Strength is Never a Weakness

Friday, 14 August 2015

Dr Luke Thomas Chiropractic Series: Issue 2 Valgus Deformity and Fascia

The first in a series of articles

Valgus deformity and fascia.

In this follow up article, I will endeavour to pick up on some common squatting faults and how they could theoretically relate to certain categories of back pain seen in my clinic, hopefully taking you on a journey across some interesting material along the way. First and foremost all views are my own, however will be corroborated by research/best clinical practice where applicable, this is also not intended as a “diagnose yourself workbook” more as an intellectual exercise for PTs, Healthcare therapists and the educated athlete.

As mentioned in previous articles by Andrew squatting most certainly not solely hypertrophic exercise, squatting in my opinion spans a chasm between balance, co ordination, strength, speed and mental focus. With so many components there is A LOT that can go wrong and ultimately lead to injuries. Personally I think that the largest amount of ignorance is to be found with regard to neurological stabilization (balance) within the squat (as Andrew alluded to in his last article). We constantly train strength, speed, power, and watch videos on mental focus/motivation, yet if we have an issue we normally negate the balance/co ordination component. Ignoring this vital aspect is often a major tripping point for the intermediate lifter. Looking at the sensory homunculus (a homunculus is a physical representation of the density of sensory nerves and thus the amount of brain attributed to them) we can see an inordinate amount of receptors in the hands, the face, the tongue and then the feet. Ill hopefully touch further on this in following articles, but these are the main areas of the nervous system that are constantly sending signals to the brain in order to allow it to modify and stabilize in its environment, when we squat we should pay more attention to our feet.

Following on from that statement ill begin on the first category, and one I suffer with myself.

Valgus deformity.

Valgus deformity refers to an inwards collapsing of the knees at any point in the squat. I asked Andrew previously for his opinion on this, and very rightly he concluded a weakness/inhibition of the glutes (med) leading to a lack of external rotation of the femur. As a coach he suggested banded hypertrophy work, alteration of my stance, using my hips more (opening up my hips/taint). Some possible solutions to a very common problem in many lifters. Why did this issue arise though? As we know the body is fond of subconscious shortcuts and normally utilizes the path of least resistance without you even realizing it. The body is unfortunately only so smart; this shortcut works great in the short term, however long term leads to poor motor patterning and unsurprisingly, injury. Most evolutionary biologists will tell us this is short term compromise is a neurological adaptation evolved to get us out of sticky situation (cue being chased by a bear and stubbing your toe followed by a limping gallop) works great there and then, just not over and over again as in our training. Does that mean there is a case for a mild vaglus deformity on meet day? Possibility……

How does this relate to back pain? Just as I introduced you to some of my favourite functional categorization of the joints of the body (joint by joint approach by Mike boyle/Gray Cook), ill now introduce you to my favourite categorization of the human fascial planes.

Thomas Myers introduced “Anatomy Trains” in 2008 and it was a real game changer for manual therapists, Myers realized that since the inception of anatomy we have always used a knife to dissect the body.

We sliced the arm open to find the bicep sitting there, from physiology we then deduced that as the bicep contracts it flexes the elbow. Perfect. This is now the norm, we are still taught this in school, college and university, it completely makes sense and there isn’t much point challenging that, or is there?

What keeps us, as big fleshy sacks of meat, in one piece? We are covered in a an inordinate amount of connective tissue called fascia, this is a sheet like tissue that covers our muscles, organs, nerves, skin, etc…..

You may have even heard of from manual techniques that aim to target it (myo-fascial-release) this tissue is comprised of a matrix of collagen (a protein) which houses in it a number of cells, chemicals, proteins and water. This is all referred to as the intracellular matrix, put simply it’s the spaces in-between every cell in your body. Here is the most interesting part, for centuries we have imaged fascia to be an inert tissue, just laying in-between stuff minding its own business, until recently when in an almost epiphanic moment more and more of the fascias secret began to be unravelled.

Ill stick to the most applicable one however, otherwise this article could go on for pages. So this assumable inert fascia has been actually found to be a remarkably responsive tissue, that when stressed is able to reinforce itself, when stretched it reflexively relaxes (only at 4% stretch, at 8% it has an adverse effect showing the subtle delicate nature of the tissue) when left alone it dehydrates horribly (thixotropic nature) becoming stiff and bogged down in metabolic toxicities (part of the reason why you “stiffen up” with immobility).

