CB Athletic Consulting, Inc. Training Report
Issue #126
1 – Core Strength for Young Athletes
John Gray is a Ph.D. Candidate in Spine Biomechanics at the University of Waterloo, working with internationally-renowned Spine Biomechanist, Dr. Stuart McGill, Ph.D. Having the responsibility of managing this highly active research laboratory, John is ahead of the curve on issues related to training and rehabilitation exercises and the mechanisms of low back injury in sports.
John is also the co-owner of First Line Kinesiologists, Inc., a Toronto-based company that specializes in exercise management for chronic illness and injury, and sport-specific conditioning for recreational to competitive athletes. Working with special cases of all ages and playing levels, their consistent results and high client satisfaction have earned the confidence of many health care practitioners in the Toronto area.
John Gray is a Certified Kinesiologist with the Ontario Kinesiology Association, a Certified Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association, and an NCCP Certified Weightlifting Coach. He has over 10 years of experience working with executive clients and athletes. He also authoritatively co-moderates the esteemed Supertraining discussion forum (Yahoo Newsgroups).
CBAthletics.com: John, you recently wrote about poor posture developed by young hockey players. Can you please explain what problems may develop?
JRG:
There are two aspects of the sport that, when combined, can lead to younger players developing back problems:
a) Fatigue
b) The forward-bent posture that is necessary when playing hockey.
We've been quite vocal that adopting a flexed spine posture during prolonged or repetitive activities has the greatest potential to herniate discs and strain the ligaments of the low back.
CB: By that, you mean that a flexed spine posture (rounded back) is an effective way to “hurt your back”, right?
JRG:
Most definitely. Over time, when the spine has been flexed forward, either for prolonged durations or over many repetitions, the posterior (rear) fibres of the intervertebral disc are kept under great tension and can rupture. These forces can reach up to and over 600kg in the average person!
The bad news about disc anatomy is that it doesn’t have its own blood or nerve supply. So, you can’t feel when these fibres are being damaged. And more importantly, once they’ve been damaged, they don’t heal. At advanced stages of injury, ruptured disc fibres will develop into what people recognize as a disc bulge or herniation.
CB: So what would happen to the hockey player’s low back in the above example?
JG:
For the young hockey player, what happens being bent-over is that once fatigue starts to set in, the typical postural response is to round-out (flex) the spine and “hang” on the spinal ligaments to take some of the load off of the fatigued muscles of the back.
Although this posture helps to decrease muscle fatigue, the longer this type of posture is sustained, the higher the risk of a disc injury. Although the muscular effort is lower in flexed postures, the discs end up paying the penalty for the additional stress this creates in the posterior fibres of the disc.
There is an additional problem in that a flexed spine posture decreases the ability for the low back muscles to resist shearing (forward-backward) forces, since some important muscles are made helpless to guard against forces imposed by the weight of the upper body, or from a hit from behind. Combine this with tightened, elongated, spine ligaments that are already primed for a strain injury, and the chances of some form of spine injury are greatly increased.
Some other problems that go along with flexed postures are lack of flexibility in the hamstrings and hip flexors. Tight hamstrings actually reinforce the flexed spine because they can emphasize a posterior pelvic tilt. Tight hip flexors place significant compressive loading on the discs, which can add to already high disc stresses in a flexed spine.
So as you can see, there are a number of interrelated co-factors that can become problematic to solve, especially in chronic cases.
CB: What exercises or techniques can hockey players and other athletes use to strengthen their backs and avoid injury?
JRG:
This is definitely an "easier said than done" issue. As a start, most athletes are more interested in playing their sport rather than training for it.
In my experience, the vast majority of players (regardless of sport) get all of their conditioning during team practice. By doing this, they are both limiting their athletic development as well as increasing the likelihood of an injury. Good general physical preparedness is not an option for high performance sport in the long term.
Having said that, there is little evidence that any resistance exercise program can alter posture, since posture is driven mainly by habitual factors and not strength per se. However, we do know that the long-term effects of posture will have an impact on the susceptibility to injury, and can affect the timelines to recovery from a low back injury.
CB: What should parents and hockey coaches do to help the player?
JRG:
Obviously, this means that the coach should keep an eye on skating technique and make sure that young hockey players are skating well technically - not just cranking out laps to get to the end of the practice.
If a young player has had an episode of low back pain for any reason, then the parents should keep an eye on that youth's postural habits in situations like doing homework and relaxing at home. Prolonged slouched postures can affect recovery and even lead to an increased risk of a future injury.
CB: Is there a way to prevent low back injury in athletes?
JRG:
In terms of prevention of low back injury, one thing we do know is that, for the general population, muscular endurance appears to be more protective of a low back injury than strength.
That is, all things being equal, stronger people aren't necessarily less prone to injury. However, in the case of contact sports, I'm not entirely sure this applies directly. Prevention of injury may also be enhanced by a greater strength reserve capacity
maintained in the back muscles (you might say it has a higher tolerance to failure). So, I am indeed in favour of developing back strength in athletes, just not at the expense of muscular endurance.
CB: How can strength coaches design training programs to help athletes maintain a healthy lower back?
JRG:
When working with athletes, I rarely give absolute restrictions to exercises. This is because most of the "definitive" information available deals with preventing low back pain and exercising the back for health reasons. Unfortunately, this does not always apply to competitive sport, where athletes will often rationalize playing in pain for the desire to win.
Since sport training often requires higher levels of physical stresses than those in a fitness program, we need to make educated choices of the exercises that will deliver the best results while minimizing the potential for (re-)injury. In training for sport, the potential for injury always exists.
The only exception to my rule above is that I will never suggest that anyone perform isolation exercises for the low back and abdominals (e.g., on seated back extension or trunk flexion machines.) Although these exercises are well known for targeting the spine extensors and flexors, the movements involve the exact mechanism our research laboratory has previously shown to be the most effective way to herniate a disc.
CB: What types of exercises can be used in strength training programs for athletes?
JRG:
Exercises involving the back muscles should focus on creating the movement through hip extension, and not the back. These exercises include squats, various lunges, and deadlifting variations, to name a few. I also include back extensions, reverse hypers, and good mornings. I love the glute-ham-gastroc machine, although it is difficult to find in many gyms.
Regardless of the exercise being performed, care must be kept to maintain a neutral curvature of the low back, and not allow it to flex during any of the exercises. Of course, I’m talking about the weight room. In some sports drills this is impossible, so you need to modify this to not allow “appreciable” flexion of the spine.
Muscular endurance can be built up by doing what is widely known as the "Big 3" exercises: bird-dog, side bridge, and abdominal curl. Athletes need to work up to around 20 repetitions per set, holding each repetition about 10 seconds. Some people prefer a front plank to the abdominal curl, which is a good substitute as long as the person does not have hip flexor issues such as tightness or pain. The "Big 3" exercises are also considered to help in retraining the "motor control" of the spine muscles in these prolonged stabilizing tasks.
CB: John, can you explain what makes Dr. McGill’s abdominal curl different from the traditional sit-up and abdominal crunch?
JRG:
The driving concept that was developed by Dr. McGill was that the best spine stability exercises needed to maximize muscle load while minimizing spine load. Take crunches, for example. Although you will generally work harder in an abdominal crunch if you curl up more, you are increasing the loading on the spine discs to a significantly greater extent.
Some useful technique points in Dr. McGill’s abdominal curl are:
1. ALWAYS keep one leg straight. This helps to maintain the neutral spine during the exercise which keeps spine loads lower than if both legs were bent.
2. Only curl up to the point where the shoulder blades just come off the floor. The pivot point is not in the low back, but in the rib cage.
3. Keep your head in a neutral position and pick a spot on the ceiling. Try to lift from your shoulders toward the spot on the ceiling, instead of curling down toward your feet. If it seems easy, you are probably doing something incorrectly.
4. For additional challenge, hold the “up” position for 3-5 seconds and say the count out loud. This increases the work on the spine stabilizers by forcing them to aid in breathing as well as spine stability.
5. Try performing 10 repetitions with a 5 second hold. An upper limit I’ve used with athletes and clients is 20 repetitions with a 10 second hold.
CB: Thanks John. We’ll be back with more in the next issue, including discussions of the low-back issues in other sports, female athletes, and office workers.
The information on cbathletics.com is for education purposes only. It is not medical advice and is not intended to replace the advice or attention of health-care professionals. Consult your physician before beginning or making changes in your diet or exercise program, for diagnosis and treatment of illness and injuries, and for advice regarding medications.
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