach grinding for neuro training, dropping pushup to flush out muscle, dumbell
bench press for gluts, standing one arm cable push
 Pavel punch: release then add bag strike
 Pull
 Pull-up workshop, Partner pull or rack row pullup with speed, One arm cable pull  Twitch training
down on 45 degree bench, heavy rope pulls, battle ropes
 Lift  Visualization
 OH hand push squat, cantelevered table back/hip extension, kettlebell swing with
KIME, 1 leg KB deadlift(push heel), goblet squat, kneeling band hip thrust, bar lift  Rhythmic cyclical swinging, shaking to relax muscles (fat
 Carry tongue) etc. then pavel pullups (sets x 2 reps)
 Suitcase, dumbell, bottoms up kettlebell, yoke, mini band monster walk
 Landing quiet
 Torsional
 Hip airplane, Lateral cable arm hold (vary length-level), lateral cable walkout, hip
ext rotn cable pull(correct hips-knees), progress to Pallof with correct muscle
sequence, wood chop high & low, slamball helicopters.
 Special for individual
 Short bar wrist fig 8, neck, Or?? Hip flexion (wall sit with leg raise)

Page 14
 A summary of considerations for developing
A complete program will incorporate:
general progressions:
 Peak and taper according to competition schedule.
 1) Movement preparation: Address the damage created by the other 23
hours in a day – free hips, activate Gluts, ROM of each joint.
 Great athletes use 4-6 week training cycles – or are
 2) Prehabilitation: Enhance resiliency of joints at risk (back, shoulders? etc). you the person who MUST go to the gym everyday?
 3) Core work: Direct training is better than indirect training.
 4) Power: Keep explosive movements as we age. Remember body weight.
 Corrective exercise to stability to performance.
 5) Resistance training: Be creative.  Basic motion/motor patterns to stability to endurance
 6) Energy system development: Cardio does not mean treadmill running – to strength to power.
kettlebell intervals, sprints, floor calesthetic complexes, etc.
 7) Regeneration and recovery: Stretch, foam roll, nutrition, hydration etc.
 Body weight to external resistance.
 Stable surfaces to labile surfaces to labile loads.

A Few thoughts:
Additional reading
• Spend less time under the bar and more time with
asymmetric carries
Siff – Supertraining
• Train speed of contraction and relaxation
Boyle – Functional Training
• More time on the sled
Santana – Functional training series
• Learn to enhance proximal stiffness for speed and effective
mass – crisper, faster, precise explosive movement. Tsatsouline – The naked warrior, &
• The core must not only keep up but underpin all other Beyond Bodybuilding
strength
• Spare the spine and increase training capacity

www.backfitpro.com

Page 15