IOL Strength and Conditioning

At our IOL Bash event last weekend in Scranton, PA, folks who knew I’d spent the first part of the year with hip mobility being one of the top goals wanted to know more about the process. Once I discovered there was a problem, what did I do to fix it?

It was a priority, thus we’re talking about a lot of effort, meaning doing hip mobility work at least a couple times a day. Patience is key, because with immobile hips, there’s not much movement, and the exercises feel, er… stupid. I went from locked down hips — about as immobile as one can be and still be walking — to fairly mobile, and in the process rid myself of chronic back pain and at the same time regained joy of movement. It was more than worth the effort, a great payoff and highly recommended.

One thing before we get started: The mental aspect is a big component often forgotten. Many of us hold our lower abdominal region tight — suck in your gut, right? — and that certainly contributes to our pelvic immobility. You’ll have to purposefully relax your pelvic region in order to get your hips mobile when you’re walking down the street.

Another key to help you get started: Learn where you hips are. If when told to put your hands on your hips you find your hands on the sides of your waist, you’ve got it wrong. The hip joints we’re working on with our mobility programs are at the top of the leg, where the long femur bone rests in the hip socket. This is not to say we don’t need pelvic mobility; we do. The thing is, you’re going to get pelvic mobility out of hip mobility work, but if a beginner at mobility targets the top of the pelvis, what’s probably going to happen is lumbar rotation, not pelvic or hip mobility. So focus on the actual hip joint and save yourself a backache as you’re starting down the mobility path.

To make sure you keep this up long enough to see some progress, and to grab a little pre-workout activation in the process, do some of your hip mobility exercises before your workout. And absolutely do some hip mobility along with some foam rolling on your non-workout days to keep things progressing. Those readers with desk jobs will get double benefit by doing hip and thoracic spine mobility work after sitting all day, and if it’s possible to do a little at other times during the day, so much the better. Sitting is the absolute worst possible thing for optimal hip mobility.

If you combine strengthening the small muscles with stretching the tight ones, for example using the arms-overhead lunge stretch, your hips will begin to loosen up within a couple weeks. You really will feel the difference.

My full list of hip mobility exercises used to free up locked-down hips follows. Why don’t you pick four different exercises and do them daily this week; pick another four for daily use next week and continue changing weekly until you’ve tried them all. By then, two things will have happened. First, your hips will be more mobile and there’s a reasonable change your nagging backache will be gone. Second, you’ll know which exercises were hard for you; those are the ones you’ll want to keep after until the movement is fluid and easy.

One of my favorites is one-leg hip circles. Stand tall; stick one leg across the body to the opposite side and make small circles with the foot outstretched to the side, then reverse direction. Move the foot to the front and repeat; shift the foot to the outside and repeat; continue to the back and repeat the circles on both directions. Change legs and do it all again.

As you begin, the circles will be small and the hip will fatigue quickly. Happily, these small muscles strengthen fast. Hip circles were originally suggested by Dr. Eric Cobb over at Z-Health, and are also taught by other joint mobility proponents.

Your other selections follow:

Hurdle stepovers from the front, facing the bar
Hurdle stepovers from the side, side to the bar

Side-lying leg swings, forward and back
Hockey groin stretch

Lunges, lunge backs, side lunges
Dynamic kneeling hip mobility

Step-ups, step-downs
Single-leg deadlifts, hands supported

Standing leg swings, front to back
Standing leg swings, side to side
These are done standing near a counter top where the hands are placed for balance; the swing is small — not energetic; if the low back moves, the swing is too long.

Hip rockers
Hip bends
Hip circles
Hip thrusts

Holds at the bottom of the squat, done at the corner of the kitchen counter, one hand supported on each side

Stability ball side to side hip extensions
Medicine ball Heismans
Quadraped hydrants

Internal and external hip rotation: side-lying clams, hip abduction/adduction (feet against wall, body on floor), a femur rotation move with the legs upright against the wall, and a pilates move: body on floor, legs raised with a small ball between the feet, opening and closing at the knees

Pelvic clock, a Feldenkrais movement pattern

Another great full hip motion for which I have no name: From a side-lying position with the left side on the floor, put your right foot upright, a “standing” position on the inside of the left leg. Lift the leg straight up a bit, the knee moving toward the ceiling. Then begin to turn the leg over toward the left — it feels a bit like unhinging at the hip socket. Continue lifting and turning in a coordinated effort until you touch the top of your right knee to the floor next to your left leg. Then reverse sides and try with the left leg over toward the right side. Note if both, either or neither knee touches the floor, and if the movement is smooth or jerky.