Myers found that by eliminating the callus nature of the knife out of the dissection process we are left with a very different corpse, the body is wrapped in layers of fascia, layers that distribute the push and pull of daily life, and of course – squatting. These facial paths he named trains, they are predicable lines of stress that aid the action of the muscle in moving joints. No longer should we think of the bicep as an elbow flexor… yes it is the engine of the steam train providing the force, however it is the superficial arm line that provides the tracks for the engine to run on, its line of pull is far further reaching and all encompassing.

Superficial arm line:

Dissected facial lines (using a knife…..)

This paradigm shift is still slow to take hold, however its truth is infallible and as manual therapists and athletes we should be aware of these principals. Why is this relevant, well coming full circle back to the valgus collapsing in the squat, we remember Andrew proposing the glute inhibition as the principal fault, which I totally agree with. One of Myers most applicable lines for lower limb power lifting is the spiral line.

Now following this line we can see the perfect theoretical reason for valgus collapse. Glute switches off (goes slack) vastus lateralis/ITB tension increases (increased pull) knees cave (slack) fibularis near have a heart attack and lock up (severe increased pull) trying to perform the job of the far far far larger glute muscles (also leading to a transfer of weight to the medial foot – pronation which is a whole different issue).

This spiral line slings around the sacroiliac joints providing them with support and stability they need, take away the sling by inhibiting certain areas in it, and often we are left with a irritated and unstable sacroiliac joint (pain in the low back just of the centre). No matter how much physio/chiro/massage you get on that SI (sacroiliac) joint, every time you go to squat BANG its back within a couple of weeks like a stabbing toothache. Make sure you see a healthcare professional who will address all the issues, not just the obvious ones!

Thanks again to Andrew for the guest spot, until next time.

Thank You Luke for another Great Post

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University.

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019.

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications:

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning.

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering.

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness.

I had my own business for providing training plans for teams and athletes.

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships,

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge.

Contact details below;

Facebook: Andrew Richardson (search for)

Facebook Page: @StrengthisNeveraWeakness

Twitter: @arichie17

Instagram: @arichiepowerlifting

Snapchat: @andypowerlifter

Email: a.s.richardson@tees.ac.uk

Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278

Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7

Sunday, 9 August 2015

Squatting is a Balance Skill

Most people view the squat as a muscle building exercise, powerlifting movement for strength or something that Instagram models talk about 24/7 involving bathroom selfies of their ass. What I am going to do in this article is challenge this train of thought.

The Squat is a Balance Skill

That a lack of detailed understanding of the subtler aspects of squat technique can compromise the ability of coaches to rapidly teach effective, safe & deep squatting. Many S&C (Strength and Conditioning) Coaches put athletes into different categories based on their sport & if they should do the squat. Some S&C coaches fail to teach the squat as they don't understand the different biomechanical differences of each individual. They get frustrated at the fact their athlete cannot do a squat correctly so they pull it out of the programme. This is incorrect, the problem 90% of the time lies with how it is being coached. Remember S&C Coaches come from a sports science background and using scientific language to coach someone with no understanding of your field will struggle to comprehend what you are saying.

That is why (personally), I will always listen to a weightlifter/powerlifter on how to squat than someone who has a degree. Why? As they haven't got the practical experience to be able to make a comment/coach the movement. The article will assume the readers are aware of what a squat is from many journals books and articles it is a well established movement (1-6). The article will look at the finer aspects of the technique.

The analysis of the squat is looking at a number of things

1/ Balance
2/ Stability
3/ Limb Length: Equally balance is very important for a good squat but, is heavily influenced by the anatomy of the athlete. For instance it has been suggested that an athlete with short legs & a long torso is built for squatting but why? Firstly, short lower limbs result in less posterior movement of the PCOM (projection centre of mass). Secondly & more importantly, the longer torso makes it much easier for the athletes to move a larger proportion of the upper body mass forwards with only a modest amount of forward lean. In contrast, an athlete with a shorter torso will require much forward lean to create the same effect on their PCOM.
4/ BOS: Base of Support
5/ PCOM: Projection of the Athletes Centre of Mass
6/ What Sport they Play

Basic physics tells us that the closer the PCOM to the edge of the BOS, the less stable the athlete. If the PCOM traverses outside the BOS, the athlete is likely to fall, due to their inability to impress significant horizontal forces or acceleration during the squat lift.

