Friday, November 2, 2012

[GTS Training] Sit ups, hip flexion and back pain.

By Jason Kelske CSCS & Jonathan Hodges PT, DPT, Master of the Universe

This blog post started as an email conversation between a good friend of mine (who also happens to be a brilliant physical therapist).  Both of us treat and aim to correct issues associated with lower back pain.    Let's take a look at a few things you could be doing right now that may be contributing to your lower back pain.

"Another clinical issue is the peril in training hip flexion power given the associated loading of the lumbar spine.  This is usually reserved for those who no longer have pain - training hip flexion often retards progress toward the elimination of pain. It is usually wise to build extensive spine stability prior to progressions into building hip power."

If you have back pain,  go easy on the movements that involve lots of hip flexion. Not only for the reasons we're talking about here and below, but the most common cause of lumbar disc injury is loaded hip flexion (or forward flexion of the trunk, i.e. bending over). Just pay attention. If you have back pain with coughing or sneezing, time to make an appointment with your nearest MD, Chiro or physical therapist. Maybe in a different article, we'll make the argument that blown discs start off as psoas dysfunction (combined with lumbopelvic assymetries!). Now that you're sufficiently terrified to bend over and tie your shoes, read on.

Hip Flexion (think knee upwards)

Hip flexion = bringing your knee up to your chest.  The hip is flexing toward your abdomen.  One of the primary muscles responsible for hip flexion? The psoas. 

Janet Travell, a preeminent author in myofascial release dubbed this muscle the "Hidden Prankster". Additionally, the psoas stabilizes the spine to allow hip flexion by creating a stable platform to initiate the movement against.
The "Hidden Prankster". The psoas.

The issue... 
Although the psoas is responsible for flexing the hip, it also attaches to the lumbar spine. In fact, purely anatomically speaking, the psoas attaches to every lumbar vertebrae and even the lower thoracics compared to its relatively small insertion on the femur. There is no way to have good lumbopelvic function without good psoas lengthening. And sitting on your ass all day isn't helping this lengthening.

Prolonged sitting = tight psoas.
Hidden Dangers of the desk jockey.

"Caution is advised when training this muscle (the psoas) due to the substantial spine compression penalty that is imposed on the spine when the psoas is activated." 

Ruling out the internal structures of the spine, the psoas will create more back pain than almost any other muscle group, including the hamstrings. PSOAS is the Lumbar Spine. The Lumbar Spine is the Psoas. Finkle is Einhorn. Einhorn is Finkle. They cannot be separated and need to be thought of as a cohesive and complementary unit.

When are you performing hip flexion? Let's keep it clean here folks.


    • Sitting for 10-14 hours per day at the table, in the car, at your desk, etc.
      • That's a lot of static reps!
    • Biking.  Think spin class. Thanks for nothing LANCE!
      • That's thousands of reps of hip flexion.
    • Sit ups. 
      • If you're performing round back decline sit ups, odds are you're performing lots of reps, hitting those hip flexors hard and the abs very little.


    It would follow than that us spending the majority of the day in a contracted or shortened state and then on our lunch break, trying to initiate movements requiring full hip extension and functional LUMBAR mobility could be a recipe for disaster?? Ok, maybe not disaster but possible low back pain, poor glute activation and a subpar athletic performance.
      Perform 100's to 1000's of these... here comes the pain train!
      "When cadaver pig spines were placed in machines as part of a series of recent experiments and bent and flexed hundreds of times, the pigs’ spinal discs almost always ruptured, eventually." - Are Crunches worth the effort?

      Bring balance back to your body.

      In training, our job is to bring balance back to the body.  If you're performing thousands of reps in one direction, odds are you're going to suffer an overuse injury... in this case? Back pain, or perhaps inability to engage one of your most powerful muscle groups... the glutes!

      Ask anyone if they stretch and if they say yes (liars); whats the most commonly stretched muscle? Board says...hamstrings!! I'd say it's at least 4:1, nay 10:1, (outside of runners) of athletes who give equal time to the psoas AND hamstrings. Also, I encourage you to try to mix the word 'nay" into your daily conversation as often as possible.

      Your mission, if you choose to accept it... 

      Counter the thousands of reps you're performing daily by performing HIP EXTENSION (squeeze those butt cheeks all the way through!) based release exercises, movements and stretches in your training program. Next time, we'll talk about KStarr's (as demonstrated in Tim Ferriss' 4-Hr body) psoas release and why I think it's the best around. And we'll offer a few accoutrements to make it even better.

      Solid Mechanics/ Neutral Spine / Hip Extension!

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