Some of the hip range of motion exercises – leg circles being a great example, or the pelvic clock – may have a part of the circle “missing” – your circle isn’t round. It’ll feel stupid and you’ll want to discontinue the exercise, but if you stick with it, the smaller muscles will strengthen, you’ll gain more control of the movement and the circle will round out. Bravo! It’s small things like this what will contribute to that miraculous day when your back pain goes away for good.

The most unusual and perhaps most effective thing I’ve learned in all this is to slow down and to make the movement smaller. That’s how we can really feel what’s going on, where the action starts and ends, where there’s a hesitation or a “dead spot,” and then we can start sorting out the origin of the problem.

That’s the thing with hip mobility — there are so many things going on that allow, stop or create movement. We think of it as a ball moving around a socket and forget all the muscles, tendons and ligaments that contribute to making the motion happen.

The hardest part is figuring it out. Fixing it is easy, sometimes ridiculously easy.

If you’re a visual learner and want to see some of this in action, I got a good introduction to hip mobility from John Izzo’s Free the Hips dvd. Here’s a preview:

Be sure to read Mike Boyle’s Understanding Hip Flexion, too.

Bonus material:
* Listen to Caroline Blackburn explain some of what we’re working on fixing here.

* Run yourself through Boris Bachmann’s hip and hamstring mobility drills

* Rope or band stretches: Hamstring, groin, IT Band (cross body), quad (facedown, pull back), ankle, calf and knee

Last week I wrote a brief comment in closing the newsletter that the bypass done by Dave’s surgeon in February of last year didn’t really fix anything. A few email correspondents questioned that, some wondering of my meaning and others flatly disagreeing.

Still others wrote to ask about his recent surgery, or how we felt about his lengthy chelation treatments now that we have the benefit of hindsight. This seems like a good opportunity for an overview of his medical history of the past couple of years so we’ll have it all in one place for later review.

In June of 2006, we went with a number of other IronOnline forum members to a small bash event in Juneau, Alaska. Dave was a month or a bit more into a problem with occasional numbness in his legs, and on the trip he discovered it was bad enough to keep him from walking with our fellow travelers.

Along with the tingling and stinging in his legs came a shortness of breath, and because of his past history of heart disease, including stents his cardiologist embedded in 2000 to open an artery, we began this drama again at the cardiologist’s. We didn’t get much of a response from the doctor who had taken over the practice a couple years before and with whom we didn’t have a relationship, and lacking confidence in his shrug of the shoulders, in November we went to another cardiologist for a second opinion.

The new doctor sent Dave for the normal list of cardiac testing, ending with an angiogram in January, 2007. His recommendation was a referral to a cardiac surgeon for a quadruple bypass, and as long as his chest was open, the suggestion was to fix a heart valve that was damaged during his 1983 near-fatal congestive heart failure. Both the bypass and the valve repair were done about a month later, February 22, 2007.

The results of this major, sternum-opening surgery were disappointing because he didn’t get better after it. In fact, within a few months he’d had a heart attack, decreasing his heart function even more. Would he have had that either way? Of course, we’ll never know.

This is not to say he didn’t need bypass grafts — that also we’ll never know for sure. The disappointment was his breathing didn’t get better, which was one thing the bypass was expected to address.
The major benefit of the valve repair would have been if he’d been able to go off blood thinners, but since his heart is regularly in atrial fibrillation because of the earlier heart failure, he’s not able to enjoy that aspect of the valve repair.

Meanwhile, his cardiac surgeon knew of his original complaint of trouble walking, and sent him off to a vascular surgeon after bypass recovery, thinking perhaps his arterial blockage was systemic and a case of peripheral artery disease (PAD) was causing the stinging legs, what PAD sufferers recognize as intermittent claudication.

That made sense to us, but two months and two vascular surgeons later, the agreement was that he had a mild case of PAD, but they did not think it was enough to cause his worsening leg problems, and they both recommended no further action.

At this point, about a year into the process, we were beginning to wonder about nerve blockage in the low back, but with the choice being back surgery or another stab at clearing the arteries, we went toward the less aggressive alternative medicine option, which was the point you began to hear Dave’s stories of sitting in the doctor’s office during his twice-a-week, three-hour intravenous chelation treatments.

Three months later, with the leg pains still worsening and the chelation treatments finished, Dave next went to a back pain specialist who ordered an MRI. When he got an offer of cold laser treatments with little assurance of success, Dave made an appointment with a physiatrist, who read the same MRI and told him nothing but back surgery was going to help.

