Restoring the T- Spine

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Okay Officer Hunchback, it’s time to address your thoracic issues. The bad news for you is that having a rounded upper back can be the gateway to back pain, neck pain, shoulder pain, and more pain (and by the way you cant press as much weight overhead). The good news is that you can work on your thoracic spine, start relieving all that pain and be more awesome at pressing weight overhead.

Fun fact for all of the Keith Cushman  (the kid from Jerry Maguire) fans: The human head doesn’t weigh 8 lbs. Okay I’m sure some do but it’s usually estimated at 10-12 lbs according the googles. It’s widely quoted that for every inch your head of forward of center, the stress on your neck increases by another 10 lbs (I didn’t find the study but have seen the textbook  Physiology of Joints by A. I. Kapandjii cited as the source)  Is your head 3 inches forward of center? Well that’s like 42 lbs of stress on your neck so…. way to go you overachiever.

The vest/uniform shirt combined with sitting in a squad car is a powerful combination that will Quasimodo you in a hurry if you’re not cognizant of position and fail to take corrective measures.  If you’ve let this go on long enough your spine is probably stuck. It’s bad enough that trying to stand up straight like mama said won’t quite cut it. Even going through a solid bracing sequence wont quite get the T-spine where it needs to be.  You’ll need some amount of force to restore extension. Don’t have a chiropractor in your pocket that can adjust you before and after work? Give this a try.

Quick test: Can you keep your body in a braced position neutral spine position and put your arms overhead? If yes, check again make sure your rib cage is still down… cheater.

 

Not overhead. Try to load a kettlebell in this position and see how long you can hold it there.

Still not overhead. My hands are more vertical, but I’m cheating. Look extension load in the low back to get them there. Can you load this position? Yes you can. Do it enough and you’ll find out why missing thoracic extension can lead to low back pain.

Much better here. We have a flat back, the ribs are down and hands are vertical.  Not quite perfect, but this good enough to safely put some load on it.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: The overhead position is a great test and retest to look at improvement in T-spine extension but there’s a lot more work that can be done to clean his position up including soft tissue work on the chest, triceps, lats, and serratus just to name a few. We’re just looking for improvement. This post isn’t the end all be all for perfect overhead position. 

Foam roller extension level 1

Roll your back from the base of your ribs to your neck over the foam roller 20-30sih passes or until you stop noticing change. Focus on getting as much extension out of your thoracic spine as you can. Put your hands over head to make it a little more awesome. Feel free to roll side to side as you roll up and down to get the ribs moving too. By the way if this makes you want to vomit, chances are your tissues are junky. But on a more serious note if this feels like it’s aggravating any injuries then bail. Go see your chiropractor, physical therapist or other qualified professional.

 

This my friends is flexion of the T-spine, you might start here to make some superficial passes but you need to work on getting that upper back as extended as you can to try to restore normal position. If you’re stuck here keep working and think about relaxing over the roller. Foam rollers are really big and soft so if just doing this is causing discomfort, you got some work to do kiddo.

 

 

Here we are looking better with a flattish back. Remember flattish is extension in comparison to today’s standard kyphotic rounding. Even when you get here, keep working to bias your t-spine into extension.

 

Here’s a good variation to get some snap, crackle, pop going. Hug yourself, hang your head back and slowly steamroll the foam roller toward your head.

 

Throwing the arms overhead really cranks up the extension tension. The function of the shoulder blades and the thoracic spine are so intertwined that they’re inseparable as a functional unit when it comes to putting your arms overhead (hence our earlier test) Hit this position before you even think about putting weight overhead in a military press, snatch, jerk or anything.

 

You can drop your hips and use that to bias a more globally extended spine. You can keep or leave  dropping the head back here. (my head looks like it’s gonna explode for a reason, and it’s not because this is without discomfort for myself).  If you’re actively dealing with some low back issues, keep your butt active and squeeze it a little to prevent too much low back extension.

 

You have a variety of options here Use what works for you in your current situation.

Foam roller extension level 100

Alright, now it’s time to turn it up a notch. Grab a weight, put it on your chest, hug it and start rolling out your back keeping the focus on thoracic extension. Use what you can of all the above mentioned techniques in combination with a huggy weight. The hands overhead variation is tough here but you can place the weight on the ground above your head. Grab the weight and use it to anchor your arm into a stable position as you bias extension.

I use a 40 lb medicine ball as my “huggy weight.” You can use about any weight you have accessible. kettlebell, bumper plate or even your two year old child…. yes I’ve done it, and it worked.

Work on extension joint by awful joint.

The foam roller is great for restoring multi segment extension but sometimes we need to be a little more precise and a little more severe. A couple of lacrosse balls taped into a peanut of death or a MWOD Gemini work great. Take a few light passes up and down the length of the t-spine first to get warmed up. Then settle in, let the shoulders and neck lay on the ground and lower your hips using the peanut as the fulcrum to work on each joint individually. Let as much as your trunk contact the ground as you can. Think about breathing through your back into the peanut, and work gently in and out of flexion and extension taking several reps at each segment. Work all the way up to your shoulders from the base of your t-spine/ribs. Add your huggy weight to really ratchet it up here.

  

 

I promise this feels good.

 

Do what you can with the foam roller and peanut variations. If it’s ever so much discomfort that you find that you can’t relax or, take a full breath in and out, readjust and/or back off a progression.

 

The squishy balls soft tissue smash.

When we need to unstick some junky fascia and reset muscle tension softer balls are clutch . The harder and larger implements work better for forcing your spine into extension and can get some of the soft tissue work done but inversely, a softer ball will do some of some of the extension work and seems to work much better on the soft tissues of your back. The reason they work so well is that they are a little more grippe and create a little more shear between tissues and they yield to bony prominence allowing them to get into some nooks and crannies that harder balls bypass.  I love pinky balls for this. The older harder version are my favorite but they’re becoming more difficult to find. The newer softer versions of the pinky ball work fine too but at they’re a little softer. Jill Millers Yoga tune-up balls are also fantastic. You know what Jill Miller also has that’s fantastic? This video on a ball sequence to work on the back and neck.

 

Think about restoring extension before/after work, and always make sure its there before you start putting weights over head. I highly recommend doing the softer ball work a little before you go to bed…. Aaaaaaannnnnnddddd you are welcome. I’m serious it’s money for turning on the “off switch.” When  I take the time to do this I need fewer pillows bolstering my head and neck and I sleep like a rock.

 

Becoming a modern spartan ” The 300 challenge”

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The title of Kelly Starrett’s book Becoming a Supple Leopard comes from  the concept that you should have full capacity of your body readily available at all times. The leopard doesn’t go through a dynamic warm up, stretch out and foam roll before it takes off at a dead sprint to do leopardy things. The leopard is just in a state of readiness so it can do what it needs to whenever the opportunity arises.

I can’t think of any segment of the human population that the supple leopard concept applies to more than the modern law enforcement officer or soldier. No other professions require a higher state of readiness. We are required to be able to go from sitting in a car for the better part of eight hours to getting into a foot race, wrestling a suspect to the ground or fighting for our life in all out war without the opportunity to warm up  and mobilize. It’s really an insane requirement that cops are trying to meet every day.  Instead of the supple leopard I like to call it being a modern spartan. 

It’s a massive undertaking to maintain this state until retire. I hate to say it but the ugly truth is that most of us aren’t there.  Even if we forget about the requirements for speed, strength, power, endurance we’re still working with limited capacities  of our body which leads to injury and that’s not good enough.

In my Last post I talked about restoring hip extension and feeding some slack into the front of the hips. At first glance it sounds counterproductive to say that sitting in flexion is the enemy shortening anterior structures of the hip and extension is the fix. In the next breath I say you need have more hip flexion. Guess what. It turns out that sitting in a squad car in mid range positions wrecks flexion too so basically the average cop is really messed up and stuck in a crummy position. To work on flexion we’re going to use the the deep squat. Not only does it challenge hip flexion but it gives us a look into the other problem areas in the feet, ankles, and back which we’ll talk about over the next few weeks.

Time for a little reality check

Squat down while you read the rest of this blog.  I’m talking allllll the way down. Like thighs below parallel, can in the sand chilling on the street corner of a third world nation squat. Seriously, if you’re somewhere that it is at least somewhat socially acceptable and you don’t have any known injuries that prevent you from squatting give it a try. If your job requires you to run, jump, wrestle, fight or whatever without warning you should be able to squat for the next few minuets.

When’s the last time you squatted like this and held it for any length of time? For cops that don’t intentionally work on this position, the question is answered with a surprisingly simple and accurate mathematical formula:

Years you’ve been a cop  Forever = Last time you squatted and held it.

It’s not just cops but most humans  in industrialized nations don’t spend enough time in this position. In the first episode of MOBILITYWOD, DR. Starrett introduces the 10 minute squat test and makes the claim that nations with populations that sleep and toilet on the ground have very little hip and low back disease. I couldn’t locate the research that makes that claim directly but did find an interesting study that states high income nations are 2-4 times more likely to suffer from low back pain than low income nations so Starrett’s claim seems to hold water.

Check it out here:  The epidemiology of low back pain in the rest of the world. A review of surveys in low- and middle-income countries.

I’m going to suggest that your performance in 10 minute squat is inversely correlated to the likelihood that you do or will have back pain. If I’m correct  then we can decrease back pain by improving competency in the squat. It’s not so much the squat itself that addresses back pain but having a bodywith the attributes that can be stable and comfortable in the bottom of the squat is a body that is less likely to have problems that result in back pain.

The 300 challenge

The objective is to accumulate 300 minutes of squatting an eliminating free time couch sitting for 30 days. Think of this as a 30 day cleanse for your hips and back. If your good at math then you probably figured out that I’m just applying the 10 minute squat test every day for 30 days.

The idea is to use cumulative dosing to get you comfortable in the position. I’m talking about FIVE HOURS throughout the month in a squat. After the month hopefully you’ve mastered the test and are comfortable in this position. All you need to do to maintain it is use it in every day life. Squat down to play with the kids, grab something off of the bottom shelf, organize the fridge, change a tire or whatever. Try to accumulate 10 minutes every day using the squat. That’s something like 2.5 days of squatting in a year! Use the test periodically to check in and make sure you haven’t lost capacity.

Let me be clear… 10 minutes of legit, unsupported squatting in one session is the end goal. The first few times you try this it will humble you.  It doesn’t have to be a perfect squat and you might need to break it up into multiple sessions for the first few days with a minimum dosage of two minutes per session.  But we’re working toward the goal.

Some pointers on the squat

Want to start an online argument in the exercise and fitness community? Try to teach the squat. A lot of smart people out there teach the squat differently and argue that their way is the only and best version of the squat. Here’s the deal… the best way to squat is going to depend on the task at hand and individual lifter anatomy. Without getting overly specific, here are some basics.

  1. Like everything else we start with a braced neutral position
  2. Initiate the squat by setting the hips back to load the hamstrings.
  3. Keep the shins vertical as long as you can.
  4. Keep the knees over or slightly outside the feet, don’t let them collapse in.
  5. Maintain even pressure throughout the foot.
  6. The squat isn’t legit until your hips are below your knees.
  7. Maintain a flat back as deep as you can. We’re unloaded here so rounding at maximum depth isn’t the end of the World.

Keep even pressure throughout the foot. All three points should be in contact with the ground at all times.


Don’t over-complicate the squat. If you need more instruction,  just look at the natural squat of a toddler. It’s beautiful and effortless. These photos were taken simply by asking my kid to squat. ZERO instruction required. Frankly her position is immaculate and not trashed by a destructive environmental load.

