T Nation

To Mike Robertsen


#1

Hi Mike. Im a 24y old powerlifter and chiropractic student from Norway. (Sorry for the bad english). I read your article "Heal the hunchback", and as i chiropractor I know that this combination of "upper crossed syndrome" and "lower crossed syndrome" is very common and it increases your chance of getting an injury or pain in the upper and lower body. First of all I think its very good that you get this information out to the poor "benchpress loving" people out there!

Id like to add a few smal details; first of all, you said "Even though the lats are on the back side of the body, one of their primary roles is internal rotation, so they must be stretched". I find this incorrect because of beside of internal rotation in the glenohumeraljoint the main movment of the latissimus dorsi muscle is retraction of the arm/shoulder. Retraction of the arm/shoulder is what people with upper crossed syndrome realy wants to achieve. second of all; the lats are usaly not overactive or inhibited in upper crossed syndrome so stretching of this muscle is not necessary.

The overactive iliopsoas and spinal erectors muscles, inhibited gluteus maximus and the anterior pelvic tilt creates a hyper lordosis in the lumbar spine and that is what we must avoid! The stretches you refer to called "a prayer" and "Thoracic Extension on PVC Pipe" also creates this hyper lordosis, BAD! The thoracic extension on PVC pipe is great IF you keep your lumar spine flexed!

I`d also like to see strength training for the deep stabilizing system, the multifidus and the transversus abdominis muscles, and strength training for the serratus anterior muscle as this muscle along with rhomboids, the lower trapezius fibers and the "deep neck flexors" are often inhibited in lower crossed syndrome. And this leads to reduced stability of the whole shoulder. The synergist "sternocleidomastoideus muscle" is forced to be overactiv that might lead to headache, problems in the TMJ (jaws), hyper extension of the cervical spine and fixations in the upper cervical spine.

The workout looks great by the way! Maybe a little easyer load on the external rotation movements in the beginning, about 15reps.

this is not ment to be negative feedback, but as contructive criticism

Yours in chiropractic //Powerman


#2

I've addressed your concerns below:

First off, I stand by my statement regarding the lats, especially when it comes to people who weight train. When analyzing many kyphotic postures, you will notice not only a rounding of the shoulders forward but also an internal rotation of the arms when viewed from the side. When the arms are internally rotated (e.g. the back of the hand is facing forward) you know the lats are overactive. Most trainees who train back are quick to perform pulldowns, pull-ups, pullovers, etc., but far fewer perform rows or any kind or specific scapular retraction/depression work. This type of work is crucial to balancing the upper body and maintaining the integrity of the entire shoulder complex. Stretching the lats is a general recommendation that would help most trainees; that's the best I can do without seeing someone in person and assessing their posture and movement.

Please also note that just because someone may have a kyphotic posture doesn't necessarily mean that they have upper crossed syndrome. It seems that far too often therapists and clinicians see one or two signs of upper crossed, lower crossed, or layer syndrome and prescribe treatment accordingly. Instead,a comprehensive analysis of the posture and movement patterns of each indvidual client/patient should be performd and the necessary areas addressed, whatever they may be. No need to guess here; by using the proper tests the postural and motor faults will be evident.

As for your next point, I am well aware that we are trying to avoid and prevent hyperlordosis of the spine. The stretches you allude to are provided as a way to stretch the latissimus dorsi and improve extension of the thoracic vertebrae, respectively. Unless you have no lumbo-pelvic control, a simple drawing in (I hate that term, btw) of the abdominals and posterior tilt of the pelvis prevents any undesired hyperlordosis.

With regards to the deep stabilizing system of the core, it has it's place in a training program but too many overemphasize and spend excessive time working on 'isolating' or making sure a muscle is 'firing' properly. It has been shown in numerous studies that in healthy, uninjured trainees the TVA fires up to .5 a second before any movement of the leg. Second, while I feel that improving the recruitment and motor control of the deeper musculature is important, it is just as if not more important to make the entire core area strong. You can work to recruit and fire as much as you want, but until someone is strong and healthy enough to pick up cat litter, groceries, or their child, then you can throw all that isolation work out the window. It's only a small part in the progression from motor control to functional, every day movement.

With regards to the more cervical section of the spine, I did not discuss this topic in my article due to brevity, but it can also be affected when the posture is kyphotic. Typically the compensation pattern is as you stated: With protraction or 'jutting' of the chin, inhibition of the deep neck flexors such as the longus capitis and rectus capitis are usually paired with concomitant overactive antagonists (suboccipitals) and synergists (SCM).