The physiatrist’s referral to neurosurgeon in February, Dr. Jim Kohut, led to further cardiology workups, including installation of a pacemaker, before the surgeon was comfortable performing such a major back surgery on a guy with an ailing heart.

Incidentally, this involved another cardiologist, Dr. Raj Singh, with whom Dave enjoys a newfound confidence and to whom his medical files were permanently transferred. In the process of getting Dave ready for the back surgery, Dr. Singh did another angiogram and a bit over a year after the bypass declared his newly grafted arteries completely clear.

During bypass, two mammary arteries in his chest were moved into place, one artery from an arm was used and a large vein from his leg. Were those arteries and the vein clear when moved from their natural spots? Or did the chelation treatments clear existing blockages? Unfortunately for those of you who were following the chelation adventure for your own purposes, we’ll probably never know.

As it turns out, what he needed to address his leg symptoms was back surgery – laminectomy at L2, L3, L4 and L5, which was done five weeks ago. We’re now two years and a few months from those initial days of increasing disability, and today, after a variety of medical visits, he’s finally on the upswing in terms of normal, pain-free walking.

Dave’s newsletter last week spurred a lot of questions about hip mobility in general and an elevated hip in particular, with readers asking how to recognize the problems in themselves, and what to do to fend off the back surgery Dave eventually needed.

When I first met Dave in 1984 he had the elevated hip; I noticed his stiff, one-sided walk a long time ago. He says he’s had it a lot longer, but doesn’t remember when it started. I had an elevated hip — one hip higher than the other — for at least a couple of decades, that I know for sure.

Here’s the thing: It wasn’t until this year we learned it wasn’t a structural deficiency and that it could be fixed. I’d never heard of such a thing, and I suspect that’s true of most of the readers, and is the reason I’ve been nagging at this joint mobility and corrective exercise stuff all year.

In some cases there’s an actual leg-length discrepancy; usually it’s a functional issue, not a structural issue. Only about one in six people with a higher hip have a physically longer leg; the rest have an elevated hip that can be fixed in fairly short order. Muscles on one side are pulling the hip up, while muscles on the other side are weak and unable to offset the stronger side. We do weight training around here to make things stronger; this should be easy enough to fix, right?

If you look in the mirror at the top of your pelvis (that spot where we erroneously put our hands when we put our hands on our “hips”) and think one side looks higher than the other, you may have an elevated hip. If you’re unsure, take a couple of photographs — straight on, not at an angle, front and back shots. Print them and use a ruler to draw a straight line if you can’t tell for sure by looking. Better yet, take the photos in front of something straight, a window frame for example, to help you see level. In a clinical setting, the modern rehab folks will take photos with a grid background, full length with the patient wearing nothing but shorts or shorts and a bra top so they can really see what’s going on.

Once you’ve determined one hip is higher than the other, have someone measure your legs with a tape measure from the top of the anterior superior iliac spine (ASIS), the front of what we wrongly call the hip, to the inside of the ankle bone. If there’s a discrepancy of more than a quarter-inch, go to a medical doctor or chiropractic physician for an x-ray — that’s the only way to know for certain if the actual bone lengths are different.

Structural issues should definitely be addressed, usually meaning an elevated shoe on one side, to limit the problem so it doesn’t contribute to a cascade of whole-body pain.

Most commonly you’ll find no difference in leg length and can go to work on fixing the elevated hip on your own.

Why it’s worth the trouble fixing it is the list of other problems that tag along with an elevated hip. We can trot along fine with this in our 20s, 30s and maybe even 40s, but in my experience and in Dave’s, trouble is just around the bend after that.

Picture a skeleton hanging from a rod. Now visualize pulling on one hip to lift it higher than the other. Is it obvious in your imagining that other parts of the skeleton have to shift to allow that to happen?

That’s exactly what happens in real life, too. When the hip comes on up one side that leg gets a little shorter on the way to the floor, and upwards, the spine bends a little toward the opposite side, making the waist a little shorter on the elevated side and putting the person in functional scoliosis. It’s not structural scoliosis, where the spine is permanently bent, it’s functional and can be fixed.

It also means it will stay that way if not fixed, indicating a future of back, hip and leg pain for the person who’s either uninformed or unwilling to step back from their training long enough to fix what could eventually be a serious physical issue. If the sufferer ignores the pain long enough, maybe he or she will need back surgery such as Dave’s, getting another chance to go back and fix the functional problems after recovery from a major surgery.