Key Coaching Cues for a Successful Bodyweight Squat

1/ Chest Up (Understand it before using it): https://www.youtube.com/watch?v=IZDVHVohtmE

2/ Bracing: https://www.youtube.com/watch?v=VcY3YSW9vX4

3/ Sitting Back: Sitting back is an appropriate cue but one that is not always recognised/understood in literature. However it is understood well in powerlifting circles. It is paramount one understands what happens when "sitting back". Consider the movement of the PCOM of the athlete as they progressively push their hips backwards during the initiation of the squat. If all other things remain equal as the depth of the squat increases & the athlete sits back, the PCOM moves to the rear of the BOS decreasing the athletes stability.

However if they continue this movement the PCOM will move outside the BOS & the athlete will fall backwards. This part is seen very commonly amongst beginners whom have never squatted. Then we have athletes whom have been coached with an emphasis of "sitting back" who squat with excellent spinal posture but cannot achieve any appreciable depth. The continued sitting back makes it impossible to achieve any extra depth without taking the PCOM outside the BOS. This can be due to - certain muscles not engaging/activating - lack of mobility around a joint - flexibility of the muscle - positioning of limbs (stance set up will either hinder/facilitate ones biomechanics). These athletes have great balance, stability, strength in a small ROM but if we altered their mechanics by increasing their ROM they would find it hard to maintain good technique/good balance as this new ROM has not been trained. Thus the unfamiliarity leads to falling over = Lack of Stability and Balance
Main reason for Technical errors within squatting is a lack of ability of athletes to solve this balance challenge There are 2 incorrect strategies to gain More Depth

1/ Knee Bend: Excessive anterior translation of the knees relative to the ankle joint. Creates a forward shift of athletes mass. Common for un-coached athlete to adapt knee bending to start the lift to maintain stability. Not good as it shifts weight onto knees & patella tendon. Now patellafemoral pain will often lead an athlete to adopt a squatting style with their hips further back & balance achieved through forward flexion of the trunk. Allows tibia to be more vertical, and as a consequence, loading the anterior structures less thereby provoking less pain.

2/ Leaning Forwards: Less common than the above, due to greater sheer forces it places on the spine. Folding of body accompanies some knee bending. Forward lean is commonly used in powerlifting club (by pushing hips back equivalent to large amount of forward lean). This is achievable as you don't need to do a very deep squat (hip crease must break parallel). To achieve a deeper squat using this style, a greater flexibility at the hip particularly the adductors. The both strategies above are used by inexperienced athletes as its a limitation on how they "view" a squat

The Appropriate Method to Squat

Use the rotational capacity of the hip to maintain the PCOM over the BOS. An external rotation of the femur about the pelvis permits the hips to travel forwards, keeping the PCOM within the BOS & allowing the athlete to maintain their stability. As depth increases the athlete must be taught to externally rotate the hip, dropping the pelvis to travel forwards restoring the stability of the athlete. As Ed Coan would say "open up your taint" this cue relates, really well to what is being stated above. Personally if an athlete fails to use their hips then their kinetic chain is very limited to what it can do. Opening up the hips allows the pelvis to go lower, get more muscles involved (glutes, hips, adductors and IT bands) to help overcome gravity against a weight/produce more force. A good way to teach someone to use their hips by using the box squat. Always teach a novice how to squat using the following progressions/regressions: - High Box Squat (above parallel) bodyweight - Parallel Box Squat bodyweight - Below parallel box squat bodyweight - same as above except with a kettlebell and perform a goblet squat to a box - Bodyweight squat parallel - Bodyweight squat below parallel - Then progress to barbell box squat and barbell squat Shoes: Insoles if need be Oly shoes help those with limited ankle flexion but ankle flexibility isn't the main contributor to high squats. Address the hips & thoracic first then the ankles in order of importance.

References

1. Brown, L,: Which way to do the Squat Exercise?. Strength and Conditioning. 20, 65-66 (1988)
2. Chiu, L.z.f. et al.: Sitting back in the Squat. Strength and Conditioning Journal. 31, 25-27 (2009).
3. Chiu, L.Z.F., Burkhardt, E.: A Teaching Progression for Squatting Exercises Strength and Conditioning Journal. 33, 46-54 (2011).
4. Cissik, J.: Coaching the front Squat. Strength and Conditioning Journal. 22, 7-12 (2000)
5. Comfort, P., Kasim, P.: Optimizing squat technique. Strength & Conditioning Journal. 29, 10-13 (2007)
6. Frounfelter, G.: A Progression for Teaching Athletes to do Squat Exercises. Strength & Conditioning. 19, 14-17 (1997).