As for the comment regarding the external rotators, I will give you this snippet(?) from an upcoming article I have written:

"Before I go on, I'd like to step onto my soapbox and address the topic of external rotation strength. When working towards my Masters degree, we had a discussion regarding training of the external rotators. An athletic trainer in our class had the audacity to state that the most you EVER need to use in external rotation exercises is 2.5#'s; that's it, no questions asked. She stated that you simply did not need to use any more weight, regardless of circumstance because they are smaller muscles and didn't need much stimulation. Unfortunately, I've met several people since then who actually AGREE that training the external rotators should only use minimal weights and high repetitions. Here's the question I pose to these people: What makes the external rotators different? Doesn't it make sense that these muscles strength should be increased proportionately (whatever that proportion may be) to their counterparts? Obviously the external rotators are not designed for huge amounts of power production, but that doesn't mean that they can't or don't need to be stronger. I'm all for starting off light with external rotation exercises to increase awareness, motor control and learning how to use these muscles properly, but at the same time there's absolutely no reason you shouldn't periodize your external rotation program to include strength improvements as well. Can you honestly say that trainees with a 200# bench, a 500# bench and an 800# should have identical strength profiles when it comes to their external rotation strength? For a group that's so interested in balancing or finding optimal ratios between certain muscle groups (e.g. quad/ham ratios), I find this argument absolutely ludicrous. But, I digress"

I appreciate your criticism, but please contact me personally if you wish to do so again in the future.

Stay strong
Mike Robertson


#3

Mike - awesome article.

I've been trying to rehab a bum shoulder for the past year, and most of the stuff I've been able to find online gives some combination of rotator cuff exercises, scapular stabilization, and correcting pelvic tilt issues.

Does anyone have information on how to correct the problem when one shoulder is significantly higher than the other? My bum shoulder is about an inch lower than the other, all the corrective exercises I listed above have really not helped my shoulder issues (even after a year of trying).

Any info would be much appreciated.

Thanks


#4

Mike, thanks again for another great article.

It's given me more insight into my postural woes and knee pain.

Keep 'em coming.


#5

Powerman,

You stated:

"I find this incorrect because of beside of internal rotation in the glenohumeraljoint the main movment of the latissimus dorsi muscle is retraction of the arm/shoulder. Retraction of the arm/shoulder is what people with upper crossed syndrome realy wants to achieve. second of all; the lats are usaly not overactive or inhibited in upper crossed syndrome so stretching of this muscle is not necessary"

While the lats do effective downwardly rotate the entire shoulder girdle during adduction, the main movement is definitely extension of the humerus. That said, in both cases, due to the lats' distal attachment on the medial side of the intertubercular groove of the humerus, it's virtually impossible to have adduction, extension, and horizontal abduction without internal rotation occurring. No matter how slight, it's occurring; it's just a matter of points of attachment. As such, given the high volume of chinning and adduction work in most programs, I see the observation that stretching is unnecessary as absurd. Mike hit the nail on the head; everyone should stretch them in spite of the fact that there is a small minority without the problem.

Regarding the thoracic extension stretch on a PVC pipe, anyone that cannot maintain pelvic neutral and resist accentuated lordosis during this implement has much more serious problems that need to be addressed.

You also said:

"I`d also like to see strength training for the deep stabilizing system, the multifidus and the transversus abdominis muscles, and strength training for the serratus anterior muscle as this muscle along with rhomboids, the lower trapezius fibers and the "deep neck flexors" are often inhibited in lower crossed syndrome. And this leads to reduced stability of the whole shoulder. The synergist "sternocleidomastoideus muscle" is forced to be overactiv that might lead to headache, problems in the TMJ (jaws), hyper extension of the cervical spine and fixations in the upper cervical spine."

All correct observations, but as Mike said, it's tough to cover everything in one article. Granted, the TVA and multifidus will get some activation provided you're maintaining normal lumbo-pelvic control during the aforementioned stretch. I definitely agree with training the serratus anterior and stretching the SCM and levator scapulae, but you can only do so much in a limited amount of space. That said, I think that Mike did an excellent job with the space allotted to him.

BTW, numerous individuals have used my rotator cuff training article with outstanding results; none of the sets exceed 12 reps. Your 15-rep mandate is somewhat arbitrary, as it doesn't take into account time under tension or training history. I'd say 5-6 is a better estimate of the fewest reps one should do.

Good thinking, Powerman, but I encourage you to walk a mile in a writer's shoes; it's very difficult to say everything you could say without overloading the article and alienating readers.


#6

I agree Mike, great article! I'd also like to say that I found the points made on this thread fascinating. Why is it that I hardly ever see threads like this? A discussion of an interesting training topic, with intelligent points/counterpoints being made in a respectful manner.


#7

jro - Without actually seeing your posture and movement patterns, I would be willing to guess that you either have uneven hips, a lateral listing of your spine, restrictions in your mysofascia, or a combination of these. To answer your question, it might be a good idea to visit either a chiropractor or someone trained in myofascial release to determine what can be done to improve your situation. If you send me pics I can try to help you out as well.

SKMan - I agree, it's always nice to have intelligent conversation. I probably sounded a little defensive in my first post, but I didn't agree with the way in which the writer approached the issue. I'm all for constructive criticism, but a public forum isn't the place for it.

EC - Nice points regarding posture...the work you have already put out (and are coming out with) are top notch!

Stay strong
MR


#8

Mike -

Thanks for the advice. I'm already planning on seeing a chiropractor.

It is very likely that my hips are uneven since I broke my femur a little over a year ago.

Thanks again,
Jro


#9

Mike, thanks for the article. I've recently been injured, so this stuff is a high priority right now. Also thanks to Eric for his advice and rotator cuff article.

Powerman said: "The overactive iliopsoas and spinal erectors muscles, inhibited gluteus maximus and the anterior pelvic tilt creates a hyper lordosis in the lumbar spine and that is what we must avoid! The stretches you refer to called "a prayer" and "Thoracic Extension on PVC Pipe" also creates this hyper lordosis, BAD! The thoracic extension on PVC pipe is great IF you keep your lumar spine flexed!"

Mike responded: "As for your next point, I am well aware that we are trying to avoid and prevent hyperlordosis of the spine. The stretches you allude to are provided as a way to stretch the latissimus dorsi and improve extension of the thoracic vertebrae, respectively. Unless you have no lumbo-pelvic control, a simple drawing in (I hate that term, btw) of the abdominals and posterior tilt of the pelvis prevents any undesired hyperlordosis."

And Eric added: "Regarding the thoracic extension stretch on a PVC pipe, anyone that cannot maintain pelvic neutral and resist accentuated lordosis during this implement has much more serious problems that need to be addressed."

Uh-oh. I am one of the ones with "no lumbo-pelvic control" who cannot maintain neutral lumbar curve while doing a thoracic extension stretch. What Powerman described is exactly what happens to me. And I am injured and in pain, like most of the people who go to see chiropractors. So maybe Powerman sees a lot of people like me, whereas Mike's article was probably geared toward the lifter with obvious postural problems but maybe no injuries (yet). I feel even worse now that I know that Mike and Eric didn't even imagine that anyone reading the article would be in such a bad condition as me!

I probably CAN keep a neutral lumbar curve during the thoracic stretch if I pay close attention and get feedback by looking in the mirror. But if I extend my thoracic spine, I automatically extend my lumbar spine into hyperlordosis, especially when standing (I'm more successful when flexed at the hip). So that instruction, to "draw in" or whatever, becomes really important for me.

I also would like to second the request for information on correcting lateral imbalances. My husband looks like the Tower of Pisa and I've had a hard time finding recommendations for corrective exercises.

Thanks again for the great info! I look forward to more.


#10

Mike! If you see what I wrote about high reps on rotatorcuff, it says in the beginning, not always. Me and my clients do of course work out the rotatorcuffs with heavy weights and a low number of reps. But the first times you're doing the rotatorcuffs, it's ok to try it with lighter load. Anyways, that's from my experience.


#11

Great stuff, Mike, and as usual, great input from EC.


#12

"But the first times you're doing the rotatorcuffs, it's ok to try it with lighter load."

I think that's true of any exercise; you have to walk before you can run.


#13

Powrman,

I like the fact that you decided to post this in a public forum. Despite how Mike may have taken it initially, I think this has proved to be a learning experience for the rest of us reading this thread. Besides, had you not posted we would not have heard your arguments nor Eric's.

Perhaps not to step on anyone's toes you could PM the person in question in advance and ask them so that we may all benefit from your discussion.

Thanks to Mike, Powrman, and Eric for their knowledge.


#14

I agree. I don't see anything wrong with broaching the subject on this forum. The post was cogent and respectful, and raised some good points.

Far from being a bad thing, we should have more of these.


#15

Just my 2 cents, I'd like to throw my hat in with Char-Dawg & Kinetix on this one. Both Mike and Eric are extremely articulate and knowledgable in their areas of expertise. Your knowledge and experience shine through!

We on the forum learn from questions posed by others and from debate and discussion. We learn even more when intelligent people take opposing positions and explain why they do so. It's kinda like O'Reilly, "We report, you decide." (grin)

Powrman, Mike, Eric, thank you so much for the rational, intelligent, respectful debate. We need more discussions on the forum of this caliber.


#16

I'm excited to hear that everyone has gained so much insight from this discussion thread and article. Like I told TC, I've probably received close to 100 e-mails from this article alone!

If you liked this article and discussion thread, stay tuned for the collaboration that EC and I are going to turn out...it will take our postural discussion to a totally different level!

Stay strong
MR


#17

I second TT. We need more articulate, non-inflammatory debates around here.

I will definitely keep my eyes peeled for the article by Mike and EC.