With an elevated hip where one side is higher than the other there’s fascial or muscular tightness pulling the spine, and weakness on the other side allowing it to be pulled. We get regular massages or work on self-myofascial release with a foam roller and a tennis ball, add a little stretching and over time the soft tissue normalizes, the pulling stops and the spine goes back into its normal alignment. This is quite common… just most of us haven’t known that before.

We then work to balance the endurance strength of the two sides so that normal posture becomes easy to maintain.

This would also be the time to sort out any pelvic tilt and rotational issues to bring the pelvis back to its optimum position of a *slight* anterior tilt, which puts the spine in a mild lumbar lordosis, exactly where we want it.

At the same time, we would be working on joint mobility, especially in the hips and upper spine. In fact, this is exactly what Dave began working on this past week as part of his back surgery rehab. The more mobile and freely moving those areas are, the easier it is for the postural muscles to hold us in good static positions.

Here’s a review of joint mobility and foam roller rehab programs. I hope you’ll take some time with this and treat it seriously even if you don’t have an obvious hip elevation, because free moving hips is the key to easy movement now and into the later decades. If you do find an elevated hip, here’s how to get started fixing it.

Two new field records, six event wins, a second and a third placing earned Dan John first place overall in the Men’s Master’s Division (age 50+) in the scorching heat in Pleasanton, California, last weekend at the 2008 Highland Games.

Of course, the pros were on tap, including five-time world champion Ryan Vierra, who finished out of the top three this year, returning title-holder Sean Betz, who placed second to the eventual overall winner, Eric Frasure, as were the women, where Mindy Pockowski set and re-set a world record in the weight over bar event while her professional competitor husband crouched nearby.

Eric Frasure, Pleasanton Highland Games Pro Winner, 2008

But the attention of our group was solidly on Coach John, a strength coach with a substantial following of athletes and training enthusiasts and who takes the lead in a training Q&A section of our IronOnline forum. How could we not look toward our pal Dan, who once wrote the following of his first highland games competition:

“When I showed up people were dancing, men were in skirts, guys were drinking booze and competing in throwing big stuff. I said to myself: ‘This is heaven.’ “

Don’t you just have to follow around a guy like that?

It’s especially fun when the fellow you’re tracking is taking home all the medals.

Dan John, heavy weight for distance

The event implements are odd and the rules are unusual, some less understandable than others (think caber). Most of the events take a best of three attempts, but a few go on until someone is the clear leader… except in the case of a tie, when the thrower with the fewest misses takes first place. In the one event Dan won this way, and as such explained the rules that allowed me out of the sun for a brief respite, he called it a sloppy way to win, but I noticed he took the medal anyway.

Most interesting was the variety of throwing techniques: Anything goes it seems, and each competitor demonstrated a different throwing style. Dan’s is clearly based in his discus history, but wouldn’t you know it, right when I was starting to get his style down and the timing right for photography, he up and switched mid-event between straight-forward throwing to rotation.

And each event is different. Even though the idea is to throw an implement for distance, in the Stone Put he made no turns; in the heavy weight for distance he took two; and in the hammer it was three.

Oddest of all is the caber, similar to a tree trunk that’s been sanded down to a short telephone pole with one end tapered. The attendants prop the thinner end of the caber in the athlete’s toed-out feet. The competitor then brings the pole upright and while balancing it straight into the air, begins to walk or run down the field. When he or she is confident the pole is stable, a huge heft propels the caber into the air. The goal is to flip it over so the larger end hits the ground first and the smaller end extends straight away from the thrower’s body in the 12:00 position. Many, many throws did not turn the caber at all, and it was great fun to see all three of Dan’s tosses land in near-straight positions after the highest of flights through the air.

Dan John, caber toss

The unofficial results of Dan’s Pleasanton throws, August, 2008:

Stone Put, 1st, 41 feet, new field record
Braemar Stone, 1st, 29′ 5″, new field record
Light Hammer, 1st, 98′
Heavy Hammer, 1st, 83′
Light Weight for Distance, 2nd, 55
Heavy Weight for Distance, 1st, 40
Weight Over Bar, 1st, 15′
Caber, 3rd, 11:30

Here’s what I saw in the midst of throwers’ yells and the all-day drone of hundreds of bagpipes.

Masters competitors Dan John, Larry Sisseck and Jim Walker

The bagpipe parade

Iron sport historian, highland games MC, David Webster

Dan, mid-toss in the weight-over-bar event

Not a dry eye on in the grandstand as the Marine Band performed.
It’s an appreciated time to be in the US military.

Interested in trying your hand at some implement tosses in your neighbor’s backyard? In this article, Dan discusses how to get started throwing: Thinking Throwing Through.

I leave you with the most intriguing shot of the weekend: