ULTI BACK FITNESS AND PERFORMANCE STUART MCGILL, PHD FOURTH EDITION. Professor of Spine Biomechanics University of Waterloo Canada

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3 ULTI BACK FITNESS AND PERFORMANCE FOURTH EDITION STUART MCGILL, PHD Professor of Spine Biomechanics University of Waterloo Canada Backfitpro Inc. (formerly Wabuno Publishers) Waterloo, Ontario, Canada 2009

4 ISBN: Fourth Edition Copyright 2009 by Backfitpro Inc. Copyright 2004 by Backfitpro Inc. All rights reserved. No part of this publication can be reproduced in any form or by any means without written permission from the author. Printing Printed in Canada Wabuno Publishers, Backfitpro Inc. 292 Beechlawn Dr., Waterloo. Ontario, Canada N2L 5W7 Copies of this book can be purchased in bulk quantities at reduced rates. Contact: kathryn@backfitpro.com FIN Cover Photos: Front Cover - Spine image courtesy of Primal Pictures. Back Cover - Top image courtesy of Steve Brooks (University of Waterloo), middle image with permission of my friend and dancer/choreographer Indy Tyler, bottom image with permission of my friend and world champ Jerzy Gregorek. Disclaimer: No exercise can be deemed "safe" or "dangerous". However inappropriate exercise has an increased risk for harm. The information in this book is to assist in wise exercise choice. The author and publisher are not responsible for poor choices or any harm that may result. -ii-

5 Table of Contents Acknowledgments... 1 Preface... 3 Part I Scientific Foundation Chapter 1 - Laying the foundation - Why we need a different approach... 9 The Ultimate approach The concept of tolerance and capacity Current low back disorder myths The myths associated with stretching The myths associated with strengthening - rehabilitation vs training for performance Motion and motor changes from back injury - pain inhibits optimal motor patterns What distinguishes the best athletes? Focusing on multifidus, or transverse abdominis or any other single muscle - Misdirected clinical effort The confusion between rehabilitation and performance training The pollution of body building approaches in low back training Athletic bad backs: Dealing with the cause and the role of prevention The mind and performance The doctor says the pain is in your head - don't believe it! Each person is an individual - there are no approaches that work with all Are back troubles a life sentence? How we obtain the evidence to improve back training - Our unique approach In-vitro lab The in vivo lab for the modeling process Chapter 2 - Exercise science and the back - Removing the confusion Introduction Training affects all systems Preliminary issues for designing a program Strength Factors that limit training outcome Biomechanics and training The concept of the moment Muscle mechanics The Russian philosophy of training -iii-

6 Ultimate Back Fitness and Performance A note on Plyometrics Strength and posture Proprioception training The science of flexibility Progression of a program with younger athletes Training balance The popularity of the Olympic lifts: Justifiable or misdirected Training with machines - a discussion The principle of dynamic correspondence Safety Issues - a generic discussion Principles for designing a good warm-up Specific Considerations for Rehabilitative Back Exercise Back Flexibility Strength and Endurance Spine Power - integration of flexibility and strength discussions Motor patterns Eliciting volitional movement Aerobic exercise Studies on the connection between fitness and injury disability Order of exercises within a session Establishing grooved patterns Breathing Time of day for exercise Clinical Relevance for the Rehabilitative Exercise The process of injury: Tissue response to mechanical load Chapter 3 - Helpful Facts: Anatomy, Injury Mechanisms and Effective Training Some anatomically based facts Basic neural structure - activating back muscles Are you a master of your motor control domain? The full spine The vertebrae Vertebral endplate fractures Posterior elements of the vertebrae and neural arch fracture Optimizing health of the intervertebral disc Avoiding disc herniation Muscles The proprioceptive function of the small rotators and the intertransversarii The back extensors have several important roles: Longissimus, iliocostalis and multifidus Latissimus dorsi is a critical performance muscle Abdominal muscles Abdominal fascia -iv-

7 Table of Contents Rectus abdominis Abdominal wall - Obliques and transverse abdominis Psoas Quadratus lumborum Ligaments The pelvis and hips and related musculature are important considerations for the back The great ones train the hips Chapter 4 - Normal Back Function and Changes Following Injury How you stand is important Lumbo-Pelvic rhythm, bending, performance and injury risk Additional thoughts on spine bending General muscle activity amplitudes Mechanics of specific activities Loads on the low back during lifting Consider sitting to be a dynamic task The mechanics and implications of walking Pulling and pushing technique is critical Loads on the low back during flexion exercises Loads on the low back during various push-up exercises Loads on the low back during extension exercises Pulling patterns for the posterior chain: Sled drag and mini bands - Integrating the hips On backpack carriage and training Bedrest, back pain and exercise Other facts that assist performance Spinal memory Confusion over twisting What about back belts Guidelines for serious athletes Nature's back belt - the abdominal hoop and the Lumbodorsal fascia Pain Pain Predominant pain generating mechanisms in athletes Sciatic symptoms Sacroiliac pain - Is it from the joint? Staying within the "Biomechanical envelope" Biomechanical, Physiological and Motor Changes Following Injury Pain and central sensitization Motor control changes The crossed-pelvis syndrome and gluteal amnesia Other lingering deficits following injury -v-