Scaling the squat test 

If your body is lacking the capacity to get down into the squat then we can start by simply mimicking the squat position by laying on the ground with your butt as close to the wall as possible and putting your feet on the wall to get you in deep squat position.

  

If you can squat but need a little help maintaining stability or just need some help with endurance while you’re down there we have a few different options available.

Back to the wall. This allows a substantial amount of support and increases demand on the legs and torso from the feet on the wall option.


Grab onto something solid. A door frame, squat rack or training partner works great. This allows you to have more control over your position. You can pull forward with your arms to control your torso position and adjust demand on our ankle. You may find that just pilling with two fingers is enough assistance.

Use a counter weight. It doesn’t take much weight to change your center of gravity just enough to take some of the demand off the ankle and allow you to maintain a more upright torso. Holding an object in both hands also allows you to stabilize your thoracic spine through external rotation of the shoulder.

Power band around the hips. It helps keep you upright and allows for freedom to work toward an unsupported squat. The power band also forces you to push your knees out to maintain a stable hip. You really have two options here: 1) Arms in the band 2) Arms out of the bands. In the band creates a more stable position. Arms out of the band requires you to generate a little more stability on your own.


No sitting

As for the no sitting portion of the challenge. No unnecessary crappy sitting for the month. You’ll still sit when required to at work or other like situations. But we’re focusing on the extra mid range sitting here.  You can still sit but use the floor and if you use the couch then sit in half lotus, crossed legged, legs straight, or really crank up the hip stability with full lotus. Don’t forget there is always kneeling, half-kneeling, or you could just squat and do the couch stretch during your down time.

  

  
  
 

Use your best judgement here talk to your doctor, chiropractor or physical therapist before you start if you think you need to. If you can’t get near this position without excruciating pain that’s not good enough.  Work with them on a plan to get a legit 10 min squat because theirs a high likelihood that’s the plan that gets you out of pain.

Believe me this challenge is a worthwhile endeavor. Make the commitment and keep working the couch stretch too. After learning to stand and work from a neutral braced position, maintaining full range of motion in both extension and flexion is an obvious second step to becoming a modern spartan and a pain free cop.

 

 

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Restoring hip extension.

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If you’re sitting in a squad car all day you’re going to be short in the anterior (front) hip. Realistically you go days without bringing your hip into extension for any meaningful amount of time.  You might spend some time in neutral while standing but you spend almost no time in hip extension. When you don’t get into extension your body adapts to this flexed hip paradigm and shortens the hip flexors. When these structures get short it creates passive tension in the system and becomes a major contributor to anterior pelvic tilt, overextended lumbar spine and ultimately back pain.

My first post addresses pelvic tilt from motor control standpoint. Now it’s time to start feeding some slack into the system to relieve the passive tension that’s dumping you pelvis. Lesson one still applies, don’t forget to stabilize the trunk and pelvis as we work on extension.

Step 1 Spend more time standing- Siting too much is the problem it only makes sense that standing more mitigates the problem. When you stand you need to stand well. If you let your pelvis hang out all dumped forward and don’t level it out while you’re standing the relative position of your hip and thigh is still in flexion.

Step 2 Spend some time in the half kneeling position- Gotta do something on a table or desk? Ditch the chair when you can and go down to one knee. Get your down knee behind the hip to bring it past neutral into extension. Use some padding on the down knee if you need it.

 

Step 3 Torture yourself with the couch stretch- Simplistic and evil the couch stretch is the best way to open the front of the hips.  Kelly Starrett popularized it in the second episode of MWOD.  Think of it as a runners quad stretch on steroids and PCP.

The setup– Start on all fours and place one shin against the wall with your knee in the corner of the wall and floor. The opposite foot steps forward into a lunge position.

    

Squeezing the butt and driving the hip forward in this lunge position might be enough for starters. If this is all you can handle that’s fine. This is still extremely effective. Work from this position until you’re ready to go vertical.

The stretch- Squeeze your butt, drive off of your front foot, bring your hips forward and posture up.  The words tear open the hip come to mind here but in this case it’s a good thing.

All of the slack is pulled up by extreme knee flexion on the vertical shin. When you bring your hip to extension it’s really something special… in a painful want to throw up but still a good thing kind of way. Chances are that you will pull the knee out of the corner of the floor and wall. That’s cheating and you’re robbing yourself of maximal hip extension. Don’t be that guy.


When you’re able to keep posturing up until you can get your back upright and parallel to the wall without overextending your low back. If you get all the way up make sure your butt is still turned on and hang out for a minimum of two minutes. If you can’t squeeze your butt then back off a little bit.

If you need a little support to posture up a PVC pipe works great in this end position.

 

When to do the couch stretch

It’s a great option for cops before and after a shift. Your hip is going to be in mid range flexion for an extended period of time so prep for it then undo the damage of your shift as soon as you can.

How to super charge the couch stretch

Front foot elevation – If you want to take this stretch to a level that might be outlawed by the Geneva convention put something under the front foot to raise it up a few inches. We want quality stretching not just a circus trick here so if you can’t do this and keep your butt turned on then stick with the original recipe couch stretch for your extra crispy hip flexors.

Power band hip extension assisted torture hell– You know that spot where your butt meets the rest of your thigh? Stick a power band there and wrap the other end around something solid to assist your hip into full extension.

If you don’t have a squat rack to tie a band to then a kettlebell or a trustworthy training partner works well too.


Work on it

The couch stretch is not just something you try every now and then. I know it can suck big time but you need to take your medicine and dedicate some serious time to working on it. Several times a week if not daily is not unreasonable. Keep practicing it until you get comfortable doing it. When you got it mastered keep working on it to maintain hip function. Don’t forget you’re still sitting way too much. Full hip extension is the first half of complete hip mobility. Next week we’re going to work on some full hip flexion in the deep squat.

We gotta start somewhere.

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Here’s the deal, being a cop can be AWESOME! Having a badge is the a ticket to the greatest show on earth. One thing about being a cop no one told you before you joined the brotherhood is that this job will wreck your body. The reality is that someone probably told you but you were 22 and bulletproof  which makes you deaf to such warnings. The ugly truth is that your body takes a slow quiet beating day after day that you don’t notice until its too late. You end up injured, broken and off of work. If you’re lucky enough to last your 30 years to a full pension you probably wont have enough use of your body to really enjoy your retirement years if you don’t do something about it sooner than later.

We gotta start somewhere

We got to start somewhere our first project is to go after the champ. Low back pain (LBP). It sends cops to disability retirement all the time so mission one is to start take a crack at it.

Cops have crappy backs so do most modern humans.  Back pain is estimated to effect 80% of the American population at some point in their life and it costs us an estimated 50 billion dollars a year. Cops back problems are only slightly more common (about 6% more than the the rest of the population).  While the injuries are not necessary unique cops deal with a specific set of compromises that send us to pain city so what does the research say?

There a handful of studies that have been done on back pain. If your interested in reading a summary of the studies here ya go. Allow me to summarize the summary.

  1. Sitting in a car with a duty belt on is bad.
  2. Sitting in a car with a duty belt on while over weight is worse.
  3. Sitting in a car with a duty belt on while overweight and not having any physical activity is really really bad.

The studies correlate risk factors but at best we’ve only been theoretical about the actual mechanism of injury. Most theories seem to focus the blame on the weight of the duty belt others focus on uneven weight distribution being contributing factor. But ultimately everyone’s just hypothesizing so I’ll toss in my two cents with the rest of guessers.

It’s all about position. We need to take a look at positions we’re in or more importantly the positions were restricted from getting into as we spend all day sitting in uniform. Long story short were stuck in mid range positions and hanging on the meat. We almost don’t hit full range of motion in our hips so our bodies adjust to the ranges we require of it which on a routine basis is enough to sit in a car and reach the steering wheel. Most of the time just chill with our musculature turned off letting our body create a crappy default position that translates from our sitting to our standing, running, jumping, ect. So that’s where were going to start. The default position.

Before you move well you need to learn to stand well.  I get that it sounds super lame. It’s hard to get stoked about standing but standing is a technical skill. Building a template on how to organize your body in a way that protects your back is key to injury prevention and longevity. Practice it enough to make it your default position and will unlock performance even when your tired. This is truly the first steps on the path to being pain free.

Yo mama’s coaching cues are so bad…

Like I said standing is a skill and it’s not as simple as you probably think. When you young your parents probably told you to stand up straight. It’s the right idea but a little more coaching needs to happen here. Go a head give it a shot real quick stand up straight. Chances are that you just extended across the length of your spine. Which does counter the kyphotic curve of the thoracic spine making it a little flatter and makes you “puff” your chest out  so you look confident. This also exaggerates the lordotic curve of the lumbar spine. This is not a straight back. Yo mamas coaching cue is so bad it just gave you stripper back.  Trying to stand up straight without making your hips neutral is like trying to build a tower of playing cards on a slanted table. It’s not gonna work right.

Standing up “straight” with a huge extension load in the lumbar spine. That big sweeping curve in my low back that’s “stripper back”

To stand well means you have a neutral pelvis with a supported flattish spine.  It’s more than just standing upright and not slouching. It’s active standing. The yogies call it Tadasana (tah-DAHS-uh-nuh) or mountain pose. The quick and dirty on it is this. Working from this position protects your back. When you work from a protected position your body knows it and opens up the flood gates of power with more range of motion. If you really want to dig into the reasons why check out Kelly Starretts’s book Becoming a Supple Leopard.

Follow this quick sequence and see how you feel.

  • Start by standing with your feet under your hips and pointed straight. (for the yoga purists out there true tadasana starts with feet together)
  • Squeeze your but to bring your hips to neutral and externally rotate your your legs. Think of screwing your feet into the ground. Left foot counterclockwise and right foot clockwise. if you are doing it right you will see the arch in your foot rise.

    K eep your feet stay straight and your toes on the ground. just add tension to the system with external rotation generated at the hips to screw your feet in the ground.

If you think your flat footed chances are you stand like a fool. Top: Collapsed flat foot with navicular drop which is a mechanism for injury. Bottom: foot with arch created with a little butt squeeze and some external rotation.

  • Keep your ribs down. If you find yourself getting puffy chesty you’re  overextended at the thoracic thoracic spine then you need flatten it out.
  • Support the flat thoracic spine and keep your shoulders back with active, externally rotated shoulders. With your arms at your side turn your thumbs away from your body by rotating your shoulder. Keep your elbows close to your sides and move your hands away from your body. Think reverse seal clap.

    Fist try to just pull your shoulders back. It probably feels more stable than letting them hang out in the front of your shoulder capsule. Now try the external rotation model shown here. Did you feel that the contraction across your back? That’s what were looking for to support your back. You don’t have to walk around with your arms out just hang on to the tension back there to keep your shoulders back and the spine supported.

  • Get tall. If your head is ahead of your shoulders thing about makeing your neck as tall as possible. This cue seem to work better than bring the head back

The difference is suttle but the ramifications over thousands of hours is not. Top : Overextended back with anterior pelvic tilt is a recipie for disaster. Bottom: Neutral pelvis generated with a squeez of the butt and a little external rotation.


If you have back pain you might find going through this sequence alleviates the pain. Detectives might call a clue. This neutral position or some variation of it is what you should strive to be in at any given time. When you stand, walk, run, deadlift or squat. Any time you move you challenge your ability to maintain this position. The goal now becomes to test how much load you can handle with a braced flat back. The more  demand (weight, cardiovascular, any kind of fatigue ) you can handle without breaking your neutral position is the new metric by which we need to start judging our movement.

Knowing how to learning to organize yourself to stand is only the beginning. Once you learn the model you have the opportunity to make a better decision. Now go make a better decision.