8 Ultimate Back Fitness and Performance Chapter 5 - Enhancing Lumbar Spine Stability Finding about spine stability can be summarized as follows: A few crucial issues to enhance fitness and stability training A classic- viewing instability and injury Illustrating the important conditions for stability Stability myths, facts, and clinical implications Ensuring sufficient stability usually only needs modest levels of muscle activation The special case of transverse abdominis Abdominal bracing vs. hollowing Breathing and stability Summary: The lesson for athletes Part II Individualizing Programs Chapter 6 - Fundamental principles of movement and causes of movement error Section 7. Identifying the fundamental movement patterns Section 2. Identifying movement errors and correcting their cause Finding optimal movement and performance techniques Principles for optimizing performance Summation and continuity of joint forces and moments Production of linear impulse Direction of force application Principle of stability Summation of segment velocities Production of angular impulse (rotational motion) Conservation of momentum Manipulation of moment of inertia Eliminate energy leaks Principles for safety Minimization of tissue stress Optimal joint positioning Minimization of fatigue Qualitative biomechanics to analyze the movement - putting the principles together Final thoughts: Control feedback and proprioception Section 3. Understanding the stages of motor skill development to better teach motor skills Chapter 7 - Injury prevention and injury proofing Preparing the athlete Reducing the risk in athletes - guidelines What coaches need to know -vi-

9 Table of Contents Chapter 8 - Evaluating and qualifying the Athlete/Client The first consultant-athlete (with back symptoms) meeting So what have we learned? The first meeting for those without back troubles Some additional performance-specific tests Assess postu re Basic Movement - The squat Basic Movement - The squat - Choosing optimal hip and foot width Looking for spine "hinges" Poor control in torsional tasks Stable patterns during challenged breathing Endurance Testing Specific movement screens A philosophical approach for selecting specific tests, and designing the program Step 1. What are the demands of the sport/activity? Step 2. What are the capabilities of the athlete - together with current deficits Step 3. Designing the program A final note on qualifying the athlete for specific training exercises Part III Building the ultimate performer - Putting it all together Chapter 9 - Developing the Program Some preliminary matters Some notes for the chronic back Keeping a journal of daily activities Ensure continual improvement How long should each stage be? Training with labile surfaces underneath the athlete Training harder and longer is not always better Some final thoughts on reps, sets and sessions Stages of athlete progression Chapter 10 - Stage 1: Groove motion/motor patterns and corrective exercise A note on the training environment Awareness of spine position and muscle contraction Lumbar spine proprioception training Corrective standing approaches Corrective walking approaches A convincing demonstration of the influence of posture on strength Distinguishing hip flexion from lumbar flexion - Teaching the motion pattern Perfecting the "hip hinge" -vii-

10 Ultimate Back Fitness and Performance A note on spine stability, spine motion and control Locking the rib cage onto the pelvis Mental imagery Steps of mental imagery Other imagery exercises to develop motion/motor awareness Important abdominal patterns Abdominal hollowing is dysfunctional - Abdominal brace instead Teaching abdominal bracing A note on fascial raking Building squat patterns Re-training the gluteal complex 7. Learning to activate gluteus medius 2. Learning to activate gluteus maximus 3. Beginning basic squat patterns Star exercises Active flexibility and stretching for back performance Active flexibility for the back Sparing the back while stretching the hips and knees Chapter 11 - Stage 2: Building whole body and spine stability Whole body balance Balance training examples that progress from less demanding to more demanding for the back Specific exercises to develop whole body balance Soft hands Japanese stick Exercises for training the stabilizing muscles Training the stabilizers of the lumbar spine: The "Big Three" The Curl-up A trick to alleviate neck symptoms Isometric exercises for the neck Curl-up progressions More on the abdominal progression The side bridge Training spine stability during high physiological work rates The Birddog Advanced motor patterns with the Birddog Building the stabilization program Safe progressions of back exercises Chapter 12 - Stage 3: Endurance The reverse pyramid for endurance training Training for endurance events Breathing mechanics -viii-

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